Inspection on 06/06/07 for The White House, Falmouth

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The White House, Falmouth 12/03/09

The White House, Falmouth 25/03/08

The White House, Falmouth 11/10/07

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 The White House 128 Dracaena Avenue Falmouth Cornwall TR11 2ER Lead Inspector Diana Penrose Unannounced Inspection 6th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The White House DS0000065484.V341465.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 DS0000065484.V341465.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House 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 DS0000065484.V341465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 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; the registered provider supplied this information to the Commission during this inspection. 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 DS0000065484.V341465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An Inspector visited The White House Care Home on the 06 & 07 June 2007 and spent thirteen and three quarter hours at the home. This was a key inspection and an unannounced visit. 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 was on ensuring that residents’ placements in the home result in good outcomes for them. It was also to gain an update on the progress of compliance to the requirements identified in the last key inspection report dated 23 August 2006 and updated in the random inspection report dated 27 March 2007. All of the key standards were inspected. On the day of inspection sixteen residents were living in the home. The methods used to undertake the inspection were to meet with the residents, staff, relatives and registered provider to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. Residents generally expressed satisfaction with the care and services provided at the home and said they are treated with kindness. The registered provider has not complied with all of the requirements set at the random inspection in March 2007. Twelve requirements have been notified following this inspection; four are re-notified. 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. A breach of regulations occurred since the last inspection concerning the non-payment of the annual bed fees; the outstanding balance has now been paid. What the service does well: The home provides a comfortable, homely environment for residents that is free from offensive odours. The registered provider has worked hard to improve the décor and furnishings in the home and has plans to progress this further. The registered provider undertakes an assessment of resident’s needs prior to their admission to the home. Other relevant documentation is also obtained from organisations such as the department of adult social care and healthcare trusts. Each resident has a care plan with relevant risk assessments included. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 6 There is a suitable system in place for medications and staff have received training in this area. Residents say that in general they have control over their lives and their individual preferences are respected. They say their healthcare needs are met and they are treated with kindness by the staff. Visitors are welcome and can be received in private. The registered provider encourages care staff to undertake NVQ training and she said that 73 are qualified to at least level 2. What has improved since the last inspection? What they could do better: The care planning documentation is being reviewed by the registered provider. She must expand this now so that all residents have an updated and detailed care plan that informs and directs staff fully on the care to be provided. The care plans must be compiled with the resident or their representative and signed as agreed, some residents were unaware of their care plan at this inspection. The registered provider is in the process of updating the risk assessment for the use of bed rails and this needs to be completed according to the guidance issued by the Department of Health. The care plans and risk assessments must be reviewed regularly to include any changes. The registered provider said that new care staff receive some medicines training during induction to the home, she agreed to formalise this so that it can be evidenced during inspections. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 7 Staff must respect residents privacy and dignity two residents were seen inadequately dressed, one whilst waiting for a bath and one coming out of the bathroom. Another was sat on a commode in her room with the door wedged open, she did not hear a knock on the door and there was no indication not to enter. Appropriate activities need to be provided according to the residents preferences and individual records should be kept. There is no programme of events and residents did not know when activities were taking place. The food provision must be improved and should include fresh produce. Comments about the food provision were variable, some said it was good, some said it depended on who was cooking and some said it was not good. There needs to be more choice on the menu, some residents said that they could have something different if they wished, others said you get what is cooked on the day. None of the residents spoken with knew what was for lunch until just before it was dished out. At present the care staff cook the food, the registered provider said she is advertising for a cook. All staff must have appropriate adult protection training and this must be given priority, as there have been issues since the last inspection. The heating controls must be fixed so that radiators can be turned down in hot weather, areas of the home were very uncomfortable due to overheating. The hot water is not regulated; the registered provider must take steps to ensure compliance with current regulations to prevent scalding. Health and safety risk assessments must be reviewed and include external doors and windows of the downstairs bedrooms, access to the sloping garden at the back of the home and the shed used for food storage. A television bracket in one room needs to be removed to prevent a possible accident. Fire doors must not be wedged open; the registered provider must