Inspection on 05/06/08 for The White House

This inspection was carried out on 5th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The White House 08/12/08

The White House 19/06/07

The White House 12/07/06

The White House 22/02/06

The White House 20/07/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 The White House 219 Green Lanes Wylde Green Sutton Coldfield West Midlands B73 5LX Lead Inspector Kulwant Ghuman Unannounced Inspection 5th June 2008 09:30 The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Address 219 Green Lanes Wylde Green Sutton Coldfield West Midlands B73 5LX 0121 355 0908 F/P 0121 355 0908 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) Robinia Care West Midlands Limited Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65. Date of last inspection 19th June 2007 Brief Description of the Service: The Whitehouse is a large detached property in the Wylde Green area of Sutton Coldfield. There are communal areas on the ground floor, consisting of a dining room, lounge, bathroom, toilet, laundry and kitchen. There are seven single bedrooms, two of which are on the ground floor and five on the first floor. Two of the bedrooms on the first floor have en-suite bathrooms. The office/staff sleeping in room is also on the first floor. There is a pleasant garden to the rear of the property, which consists of a paved patio area and a lawn. There is some off road parking for a few cars to the front of the premises. The Whitehouse is located close to local amenities in Wylde Green and Sutton Coldfield. It is also close to bus routes for Sutton Coldfield and Birmingham. The service provides care and support services for up to seven adults with learning disabilities. The reader will have to get information about the fees for living in the home directly from the home. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor outcomes. Two inspectors carried out this inspection over one day during June 2008. As part of the inspection we had a look around the home, spoke to three members of staff, the manager, four of the people who lived in the home and the parents of one person who lived in the home. We also looked at the care files of two of the people who lived in the home and some staff files as well as some health and safety documents in the home. Before the inspection the Annual Quality Assurance Assessment (AQAA) was sent to the home to be completed however. This asks the home to provide information about what the home feels has been done since the last inspection. The manager spoke to the inspector to ask for some more time as she said she had not received the AQAA and said that she would complete it and return it to the Commission. The manager has since left the home. To date this has not been returned to the home The home had received one complaint from a neighbour regarding cigarette ends being thrown into their garden and noise from the banging of the clinical waste bin. This had been responded to appropriately. Before the inspection someone whose name was not given to us told us that the motability vehicle of a person living in the home had been stolen and they thought that some staff that no longer worked in the home had taken it. The police had been informed that the vehicle had been stolen but not who was suspected of taking it. No names were given to us about who this was and so this could not be pursued. In addition, concerns were also raised hat food that had been bought for the home had been taken home by a member of staff. Senior members had heard of this concern and we were told that it had been looked into and found to be unsubstantiated. Since the last inspection an issue was raised about the partner of someone working in the home coming to the home and talking in a stern way to someone who lived in the home. The matter was looked into by the home and the person no longer works at the home. An issue of adult protection had been raised by a health professional regarding the care being given to someone living in the home. This matter was subject of investigation at the time of the inspection. During the inspection we were told by one person living in the home that he had been shouted at by two people who worked there. One person was no longer working at the home. This issue was passed to the acting manager to look into. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments needed to be improved so that it was clear what the needs of the people living in the home were, how they were to be met by staff, what the risks for individuals were and how they were to be managed. There needed to be better planning of activities during periods of time when the people living in the home were on holiday from colleges and day centres. Annual holidays needed to be discussed and arranged earlier so that the people living in the home could take advantage of warmer weather and any offers available. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 7 Better use of the communication books would enable relatives and day centres to have greater awareness of things that happened in the lives of the people living in the home and promote discussions between them. The people living in the home needed to be given opportunities to talk staff when they needed to. This would make them feel valued and protected. The home needed to ensure that medical appointments were attended by the people living in the home and that they were accompanied by staff who had knowledge of their needs and how they were being met. They needed to take with them the appropriate records that would be needed. 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 DS0000064612.V366366.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home had been living in the home for some time. The assessment process was not assessed during this inspection. The long term desires of the people living in the home should be identified and a plan made to show how these are to be achieved. This will ensure that there are goals that the people living in the home want to achieve and can these can be monitored. EVIDENCE: No one new had moved into the home since the last key inspection. The files sampled had identified what the individual would be doing on a daily basis but the documentation shown on the day of the inspection did not show what the short and long term goals of individuals were and how they were to be achieved. At the previous inspection the service user guide was inspected and it appeared to meet the needs of the people living in the home. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 8 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were no individual plans showing what the needs and personal goals of the people living in the home were. The people living in the home were not assured that their skills would be developed and kept under review. People living in the home were able to make some decisions about their lives but meetings that had been in place to help them make decisions about their lives were not being held on a weekly basis. This meant that views of the people living in the home were not being taken into account regularly. The paperwork in the home was disorganised so that it was not possible to see how and what risks individuals were able to take to enable them to be as independent as possible. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 11 EVIDENCE: At the time of the last key inspection the manager had identified that the care plans were in need of being updated. Two files were seen during this inspection. The files appeared to be disorganised and there were no real care plans that could be identified as a document that identified the needs of the people living in the home and how these needs were to be met. There were no indications in the files shown of what the goals for the individuals were and how they were to be achieved. People living in the home were able to make some day to day choices. For example, one person was seen to stay in bed until quite late in the morning and then was seen to be listening to music in his room. Some of the people were able to make drinks for themselves. The paperwork seen showed that another person often woke up quite early in the morning and was able to have breakfast at that time. At the time of the last inspection the people living in the home met on a weekly basis to decide what meals they wanted during the following week and what activities they wanted to take part in. The inspectors saw evidence that since the beginning of 2008 there had been two such meetings and we were told that the notes of another two were on a lap top computer with someone who had left the home. There was no evidence that these meetings had been replaced with any other form of consultation with the people living in the home or their representatives. It was important that these meetings were re-instated so that the views of the people living in the home could be included in planning the week. One of the files seen showed that there were some risk assessments in place for example, the use of a temporary wheelchair and agreement for medication to be given other than orally for one person and a risk assessment for another person around access to knives in the kitchen. One of the files indicated that there was a possibility that the person had a nut allergy. There was no risk assessment in place with respect to this but staff said the individual was able to eat nuts. This issue needed to be resolved for the safety of the individual. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 12 At the time of the last inspection it was identified that risk assessments were needed for the bed rails and bumpers for an individual who’s file was sampled. No evidence was available in the file that this had been risk assessed. Also identified at the last inspection was that this individual was sometimes put on her bed when agitated. The inspector identified that this could be seen as a form of restraint and records needed to be kept of when this happened and how often. At the time of this inspection there was no evidence that this was still taking place. The behaviour management plan did not identify this as a way of managing her behaviours, however, it had been observed as a management practice during a visit by health professionals to the home. It is of concern that this matter has not been addressed. There were some behaviour management plans in place for one individual that detailed the sort of behaviour that could be shown and what actions could be taken to manage them. For another individual it was of concern that some staff had knowledge of a behaviour where the individual made allegations about people but this was not recorded and no strategy was in place to manage this behaviour. This information could easily be lost as the turnover in the home has been significant and shows the need for this information to be recorded along with a management plan so that new, or temporary staff would have something to refer to if the need arose. There was an appointee for the people living in the home where families were not managing their monies. The appointee was someone in the provider organisation but not employed directly in the home. Where small amounts of money were held in the home the records for these were adequate but the home needed to ensure that there were always two signatures for any expenditures made on behalf of the people living in the home. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home had access to a variety of activities that were varied and enjoyed by the people living in the home. They were able to access the local community and have contact with family as needed. This enabled them to develop and maintain relationships with people important to them. It could not be evidenced how people made choices about the food they ate and whether a varied and nutritious diet was available. EVIDENCE: There was evidence that there were some activities in the home such as people attending day centres, drama classes, discos, shopping, going to the pub and The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 14 cinema. One of the relatives visiting the home stated that there had been more activities in the home than at the last inspection however weekend and half term activities were less well organised. During the inspection two individuals were taken out for a walk by two of the staff in the home. One of the relatives said that the people living in the home had had a holiday last year but it had not been until the end of September. At the time of this inspection no holiday had been arranged