CARE HOMES FOR OLDER PEOPLE
The White House, Falmouth The White House 128 Dracaena Avenue Falmouth Cornwall TR11 2ER Lead Inspector
Stephen Baber Unannounced Inspection 25th March 2008 08:45 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.V360416.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.V360416.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 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.V360416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th October 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 parking area to the front and slopping gardens to the 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 £305 to £415 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.V360416.R01.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 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection, which was unannounced. It took place on 25th March 2008 and lasted for approximately six and half 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 principle method of inspection was case tracking. At this inspection, three residents’ were case tracked and interviewed. This is followed through with interviews and/or observation of them and staff working with them. In addition an inspection of the premises, examination of care, safety and employment records and discussion with the registered provider, relations and staff took place. Their comments are included in this report. Staff members on duty were interviewed and there were opportunities to observe the daily life of the home and staff interaction with the residents’. The provider completed the AQAA (Annual Quality Assurance Assessment) and forwarded it to the Commission prior to the inspection. This provided useful information on key aspects of the home’s operation to inform the inspection process. We spoke with the majority of the residents’ who said that they were comfortable and well cared for at the home by the provider and staff. There was some evidence of ongoing work to improve things for the residents’ with the provider complying with the majority of the requirements and recommendations made in the last inspection report dated October 2007. These will be covered in the main body of the report. What the service does well:
The White House provides a warm, comfortable, homely environment for the people using the service. The home is clean and there are no offensive odours apart from two residents rooms. The home is registered to provide for care for elderly people and it was noted that there were some people with dementia.
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 6 Approximately half the current team of care staff, including the provider, have undertaken training so that they can better meet their special needs. It is also important that the Statement of Purpose explains how the care needs of people with a dementia are catered for. Most of the residents who were interviewed at the time of the inspection said that they are satisfied with the care and services provided to them, including arrangements to maintain their privacy. One resident said “I would soon tell them if they were not respecting my privacy and dignity” Most of the residents who were interviewed said that they are very satisfied with the food provided to them. They are able to choose to either have their meals served to them in their own rooms, or to dine in the home’s attractive main dining room, which adjoins the lounge. All of the residents in the home said that they feel safe there and most said that they are satisfied with the care provided to them by the staff. Visitors are welcome and there are plenty of people coming and going from the home so residents are not isolated. The home provides residents with a pleasant and restful environment. It is well furnished and comfortable and is being continuously improved. Most of the home’s staff are qualified or working towards achieving formal qualifications so that residents can have confidence that they are competent to work with them. The provider is very experienced in the care field with over 40 years experience in management and the delivery of care services. There is enough information about her in the home to provide evidence that she is fit to be employed in her current capacity and she explained that since taking over the home she has ploughed back her money to improve the interior and exterior of the home. Evidence of recent improvements included radiator covers, new carpets in the hall and communal areas and repainting in some areas of the home. The provider hs also employed additional staffing I.e. extra care assistant at the main busy times of the day (9 till 12) and maintenance personnel to improve the exterior of the home. Prospective residents are assessed prior to admission to the home and they are invited, along with their family, to visit the home to meet staff and other residents. The people using the service have individual care plans that they agree and sign. The plans are reviewed monthly with changes recorded. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The provider was given very detailed feedback at the end of the inspection and welcomed the opportunity throughout the inspection to show the work undertaken to meet with her responsibilities under the Care Homes Regulations. The following areas were discussed, and agreement reached on a way forward to meet all of the requirements set out in the improvement plan. The provider should continue with the previously agreed improvement plan to provide thermostatic control valves to all hot water outlets in accordance with risk assessments and residents’ needs. The registered person should having regard to the size of the care home and the statement of purpose and number and needs of residents ensure at all