liaise with the fire authority regarding alternative arrangements. The registered provider needs to update the list of residents accommodated, held in the residents fire risk assessment. Appropriate protective clothing must be worn when necessary, for example aprons when serving meals. The grounds require a general tidying. Attention needs to be paid to cleaning areas such as hand-basin overflows and lampshades. The registered provider must supply the Commission with details of her staffing proposals. Staff must be appropriately supervised prior to a satisfactory POVA/CRB check being obtained. All staff files must include a photograph of the person. The registered provider must maintain evidence of her training qualification and that her training skills are up to date, she must send evidence to the Commission. There is evidence that some training takes place and some certificates are held, however training records must be kept up to date and there must be evidence that staff attend appropriate fire training. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 8 Staff would benefit from training in the diseases of old age with particular relevance to the client group in the home. The registered provider must concentrate on the legal requirements of this report and ensure that statutory issues are dealt with. She is in the process of moving files from her house into the home and storage has been provided in the office. It will be beneficial when this has been completed. The registered provider must establish and maintain a system for evaluating the quality of the services provided at the care home. There are two quality assurance files that look impressive but a great deal of the forms are not used or are not kept up to date. Formal staff supervision must take place, the national minimum standards recommend six times a year. The home’s policies and procedures require reviewing and updating those specifically identified during the inspection and discussed with the registered provider are the complaints policy, adult protection policy, medicines policy, restraint policy, training policy, quality assurance policy and health and safety policy. There is no audit of accidents in the home the registered provider agreed that these should be done in future in an attempt to prevent accidents occurring. Data sheets, for compliance with the Control of Substances Hazardous to Health (COSHH), must be made available to staff, so they know what to do if there is an incident with a hazardous substance. 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 DS0000065484.V341465.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 DS0000065484.V341465.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): 3 (6 is N/A) 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. EVIDENCE: Evidence was provided in the form of records, talking with residents and the registered provider. The registered provider said she visits new residents prior to admission and information is obtained from the resident, relatives and any other appropriate person. There is a specific document used for the assessment of prospective residents. Records for new residents were thoroughly completed and information from other sources was on file. The registered provider records who was involved in the assessment on the forms. Another assessment is undertaken when the resident moves into the home and from this the care plan is compiled. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 11 This home does not provide intermediate care. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual care plans are generated for each resident; they are in the process of being updated to 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 is a suitable system for dealing with residents medicines and assure residents safety; the policy must be updated for staff to refer to if they are unsure. Systems must be improved to ensure that residents are respected and their privacy is upheld at all times. EVIDENCE: Evidence was provided in the form of records, observation, talking with staff, residents and the registered provider. The registered provider has been reviewing the care planning system to try and avoid unnecessary duplication and to make the plans more directive for the care staff. She said she also wants to involve the care staff in the compilation of care plans as she does them all herself at the moment. The The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 13 registered provider said there will be a social and a night plan included when the documents are complete. Some care plans have been signed by the resident or a representative although some residents said they were unaware of their care plan. Risk assessments are undertaken for residents including Waterlow, Barthel, nutrition, moving and handling and falls. There is a risk assessment for the use of bed rails, which the registered provider is updating; she now has the relevant guidelines. The restraint policy states that bed rails will not be used; this needs to be amended as they are in use. Not all of the plans inspected had been regularly reviewed, the National Minimum Standards recommend monthly. Daily records are maintained they are variable in quality and not very informative. Doctors and other healthcare professionals visit residents as appropriate and records are kept. The home has some equipment for moving and handling and pressure relief. The registered provider stated that the community nurses could supply this type of equipment if more is required. Residents are weighed regularly according to their individual requirements. The registered provider said the residents are quite mobile and some go out walking. She said the staff encourage them to move about and they play games such as throwing sandbags to encourage movement. Residents talked about sight tests and visits from a dentist. There is a policy and system in place for dealing with resident’s medicines. The policy still requires updating to ensure that care staff know what is expected and it needs to refer to The Royal Pharmaceutical Guidelines for the Administration of Medicines in Care Homes. A monitored dosage system (MDS) of medication is used in the home. Records of the receipt and administration of medicines are maintained and there is a book to record any that