Inspection on 11/10/07 for The White House, Falmouth

This inspection was carried out on 11th October 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

The White House, Falmouth 12/03/09

The White House, Falmouth 25/03/08

The White House, Falmouth 06/06/07

The White House, Falmouth 23/08/06

The White House, Falmouth 20/03/06

The White House, Falmouth 04/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The White House, Falmouth The White House 128 Dracaena Avenue Falmouth Cornwall TR11 2ER Lead Inspector Stephen Baber and Diana Penrose Unannounced Inspection 11th October 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The White House, Falmouth DS0000065484.V349660.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, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House, Falmouth Address The White House 128 Dracaena Avenue Falmouth Cornwall TR11 2ER 01326 318318 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) Mrs Helen Judith Christopher Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2007 Brief Description of the Service: The White House is situated in Falmouth on the main route into the town. The home provides personal care for up to seventeen elderly people. Accommodation is provided on two floors and there are stair-lifts to access the first floor. Residents have their own bedrooms that are fitted with hand washbasins. There are sufficient toilets and assisted bathing facilities are provided. Meals are prepared in the kitchen on the ground floor and served in the lounge diner. Residents can choose to eat in their individual bedrooms if preferred. The home has small gardens at the front and rear with patios accessible to residents. Some areas are suitable for wheelchairs. The front access to the home is on a slope and limited parking space is available. There is a flexible visiting policy and residents can see their visitors in private. Information about the home is available in the form of a residents’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £300 to £412 per week. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Mrs Christopher became the owner of the home in December 2005. She is responsible for the day-to-day running of the home and employs a team of care assistants and domestic staff. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) have made changes to the way we inspect services. Known as Inspecting for Better Lives (IBL). We are now more proportionate when reporting our findings, and more focused on the experience of people using services. This was the homes fourth inspection and some improvements have been made since the last inspection such as new carpet, redecoration and new arrangement in the entrance hall. The purpose of the inspection was to ensure that resident’s needs are appropriately met, with good outcomes provided to them. This was an unannounced key inspection with two inspectors. It took place on 11/10/07 and lasted for 4 hours. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents’ placements in the home result in good outcomes for them. The inspection included interviews, some held privately in residents’ rooms and some in the communal area of the home. There were only three members of staff on duty and they had to meet the care needs of residents and cover management, cooking and domestic duties between them. The provider we were told was on a day off but later established that she was on two weeks annual leave leaving no management presence in the home. We talked with the three staff and there were opportunities to directly observe aspects of residents’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and discussion with the senior care assistant in between her various duties. We were unable to carryout a full inspection because the required records were not available for inspection. We were told that some of the records were stored at the home of the provider. records were not available and in some cases off the registered premises in the house of the provider which is next door to the home. This is contrary to Section 31 of The Care Standards Act 2000 and this matter will be referred to the Commission for further action. The provider has not returned her Annual Quality Assurance Assessment (AQAA) which is a legal requirement under Regulation 24 of The Care Standards Act 2000(Establishments and Agencies) (Miscellaneous Amendments) 2006. The Commission may take enforcement action. The people living in the home gave us mixed views. Some said they were happy at the home and nothing much has changed. Others said the home is understaffed and they would like to have more staff around to give help. Another comment was that there is a reliance on frozen food and vegetables and bought cake. We evidenced this at the inspection when we noted that The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 6 tinned rice pudding and frozen vegetables was being used and bought cake was being stored in the shed at the back of the property. The registered provider has not complied with all of the requirements set at the Key inspection in June 2007. Eight of the twelve requirements have been re-notified following this inspection and two re-notifications. Many records have not been kept up to date, and some of the home’s policies require reviewing and updating. The management of the home needs to be better organised; work needs to be prioritised with systems put into place to be effective. two re-notifications. Many records have not been kept up to date and the home’s policies require reviewing and updating. The management of the home is disorganised; work needs to be prioritised with systems put into place to be effective. What the service does well: What has improved since the last inspection? There has been some improvement since the last inspection: • The reception desk has gone from the front entrance and it now looks very welcoming with domestic style chairs and new carpets. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 7 • • • • Medication is stored in the new office which serves as a sleeping in room for the sleeping in member of staff New carpet in the lounge Wooden ceiling in the lounge has been painted white. Fire training for all staff was carried out in September 2007. What they could do better: Detailed feedback was given to the senior care assistant who was dividing her duties between cooking, care assistant and management. The following areas were discussed with the senior: The following areas were discussed with the senior Radiator covers must be fitted in some residents rooms and all areas occupied and used by residents. The radiators were very hot and if residents fall against them serious injury may occur • Call bell leads were missing from some rooms, toilets and some communal areas • High cleaning was required in all areas of the home • Outside windows required cleaning • Fire doors marked “keep shut” were open and one had cleaning material in them • Odour in three rooms needs to be eliminated • The importance of fresh vegetables and home cooking including choices available to them. • Low staffing ratios and no person to manage the home in the absence of the provider. • All records should be kept at the home and be available for inspection at all times. • There was a lot of rubbish outside some bedrooms particularly room 9 • Exterior paintwork was peeling in some areas and the garden looked un cared for and was overgrown with grass and weeds. Fallen apples from the trees could present as a trip or slip hazard to residents and staff. • This in addition to all the other matters listed in the report e.g. records not available improvements promised at the last inspection not being met and poor communication with the Commission such as i.e. no response to the improvement plan and non-return of the AQAA before the inspection. The evidence gathered by us shows with that there has not been significant improvement to comply with the findings of the last the key inspection carried out in June 2007. In fact it would appear that the home has not moved forward as promised by the registered provider. The White House has been judged as “poor” which, means that it has significantly more weaknesses than strengths. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 8 • • Important elements of key National Minimum Standards are not being met. We judge that residents are not safe as a result of how the service delivers the outcome areas and we evidence a trend towards deteriorating service quality in the outcome groups inspected. The registered provider did not send in her improvement plan as a result of the last inspection. Another improvement plan will be forwarded as result of this inspection and must be returned to the Commission. 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, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 9 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, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 10 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): Standard 3 was assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of all residents are assessed prior to admission. This ensures that the home can meet the resident’s needs. EVIDENCE: There have been no new admissions to the home since the last inspection. There is clear assessment documentation, distinct from care planning, which addresses resident’s personal, health and social cares needs in line with the National Minimum Standards, including needs relating to their background, religion and culture. Assessment documentation was not always signed by the resident or their representative to indicate their participation in and agreement with the information. The White House, Falmouth DS0000065484.V349660.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Current care plans do not fully address their personal, health and social care needs, including needs relating to their background, religion and culture, which residents can participate in drawing up and are regularly reviewed. Specific improvements are needed to protect residents from risks associated with medication errors. Improvements are needed to provide residents with a greater degree of choice as to the level of privacy they wish to enjoy. EVIDENCE: The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 12 The current care plans were inspected. We were told at the last inspection that new ones would be put into operation. This has not been done and the provider who was contacted by telephone said that they were still on her personal computer. Current care plans lack clear direction on how residents needs should be met. There is also a lack of evidence of regular, ongoing reviews of resident’s needs and participation by residents in the care planning process. Only staff who are trained in the safe handling of medicines assist service users with their medication. Medication was observed and staff showed that it is undertaken correctly. An area that has improved is the safe facilities for storage and the administration of medicines, but the written policies and procedures to guide staff were not inspected due to the records not being available. We noted that two separate pots of prescribed creams were in the bathroom. We also evidenced the same cream in the resident’s bedrooms. We hope that the cream in the bathroom was not used as stock cream for all residents. Most of the residents who were interviewed said that they are satisfied with the care the home provides, but some would like more staff available to assist with care needs. Some residents said that they are satisfied with the care the home provides, including arrangements for maintaining their privacy but physical improvements to the home’s environment are needed to ensure that they are fully able to choose the level of privacy they wish to enjoy. All bathrooms and toilet doors need to be lockable. Residents must be provided with lockable storage space in their bedrooms. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14, and 15 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements are needed to ensure that resident’s cultural and religious needs are fully recognised and met. Specific improvements are needed to ensure that all residents receive a nutritional, balanced diet, which is acceptable to them EVIDENCE: The majority of residents were in the lounge. Some were watching the television, others were asleep and some quietly thinking to themselves. The senior care staff said that more activities have been introduced and were planned for the near future. The residents interviewed were satisfied with the activities provided to them. We were unable to see the records in respect of the residents likes, dislikes and preferences with regard to activities, but there needs to be more consideration of their religious and cultural needs as part of the assessment and care planning process. Most of the residents who were interviewed at the time of the inspection stated that they are not very satisfied with the meals provided to them at the home. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 14 Residents said that they would like to have a full choice at meal times and have fresh vegetables and home baked buns and cakes. They are able to choose whether or not to have their meals served in their bedrooms or in the home’s dining room. Most residents spoken with were unaware of what the lunchtime meal would be until just before the mealtime. Most said there is no choice at lunchtime however some said they have something different if they do not like the set meal. Everyone said there is a choice at teatime Meals are prepared and cooked by the care staff however the registered provider said at the last inspection that she is going to employ a cook. Attempts to date have proved unsuccessful. At times the person cooking has to leave the kitchen to attend to residents care needs and residents said this is always the case and the food gets spoilt. There is a set menu indicating that a variety of food is on offer. There were two oranges, apples and old potatoes in the store cupboard outside. Fresh vegetables and fruit should be available for residents each day. There was water and fruit juice available in the lounge and bedrooms for residents all day. Meals are served in the dining/lounge areas or individual bedrooms if residents prefer. The dining tables have tablecloths and special cutlery is supplied for those who need it. The lunchtime meal was pork casserole or sausages with potatoes and frozen vegetables followed by tinned rice pudding. Resident’s comments about the food were variable. “The food is not bad”, “The meals are not very good”, “The food varies depending on who is cooking” and “We don’t have fresh vegetables and fruit each day”. The dry food stores were in a shed, which was situated in the back of the garden. This meant that staff had to leave the premises to get stock including cakes, which were being stored in the shed. We are unsure if a risk assessment for the safety of staff and protection against vermin has been completed and will check at the next inspection. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that states complaints are listened to and acted upon. Some arrangements are in place for the protection of residents to safeguard them from harm or abuse. Systems to protect residents from abuse need to be improved particularly in the area of staff awareness training. EVIDENCE: The homes complaints procedure was not available for inspection. Residents said they know how and to whom they would make a complaint if they had to. All of the residents apart from one confirmed that they feel safe in the home and most were satisfied with the care they receive but formal systems to protect them form abuse need to be improved. This includes staff training, written procedures to guide them on what to do should they suspect abuse of a resident and maintenance of records about staff to demonstrate that they are safe to work with vulnerable people in a care setting. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 16 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): Standards 19 and 26 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provides a reasonable environment for residents and staff and there is some evidence that upgrading work has been taking place. Thorough cleaning schedules, which will address high cleaning throughout to make it a more pleasant place to live in. EVIDENCE: Evidence was provided in the form of a tour of the building, observation, talking with residents, staff and the registered provider. The home is warm and comfortable and lighting is domestic in type. Residents have their personal possessions around them and they said the accommodation provided meets their needs. Residents share a large lounge diner where a majority of them spend their time. There is a budgerigar in a The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 17 cage in the lounge and a tank with tropical fish. All bedrooms apart from five have been refurbished. The lounge has been decorated and new carpet has been put down. The bathrooms upstairs still need upgrading and the broken bidet removing. We