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 8 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 the residents. The home is registered to provide for older people. It was noted that some residents have mental health care needs. The provider has to update the Statement of Purpose and Service User Guide to explain how the training of staff, services and facilities of the home can meet their needs. Whilst staff have recived dementia training further updating training should take place so that they can meet their specialist and changing needs of the residents. The home’s environment should continue to be be improved so that residents are able to exercise a greater degree of choice about the level of privacy they wish to enjoy. This includes lockable storage space in bedrooms so that residents can safely store items of personal value or medicines, should they choose to manage them for themselves. It was noted that creams were stored on the sink. Menu plans should list an alternative for every meal so that residents are able to exercise a greater degree of choice. Individual records of food provided is maintained so that residents nutritional needs can be monitored. Systems to ensure good hygiene in the home need to be improved so that residents are protected from the risk of infection as far as possible. This includes provision of suitable hand washing facilities in all the bathrooms, it was noted that some staff did not wer protective clothing when working in the kitchen. Staff have received training in infection control. The home’s provider should review the fire safety risk assessment and make sure that wooden door wedges are not used. We understand that six “door stops” are going to be purchased. Residents can be confident that they are safe in the home. Evidence of policies and procedures and care recording throughout the inspection was presented in proprietary recoding systems supplied by a company. It is recommended that whist the recording formats comply with key National Minimum Standards and the regulations some policies and procedures should be personalised to the home and recording formats should not rely on ticking boxes E.g. Complaints procedure should be personal to the home with the contact details of the Department Of Adult Social care recorded for residents. The Safeguarding policy and procedure should also be more personalised to the home and detail what action the provider would take if an allegation or suspicion of abuse is made. Identified Risks but provide information that directs and informs the staff. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 9 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.V360416.R01.S.doc Version 5.2 Page 10 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.V360416.R01.S.doc Version 5.2 Page 11 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. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide appropriate care. Residents participate in the assessment process, which fully considers their needs so that they can be confident the home will be suitable for them. EVIDENCE: Evidence was provided in the form of documentation, records, talking with the people using the service, staff and registered provider. The registered provider said that prospective residents and their family are encouraged to visit the home to have a look around. The registered provider
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 12 undertakes an assessment of the prospective resident’s needs during this visit or goes out to assess them; in their home or in hospital for example. Assessments of 3 resident files were inspected and found to be satisfactory. Discharge information from hospital is obtained where appropriate. Assessment documentation for the most recently admitted resident was signed by them or their representative to indicate their participation in and agreement with the information. The provider explained and we observed that some residents suffer from dementia. The current staff team have undertaken training in caring for people with dementia, via local training agencies (DMT). It is recommended that the Statement of Purpose provide detailed information that explains how the home can meet the needs of residents. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Individual care plans are generated for each resident that reasonably inform and direct staff in the care provision. Residents have access to health care services as necessary to ensure their assessed needs are met. There are systems and policies in place for dealing with resident’s medicines. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. EVIDENCE: Evidence was provided in the form of documentation, records, case tracking and talking with the people using the service, staff and registered provider. Each person accommodated has a written care plan that is agreed and signed by the resident. Care plans are reviewed on a monthly basis and changes are recorded. There are risk assessments included in the care files that provided
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 14 information for staff that informed and direct staff. Staff said they found the information helpful and easy to follow. One member of staff who has worked at the home for 12 years said there has been a great improvement in the information provide for the staff since the provider has taken over. Where risks have been identified the provider completes a risk assessment. One risk assessment “identified Risks relied on ticking boxes. More information should be provided to inform and direct the staff. Day and night records are maintained and are informative. There is a photograph of the resident in their file, which assists new members of staff. There are records of visits by doctors and other healthcare professionals. Residents are weighed regularly according to their individual requirements. We observed the senior care assistant working very efficiently with the district nurse and doctor to provide a good outcome for the resident. Very detailed feedback was given to the provider after their visit. A monitored dose system is in place for medications. There is a medicines policy and a homely remedies policy. Senior carers are responsible for overseeing the medicine system. Care staff that administer medicines receive training in the safe handling of medicines. The pharmacist reviews resident’s medication regularly and provides training for staff; there is a record of her visits. The receipt, administration and disposal records are up to date. Residents’ privacy was upheld during the inspection. Residents said they are treated with respect and their privacy is upheld at all times. “One resident said she would soon tell the staff off if this wasn’t respected”. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 15 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 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. Routines are suitable to meet individual residents needs. Residents can receive visitors when they choose. Residents said that they were satisfied with the catering arrangements although they would like to see a daily menu with choice recorded. EVIDENCE: Evidence was provided in the form of documentation, talking with the people using the service, staff and registered provider. Residents said they could get up and go to bed when they wished, and can make decisions how they spend their time.The provider said she has employed an activities assistant for 12 hours a week to provide individual and group activities for the residents. Activities include for example include music and aromatherapy groups, music, and singing. Monthly visits occur from the Church of England Vicar. There seemed good interaction between residents and staff. All activities are recorded in individual resident profiles.