are disposed of. A photograph of each resident is held with his or her medication chart. Handwritten medicine details or instructions on the medication charts are few but are witnessed with two signatures recorded. There are no controlled drugs in the home or medicines needing to be stored in a fridge. Patient information leaflets are obtained for medicines in use and retained with the medicine charts. The registered provider said that staff have received training in the administration of medicines and there was some evidence on the personal files. The registered provider said that new care staff receive some medicines training during induction to the home, she agreed to formalise this so that it can be evidenced during inspections. Staff were observed to generally to respect residents privacy during the inspection. It was however noted that two residents were inadequately dressed one whilst waiting for a bath and one coming out of the bathroom. The inspector also walked in a room to find a resident sat on a commode; her door was wedged open with a wheelchair and there was no indication that people should not go in, she did not hear a knock on the door. One resident said she was not respected by staff but did not ellaborate on this. Residents said they could see their visitors in private if they wished. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides some activities but more needs to be done to offer a lifestyle that meets individual residents needs. Links with family, friends and the community are good and allow residents the opportunity to socialise. Residents are helped to maintain control over their lives and staff appreciate their individual preferences and choice. Dietary needs of residents are catered for with a selection of food available; more could be done to ensure that it is of a consistent standard and meets the residents taste and preference. EVIDENCE: Evidence was provided in the form of records, observation, talking with residents and the registered provider. There is some evidence that activities take place in the home and some records are kept. Activities are optional and residents can spend time in their own bedrooms if they wish. Residents talked about a musician that comes in, bingo, art and craft. The registered provider said there is a religious service once a month and the vicar visits two residents individually, one or two residents go out to church. She said she has been trying to organise trips out The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 15 but the residents are not interested; she talked about a meal out that she had to cancel because the residents did not want to go when they were told they had to pay. She said she is hoping to start some gardening with the residents when she gets the raised beds organised. A survey to find out what residents would like will be beneficial. The records are sparse and not maintained for each individual resident. There is no programme of events; staff said there would be bingo on the first day of the inspection but it did not take place. Staff were observed talking to residents and a few residents were talking together. The television was on all day and residents said that some people watch it. Several residents were asleep in the lounge in the afternoon. There is a record of visitors to the home and there were visitors in the home during the inspection. Residents said they could receive visitors in private and at any time. Visitors spoken with said they are made welcome in the home and can call in when they like. Some residents said they go out with their friends and family. Some residents said they have control over their lives and can do what they wish each day. Residents meetings have taken place and residents said that the registered provider does discuss things with them. All residents have their own possessions in their rooms and are free to move around the home, as they are able. They said they are given choices as to what clothes to wear, daily routines and so on. They also said they are addressed by their preferred name. 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. The menus were seen on the reception desk, the registered provider stated that they are normally on the dining tables each day. Food records were also kept on the reception desk, these showed that some residents have an alternative to the set menu. Meals are prepared and cooked by the care staff however the registered provider said she is hoping to employ a cook. 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 bananas, potatoes and onions in the store cupboard outside. The registered provider said that she was due to go shopping but she finds that fresh produce tends to go off quickly and frozen vegetables are more nutritious. Fresh vegetables and fruit should be available for residents each day. Residents said biscuits are available at teatime, rich tea biscuits were available during the inspection, there appeared to be no choice. The registered provider said she buys a special cake when a resident has a birthday. There was water and fruit juice available in the lounge and bedrooms for residents all day. Meals are served in the dining area at one end of the lounge or individual bedrooms if residents prefer. The dining tables have tablecloths and special The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 16 cutlery is supplied for those who need it. Care staff and the housekeeper were observed serving meals to residents without protective clothing. The care assistant cooking the meal wore a cloth apron. During a random inspection on 23 March 2007 the registered provider stated that she was purchasing kitchen uniforms for use when staff are on kitchen duties to help with infection prevention. The lunchtime meal was roast gammon with potatoes and frozen vegetables. One resident had a chicken burger instead of the gammon. Resident’s comments about the food were variable. “The food is usually over cooked”, “The food is good”, “The food varies depending on who is cooking” and “The food is appalling”. The White House DS0000065484.V341465.