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Inspection on 21/02/07 for The White House Nursing And Residential Home

Also see our care home review for The White House Nursing And Residential Home for more information

This inspection was carried out on 21st February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users were very positive about the standard of care they receive and this was borne out in observation of the interaction between staff and service users during this inspection. "We are more than happy with the care my Mother receives" was the comment of one relative spoken to. The staff team are committed and demonstrate both competence and caring in the way that they approach their work. "The staff are really kind" was one typical comment made by a service user. An ongoing programme of refurbishment is currently improving the environment of the home, and plans are in place for additional communal facilities. The home offers a pleasant, comfortable clean and well- maintained place to live and work. The standard of record keeping found was good and recently noted improvements in the administration of medication have been maintained. Service Users can be confident that the administration and management of the home supports them and the staff that care for them and that systems are in place that offer protection from avoidable risks to their heath and safety.

What has improved since the last inspection?

There were no requirements made following the previous inspection in November 2005. Since that time the home has undergone redecoration and refurbishment of communal bathrooms and other facilities and this is continuing. Staff supervision is now taking place in line with the requirements of the National Minimum Standards. This provides support to the staff team, which in turn benefits service users. Maintenance of a previously recognised high standard of care is in itself an achievement and one that probably has the greatest significance for service users.

What the care home could do better:

The Service User Guide, Statement of Purpose and Contract each need reviewing and updating in order to ensure they comply with the revised Care Homes Regulations and contain relevant current information about the service. As has previously been noted, the home would benefit from the appointment of a deputy manager to assist and support the manager and to deputise for him in his absence. Temporary provision of additional activity hours should be considered during the absence of one of the home`s activity organisers.