also noted in the bathrooms and toilets that radiators were very hot and residents should be protected from burning themselves by the fitting of radiator covers. The same applied to resident’s bedrooms. The hot water temperature is not regulated and is very hot. Baths and showers must have the water temperature regulated to prevent scalding. The registered provider must liaise with the health and safety executive (H.S.E.) to ensure compliance with current regulations in respect of water temperatures and radiator covers. There must be risk assessments in place for the hot water and hot water caution signage must be displayed. This was detailed in the June 2007 report. Grab rails and raised toilet seats are provided in toilets and there are two stair lifts to access upstairs. Residents have their own bedrooms; the double is not shared at the moment. Some of the downstairs bedrooms have doors leading to the garden; the windows in these rooms have restrictors fitted and alarms on the doors. We noted that the alarm on one door had been turned off. The registered provider must undertake risk assessments for the doors and windows taking into consideration the individual residents and their safety. The requirement from the last inspection is re-notified for the second time. As detailed in the June 2007 report there is no gardener employed at the moment, the grass needs cutting and the grounds generally tidied. There is a steep grassy slope accessible to residents; this must be risk assessed and appropriate action taken. A shed has been erected at the back of the home for storage of the freezers and dry food. A risk assessment must be undertaken for the storage of food in this shed and the risk of pests such as mice or insects contaminating the food. Outside this area were fallen apples from the apple tree. These could prove very dangerous to residents and staff should they slip on them. A small office has been provided which is also used for staff that sleep in at night The home was reasonably clean but thorough cleaning schedules must be implemented to address the odour in some of the rooms. Attention needs to be paid to areas such as high cleaning as there are cobwebs in corners and lampshades are very dusty. The laundry facilities are one washer and one drier. The home deals with all laundry and all staff undertakes this. Residents said that on the whole the system works very well occasionally they get another residents clothing with their clean laundry. Suitable hand washing facilities are provided; alcohol gel is not in use. Protective clothing is supplied. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 18 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not sufficient numbers of qualified staff who are deployed to ensure that residents are in safe hands at all times. Records were not available to evidence that staff are recruited on the basis of fair, safe and effective recruitment policies, practices, and are suitable to be employed in a care setting. Records were not available to evidence that staff are trained and competent to do their jobs. EVIDENCE: The provider was on annual leave for two weeks. We inspected the duty records, which showed that two care staff and one domestic were on duty at the time of the inspection. The senior care assistant was also the cook and management. This was not satisfactory and places the residents at risk. Duty rota’s evidenced that there are two carers on duty all of the time and at night there is one carer awake and one sleeping. There is a domestic on duty every morning although the care staff help with domestic duties and laundry, they also do all of the cooking. Staffing levels will have to be discussed with The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 19 the provider when she returns from leave. Staffing levels will need to be reviewed. Records regarding recruitment and training were unavailable for inspection. It is a legal requirement that all records must be kept secure on the registered premises. The only record we saw was a hand written record on the 6th September saying, “All staff must attend fire training” on that date. It did not detail who attended or evidence that staff signed for the training received, which would have been good practice. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 20 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): Standards 31,32,33,35,36,37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered provider needs to put systems in place to ensure the home is managed effectively. There is little evidence of systems to ensure the quality of the service is improved. This is essential to ensure residents receive a good quality service and the registered provider can meet regulatory requirements. The home does not hold money for residents at this time. Staff supervision arrangements must be improved to ensure staff receive formal support and guidance regarding their work. The registered provider needs to improve the record keeping system to ensure the records required by legislation are held in the home. Health and safety requirements need improvement so that residents can be assured they live in a safe environment. EVIDENCE: The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 21 Evidence was provided in the form of limited documentation, observations, talking with staff and residents. The management of the home is not effective and many of the records and documents are still being kept in the providers’ house. For the second time we were told over the telephone that the registered provider is in the process of moving files from her house into the home and storage has been provided in the office. This will be discussed with the provider