Inspection on 30/08/07 for The White House

This inspection was carried out on 30th August 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 28/02/07

The White House 10/03/06

The White House 13/10/05

The White House 29/03/05

The White House 06/01/05

The White House 29/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 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 30th August 2007 09:30 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.V349881.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.V349881.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.V349881.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 28th February 2007 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, corridors and passenger lift the home is not suitable for wheelchair users. The site is shared with a nursing home and both units share the gardens at the rear of the building, which comprises of a patio and grassed area with seating. There is a car parking area at the front of the building. Current scale of fees confirmed at the inspection in February 2007 is from £426.55 to £450.00, There are additional costs for hairdressing, chiropody, toiletries and newspapers. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. All of the Key National Minimum Standards (NMS) for Older People and the intended outcomes were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included reviewing the progress of the requirements made at the last inspection on 28 February 2007, and other documents required under the Care Home Regulations. Additionally a number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. Time was spent talking to residents and staff. Feedback in questionnaires received from residents and relatives was positive and those residents spoken with during the inspection spoke highly of the staff and the care they received. The service is let down by the insufficient facilities at the home to meet the needs of the residents and its stated purpose, and poor record keeping. Following the last inspection the manager informed us that it was felt that there was a disproportionate value placed on evidential records and documentation in comparison to the resident’s experience of care delivery. The registered manager was advised of the regulatory requirement to have evidential records in place to demonstrate the understanding and delivery of appropriate, consistent and individualised care and support. During previous inspections the inspector has spent time explaining why evidence presented does not always support the proprietors’ assertions of compliance. This lack of understanding and respect for Regulations and NMS is a concern for the Commission. This inspection continues to highlight significant shortfalls in records and documentation and health and safety procedures and practice required to ensure the safety and wellbeing of the residents in the home’s care. We requested an Improvement Plan in June 2007, following the last Key Inspection, in which the home was required to identify the action it is taking to make improvements required by us, within a reasonable timeframe. The Improvement Plan submitted to us was brief and did not provide a planned and detailed strategy of actions being taken by the home to achieve objectives or improve outcomes as requested. The home is let down by the poor standard of the environment and lack of facilities. Outstanding environmental improvements required over the last The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 6 three years need to be made to improve outcomes for the people who live there. Following the inspection we received notification that these improvements are to commence in the next two months and an anticipated completion date of April 2008. The home needs to assure us in writing that appropriate consultation with the residents has taken place and appropriate arrangements are in place to minimise the disruption to residents during the rebuilding and refurbishment process. What the service does well: What has improved since the last inspection? What they could do better: The overall management of the service towards compliance with National Minimum Standards and Regulation, requires a greater sustained effort through the daily leadership of the home particularly in relation to essential elements such as care management, records and documentation, staff supervision and quality monitoring and assurance. The culture and attitude of the home towards regulation does not support an understanding of regulatory requirements and the need to improve outcomes for residents. Staff’s knowledge of regulation and standards should be developed; this will enhance the quality of care provided by the home and achieve a greater level of compliance. Care plans in place at the home do not provide sufficient direction for staff. More work is required to ensure understanding and implementation of the care The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 7 planning and risk management process to enable staff to provide structured and mutually agreed support to improve outcomes for residents in this area. It is of particular concern that the home has failed to improve facilities in line with health and safety and infection control guidelines to meet its stated purpose, the aims and objectives of the service and the needs of the residents. Positive and urgent progress in upgrading the physical environment and facilities of The White House is required to improve outcomes for the residents and safe working practices for staff. Risk assessments carried out by the home do not serve to protect residents or promote their independence. The home does not supervise and support staff to ensure care is carried out in a safe way. The home has not developed a system to assess, monitor and review the quality of the care and services provided at the care home, to inform future development and planning of service provision in line with recognised good practice. 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.V349881.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 People who use this service experience adequate quality outcomes in this area. Prospective residents immediate needs are assessed prior to their admission to the home but they are not fully informed of the services that will be provided to meet their needs, or the cost for them. Further work on this process and information provision, would improve outcomes in this area and reassure the residents. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: The admission process and the associated assessment paperwork still required further work to ensure a more person centred approach and cover all the relevant subject areas. It was disappointing to find that assessments had not The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 10 been developed despite the managers’ assurances in the homes Improvement Plan that this would be the case. In general the assessments remained in a basic format that indicated an area of need that will require support. They did not give sufficient detail as to the type and level of support required, which would better inform the home in ensuring that they can fully meet the potential residents needs. 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. We noted at the last inspection that resident contracts and statement of terms and conditions provided for those people admitted to the home did not clearly inform them about the service they can expect to receive in relation to meeting their personal needs, a breakdown of the relevant fees for such a service and who is responsible for the payment of them. It is disappointing to note that work in this area has not progressed, we were informed by management in the Improvement Plan that these documents would be revised after the completion of awaited building works to the home. The works to the environment would not have any direct implications to the residents’ contract/statement of terms and conditions and therefore the home needs to immediately improve this aspect of their service so that residents are appropriately informed with a signed formal agreement in place. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience adequate quality outcomes in this area. Lack of care planning documentation in the home exposes potential risk and inconsistency of care. 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 personalised way. Healthcare needs are generally met but records need to improve to evidence this further. Medication systems are well managed. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: The sampled care plans had not progressed since the last inspection despite assurances from the manager within the homes Improvement that stated ‘assessment of needs are being regularly reviewed, care plans are being reviewed every month sooner if necessary by key workers, mental and The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 12 physical health, social and psychological needs will be incorporated in the care plans, and ‘care plans will be wrote so that staff will know what care is to be provided by Sept 07’. From observation and discussion with staff it was clear that they generally understood the individuals needs and provided a level of care that the residents appreciated. However the absence of clear-recorded guidance for staff to follow does not demonstrate a level of consistency and continuity that reassures the residents and enables all staff to be sufficiently confident to deliver safe, appropriate and agreed care in the most supportive manner. Care systems at the home need to improve so that the team can evidence a proactive, resident led approach to care provision and ensure positive outcomes for residents. The most recently admitted resident did not have a care and support plan in place nor an allocated key worker despite being admitted two weeks ago. The pre admission assessment indicated a history of falls and a medical history of osteoarthritis, one hip replacement and both knees replaced. A moving and handling assessment was not dated or signed and did not provide detailed guidance for staff in the level and type of support this person required to ensure their safety and welfare and safe working practice for staff. The emotional adjustment, loss of ability and cognitive impairment due to a stroke was not assessed or reflected within the care planning arrangements for another resident. Although the care plan was more detailed than others it did not instruct staff as to the care delivery, type and level of support required particularly with stroke and cognitive impairment related needs e.g. stimulation, communication, nutrition, positioning and mobility. Recent entries in the daily reports stated ‘unsettled’ and ‘angry and kicking’, there were no risk assessments or risk management strategies within the care plan to support the individuals’ behavioural needs. Monthly reviews were evident in the care files but the records demonstrate that these rarely result in an adjustment to the care plan despite changes in needs. A moving and handling assessment assessed one resident as being independent despite having a stroke. The assessment was reviewed in July 07 and stated ‘no change’. The resident was observed to have a bandage applied to her leg, the inspectors were advised by the person in charge that this resident was prone to falls – indicating that needs and risk had changed for this person but not identified and planned for within their review. Care plans did not reflect service users’ choice and preference with regard to agreed bathing arrangements to meet their personal needs and requirements. Residents had allocated days for bathing it is not clear as to whether this is due to the lack of appropriate bathing facilities and/or low staffing levels. The The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 13 rota indicated and staff confirmed that during the evening there is generally two staff. This does not allow for residents to take a bath during the evening and maintain safety within the home. This is a concern we have raised in previous inspections and has not been addressed by the home. A completed survey from a GP indicated satisfaction with the overall care provided by the home and the home always seeks advice and acts upon it to manage and improve individuals’ healthcare needs; and individuals privacy and dignity is always observed to be respected. The nurse advisor for care homes employed by the Primary Care Trust commented that the home addresses healthcare issues promptly and therefore they achieve a good level of hospital admission avoidance. 