Inspection on 28/02/07 for The White House

This inspection was carried out on 28th February 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 22/01/09

The White House 15/02/08

The White House 30/08/07

The White House 10/03/06

The White House 13/10/05

The White House 29/03/05

The White House 06/01/05

The White House 29/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The White House 11 Coggeshall Road Braintree Essex CM7 9DB Lead Inspector Gaynor Elvin Key Unannounced Inspection 28th February 2007 10:00 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 DS0000017980.V337269.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 DS0000017980.V337269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Address 11 Coggeshall Road Braintree Essex CM7 9DB 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) 01376 326847 01376 345966 kathy.whitehouse@tiscali.co.uk Avidcrave Limited Mrs Kathleen Teahon Care Home 14 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (14) of places The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 14 persons) Three persons, over the age of 65 years, whose names are known to the Commission, who require care by reason of dementia The total number of service users accommodated in the home must not exceed 14 persons 10th March 2006 Date of last inspection Brief Description of the Service: The White House is a care home registered to provide accommodation, personal care and support to fourteen people over the age of 65 years, not falling into any other category. The home is not registered to meet the needs of people with dementia. The White House is a detached two-storey property, accommodation is provided on the ground and first floor in eight single rooms and three double rooms. Access to the first floor is by the stairs or a passenger lift. However, due to the size of the rooms and corridors the home is not suitable for wheelchair users. The site is shared with a nursing home and both units share the gardens at the rear of the building, which comprises of a patio and grassed area with seating. There is a car parking area at the front of the building. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two visits to the service on 28th February 2007 and on 29th March, totalling nine hours. The second visit was postponed until March due to some residents and staff contracting the winter diarrhoea and vomiting virus. The Key National Minimum Standards (NMS) for Older People and the intended outcomes were assessed in relation to this service during the inspection. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. A tour of the premises was undertaken, interaction between staff and residents was observed and discussions were held with Mrs Kathy Teahon, the Registered Manager, residents, care staff and the cook. This report has been written using accumulated evidence gathered prior to and during the inspection; including a pre inspection questionnaire completed by the home; required notifications received by the Commission from the home of notifiable events affecting people who live in the home; and comment cards distributed by the Commission, completed and returned by residents, relatives healthcare professionals and two GP surgeries. What the service does well: The White House provides a homely and relaxed atmosphere for the people living there. Interaction observed between the residents and the manager and staff was comfortable, friendly and helpful. Residents said, through questionnaires and in discussion with the inspector that they were well cared for and the food was very good. Comments received from relatives through questionnaires were positive and indicated general overall satisfaction with the service their relatives received, that they were always welcomed to the home at any time and were kept informed of their relatives changing needs and when medical intervention was required. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 6 Comments from Community nurses and the two GP surgeries indicated that the home communicates clearly and works in partnership with health professionals and the staff demonstrate a clear understanding of the care needs of residents. 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. The summary of this inspection report can be made available in other formats on request. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Pre admission assessments carried out by the home did not provide sufficient detail and information to determine care needs, concerns or strengths relevant to the individual being admitted; or generate a support plan appropriate to meet their needs. The contract and statement of terms and conditions provided for those people admitted to the home does not clearly tell them about the service they can expect to receive in relation to their personal needs, the relevant fees for such a service and who is responsible for the payment of them. EVIDENCE: New residents commented that the home was very supportive at the time of their admission and were able to provide them with all the information they required. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 9 The care records of two people newly admitted to the home were examined. Records showed that the home obtains, where indicated, copies of NHS and or Social Service care management assessments that identify the individuals presenting needs and the care required of the home to meet those needs. The manager carried out Pre admission assessments. The actual level of information completed in these documents was poor and did not include a detailed assessment of behavioural, dietary, continence, mobility, emotional, mental and physical healthcare needs, abilities and strengths, particularly relevant to the older person. One assessment stated ‘no known allergies’ which was only assessed under the diet and food preference section and the medical history and medication section was blank. Other documentation indicated the person had Asthma – an allergy triggered chronic disease. The assessment also stated ‘has legs creamed and wears brown bandaging’; no further information was documented to identify the problem or how this was to be managed. This lack of information impacts on how successfully a person centred plan could be developed to deliver the quality care required to meet the residents individual needs, abilities and preferences. Completed questionnaires received from residents indicated that they were in receipt of a contract. A sample of statement of terms and conditions and contracts examined were the same and not specific to each person. They did not identify the services and facilities agreed to be provided to meet each individual’s specific needs, the actual fees payable or by whom, as required by regulation. Standard 6 is not applicable to The White House. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 10 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 & 11 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service cannot be sure that staff are fully aware of all their needs or that the care and support they require will be delivered in a structured and consistent way. Potential health related risks are not assessed, reviewed or monitored and therefore people are placed at risk by unsafe management. Unclear care planning limits the prospects of people maintaining their strengths and abilities. Healthcare needs are generally met but records need to improve to evidence this further. Medication systems are well managed. EVIDENCE: Residents spoken with said that the staff are kind and sensitive when providing care, they also confirmed that staff always knock when entering their room and that they addressed them in a respectful manner. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 11 No further action had been taken to address the lack of appropriate bathing facilities. Residents spoken with said they received one bath a week and were grateful for this as they were unable to bath at all prior to their admission. Care plans did not reflect service users’ choice and preference with regard to agreed bathing arrangements to meet their personal needs and requirements. It therefore is not clear as to whether one bath received a week is through choice or due to the limited facilities provided. Residents care plans are not derived from an assessment that fully identified all needs. They did not cover all aspects of care required or provided or any identified risks; they did not contain detailed information for staff to deliver appropriate and consistent care and reduce risks. This was particularly noted for one resident who had Asthma. A risk assessment and appropriate arrangements in relation to the management of Asthma symptoms, particularly with regard to trigger factors, breathlessness and the steps staff were to take in the case of an attack was not in place. There was an absence of detailed health related risk assessments and management strategies with regard to cognitive ability, dependency levels, mobility, continence, tissue viability, nutrition and other identified health and mental health needs. It was noted that many residents had mobility needs. One care plan examined, needs relating to mobility and pain were not assessed or planned for despite the individual having a knee replacement and requiring a walking frame. Moving and handling assessments were brief and did not detail guidance for staff in the level and type of support each individual required to ensure the safety and welfare of the resident and safe working practice for staff. Notifications received by the Commission indicated that emergency treatment was sought promptly particularly following a fall. However detailed falls and mobility assessments with management strategies and appropriate care planning arrangements may reduce the risk of falls. They provided no indication regarding the level of independence or the level of assistance each person required to enable them to participate in their personal care or daily activities which would promote their self esteem, dignity and well being and did not reflect actual physical, social or emotional needs. For example, ‘bowels and bladder’ was identified, as a need and action required of staff briefly stated ‘keep clean and dry’. This person did not have continence needs but requested a small pad at night ‘just in case’. Practical support, reassurance and maintaining dignity was not reflected within the support plan. The home operates a key working system but it appears that key workers have a limited role in actively contributing to the care planning process in assessing the type and level of support required. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 12 Those people recently admitted to the home were very pleased with the care and support they received and said they felt safe and secure knowing that they were now receiving assistance and good food as they could no longer cope at home. They were unaware of their care records. Some aspects of assessment following admission were more detailed with regard to identifying personal preferences relating to waking and bed time and included the little things that make a big difference such as the amount of light required at night, number of pillows required, normal sleep pattern, drink etc. The remainder of the assessment detracted from a personal approach with general statements such as ‘assistance required’ in washing and dressing and ‘some assistance required some of the time’. There was no indication that care plans were regularly reviewed or evaluated to ensure care provided was appropriate or that they were drawn up together with the resident or their representative if they were unable to participate. Overall care management