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): 16 and 18 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. The policy requires updating to clarify the procedure to be followed if there is an incident and staff must all receive appropriate abuse training. EVIDENCE: Evidence was provided in the form of documentation, talking with residents, staff and the registered provider. There is a suitable complaints policy in the home; the contact details for the Commission must be updated. Residents said they could raise concerns to staff or the owner of the home, however some said they would not be listened to. One person has raised concerns to the Commission since the last inspection stating that the owner and staff are unprofessional in their care provision and manner towards the residents, there has been no evidence during this inspection to substantiate this. The concerns also referred to the interview procedure but there was no documentation held or any evidence to verify this. Thank you letters and cards are kept. The home has an adult protection policy that must be updated to include the correct procedure for staff to follow and the reporting system, including The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 18 relevant contact details. There is a copy of the Local Authority procedures in the home and the registered provider said that three staff have attended the ‘No Secrets’ training provided by the department of adult social care. The registered provider has an abuse training pack that she intends to use in house. All staff must have appropriate adult protection training and this must be given priority. There have been two medication errors reported since the last inspection, these were dealt with by the registered provider and appropriate action taken. There has been one adult protection incident since the last inspection involving a resident that fell during the night sustaining two fractures. The home was inappropriately staffed that night and medical assistance was delayed. The White House DS0000065484.V341465.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): 19 and 26 Quality in this outcome area is adequate. 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 essential work has been taking place; the home will be better suited when the refurbishment programme is complete. The home is, on the whole, clean and free from offensive odours and work is underway 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 DS0000065484.V341465.R01.S.doc Version 5.2 Page 20 cage in the lounge and a tank with tropical fish. All bedrooms apart from five have been refurbished; the registered provider said the residents do not wish to have them done. The lounge has been decorated and the registered provider said that new carpet is to be purchased soon. Residents said a great deal of money has been spent on the home in the past year. The bathrooms upstairs still need upgrading and the broken bidet removing, the registered provider said she has applied to the council for a grant to help cover the cost of this. Radiators are covered but the heating controls were not working during the inspection, some radiators were very hot and could not be turned down. As it was a hot sunny day this made the home very uncomfortable in some areas. The registered provider said she was waiting for the heating engineer to come and fix it. This needs to be pursued urgently. The hot water temperature is not regulated and is very hot. Baths and showers must have the temperature regulated to prevent scalding. The registered provider must liaise with the health and safety executive (HSE) to ensure compliance with current regulations. There must be risk assessments in place for the hot water and hot water caution signage must be displayed. 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 but most of them were undone and windows could be opened wide. 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. A television bracket in room 8 needs to be removed as not in use and at a level that could cause an accident, the registered provider said she is aware of this. Several bedroom doors were wedged open with various items. The registered provider said she is hoping to purchase fire gards for some doors around the home. Fire doors must not be wedged open; the registered provider must liaise with the fire authority regarding alternative arrangements. 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; the registered provider said she has consulted pest control. 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. A small office has been provided where the freezers are stored and this is also used for staff who sleep in at night. The reception area is still in use but the The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 21 registered provider stated that she plans to demolish it and utilise the office fully when the freezers are moved. This is will improve confidentiality. The home was reasonably clean and free from offensive odours on the day of the inspection. Attention needs to be paid to areas such as hand basin overflows and 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 undertake 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 but not seen being used, the registered provider said she has had to restrict the supply of aprons as too many were being used. There is evidence that staff have had infection control training, but not what the content was. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor this judgement has been made using available evidence including a visit to this service. Staffing levels are generally suitable, however improvement is required to ensure there is an appropriate number of staff to provide care whilst others are involved with duties such as cooking and cleaning. There also needs to be sufficient staff to provide recreational activities and suitable levels of stimulation. Staff recruitment procedures need improvement so residents can be assured they are satisfactorily protected by pre-employment checks completed on personnel. There are suitable numbers of staff that have a National Vocational Qualification in care, although staff records need to better evidence this. Other staff training, required by law, requires significant improvement so residents can be assured staff are trained and competent to do their jobs. Again record keeping must be improved. EVIDENCE: Evidence was provided in the form of records, talking with residents, visitors, staff and the registered provider. The registered provider said there are no staff vacancies but she hopes to employ a cook. Staff said there are two carers on duty all of the time and this was seen on the rota. 