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. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. The extent to which the activities meet the needs of the residents varies according to level of need. The meal provision in the home is generally good. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: The sample of care plans examined showed limited information regarding residents’ personal/social histories, personal choices and daily routines. Because of this and the limitations on discussion with those residents with lower cognitive abilities, it is difficult to assess how well the daily routine caters for the individuals’ needs and choices. No real assessment of social need was evident and therefore the social activity programme is not based upon residents’ needs and choices. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 15 Activity sheets were in care files that recorded an activity undertaken but most were incomplete or entries recorded did not reflect an actual activity that promoted stimulation or wellbeing for example ‘stayed in room for the afternoon’. Whilst it is acknowledged that this may be the residents’ choice for that day it is a not an activity. Those residents who are able to express choice or are less dependent feel that they have choice within their day. The home needs to consider how they can offer a more varied lifestyle that is suited to the expectations and preferences of the people that live there. Comments received by residents in relation to how the home could improve included ‘It would be nice to have more trips out perhaps in a mini bus to local spots like Maldon or Clacton. The ride would be nice.’ and ‘it would be nice to have the flower pots in the garden cared for’, both issues related to quality outcomes that could be explored within the homes quality monitoring and assurance system. Relative comments and staff spoken with indicated that the service encouraged relatives to maintain an active role in the residents’ life following admission. Relatives informed us that they were warmly welcomed and kept informed about the resident. The homes cook indicated that she worked two days a week and the remaining days were covered by the care staff. The service provided ingredients of fresh and good quality and meals were home cooked, well balanced and nutritious. The home has a four-week rolling menu that offered no choices, however staff confirmed that an alternative would be offered if asked for. There was no evidence to demonstrate how choices are offered to those people with cognitive impairment and communication difficulties and this is an area that needs development. For example using pictures to assist staff in supporting residents to make choices should be considered. Nutritional records were inspected and it was noted that on one occasion a person with diabetes had been given fruit crumble and custard; we were advised that this was not a usual occurrence and this person would usually have an alternative sweet or yoghurt. Observation of mealtime indicated that this was a relaxed and sociable occasion enjoyed by most residents. Residents comments about the food included ‘ the food is especially good and I am never hungry’, and ‘excellent’. The White House DS0000017980.V349881.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 and 18. People who use this service experience good quality outcomes in this area. Residents can be confident that their views will be listened to and acted upon. Residents can expect staff to respond appropriately to allegations of abuse. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: The home has a satisfactory complaints procedure in place. The person in charge was not able to confirm if any complaints had been received since the last inspection and was also not aware of the complaints log or where it was kept. Residents and relatives who commented stated that they were aware of the procedure and would in the first instance, contact the manager who is very approachable and would act upon any concerns promptly. The home’s policy and procedure for Safeguarding Adults is clear and precise and all staff confirmed they had received regular training in this area. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 17 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, 21 and 26 People who use this service experience poor quality outcomes in this area. The White House does not provide a safe environment that is suited to the residents needs. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: A full tour of the premises was undertaken and issues highlighted reflected poorly on the outcomes in this area. There were unpleasant odours in some personal accommodation; toilets and en suite facilities and infection control measures were not suitable for the service. In one bedroom the carpet was heavily soiled with excrement. This was observed at 12.30pm and the inspectors were informed that this occurred the The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 18 night before and yet the carpet had not been cleaned. In response the staff maintained that the soiled carpet had been reported to the maintenance man but the carpet cleaner was out of order and no further action was taken. An Immediate Requirement notice was issued for the carpet to be cleaned immediately. Mrs Dixon, the homes administrator, advised the inspectors that there was another carpet cleaner available for use. It is concerning as to how long the carpet would have been left unattended if not seen during the inspection process in view of the person in charge was not aware of the state of the carpet and the maintenance man was not aware of the second carpet cleaner. No further action had been taken to address previous requirements with regard to updating and providing suitable laundry, sluicing facilities and bathing facilities to promote and protect the health, safety and welfare of the residents and staff. One domestic washing machine was in use and the tumble dryer was not working. Staff said that they have to carry wet washing to the adjacent nursing home to dry and collect when completed. Staff said this was heavy work and takes them away from the home. Mr Dixon, the registered providers representative, stated that plans submitted to the Local Council were approved for an extension and refurbishment to the building, but was still unable to confirm a date for when the work is to commence. Following the inspection a letter was received from Mr Dixon stating that the work should commence within the next two months and that completion was anticipated for April 2008. The next inspection will consider the work undertaken in respect of improvements to standards and outstanding requirements. The White House is an older style building; the layout is not suitable for wheelchair users due to the narrow width of corridors, size/shape of some rooms and size of the passenger lift. 