records did not address issues relevant to the specific needs of each individual or reflect the actual care being provided. Completed surveys received from Community nurses indicated that the home refers to them in a pro-active way and that staff demonstrate a clear understanding of care needs of residents. A completed survey from each of the GP surgeries indicated that the GPs who attend The White House were satisfied with the overall care provided by the home but were unsure whether their instructions were incorporated within care plans. Staff were aware of when to call for medical advice and medication was managed well. Medication was received from the pharmacy in Monitored Dosage Systems and individually named containers and was appropriately stored in locked facilities. A sample of Medication Administration Records (MARs) was examined. The records were accurately completed, signed and dated. The medication policy identified pertinent issues but required more information and guidance for staff. Where possible, the home aims to care for residents for as long as possible as per the wishes of the individual and their family, although it does not provide nursing care. Compliment cards seen reflected relatives satisfaction with the care provided at the end of life for the individual and the support shown towards the relatives during this time. Care plans viewed did not reflect the wishes of the individual on how they would like to be cared for during the end stages of life. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 13 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): People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Group activities are organised on a regular basis and enjoyed by the more able residents, but opportunities to pursue hobbies and personal interests are not provided. Those people with a higher level of physical, sensory or cognitive needs cannot be sure that their ability and needs are fully considered to enable them to participate in activities more suited to their needs. Family and friends are welcome and visiting arrangements are relaxed. Mealtimes were enjoyed and the home provides good quality food. EVIDENCE: There are people living in the home who have varying levels of cognitive impairment as well as those who have no cognitive impairment and are fairly mobile and independent. The home needs to understand how peoples different needs and abilities impact on their daily lives and participation in activities and ensure that care plans identify ways of overcoming barriers to living meaningful lives within the home. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 14 Interests and activities listed under the social care heading in the care plans were not fully explored to ascertain how the individual would like to spend their time in the care home and mainly listed general past times such as reading, listening to music and watching television. Due to the layout of the lounge it was noted that not everybody seated in the lounge were able to clearly see or hear the television mostly due to obstruction and particularly difficult for those with limited mobility and visual and hearing impairment. The more able residents were seated farthest away and said that if there was something they particularly wanted to watch or listen to they would go to their bedroom as they had their own televisions and radios. A range of large print books, videos and music was observed to be available in the lounge. The home shares a small seated area outside with the neighbouring sister home. Records did not indicate that the home supported or provided opportunities for the residents to access the Community if they wished. Relatives took those that went out. One resident stated that most staff had a good sense of humour and always endeavoured to lift the spirits of the residents. All the surveys received from residents and relatives stated that group activities and games were encouraged during most afternoons. Levels of ability were not assessed to identify the level of support required from staff to enable each person to participate fully in activities more suited to their needs, which would promote self esteem and well being. Social interests hobbies etc were not explored to ascertain how each individual would like to spend their time and how the home could support them. The manager indicated that those less able to participate in group activities participated in one to one interactions with care staff although this was not recorded within the care plans. The manager advised that she was further developing the activities programme and games more suited to meet varied levels of cognitive ability were being purchased. Guidance was sought from literature produced by the Alzheimer’s Society. Large floor games such as snakes and ladders and beetle drive were provided for group participation. A game called Memory Lane encouraged discussion prompted by large picture cards. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 15 The manager discussed the benefits of a small home and how discussion and reminiscence took place on a regular basis throughout the day prompted by general chitchat, day to day activities and resident meetings. Resident and relative surveys stated that family and friends were welcomed and encouraged to visit the home. This and previous inspections have always found the standard of food provided to be good and mealtimes enjoyed. Most residents take their meals in the dining room, some who prefer and those who require assistance were observed to eat in the lounge. Resident’s expressed great satisfaction in the quality and quantity of food provided; one resident stated that ‘meals are as good as a five star hotel and we are offered alternatives to the menu if we wish’. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 16 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service feel safe and well supported by the Manager and staff. They are confident to express their views and concerns knowing they are treated seriously and acted upon promptly. EVIDENCE: The home has a complaints policy in place. The policy states that complainants may contact CSCI if dissatisfied with the response of the home. The policy must be clearer that people may approach the CSCI at any stage, with their concerns, but also that CSCI is a regulatory body and will not necessarily investigate complaints themselves but will review and assess the home’s management of its own complaint process. The home has not received any complaints since the last inspection nor has the Commission with regard to this service during this time. Surveys received from eight residents all state that they would be happy to raise any concerns with the manager and feel assured that she would act upon them. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 17 Comments received from seven relatives indicated that they were aware of the complaints procedure and have not had any reason to make a complaint about the service. Surveys received from healthcare professionals and two GP surgeries all state satisfaction with the home and that they have not received any complaints with regard to this service. Compliments received from relatives were seen all expressing gratitude for the high standard of care received by their relatives whilst accommodated at The White House. The home’s policy and procedure for Safeguarding Adults is clear and precise and all staff receive regular training in this area. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25, 26. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although The White House presented a clean, homely and warm environment, some private accommodation, the communal area, bathing facilities and laundry and sluicing facilities fail to meet a safe standard for those people living in the home with increasing physical and cognitive needs. EVIDENCE: A tour of the home was undertaken. The home was clean and had a homely feel about it. Some bedrooms had been re decorated and all bedrooms clearly presented individuality with personal possessions and photographs around them. Refurbishment and/or replacement of sanitary facilities such as vanity units and en-suite toilets in some bedrooms are urgently required. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 19 From observation and discussion with the Manager it was confirmed that no further action had been taken to address previous requirements with regard to updating and providing suitable laundry and sluicing facilities and bathing facilities to promote and protect the health, safety and welfare of the residents and staff. Mr Dixon, the providers registered representative, stated that plans submitted to the Local Council were approved for an extension and refurbishment to the building. A date was not provided for when the work is to commence. The White House is an older style building, the layout is not suitable for wheelchair users due to the width of corridors and size/shape of some rooms. Although it was observed that some residents now required the use of a wheelchair to mobilise from one area to another and the majority of residents had varying and increasing mobility needs. It has also been noted on this and previous inspections that the size/shape of some rooms restricts options for the minimal furniture requirements and accessibly placed furniture. This also may prevent the use of hoists and access for carers; limiting the use of rooms, particularly the double rooms. The lounge due to its size, shape and layout was observed to be cramped and did not facilitate the passage of wheelchairs and residents supported with walking frames and carers safely. The need for walking frames and wheelchairs to be positioned in close proximity to the resident in the lounge posed an additional hazard in a small area. The communal bathrooms do not provide suitable facilities to cater for residents with higher dependency needs requiring assistance of staff and the use of moving and handling equipment. As previously required, consideration must be given to the provision and installation of assisted baths capable of meeting the assessed needs of residents incorporating moving and handling risk assessments and policy. Only one of the two bathrooms is operational for fourteen residents and the assisted bath with a fixed chair that lowers the individual into the bath is in need of replacing. A shower room is not suitable for its stated purpose and the facilities are also not appropriate to substitute its use as a sluice. The home does not have sluicing facilities. Laundry facilities do not meet National Minimum Standards and do not comply with infection control guidance. Action has not been taken to address this concern particularly with the high urinary and faecal continence needs managed within the home. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 20 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. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a caring dedicated staff team. They are safeguarded by robust recruitment practice that ensures staff employed are suitable for the job. Residents are generally in safe hands but individual training profiles would help to ensure that staff are competent in all areas and identify areas of weaknesses and strengths. The home demonstrates a good response to staff training in core subjects and some subjects pertinent to residents needs but an increase in staff knowledge could improve outcomes for residents, particularly in assessment and care planning. EVIDENCE: The home’s completed pre inspection questionnaire did not state that staffing hours were reviewed or how many care staff hours were required to meet the residents assessed needs; this was also not demonstrated during the field inspection to the home. The last two inspections highlighted that care staff also undertook meal preparation (breakfast and supper) and cleaning duties in addition to providing personal care. This reduced the time spent in meeting the needs of the people The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 21 who use the service, some of which have high dependency and some require two members of staff to meet personal care needs. In response to this the Manager advised that she is in the process of employing a cleaner for the home and this will free up more care staff time to spend with the residents. Surveys from eight residents and seven relatives all expressed satisfaction with the care received from staff and felt that staffing numbers were adequate. 50 of the care work force have attained NVQ 2 and 17 of the 18 care staff hold a current first aid certificate. Care staff files examined did not contain an available training profile generated from an appraisal and supervision process to determine specific annual training and development plans in relation to the individual’s needs and requirements. An annual training plan identified core training undertaken by the staff group as a whole and highlighted when refresher and update training is required. The manager continues to search for staff training in areas pertinent to the needs of the people who use the service. The Hearing Aid Clinic technician is booked to provide a short training session in understanding the workings of various hearing aids and awareness in communication needs. Last year the staff received a similar session in visual aids and awareness. This inspection highlights a training need for all staff to develop their skills and understanding in care planning and person centred care to enable them to effectively meet all individualised needs and deliver planned agreed and consistent care and improve quality outcomes for the people who use the service. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36, 37 & 38 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have confidence in the manager and they benefit from her open and transparent approach to running the home. The manager endeavours to promote the health and safety of the residents in the home but people using the service are being put at risk by the failure to improve the environment and provide appropriate facilities to meet its stated purpose and the assessed and changing needs of the residents. The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 23 EVIDENCE: Positive responses had been received on the home, care and staff. The manager operated an open door policy and was well known to residents and relatives. Quality assurance and monitoring systems were still not fully developed to meet National Minimum Standards. Although it was acknowledged the home had previously carried out resident, relative and stakeholder surveys, they were basic. Quality audits need to be addressed to provide sufficient evidence to demonstrate an open and analytical review of the service currently provided, and identify the actions required that would impact on outcomes for residents and ensure continuing improvement in the areas identified. The home supports two residents in managing small amounts of money left by relatives for every day use such as hairdressing and personal items. The records were inspected and cash balances were correct and receipts were in place to evidence expenditure. The manager felt there was an improvement in formal supervision but indicated that agendas were limited and unforthcoming from staff. The need for agendas to be reflective of working practice and competence was discussed particularly in relation to the attendance of short course training subjects. Other forms of supervision, all with equal benefit was also discussed, which could be incorporated into the process to stimulate interest and enthusiasm and inform additional topics for the agenda, but also require the maintenance of personal records. There are no thermostatic control valves on the hot water outlets within the home and although not tested with a thermometer, water from the hot taps of hand washbasins in the bedrooms was too hot to the touch. Water temperature testing was carried out by staff prior to bathing and this was recorded however residents remain at risk of scalding when using hot water from hand wash basins in their rooms. The assisted bath service certificate expired 21st April 2006 and as previously mentioned this was observed to require attention. Other safety certificates for the passenger lift, gas boiler and cooker and fire equipment were up to date. The electrical installation certificate was dated 27/01/04 and certified partial new wiring of the building. Environmental and safe working practice risk assessments were in place. The fire log evidenced regular checks carried out on firm alarms and emergency lighting to ensure working order. A fire safety inspection was carried out in The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 24 February 2007 and comments from the fire inspector stated ‘all fire precautions excellently managed’. A detailed fire policy and procedure was in place and a detailed fire prevention check list completed. Fire risk assessments were informative and simple and easy to follow identifying existing controls within everyday practice.. Policies and procedures were due for review and some required further development such as medication; and infection control required updating with current guidance by Essex Health Protection Unit revised in April 2006. . The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 25 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 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 1 1 2 2 2 1 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation Schedule 