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 16 Residents said suitable arrangements are in place for them to receive visitors. Residents can meet with their visitors either in their bedrooms, the dining room or the lounge. We were told that the provider has made improvements since the last inspection. The provider has employed an additional care assistant from 9 to 12 to enable the staff to prepare the main meal and not have to undertake care duties as well. Some of the residents said it would be helpful if the daily main meal were displayed in the lounge. We shared a meal with residents who said they were satisfied with the catering arrangements. The meal was cottage pie and three vegetables and apple pie and cream for pudding. Those residents who preferred a choice choose chicken burgher, vegetables, and potatoes. Much of what was detailed in the October 2007 report still applies and this was discussed with the provider. Meals are prepared and cooked by the care staff however the registered provider said again that she has had great difficulty employing a cook so has increased the staffing to allow the care assistant to concentrate on the cooking. This means that the person cooking does not have to leave the kitchen to attend to residents care needs. It was noted that the person cooking the main meal came from caring duties. They must were protective clothing in the kitchen to stop cross infection and maintain good practice. The provider said that fresh vegetables and fruit are available for residents each day. Invoices were inspected that recorded fresh vegetables and fruit bought. However the vegetables on the day were frozen and the apple pie was bought. 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 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. Risks assessments must be completed for the safety of staff and protection against vermin. These will be followed up at the next inspection. The provider is awaiting the fitters to arrive to fit a new kitchen The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. Arrangements are in place for the protection of residents. All staff in the home have had appropriate training to ensure that the people using the service are safeguarded from harm or abuse. EVIDENCE: Evidence was provided in the form of documentation, talking with the people using the service, staff and registered provider. There is a suitable complaints policy in the home. There have been no complaints. Thank you letters and cards are kept. The provider relies on a proprietary recording system that included the complaints procedure. The provider may wish to personalise the complaints procedure for the home and include the address and contact details of the Department Of Adult Social Care. Residents said there are no barriers to raising concerns with the staff. Staff said they could talk to the registered provider if they have any concerns, as she is always in the home or contactable next door where she lives. The home has an adult protection policy and staff said they were aware of this, and confirmed that they have received training in this area. The registered
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 18 provider has attended the Adult Social Care alerters training and has a copy of the local authority procedures. The registered provider needs to ensure that the contact details for the Commission are up to date in the policies, she said she would do this. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. There is evidence of ongoing financial investment in the home and grounds have been improved since the last inspection making them safe for the residents and staff. Protective clothing must be worn at all times to stop cross infection EVIDENCE: Evidence was provided in the form of a tour of the building, talking with the people using the service, staff and registered provider. The home is warm, comfortable and homely. It is well ventilated and there is domestic style lighting. An improvement since the last inspection is that a handyman has been employed to improve the exterior of the home and grounds.
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 20 He has improved the exterior of the home and there is an ongoing maintenance programme. Evidence was provided of the financial investment in the home with the provider improving the entrance hall, fitting new carpet, redecoration of some rooms and radiator covers. The bathrooms upstairs still need upgrading and the broken bidet removing. 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 October report. The provider said that this is the next big job to do. 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. A small office has been provided which is also used for staff that sleep in at night The home was reasonably clean but the broken seams in the double glazing doors make the doors look unclean. There was odour in two of the rooms. 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.V360416.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff are employed in varying capacities and staffing ratios must be kept under constant review to meet the complex care needs of residents to ensure their needs are met by day and night. Nearly all of the staff have formal qualifications in care, in excess of the National Minimum Standards so residents can have confidence in the people caring for them. Staff are recruited on the basis of fair, safe and effective policies and procedures so that residents can be confident that they are suitable to work in a care setting. EVIDENCE: Evidence was provided in the form of documentation, records, observation, talking with the people using the service, staff and registered provider There is a set staffing rota that ensures there are two care staff on duty at all times. At night there is one awake and one sleeping. The provider must kep under constant review the ever-changing needs of the residents and increases the staffing ratios to meet those needs. A rough guesstimate of resident dependency levels was medium to high dependency. Care staff take turns to cook the meals and there are separate cleaning staff. The provider said that she has tried to get cooks to work at the home but all her efforts have been unsuccessful. The staff said that now an extra person