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. Risk assessments were not available. The communal bathrooms do not provide suitable facilities to cater for residents with higher dependency needs requiring assistance of staff and the The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 19 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. The White House DS0000017980.V349881.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 and 30 People who use this service experience good quality outcomes in this area. Residents are generally in safe hands however the skills staff have could be developed further to improve outcomes for residents, particularly in assessment and care planning. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: Taking into consideration the assessment from the previous inspection, observation and discussion with staff, the quality outcome in this area was considered as unchanged from the last Key Inspection. The person in charge of the service, in the absence of the registered manager, was unable to locate and provide the inspectors with records required by regulation relating to staff recruitment, induction and training. Staff surveys indicated that when they started their job their induction covered every thing that they needed to know, very well, to enable them to do the job. Staff surveys also indicated that they are receiving training that is relevant to their role, helps them to understand the individual needs of the residents and keeps them up to date with new ways of working. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 21 We were not able to fully assess this outcome group on this occasion and it was therefore considered that the outcome in this area remains unchanged and will be fully assessed at the next Key Inspection. Staff surveys indicated that appropriate checks had been carried out prior to their commencement of employment. The White House DS0000017980.V349881.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, 33, 36, 37 and 38People that use this service experience poor quality outcomes in this area. Resident’s do not benefit from a well-managed service. There is no effective day-to-day management in this service during the manager’s absence from the home and therefore residents may be placed at risk during those periods. We have made this judgement using a range of evidence, including visits to this service. EVIDENCE: The person in charge, assisting with the inspection, has many years experience in health and social care, however her current role within the home is part time cook, two days a week. She resumes the role as person in charge during the Managers absence from the home. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 23 The duty rota indicated that the Manager was on duty although the inspectors were informed that she was on leave for the week. The rota did not indicate who was in charge during this time. The knowledge of the person in charge was limited in relation to the records and documentation required to effectively and efficiently run the care home. She was unable to locate documentation such as risk assessments; complaints log book, training and development plans and files, staff records and maintenance records. The home must ensure that the same standards apply when the manager is away from the home and consideration must be given to a suitable deputy who has the knowledge of the day-to-day management of the home and regulatory requirements. During the tour of the building we noted a serious issue in relation to extreme hot water temperatures from the bathroom and sink hot water taps. An Immediate Requirement Notice was issued; the maintenance person was requested to address this during the inspection by the person in charge, which he did. This should not have necessitated the attention of the inspectors to prompt this action and did not demonstrate that checks to the hot water outlets were carried out on a regular basis to ensure the safety and welfare of the service users. A requirement was made at the last key inspection to regularly monitor hot water temperatures to ensure they meet the relevant environment health and safety requirements to protect service users from scalds. The most significant issue in relation to this was the fact that there was awareness that the raised water temperatures were due to the installation of a new thermostat, over a week ago, and yet no steps had been taken to test and if necessary adjust the water temperature to a safe temperature. Mr Dixon, the responsible person for the service, told the inspectors that he was experienced in running a care home and ‘no one has been scalded yet’. Water temperature testing of a prepared bath was carried out by staff prior to bathing and this was recorded however residents remain at risk of scalding if in direct contact from hot water outlets and when using hot water from hand wash basins in their rooms. There was no evidence available in the home to demonstrate that a system for evaluating the quality of the services provided at the care home. The staff did not understand what quality assessment and monitoring was, indicating that if a system had been developed they were not included in this process. Consideration should be given to developing an internal audit system to ensure that other aspects of the service are also maintained and developed, for example, environmental audits, recording system audits etc. The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 24 Health and safety risk assessments and audits are essential to ensure that