4(8) Requirement Each resident must be provided with a statement of terms and conditions/contract that sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. That is clear, jargon free, easy to understand and gives the resident or their representative a very clear understanding of what they can expect from the service to meet their needs. All new residents must receive a full comprehensive needs assessment before admission. For people who are self funding and without a care management assessment the assessment is always undertaken by a skilled and experienced member of staff who ensures they are fully informed of all the care needs of the individual and admissions only take place if the service is confident it has the capacity to meet those needs; the information collected must be detailed enough to generate an DS0000017980.V337269.R01.S.doc Timescale for action 01/06/07 2. OP3 14 01/06/07 The White House Version 5.2 Page 27 3. OP7 15 4. OP8 18 (4) 5. OP12 16(m)(n) appropriate plan of care and guide staff in their delivery of care. The service must generate, from 01/06/07 a comprehensive assessment, a care and support plan with each service user that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal, psychological, emotional and social care needs of the service user are to be met and ensure consistent and appropriate care delivery. This is a repeat requirement not addressed within the timescale of 1st August 2005 and 10th March 2006. 01/06/07 Care planning arrangements must incorporate health related risk assessments and risk management strategies to promote and maintain physical health and identify potential and changing physical health needs in areas such as nutrition, mobility, continence and tissue viability. Consideration must be given to how the service users can receive a more individualised service tailored to meet identified needs, maintain strengths and promote optimal independence with regard to health and social needs. Opportunities must be provided 01/06/07 to enable people to exercise their choice in relation to leisure and social activities and routines of daily living, and support provided to encourage stimulation through appropriate activities which suit needs, preferences and capacities, with particular consideration given to people with physical, sensory and DS0000017980.V337269.R01.S.doc Version 5.2 Page 28 The White House 6. OP19 OP20 23 cognitive needs. Repeat requirement not met within given timescale 7th January 2006. The home must be suitable for its stated purpose, accessible and safe and meet the needs of the residents who live there. Where a timescale has been set for compliance relating to the physical environment of the home, a plan and programme for achieving compliance must be in place, followed and met within reasonable agreed timescales. This is a repeat requirement not met within timescale of 31/01/06 and 01/09/06. There must be a sufficient number of functional baths to the number and assessed needs of the service users. This is a repeat requirement not met within timescale of 31/01/06 and 01/09/06. Room dimensions and layout options must enable room on either side of the bed, to enable access for carers and any equipment needed to meet the assessed and changing needs of the resident, particularly in shared accommodation and rooms accommodating people with high mobility needs. Communal space must suitable to cater for residents assessed needs and the home stated purpose. This is a repeat requirement not met within timescale of 31/01/06 and 01/09/06. 01/08/07 7. OP21 OP22 23 01/08/07 8. OP23 23 01/08/07 The White House DS0000017980.V337269.R01.S.doc Version 5.2 Page 29 9. OP25 23. 13 Sanitary facilities and vanity 01/06/07 units must be maintained or replaced as needed to ensure the health and safety of residents. Water temperatures must be monitored to ensure they meet the relevant environment health and safety requirements to protect service users from scalds. This is a repeat requirement not met within timescale of 31/01/06 and 01/09/06. The Responsible Person must provide details within an improvement plan as to how and when appropriate laundry facilities will be provided to meet National Minimum Standards. This is a eighth repeat requirement not met within the given timescales of Sept 2006, Dec 2005, Mar 2005, Jan 2005, Jan 2004, July 2003, Sept 17/18 2002. The Responsible Person must ensure washing machines have the specified programming ability to meet disinfectant standards and foul laundry is washed at appropriate temperatures to thoroughly clean linen and control the risk of infection. This is a repeat requirement not met within timescale 31/01/06. The Responsible Person must ensure having regard to the number and needs of the service user, appropriate sluicing facilities are provided separate from service users’ toilets and bathing facilities. This is a repeat requirement not met within timescale 31/01/06. DS0000017980.V337269.R01.S.doc 13(4)(c) 10. OP26 13(3) 01/06/07 11. OP26 13(3) 01/08/07 12. OP26 13(3) 23(k) 01/08/07 The White House Version 5.2 Page 30 13. OP33 24 14. OP33 24A The registered person must 01/08/07 establish and maintain a system specific to reviewing and improving the quality of care provided and outcomes for service users to ensure the home is run in their best interests. An Improvement Plan will be 28/07/07 requested by the Commission for you to set out the methods by which, and the timetable to which, the registered persons intends to improve the services and facilities provided by the care home. The registered person shall provide a written copy of the improvement plan to the commission within one month of receipt of the request. 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 DS0000017980.V337269.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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