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 22 has been brought on duty at peak times they do not have to leave the kitchen to do care tasks as well. The registered provider said there has been new care staff employed since the last inspection. Three personnel files were inspected. Files provided evidence of application forms, 2 references, proof of identification, CRB, POVA checks and evidence of interviews. There is also a photograph of each member of staff on file. Certificates of training and a training completed are held on individual files. There is an equal opportunities policy. The registered provider said that staff receive an induction to the home and a checklist is signed. There was evidence of induction in the files. Staff have received adult protection training. The provider said that she ensures that staff keep up to date on current issues relevant to the resident group accommodated and evidence of training is recorded on file. Staff were positive about the training they have received and one senior carer who has been working at the home for 12 years said that the new provider has improved the training for all staff. There is evidence that statutory training takes place with the records showing that all staff have attended or are scheduled for training. The fire drill records were up to date and fire-training audits have been done. Infection control training is covered from induction The registered provider should also obtain a copy of the documents ‘Infection control guidelines for care homes’ and ‘Essential steps to safe clean care’. The registered provider said that health and safety training is completed in food hygiene, first aid and manual handling. Evidence of the content of this training is held on file. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 23 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, 33,35,36 and 38 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 is run in the best interest of the residents with quality assurance systems in place that will bring about change and improve quality. Systems have been put in place for when the registered provider is absent so that residents can feel secure that there is a management presence on duty. Policies, training and effective health and safety systems have been improved so the wellbeing of residents, staff and visitors are protected. EVIDENCE: The registered provider has over 40 years experience in management and delivery of care services. The provider works hands on with the staff and knows the residents well and how to care for them. The registered provider is competent in running the home and explained that since becoming the
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 24 registered provider she has constantly invested in the home to improve the outcomes for the residents that live there. The registered provider is continuing to attend training events to maintain skills and comply with regulations. Staff said the provider runs the home well and in the best interest of the residents. Residents spoken with said she is kind and considerate and manages the home well. There is an annual development plan for the home and the Quality assurance exercise for this year has just commenced. We observed the senior care assistant asking the district nurse if she would complete the questionnaire for the home and for her views and opinions on the home. A copy of the report must be sent to the Commission. Last years report has not been sent. The provider explained about a recent accident in the home that affected the resident. This must be followed up with a regulation 37 notifications within twenty-four hours of the incident The provider audits staff meetings. Supervision and appraisal. Staff confirmed that this was correct. The registered provider has completed the AQAA. The provider does not manage personal finances for the residents. Residents, family members and relatives deal with finances and fees. It would be helpful if all staff signed to say that they understand the health and safety policies. The policies and procedures were available in the office. The provider audits the accident book and amends the risk assessment. A requirement is made regarding the provision of a member of staff on duty at all times (including nights) with a first aid qualification. The registered person discussed the arrangements for the maintenance of fire training, precautions, equipment, gas and electrical equipment and appropriate documentation was in place to evidence servicing and maintenance. A sample of the servicing records for equipment and machinery were inspected and found to be up to date. We observed that wooden door wedges were used to wedge doors open and a screwdriver to wedge the office door open. This practice is very dangerous and should cease forthwith. The provider said she is going to purchase 6 new “ Door guards” in the next few weeks. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP15 Regulation 16 (2) Requirement The registered person shall having regard to the size of the care home and the number and needs of residents, 1 provides a menu board to display the meals and choices available that day. 2 the person cooking must wear protective clothing to stop the spread of cross infection. 3. Fresh vegetables and fruit should be used and are nutritionally much better for the residents. 2nd Notification 4 risk assessments must be completed for the outside shed that addresses safety for staff and protection against vermin. 2nd Notification 2 OP19 23 (2)23 (2d) The registered person shall 19/08/08 having regard to the number and needs of the service users ensure that— Fit thermostatic control valves
DS0000065484.V360416.R01.S.doc Version 5.2 Page 27 Timescale for action 19/08/08 The White House, Falmouth on hot water outlets to safeguard the residents from scolding themselves. 2nd Notification (d) keep all parts of the residents rooms free from offensive odours. 2nd Notification 3 OP27 18(1) The registered person shall, 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 residents. 4. OP38 13 (4) The registered person shall ensure that— 1 All the staff must understand the health and safety policy and procedure. 2 The registered provider must liaise with the HSE and ensure that the hot water provision complies with legal requirements 2nd Notification 19/08/08 3 A risk assessment must be undertaken for the food shed 2nd Notification 4 A member of staff qualified in
The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 28 First Aider must be on duty day and night to provide special help and support to the residents. 5 Consultation with the fire authority must take place regarding the practice of wedging doors open. Discussion must take place automatic door closures that comply with best practice. 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. 2. 6. Refer to Standard OP3 OP26 OP38 Good Practice Recommendations The registered person should amend the Statement Of Purpose to provide information on how the care needs of people with a dementia can be meet. The registered person should eliminate the odours in two bedrooms by thorough cleaning and ventilation of those rooms. The alarm on the bedroom patio door should be reinstated to protect the resident and alert the staff. The White House, Falmouth DS0000065484.V360416.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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