and it was likely that if a holiday took place it would again be late in the year. There were some concerns that due to a lack of forward planning in the home the holidays end up being at the end of the year when the weather is turning cooler or at a peak time when the holidays are most expensive. Friends and relatives could visit the home whenever they wanted and there was telephone contact with them if needed. Communication books were available for the people living in the home. All the books except one were seen by the inspector and they showed that there was very little information included in these. One of the relatives stated that they felt that these books could be better used to inform families of what the individuals had been doing so that when they visited their relatives they would know what to ask them about and develop communications with them. As stated earlier the weekly meetings for the people living in the home appeared to be haphazard and it could only be assumed that the menu had been decided upon by staff with little evidence of input from the people living in the home. The menu stated that for lunch on most days it was ‘sandwiches or service user choice’. On the day of the inspection one individual was given cheese sandwiches and crisps. The individual ate the crisps but hardly any of the sandwich. She did not want to eat it and was not offered anything else. She kept saying that she wanted to go to McDonalds. There was a list of drinks and amounts of sugar that people living in the home had. One of the people was identified as having sugar in tea. The relative stated that this had never been the case and had asked the acting manager to change it. The list was unchanged by the end of the inspection. Food that individuals in the home ate was not recorded consistently so it was difficult to determine whether the people living in the home were provided with a varied and nutritious diet that met their individual needs. There had been concerns about the fluid and food intake records for one individual in the home as the home had been unable to provide the health professionals with adequate records of what she had been taking in. The The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 15 records seen at the time of the inspection did not identify what had been eaten by the individual and what had been given through the peg feed. The dining room was quite small but homely. The dining table used by the inspectors during the inspection was unstable and rocked a lot. This could have caused difficulties for individuals who were unstable on their feet and who may use the table for support when getting up. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans did not evidence how individuals wanted to be supported when receiving personal care. This means that people living in the home may not receive personal care needs met in the way they wanted. People living in the home did not always attend medical appointments and records required by health professionals were not adequately maintained. This means it was not always possible for the health care needs of individuals to be adequately monitored. Management of medicines in the home was not robust. This meant that people living in the home may not always receive their medicines as prescribed. EVIDENCE: As stated earlier, the files belonging to the people living in the home were disorganised and information was difficult to find. The inspectors asked for the care plans and daily records for two of the people living in the home and we The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 17 were given the medical files. We were told that there were no other files with care plans in them. The medical file of one of the people living in the home included very basic information about what the personal needs of the individual were and how these needs were to be met. For example, it stated, ‘need somebody to prepare my meals and feed me. If I refuse offer me something else’. This was insufficient information for someone who had very specific needs about food intake and this information would not be sufficient to tell anyone caring for her what they needed to do. The plan did not even refer to the nursing plan that included a lot of information on the management of this individuals dietary needs. One of the staff on duty at the time of the inspection stated that the plans needed to be updated and the new manager was beginning to start this process. It is of concern that it was nearly 12 months since the last inspection and no progress could be seen to have taken place. Health action plans were in place that told people how to stay healthy but they did not include information on what should be done on a day to day basis. They did not ensure that the medical needs of people living in the home were being adequately met. At a recent meeting called because of some concerns raised by a health professional it was identified that the individual had not been attending some of her medical appointments and that the records that the health professional had been requesting from the home since September had not been forthcoming and the information was not being recorded as required. The medical file in the home showed that some appointments had been missed for the individual about whom the concerns had been raised. The file of another person living in the home indicated that an appointment had not been attended and the home’s records stated that the appointment had been cancelled by the consultant however, a letter on the file from the consultant stated that they were surprised that he had not attended the appointment especially because of the problems he had been experiencing. For another person living in the home the relatives took the individual to several appointments such as the dentist, chiropodist and GP. The relative had some concerns that at times people escorting the individuals to appointments did not have adequate knowledge about their needs and did not have the appropriate records with them when they went. One of the relatives spoken to said they were concerned about what would happen when they themselves were not able to do as much for their child. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 18 They felt that sometimes the approach of the staff meant that if the person said they did not want to do something the staff took that to be their right not to do it even if it was in their best interest to be encouraged to do it. There was gender specific care available for people living in the home and the individuals all appeared to have their own style of dress. There was a monitored dosage system in place for the management of medicines. None of the people living in the home were able to look after any medicines for themselves. The inspector was told that the painkillers for one of the people living in the home were to be given ‘as required’ but this was not stated on the medicines administration record (MAR). Another tablet could not be audited as the records showed that 28 had been received, 12 had been dispensed and 24 had been taken out to be taken on social leave but there were 11 left in the box. There was a gap in the controlled medicines book. The balance said there should be 15 tablets but there were only 14 tablets. The management of medicines in the home needed to be improved to ensure that the people living in the home received their medicines as prescribed. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home were not always listened to and this could result in them being left frustrated and worried. People living in the home were not always protected by the practices in the home. EVIDENCE: During the inspection it was noted that when an individual asked to speak to one of the staff about something the individual was told that the staff had chores to do so could not speak to them. The individual was obviously upset and was vocal before eventually going to bed. The following day the individual did not get up until late afternoon and after eating went back to his bedroom. There was no evidence that the matter had been followed up at all. During the inspection an allegation was made by one of the people living in the home of being shouted at. This matter was referred to the acting manager to follow up. The inspectors were told that the individual was known to make allegations about staff on occasions and had made such an allegation about the acting The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 20 manager. There were no records in the home to show that either any allegations had been made by the individual previously or that there were any risk assessments or management plans in place for staff to follow when these allegations were made. An adult protection matter had been raised by a health professional regarding the care being given to one of the people living in the home. This matter was in the process of being addressed at the time of the inspection. One of the relatives spoken to said that there had been some problems with the laundry where items of clothing had been washed at the wrong temperatures leading them to be damaged. There was no record of these concerns having been raised in the home. Since the last inspection there had been one recorded complaint to the home from a neighbour regarding cigarette ends being thrown into their garden and noise from the banging of the clinical waste bin. This had been addressed and the outcome was recorded. An incident had occurred in the home where it was alleged that the relative of a member of staff had come to the home and spoken to a person living in the home in an intimidating manner. The member of staff no longer worked at the home. A concern had been raised with the commission that a vehicle belonging to one of the people living in the home had been taken by ex-staff members and that food bought for the home had been taken home by a member of staff. The theft of the vehicle had been referred to the police and senior management were aware of the allegation regarding the food. The inspector was told that the matter regarding the food had been investigated and no evidence was found to support it. This matter was not recorded in the complaints folder and there was no evidence relating to the investigation about this. There was insufficient information to look at who had taken the vehicle and the matter had been looked into by the police. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation provided a comfortable and safe environment in which to live and it was clean and hygienic. EVIDENCE: The home was found to be clean and odour free. It was homely and generally comfortable. No changes had been made to the building since the last inspection and continued to be suitable for it s purpose. All the bedrooms were occupied singly and appeared to be personalised to the individuals’ liking. There was sufficient communal space for the people living in the home although one of the dining tables was found to be unstable and we had to put some paper under one leg to stop it rocking. The dining area was becoming cramped with so much furniture in it. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 22 The kitchen was homely and suitable for the number of people living there. The office accommodation continued to be small and filing cabinets had to be stored outside some bedrooms as there was no room in the office. Fold up chairs had to be hung on the wall outside the office when not in use. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been a large turnover of staff at the home and this was not good for the continuity of care for the people living in the home. Staff did not always have induction training at the appropriate time. This did not ensure that the people living in the home were being cared for by staff whohad the appropriate skills and knowledge. EVIDENCE: There had been a significant turnover of staff during the past few months at the home. A number of agency and bank staff were being used to help care for the people living in the home. The constant changing of staff was not good for continuity of care in the home. At the time of the inspection there was a team leader who had been employed in the home for nearly a year, one person who had worked at the home for just over 3 weeks and a bank staff member. A new manager had just been employed in the home. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 24 The new member of staff had not yet had her induction training but had had training in the administration of medicines and peg feeding. She had been reading the files for the people living in the home to get to know them. The file of another staff member was seen and it was noted that the individual had worked in the home for 3 months but had not had the induction training yet. She had had a lot of training in her previous employment. There was no CRB or evidence of POVA on the file. She had not had any supervisions since the manager had left. The inspectors were informed that the recruitment files for the new staff were not available as they were at head office and the person with the access to the files would not be available for duty until after the weekend. This information would normally have been sent to the home as soon as they were to be employed in the home but due to the manager leaving this had not occurred. At previous inspections it was seen that the recruitment process for the company was robust. Discussions with one of the staff did not clarify what the role of the team leader was except to ensure that tasks were carried out. The staff member said that they had not been involved in developing car plans and had little knowledge about these. At the time of the last inspection the manager stated that a lot of her time was spent helping staff assist the people living in the home due to low staffing levels. It is recommended that the company ensures that the acting manager has sufficient dedicated time to ensure that the care plans, risk assessments and other paperwork is put in order. Due to the large turnover of staff and disorganised paperwork it was difficult to determine how well the staff could support the people living in the home. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home did not ennsure that the people living there were safeguarded and listened to. Records were not maintained in a way that helped other professionals in planning there care. There was no evidence that the views of people living in the home had been used in the development of the service. Health and safety was generally managed well but some improvements were needed. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 26 EVIDENCE: There has been no registered manager in the home since February 2007. The acting manager present during the last key inspection had left and a new acting manager was in post at the time of this inspection. This means that there has been a long period of time in the home without a manager who was accountable for the day to day running of the home. There was evidence seen during the inspection and information received from other people visiting the home to indicate that the people living in the home have not been benefiting from a well run home that ensured that their personal, social and health care needs were being well met. No improvements to the care plans and risk assessments were seen in the files shown to us during the inspection. There was no evidence that the home had been using service user views to inform self monitoring, review and development of the home. The security of the home needed to be maintained at a higher level. The keys in the home were accessible to anyone entering the kitchen. We were informed that the keys to the vehicles at the home were taken from the kitchen by someone entering through the kitchen door from the garden area. The kitchen door remained open and keys were seen to be hanging in the kitchen throughout the inspection. The side gate was left unlocked the whole day and relatives had stated that they had raised this issue with the home before. During the inspection the inspector was asked to move her car by a neighbour. During that time the front door to the home was left open by staff. This could have given someone living in the home the opportunity to leave the home without the knowledge of the staff. When this was brought to the attention of the acting manager she indicated that she was aware that this had happened before. A manager from the organisation had been visiting the home on a monthly basis and had identified shortfalls such as the level of staff supervision, training for staff and fire safety checks in the reports of these visits. There was nothing to show that any actions were being taken to oversee that the identified shortfalls were being addressed. The home was safe and well maintained. The weekly fire alarm test for the week prior to the inspection had not been recorded, and the service of gas equipment needed to be pursued. There was no evidence available that the bath hoist had been serviced and this was to be faxed to the inspector. At the time of writing this report this had not been received. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 27 The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 1 X X 2 X The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 29 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 YA6 YA18 Regulation 15(1,2) Requirement Care plans for the people living in the home must be up to date and include sufficient detail to enable staff to know how to provide the support. The care plans must be in a format suitable for the people living in the home. This will ensure that the people living in the home receive person centred care. Previous timescale of 01/09/07 not met. 2. YA7 13(7) A record of any for of limitation put on people living in the home, including those to prevent harm, must be kept. This will ensure that the liberty of people living in the home is not restricted unnecessarily. Previous timescale of 20/07/07 not met. There must be a risk assessment and strategy for DS0000064612.V366366.R02.S.doc Timescale for action 01/09/08 04/07/08 3. YA9 13(4) 01/09/08 The White House Version 5.2 Page 30 managing all identified risks. This will ensure that people living in the home are protected from risks as far as possible. Previous timescale of 01/08/07 not met. 4. YA17 17(2) Sch 4(13) Records must be kept in the 01/08/08 home that enable people to determine whether the diet of any individual has been varied and nutritious and of any special needs identified.. 