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. The registered The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 23 provider’s husband undertakes maintenance tasks when he is in Cornwall; a maintenance person is no longer employed. Staff do extra shifts to cover for sickness or annual leave, agency staff are not employed. The Inspector agreed with the registered provider that she is no longer required to send copies of the duty rota to the Commission each week, as required at the last random inspection. During a random inspection on 27/03/07 staffing levels were discussed, particularly in the mornings when one carer is responsible for the cooking. The registered provider was required to send a copy of her staffing proposals, including time scales to the Commission. This has not happened and the requirement is re-notified. The registered provider stated that eight out of the eleven care staff employed are qualified to at least NVQ level 2. She said three are undertaking level 2 and five level 3. There is evidence on files that five staff are qualified. Many of the existing staff have documents missing from their personnel files; most have been working in the home for several years. Where evidence of CRB and POVA information is lacking the registered provider has asked staff to provide this by showing her their disclosure documents, not all have done this. Three files for new staff were inspected; all had two satisfactory references it would appear that two of these staff were employed prior to a satisfactory POVA first check being received. There is no evidence that these staff were supervised prior to a satisfactory POVA/CRB check being obtained. The registered provider said she is aware of the legislation; she must ensure she adheres to it. All staff files must include a photograph of the person. Any staff risk assessment, for example in respect of pregnancy, must be held on their file. There is an induction programme for new staff and the records inspected were signed and dated. The registered provider says she is a qualified trainer and undertakes training elsewhere in the country. She must maintain evidence of her qualification and that her training skills are up to date, she must send evidence to the Commission. As necessary she must agree with other regulatory authorities the training she intends to provide and ensure it meets the legal requirements. There is evidence that almost all staff have certificates on file for training in medicines, infection control, food hygiene, 1st aid, health and safety and moving and handling. Some staff are due moving and handling training for this year. There is no evidence of the content of in house training and as stated above the registered provider must ensure training meets legal requirements. One member of staff said she did abuse training at a local hotel and that someone came to the home to provide dementia training. There is no evidence of external training in the records. The registered provider said she is trying to The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 24 get this sorted. Staff would benefit from training in the diseases of old age with particular relevance to the client group in the home. Fire training records are not up to date and it is not evident that staff receive appropriate fire training at the required intervals. This must be rectified urgently. There are training audit forms for staff but they are not up to date. The training policy requires updating to include the skills for care induction programme for example. It also needs to state what training staff should undertake and the frequency of statutory training. The registered provider agreed to forward the staff training plan to the Commission; this was not received following the last inspection. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 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 DS0000065484.V341465.R01.S.doc Version 5.2 Page 26 Evidence was provided in the form of documentation, records, talking with staff and the registered provider. Mrs Christopher has owned the White House since December 2005 and has made a number of improvements to the premises since then. Staff and residents spoke positively about her. She has a Diploma in Management Studies and an NVQ level 4 in care. She said she keeps up to date with current issues regarding her client group by networking and reading relevant care publications. As stated in the previous section the registered provider must provide evidence of her training qualification and that she has kept it up to date. The management of the home is disorganised and many records and documents are in need of reviewing and updating. She is in the process of moving files from her house into the home and storage has been provided in the office. It will be beneficial when this has been completed. A breach of regulations occurred since the last inspection concerning the non-payment of the annual bed fees; the outstanding balance has now been paid. The registered provider must concentrate on the legal requirements of this report and ensure that statutory issues are dealt with. The registered provider must establish and maintain a system for evaluating the quality of the services provided at the care home. There are two quality assurance files that look impressive but a great deal of the forms are not used or are not kept up to date. The annual development plan dated 10/01/06 focuses on the environment and is not up to date. There is a residents survey and a staff survey undertaken in March 2006, neither have been audited. The registered provider said a recent survey has been done but not collated. There are various audit forms that have not been used, for example medication, environment and health and safety. The training audit forms are not up to date. Staff and resident meetings take place and minutes are kept. The registered provider said there has been a resident meeting regarding smoking in the home and the residents now have a bench outside. The minutes of the meeting were not available. The home does not handle resident’s money; the resident’s representative does this. The registered provider is aware that if the situation