issues in the home are attended to, for example infection control, tripping hazards and hot water temperatures. Food safety temperature records were inspected in the kitchen and found to be incomplete from 21/08 –24/08 and 27/08-30/08. Staff certificates in Foundation Food and Hygiene were fixed to the kitchen wall and would be more appropriately stored in the staff personal files to enable effective cleaning to take place. It was noted that two were dated August 2004 and June 2003 and no longer current. Staff advised us that all the staff named on the certificates undertook duties in the kitchen. Fire extinguishers were freestanding in the hallway and on the landing and not secured by wall brackets, this poses a hazard to residents particularly for those with impaired vision or used mobility equipment such as frames. The person in charge was unable to provide, for inspection, maintenance and safety certification or safe working practice risk assessments. Staff surveys indicated that the manager met with them regularly to give support and discuss how they were working. When spoken with staff were unaware of the meaning or purpose of structured and formal supervision. When it was explained to them they confirmed that this happened occasionally. Staff indicated that staff meetings were not held on a regular basis in the home, the last one being cancelled due to some members of staff unable to attend. Minutes of meetings indicated that two had been held in the last year. The White House DS0000017980.V349881.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 X 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X 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 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 2 2 The White House DS0000017980.V349881.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. Carried over from inspection of 28/02/07 All new residents must receive a full comprehensive needs assessment before admission to ensure the home is 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. Consideration must be given to how the service users can receive a more individualised service tailored to meet The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 27 Timescale for action 01/11/07 2. OP3 14 01/11/07 identified needs, maintain strengths and promote optimal independence with regard to health and social needs. 3. OP7 15 The home must take a more 01/11/07 robust approach to implement an active care planning process. Individualised care and support planning arrangements must be developed from a comprehensive assessment, 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, 10th March 2006 and 1st June 2007. 4. OP8 18 (4) 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. These must outline the current risk and subsequent management and be kept under regular review. Residents care plans must reflect their individual preferences and choices regarding their care and be more person centred to evidence that staff appreciate the diversity of individual residents. DS0000017980.V349881.R01.S.doc 01/11/07 5. OP14 16 01/11/07 The White House Version 5.2 Page 28 6. OP12 16(m)(n) Opportunities must be provided 01/11/07 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 cognitive needs. Repeat requirement not met within given timescale 07/01/06 and 28/02/07. The home must provide a sufficient number of functional baths to the number and assessed needs of the residents including suitable facilities that are capable of meeting the assessed needs as may be required for residents who are old, infirm or physically impaired such as an assisted bath. This is a repeat requirement not met within timescale of 31/01/06, 01/09/06 and 01/08/07. The Responsible Person must ensure sufficient number of functional baths to the number and assessed needs of the service users. 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. 30/04/08 7. OP19 OP21 OP22 23 8. OP23 23(2)(f) 30/04/08 The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 29 Communal space must be sufficient to cater for residents assessed needs and the home stated purpose. This is a repeat requirement not met within timescale of 31/01/06, 01/09/06 and 01/08/07. 9. OP25 23. Sanitary facilities and vanity 30/04/08 units must be maintained or replaced as needed to ensure the health and safety of residents. This is a repeat requirement not met within timescale of 31/01/06, 01/09/06 and 01/06/07. 10. OP26 13(3) The home must ensure appropriate laundry facilities are provided to meet National Minimum Standards and control the risk of infection. This is a eighth repeat requirement not met within the given timescales of June 2007, Sept 2006, Dec 2005, Mar 2005, Jan 2005, Jan 2004, July 2003, Sept 17/18 2002. 30/04/08 11. OP26 13(3) Having regard to the number and needs of the service users, the home must ensure appropriate sluicing facilities are provided separate from service users’ toilets and bathing facilities to control the risk of infection and meet with infection control guidance. This is a repeat requirement not met within timescale 31/01/06 DS0000017980.V349881.R01.S.doc 30/04/08 The White House Version 5.2 Page 30 and 01/06/07. 12. OP33 24(1)(a) (b) The home is required to establish 01/11/07 and maintain a system specific to reviewing and improving the quality of care provided and outcomes for service users to ensure the home is run in their best interests. The service must develop tools to gather the views of residents with cognitive impairment and include this in the quality assurance system as well as in consultation with regard to choices 13. 14. OP36 OP37 18(2) 17 Residents must be supported by a staff group that is appropriately supervised. The home must ensure records as detailed in the Care homes Regulations, Regulation 17, Schedule 3 and Schedule 4 are available for inspection. 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 01/06/07 01/11/07 01/11/07 15. OP38 13(4) 01/11/07 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.V349881.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. Extracts may not be used or reproduced without the express permission of CSCI The White House DS0000017980.V349881.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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