5. YA19 This will ensure that people living in the home received an appropriate, varied and nutritious diet. 12(1)(a)(b) The Registered Person must ensure that the weight of all the people living in the home is monitored on at least a monthly basis. Any reason why this has not been done must be documented. This will ensure that the nutritional needs of the people living in the home are met. Previous timescale of 01/08/07 not met. 01/08/08 6. YA19 13(1)(b) People living in the home must be accompanied to medical appointments by people who have sufficient knowledge of the individuals needs to be able to inform professionals of the individuals’ progress. Reasons why appointments have been missed must be fully recorded and alternative dates 14/07/08 The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 31 pursued. Records needed for monitoring by health professionals must be maintained in a way that is helpful for the professionals. This will ensure that the health needs of the people living in the home are appropriately monitored and issues addressed in a timely manner. Records for the management of medicines in the home must be accurate. This will ensure that the people living in the home receive their medicines as prescribed. A record of all complaints raised and the investigations undertaken must be kept in the home. This will ensure that the people living in the home and their representatives feel they are listened to. The mobile hoist must be removed from the home or serviced. This will ensure that only safe equipment is used in the home. 10. YA37 12(1)(a) Not assessed at this inspection. The registered person must ensure that the manager has sufficient time to update the homes care plans and other documents. Previous timescale of 01/08/07 not met. This will ensure that the people living in the home are living in a home that is able to meet their The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 32 7. YA20 13(2) 01/08/08 8. YA22 22(3) 01/08/08 9. YA29 13(4)(c) 05/06/08 01/08/08 needs and is managed appropriately. 11. YA37 17(2) Sch 4(7) The rota must show the hours worked by the manager in a support worker role. This will ensure that there are appropriate staff on duty to assist the people living there. 12. YA42 23(2)(c) Not assessed at this inspection. The bed identified during the inspection must be serviced. This will ensure that the bed is safe and suitable for use. Not assessed at this inspection. 13. YA42 23(4)(c)(v) Fire alarm tests must be carried out and recorded on a weekly basis. 01/08/08 05/06/08 05/06/08 14. YA42 23(2)(c) This will ensure that emergency equipment is in working order. Evidence that the bath hoist and 01/08/08 gas equipment in the home have been serviced must be forwarded to the commission. This will ensure that equipment in the home is maintained safe for use. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 Good Practice Recommendations Care plans needed to identify the short and long term goals for people living in the home. The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 33 2. YA5 This will ensure that the people living in the home have aspirations to be achieved and skills developed. The Registered Person must ensure service users’ statement of terms and conditions are signed and include information of the fees to be paid. Not assessed at this inspection. 3. YA6 It is recommended that care plans include evidence of how: people living in the home have been involved in writing care plans and reviews they have been consulted about having keys to their bedrooms advocates have been used to make choices they are involved in preparing meals It is recommended that the Registered Person provide opportunities for service users to access an advocate who could facilitate their weekly meetings if this is possible. Weekly meetings should be evaluated the following week to assess whether actions required were implemented. 4. YA8 5. YA13 People living in the home must be provided with sufficient opportunities for activities during the week and at weekends. There must be a clear record of activities indicating which service users have participated in these. This will ensure that the people living in the home have a fulfilled social life. 6. YA14 7. YA15 Plans for annual holidays for the people living in the home should be made in earlier in the year so that the people living in the home can enjoy the benefits of the warmer weather and get better value for money. The communication books should be used appropriately to inform others involved in the care of people living in the home of different aspects of their lives. This would enable other important people to know what has happened in their lives and give some information on which to develop their relationships and meaningful dialogue. Staff need to ensure that people living in the home are not giving too much food at one time and that the food records DS0000064612.V366366.R02.S.doc Version 5.2 Page 34 8. YA17 The White House are accurate reflections of the food given. The staff need to ensure that people living in the home have access to snacks and that they are not made inaccessible to all due to the behaviour of one of the people living in the home. Not assessed at this inspection. 9. YA19 It is recommended that the Registered Person develop individual health action plans in line with the Department of Health’s Valuing People Guidelines. Outstanding recommendation brought forward. Bedrooms without appropriate locks and magnetic door holders in place should have these fitted. Not assessed at this inspection. 11. YA30 A washing machine with a sluice facility must be provided in the home. The odour in the en-suite facility must be addressed. 12. YA32 Not assessed at this inspection. Staff must undertake induction training that is in line with the Skills for Care guidelines with the specified timescales. This will ensure that the people living in the home are assisted by people with adequate skills and knowledge. The registered person should ensure that there is a period of staff stability in the home. This will ensure that the people living in the home are comfortable with and know the people who are assisting them are aware of their needs. Staff working at the home should have regular supervision. This will ensure that staff practices are monitored and they are supported to provide appropriate care. The manager should have more appropriate office accommodation. 10. YA26 13. YA33 14. YA36 15. YA43 The White House DS0000064612.V366366.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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