CARE HOMES FOR OLDER PEOPLE The White House Nursing And Residential Home Gillison Close Letchworth Hertfordshire SG6 1QL Lead Inspector Jeffrey Orange Key Unannounced Inspection 21st February 2007 08:40 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 Nursing And Residential Home DS0000019591.V331119.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 Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Nursing And Residential Home Address Gillison Close Letchworth Hertfordshire SG6 1QL 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) 01462 485852 01462 486438 Medical Resource Worldwide Renaud Sockalingum Care Home 62 Category(ies) of Dementia - over 65 years of age (62), Old age, registration, with number not falling within any other category (62), of places Physical disability (52), Physical disability over 65 years of age (52) The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home cannot accommodate any service user under the age of 55 Date of last inspection 3rd November 2005 Brief Description of the Service: The White House Nursing and Residential Home is a purpose built home opened in 1995. It is situated in a residential area of Letchworth, with good access to the A1(M) and available public transport. Parking space is available to the front of the building. The home is currently registered to provide care and accommodation for up to 62 people, a variety of care needs are met within the home, which is registered for older people and caters for those with physical disabilities and dementia. The home’s accommodation is arranged over two floors, served by passenger lift. It has a wide range of communal day areas, including a conservatory and has a large, landscaped garden, accessible to service users, including an attractive patio area. The home has a Service User’s Guide, which includes contact details for the Commission for Social Care Inspection (CSCI), with copies of the latest inspection report also available. Current fees are from £585 - £620 per week and are due for review in April 2007. Additional charges apply for personal toiletries, newspapers, hairdressing, chiropody, dentist and opticians services. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from early morning until midafternoon and provided an opportunity to speak with service users, relatives and visitors to the home, together with the Manager and Sister on duty, members of the staff team including the activities organiser and Operations Manager. A number of key records were checked, including care plans and staff recruitment and training files and those relating to the administration of medication in the home. A tour of the premises was made, including communal areas and, with their permission, service user’s bedrooms. This report also draws on any information about the White House received by the CSCI since the previous inspection visit in November 2005. What the service does well: Service users were very positive about the standard of care they receive and this was borne out in observation of the interaction between staff and service users during this inspection. “We are more than happy with the care my Mother receives” was the comment of one relative spoken to. The staff team are committed and demonstrate both competence and caring in the way that they approach their work. “The staff are really kind” was one typical comment made by a service user. An ongoing programme of refurbishment is currently improving the environment of the home, and plans are in place for additional communal facilities. The home offers a pleasant, comfortable clean and well- maintained place to live and work. The standard of record keeping found was good and recently noted improvements in the administration of medication have been maintained. Service Users can be confident that the administration and management of the home supports them and the staff that care for them and that systems are in place that offer protection from avoidable risks to their heath and safety. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 7 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 Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 8 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): Standards 1 2 3 (Standard 6 does not apply to the White House) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a thorough process of assessment of need completed prior to the admission of prospective service users, this should ensure that only those whose care needs can be satisfactorily met are admitted to the home. Prospective service users are encouraged to visit the home prior to admission to help them judge whether it will be suitable for them. Following recent changes in the home, the CSCI and regulations governing homes’ contractual and information documentation, review and amendment of the relevant documentation is now required to bring it up to date and to make sure it complies with the revised regulations. EVIDENCE: The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 9 “We visited the home before we made a decision” was the comment of one relative. Care plans seen included a full assessment of need and involved a range of health and social care professionals as well as the prospective service user. The Service User Guide is not entirely up to date, with some details of the CSCI not correct for example. The home’s documentation does not fully reflect changes in requirements with respect to information about fees that are set out in the revised Care Homes Regulations. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 10 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 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care plans and associated records ensures that staff have the up to date information they need to appropriately identify and meet the care needs of service users. The home has sound policies and procedures for the safe management and administration of medication that ensures service users are protected and that they receive medication prescribed for them. Service users are treated with respect and their dignity is upheld. EVIDENCE: Staff and service user interaction throughout this inspection visit was seen to be appropriate and respectful. “The girls (sic) are all lovely” was one service user comment made. Medication records were checked and found to be accurate and well kept. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 11 A sample number of care plans were seen and found to include the information staff need and included evidence that they are kept under review and updated as care needs change. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Services users are helped to exercise choice in the daily routines of the home. There is a programme of activities in place that attempts to reflect the various interests and abilities of the home’s service user group. Service users are encouraged to maintain social and family contacts in line with their own wishes. Service users receive a wholesome and nutritious diet that takes account of their individual needs and preferences. EVIDENCE: “I don’t like quiche, I have ordered a jacket potato” was one comment made about the reality of choice over meals. It was confirmed from records and speaking to other service users that alternatives are always available to the planned menu and that personal preferences, for example in terms of specific breakfast cereals are accommodated wherever possible. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 13 The activity organiser provided information about the activity programme in place and several service users spoke about some craftwork they were taking part in. A number of visitors were in the home during the inspection visit and those spoken to confirmed that they are both encouraged and welcomed by staff to visit. The activity hours available are currently reduced due to the temporary absence of one of the home’s activity organisers. It would benefit service users if some temporary additional hours could be arranged to compensate for this. Quarterly service user meetings are held, the minutes for which were seen and which provide formal opportunity for service users to express views about the day-to-day organisation of the home. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 14 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 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The rights and wellbeing of service users are protected and safeguarded by the home’s policies and procedures and by the training provided for care staff. EVIDENCE: The home has a complaints policy and procedure in place, which commits the organisation to the prompt investigation and resolution of any complaints made. Service users spoken with indicated that they felt confident that any complaints would be addressed satisfactorily. Staff spoken with confirmed that they had received training in the safeguarding of vulnerable adults and this was confirmed from those training records seen. Very few formal complaints are ever recorded; it is more usual for them to be dealt with informally at an early stage. Whilst this is very positive, it may be helpful if the policy of recording complaints were reviewed to ensure that any possible trends or patterns are always fully identified. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 15 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 20 21 23 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, comfortable and well-maintained environment for those who live and work in it. EVIDENCE: Since the last inspection a programme of refurbishment and redecoration has been underway which has improved communal sitting areas, bathrooms and other areas of the home. Those individual bedrooms seen were personalised to reflect the individual tastes and preferences of the service user. The home’s domestic staff were seen to be thorough and conscientious. The result of this was that there were no obvious problems with odour on the day The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 16 of the inspection visit and the standard of cleanliness found throughout the home was good. The laundry was seen to be well equipped and organised. It is recommended that substances that may be hazardous to the health of service users are always returned to secure storage at the earliest possible opportunity after use. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 17 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 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are currently adequate although staff can be under pressure at key times. Services users receive a high standard of care from a well-motivated, trained and supported staff team. The home’s recruitment process is robust and thorough and provides confidence to service users that they are safeguarded from potential harm as a result. EVIDENCE: Recruitment files for recently employed staff were seen to include the required checks and information. Discussions with the staff team demonstrated an impressive commitment to the care of service users, a good knowledge of their needs, including those who suffer from some degree of dementia and a personal commitment to training and development. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 18 Training records confirmed that induction and ongoing training is in place and is understood that the home now meets the requirements of the National Minimum Standards in respect of the number of staff having competed NVQ level 2 training in care. Most importantly all service users, visitors and relatives spoken with throughout this inspection visit commented positively about the standard of care outcomes achieved by the staff team. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 19 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 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the management team continue to provide strong leadership to staff in order to keep service users’ needs at the centre of the home and its operation and decision making process. The standard of record keeping is good and there are policies and procedures in place to ensure safe working practices are followed, in order to promote the health, safety and welfare of service users. EVIDENCE: The manager is well qualified to manage this home and demonstrates a commitment to continued professional development and training to ensure that he remains aware of recent developments in health and social care. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 20 Staff and service users paid tribute to the way the home is managed and to the support that is provided for them. Those records seen were well maintained and effective. The size and complexity of the home puts a considerable burden of responsibility on the manager and this could be helped if, as has previously been discussed on several occasions, a deputy manager could be appointed to assist the current manager. This recommendation is again taken forward, although assurances were received during this inspection that an appointment is likely to be made in the near future. Although a requirement is made in respect of one aspect of the use of hazardous materials, the overall standard of health and safety in the home is satisfactory and is given appropriate priority. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 21 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 2 2 3 X X N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 5 Requirement The home’s Statement of Purpose and Service User Guide must be reviewed and amended as necessary to ensure it is accurate and up to date and meets the requirements of the Care Homes Regulations 2001 as revised. Substances that may be hazardous to the health and safety of service users or staff must be returned to secure storage as soon as possible following use. Timescale for action 30/05/07 2 OP38 13(4) 21/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP12 Good Practice Recommendations The homes contract should be reviewed to ensure that it is in line with guidance issued by the Office of Fair Trading. Consideration should be given to temporarily increasing the hours available for the home’s activities until such time DS0000019591.V331119.R01.S.doc Version 5.2 Page 23 The White House Nursing And Residential Home 3 OP16 4 OP27 as the activity team is fully staffed again. The procedure for the definition and recording of complaints should be reviewed to ensure that, without making the process unnecessarily onerous, it enables any trends or patterns to be identified by the home’s management. It is again strongly recommended that a suitably experienced deputy manager be recruited to strengthen the management team and deputise effectively in the registered manager’s absence. The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The White House Nursing And Residential Home DS0000019591.V331119.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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