when she returns to the home. No records were available to establish that effective systems are in place to evaluate the quality of the services provided at the care home. Comments from residents were variable and comments “ I like it here” to “I would like to move” were said to us. The staff were unable to help us again which shows that a suitably qualified and experienced person must be left in charge of the home to ensure the best interests of all residents and smooth running of the home. We were told that there would be a different senior on in the afternoon and the next day because the most senior member of staff was going away for the weekend. The registered provider was not due to return until Monday the 15th October 2007. We were told that the home does not handle residents money, the residents representatives does this. We were told that supervision is up to date but no evidence could be provided. We looked at the accident book and noted appropriate action taken by the staff when the doctor had to be called. Records relating to health and safety were not available for inspection. The senior care assistant said to us that the providers partner tests call bells weekly and emergency lighting monthly and the servicing of extinguishers is carried out yearly by contractors. An improvement plan will be sent to the provider as a result of this inspection and there is an expectation that this will be completed and returned. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 x 2 1 1 1 The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 23 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 OP18 Regulation 13 (6) Timescale for action The registered person shall make 17/12/07 arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. For example: All staff must receive appropriate abuse training Renotified (4) The registered person shall 17/12/07 ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, For example: Written environmental risk assessments must be completed, DS0000065484.V349660.R01.S.doc Version 5.2 Page 24 Requirement 2. OP38 13 The White House, Falmouth and must include: the prevention of Legionella Renotified The health and safety policy must be reviewed and updated The registered provider must liaise with the HSE and ensure that the hot water provision complies with legal requirements data sheets for COSHH substances must be available to staff A risk assessment must be undertaken for the food shed A risk assessment must be undertaken for access to the sloping garden area Radiators in some residents bedrooms communal areas and bathrooms and toilets must be fitted with radiator covers to ensure that residents are safe and until that risk assessments must be carried out particularly residents bedrooms , bathrooms and toilets. 3. OP36 18 (2) The registered person shall ensure that— (a)The registered persons shall ensure that persons working at the care home are appropriately supervised For example: All care staff must be provided with regular supervision including one to one supervision, at least six times a year, with records kept Renotified The registered persons shall establish and maintain a system for evaluating the quality of the services provided at the care DS0000065484.V349660.R01.S.doc 17/12/07 4. OP33 24 (1) 17/12/07 The White House, Falmouth Version 5.2 Page 25 home. Renotified 5. OP7 15 (1) Unless it is impracticable to carry 17/12/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. For example: the care plans must all be improved to direct staff in the care provision. Renotified a social and night plan must be included care plans must be reviewed regularly the daily records must be more informative Renotified 6. OP27 18 (1) The registered person shall, 17/12/07 having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; (b) ensure that the persons employed by the registered person to work at the care home receive— (i) training appropriate to the work they are to perform including structured induction DS0000065484.V349660.R01.S.doc Version 5.2 Page 26 The White House, Falmouth training; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. For example: The registered provider must send a copy of her proposals to improve the care staffing levels, with timescales, to the Commission. Renotified The registered provider must send to the Commission evidence of her training qualification and that her training skills are up to date The registered provider must ensure the training she provides meets legal requirements The training policy must be updated The staff training plan must be sent to the Commission Renotified 7. OP10 12 (4) The registered person shall make 17/12/07 suitable arrangements to ensure that the care home is conducted— (a) in a manner which respects the privacy and dignity of service users; (b) with due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of service users. Renotified Provide locks on bathroom and toilet doors and consult with residents about whether they would like to be able to lock their door. The registered person shall make 17/12/07 DS0000065484.V349660.R01.S.doc Version 5.2 Page 27 8. OP9 13 (2) The White House, Falmouth arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. For example: The medicines policy must be updated to ensure that care staff know what is expected. Renotified 9. OP15 16 (2) The registered person shall having regard to the size of the care home and the number and needs of service users— (i) provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users; For example: Fresh fruit and vegetables must be provided A proficient cook must be employed Renotified (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. Renotified 11. OP19 23 (2)23 (4) The