changes she will require a suitable system and policy in place. Residents are not provided with lockable facilities at present, however when new furniture is supplied a lockable drawer will be included. The registered provider pays for hairdressing and chiropody and so on and the representatives are sent a bill for this. Receipts are maintained. There are supervision charts that are not up to date, actions are written by the registered provider but there is no facility for staff feedback. Formal staff supervision must take place, the national minimum standards recommend six times a year. The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 27 The health and safety policy must be reviewed for accuracy. There are some environmental risk assessments but these must be expanded (see environment section). Service and equipment checks are undertaken as appropriate, the boiler is due to be serviced. The portable electrical appliance testing and electrical wiring test are due in July 2007. There were seven accidents recorded for May 2007, this seems high considering the residents accommodated. There is no audit of accidents in the home the registered provider agreed that these should be done in future in an attempt to prevent accidents occurring. COSHH data sheets were not available to staff. There is a fire risk assessment. The resident’s fire risk assessment needs reviewing, the list of residents is not up to date. The registered provider agreed to do this. The fire book was inspected. Tests on call points for the fire alarm; emergency lighting and fire extinguishers appear to be tested regularly. Fire training is not up to date (see staffing section) The White House DS0000065484.V341465.R01.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 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 N/A 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 2 13 3 14 3 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 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 2 1 The White House DS0000065484.V341465.R01.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 OP7 Regulation 15 (1) Timescale for action Unless it is impracticable to carry 17/09/07 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. Re-notified • a social and night plan must be included • care plans must be reviewed regularly • the daily records must be more informative The registered person shall make 06/08/07 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, DS0000065484.V341465.R01.S.doc Version 5.2 Page 30 Requirement 2 OP10 12 (4) The White House religious persuasion, racial origin, and cultural and linguistic background and any disability of service users. 3 OP9 13 (2) The registered person shall make 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. 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 (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. 5 OP19 OP38 23 (2) The registered person shall 17/09/07 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, DS0000065484.V341465.R01.S.doc Version 5.2 Page 31 17/09/07 4 OP15 OP12 16 (2) 17/09/07 The White House 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. 23 (4) 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 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 • Fire doors must not be wedged open The registered person shall make 17/09/07 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 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— DS0000065484.V341465.R01.S.doc 6 OP18 13 (6) 7 OP27 OP30 18 (1) 17/09/07 The White House Version 5.2 Page 32 (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 employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs; (c) 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 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. Re-notified • 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 8 OP29 19 (1) The registered person shall not DS0000065484.V341465.R01.S.doc 17/09/07 Page 33 The White House Version 5.2 Sch 2 19 (11) 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 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 service users away from the care home premises unless accompanied by the staff member. The registered persons shall establish and maintain a system for evaluating the quality of the services provided at the care home. The registered person shall ensure that— (a)The registered persons shall ensure that persons working at the care home are appropriately supervised For example: DS0000065484.V341465.R01.S.doc 9 OP33 24 (1) 17/12/07 10 OP36 18 (2) 17/12/07 The White House Version 5.2 Page 34 • All care staff must be provided with regular supervision including one to one supervision, at least six times a year, with records kept 17/09/07 11 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 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 DS0000065484.V341465.R01.S.doc The White House Version 5.2 Page 35 12 OP38 13 completed training matrix to the Commission. Re-notified 17/12/07 (4) The registered person shall 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, and must include: • external doors from residents bedrooms • windows that are not fitted with restrictors • the prevention of Legionella rd 3 Notification • • 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 The television bracket must be removed in room 8 A risk assessment must be undertaken for the food shed A risk assessment must be undertaken for access to the sloping garden area Version 5.2 Page 36 • • • • The White House DS0000065484.V341465.R01.S.doc • Protective clothing must be worn when appropriate 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 3 4 Refer to Standard OP12 OP12 OP29 OP30 Good Practice Recommendations Social and recreational activities should be more suited to individual residents, more organised and residents should know what is available and when. Activities records should be maintained for each individual resident Staff should show the registered provider their CRB checks so that she can record the disclosure numbers and results The content of training provided by the registered provider should be available for inspection The White House DS0000065484.V341465.R01.S.doc Version 5.2 Page 37 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. 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