registered person shall 17/12/07 having regard to the number and needs of the service users ensure that— (o) external grounds which are suitable for, and safe for use by, service users are provided and DS0000065484.V349660.R01.S.doc Version 5.2 Page 28 17/12/07 The White House, Falmouth appropriately maintained; (p) ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. Subject to paragraph (4A) the registered person shall after consultation with the fire and rescue authority — d) make arrangements for persons working at the care home to receive suitable training in fire prevention; and (e) ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, residents, are aware of the procedure to be followed in case of fire, including the procedure for saving life. For example: Fire training must be provided at the statutory intervals Fire training records must be kept up to date and available for inspection Renotified 12. OP30 18 (1) The registered person shall, 17/12/07 having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; (b) ensure that the persons employed by the registered person to work at the care home receive— DS0000065484.V349660.R01.S.doc Version 5.2 Page 29 The White House, Falmouth (1) training appropriate to the work they are to perform including structured induction training; and (2) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. For example: The registered provider must send a copy of her proposals to improve the care staffing levels, with timescales, to the Commission. Renotified The registered provider must send to the Commission evidence of her training qualification and that her training skills are up to date The registered provider must ensure the training she provides meets legal requirements The training policy must be updated The staff training plan must be sent to the Commission Renotified 13. OP29 19 (1) Sch 2 19 (11) The registered person shall not employ a person to work at the care home unless— (a) the person is fit to work at the care home; (b) subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2; (1) Proof of identity, including a recent photograph. Where a registered person permits a new worker to start DS0000065484.V349660.R01.S.doc 17/12/07 The White House, Falmouth Version 5.2 Page 30 work pursuant to paragraph (9) the registered person shall— (a) Appoint a member of staff (the staff member), who is appropriately qualified and experienced, to supervise the new worker pending receipt of, and satisfying himself with regard to, the outstanding information in relation to a criminal record certificate; (b) so far as is possible, ensure that the staff member is on duty at the same time as the new worker; and (c) ensure that the new worker does not escort residents away from the care home premises unless accompanied by the staff member. Renotified 14. OP37 17 (1) The registered person shall— (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; (b) ensure that the record referred to in sub-paragraph (a) is kept securely in the care home. (2)The registered person shall maintain in the care home the records specified in Schedule 4. (3)The registered person shall ensure that the records referred to in paragraphs (1) and (2)— (a) are kept up to date; and (b) are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. (4) The records referred to in paragraphs (1) and (2) shall be DS0000065484.V349660.R01.S.doc 17/12/07 The White House, Falmouth Version 5.2 Page 31 retained for not less than three years from the date of the last entry. Sch 4 (6) (f) correspondence, reports, records of disciplinary action and any other records in relation to his employment; (g) a record of all training undertaken, including induction training. For example: any risk assessments undertaken, for example in respect of pregnancy. You must send a copy of your completed training matrix to the Commission. Renotified 15 OP38 23 (2)23 (4) 17/12/07 The registered person shall having regard to the number and needs of the service users ensure that— (o) external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained; (p) ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. Subject to paragraph (4A) the registered person shall after consultation with the fire and rescue authority — d) make arrangements for persons working at the care home to receive suitable training in fire prevention; and (e) ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 32 users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. For example: Fire training must be provided at the statutory intervals Fire training records must be kept up to date Renotified 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 OP29 Good Practice Recommendations Staff should show the registered provider their CRB checks so that she can record the disclosure numbers and results Renotified Social and recreational activities should be more suited to individual residents, more organised and residents should know what is available and when. Renotified Activities records should be maintained for each individual resident Renotified The content of training provided by the registered provider should be available for inspection Renotified The odour in three rooms should be made eradicated and high cleaning throughout the home should be implemented with detailed cleaning schedules. DS0000065484.V349660.R01.S.doc Version 5.2 Page 33 2. OP12 3. OP12 4 OP30 5 OP26 The White House, Falmouth 6 OP38 The alarm on the bedroom patio door should be reinstated to protect the resident and alert the staff. The White House, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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, Falmouth DS0000065484.V349660.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!