Inspection on 05/07/05 for The White House Nursing And Residential Home

This inspection was carried out on 5th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The White House Nursing And... 21/02/07

The White House Nursing And... 03/11/05

The White House Nursing And... 01/02/05

The White House Nursing And... 29/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The White House Nursing and Residential Home Gillison Close Letchworth Hertfordshire SG6 1QL Lead Inspector Angela Dalton Unannounced 5th July 2005 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 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 I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 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 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 Resources Worldwide Renaud Sockalingum CRH Care Home with Nursing 61 Category(ies) of DE(E) Dementia over 65 (61), OP Old Age registration, with number (61), PD Physical Disability (51), PD(E) of places Physical Disability over 65 (51) The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home cannot accommodate any service user under the age of 55. Date of last inspection 1st February 2005 Brief Description of the Service: The White House Nursing and Residential Home opened in 1995 and is a purpose built home situated in a cul-de-sac within a residential area, near both the local day centre and hospice. The home has 61 beds, 10 of which are residential and features a recent extension incorporating nine rooms and a conservatory. There are 20 rooms on the ground floor and 40 on the first floor. The home has seven different day areas and the large garden is landscaped and well maintained. Service users can access this and a patio area is well utilised. A variety of care needs are met within the home as it is registered for older people and caters for those with physical disabilities and dementia. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two Inspectors between 10am and 4.40pm on July 5th 2005. Overall, the inspection was positive but there were elements of the home and care that had deteriorated since the previous inspection. Service users confirmed that they received good care and that staff were kind and helpful: one service user said that nothing was too much trouble for staff. What the service does well: What has improved since the last inspection? What they could do better: Aspects of personal care such as cleaning fingernails, dentures and shoes have deteriorated since the previous inspection. A requirement has been made to review staffing levels, as there appears to be a link between the sometimes low staffing levels and quality of care delivery. This is also apparent at night because of the level of incidents occurring. An over bearing odour of urine was present in a bedroom. An additional bedroom was successfully cleaned during the inspection. Care plans continue to identify needs but fail to expand upon The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 6 how to manage them. Some staff failed to observe good infection control practice by failing to change gloves and aprons between tasks. 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 White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Care plans identify needs but do not equip staff to manage or monitor individual requirements. EVIDENCE: A statement of purpose is available to all service users and a copy is on display in the reception area of the home. A version is also available in Braille should it be required. A contract of the home’s terms and conditions is kept on individual files. The home manager or one of the nursing team assesses service users’ needs prior to admission to the home. Relatives are able to visit freely and sit in one of the lounges, conservatory or in the garden area. The home does not provide intermediate care. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Care plans do not provide comprehensive information about service users’ needs. The dignity of service users is not observed. EVIDENCE: Although needs are identified as part of the assessment there were areas that remained blank or incomplete in the plan of care. Individual needs such as verbal aggression, episodes of trauma, mental health requirements, risk of falls etc. were identified as part of the assessment but no further information is recorded. Staff are ill equipped to meet needs if no management or monitoring tool is in place. There is little evidence where incomplete care plans exist that individual health needs are being met. As stated earlier poor denture care was noted by the inspectors as well as dirty shoes and finger nails. This compromises the dignity of service users. The bedroom that had a strong odour of urine was occupied. Steps were taken to relocate the occupant at the end of the inspection but they had been residing in unacceptable conditions prior to changing rooms. The medication recording system has improved but a little work is still required. Temazepam must be stored as a controlled drug. The medication fridge is recorded as being at a consistently high temperature and this must be addressed to ensure safe storage of medicines. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 10 The practise of men and women sitting in separate lounges continues. It is recommended that some proactive work take place to identify ways of the two separate groups being encouraged to mix. The lounges are referred to as ‘ladies lounge’ and men’s lounge’. On the day of inspection the men were sitting in a small lounge which was crowded, ladies were sat in the two larger lounges The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 A variety of activities take place within the home. Service users are able to exercise choice regarding meals and daily activities. EVIDENCE: On the day of inspection a trip out strawberry picking followed by a visit to a local café had been arranged. The home employs a full time activities coordinator and records reflected this. Newspapers are purchased for those who want them. The home maintains links with the community and had students from local schools on work experience. Lunch almost reflected the scheduled menu but vegetables were not served. This will be monitored by the Assistant Director and Inspectors were assured that it was an isolated event. An alternative to the main meal option was available. Service users were assisted in a gentle and appropriate manner by staff. Plenty of drinks were available for service users. Fresh fruit is not on display and a recommendation has been made to make it available with the tea trolley. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Processes are in place to ensure complaints are acted upon. EVIDENCE: Staff have attended adult protection training. The complaints procedure is incorporated into the service users’ guide and is on display throughout the home. The Assistant Director was aware that the situation where a service user was living in a bedroom that had an unbearably strong odour was far from satisfactory. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Service users’ do not live in comfortable, odour free surroundings. EVIDENCE: The majority of the home was clean and odour free. The disappointing factor regarding the malodorous room was that it is exceptional, as previous inspections have found the home to be odour free. A requirement has been made to improve the situation. Impervious backed carpet has been fitted but requires cleaning within two hours to prevent odours forming. This had evidently not occurred. Staff had not identified it as a concern and had failed in their duty of care. The manager was aware of the issue but had gone on annual leave without addressing the situation. Staff were observed to not change their gloves and aprons as they changed tasks. All have attended infection control training but were not applying measures to prevent cross infection. Communal facilities were available but as explained earlier were a little cramped at times. Plans have been submitted to introduce an additional room but work has not yet begun. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 14 A requirement has been made to ensure that service users have access to footplates for their wheelchairs. A requirement has also been made to ensure that the ambient temperature is suitable for service users. This is an ongoing issue within the home where the heating is turned off, windows opened and service users have blankets over them. Staff appear to consider that if they feel hot then so do service users. They are not mindful of the fact that they are constantly moving and able to vocalise their requirements. The Assistant Director aims to ensure that a member of staff is responsible for ensuring a comfortable temperature in the home. The weather on the day of inspection was unseasonably cold and appropriate measures had not been taken within the home to ensure the comfort of service users. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Recruitment records are not stored securely. Staffing levels do not meet service users’ needs. EVIDENCE: The rota reflected that the home has not been fully staffed for several weeks. The manager has been counted in numbers which reflects that they have been delivering hands on care as opposed to managing the home. A requirement has been made to submit an audit of staffing levels to demonstrate adequate levels of staff. On examination of accident records there appears to be a number of incidents at night, which seem to correspond with compromised staffing levels. A recommendation to employ a deputy has again been made. The nursing team are reluctant to act as deputy in the manager’s absence. The Assistant Director informed the Inspectors that there would be a deputy appointed in the near future. Recruitment checks were more thorough but CRB checks were on display in the unlocked office (with the door open) when the Inspectors arrived. Confidentiality was not observed and records were not stored securely. A requirement has been made. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, The manager is currently discharging his responsibilities fully and this is a contributing factor in the slight deterioration in services that have been recorded in this report. EVIDENCE: The manager was on his first day annual leave on the day of inspection. The Assistant Director will pursue areas of concern as it appears that whilst the home manager forms part of the staffing numbers the management of the home has been neglected. It is recommended that the home manager balance his management and clinical tasks. Staff are awaiting clearance to fill vacant posts. Steradent was in service users rooms and must be treated as a COSHH item either risk assessed for service users who can safely maintain their own supply or kept on behalf of service users who cannot. An immediate requirement was made to regulate the water temperature and record it daily, as it is currently too high. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 2 3 2 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x x x x x 3 2 The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? 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 OP8 Regulation 12(1)(a) & (b) Requirement Care Plans must provide comprehensive insformation to manage and monitor identified needs e.g. falls, mental health needs. Temazepam must be treated as a controlled drug. Medication fridge temperatures must be within the prescribed range The dignity of service users must be observed. Personal care must reflect this as levels of care do not currently reflect this (e.g. dirty nails, dirty shoes and unclean dentures). The home is not warm enough for service users and bedrooms must be odour free. Service users must be offered the opportunity to share the lounges. Footplates must be available for service users to use. The temperature of the home must be comfortable for service users as it was cold on the day of inspection. The temperature of the home must be monitored throughout the day. The strong odour of urine in a specific bedroom must be eradicted. Timescale for action 31/08/05 2. OP9 13(2) 31/07/05 3. OP10 12(4)(a) 31/07/05 4. 5. OP22 OP25 13(4)(b) 23(2)(p) 31/07/05 31/07/05 6. OP26 16(2)(k) 06/07/05 The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 19 7. OP27 18(1)(a) 8. OP29 17(2) 37 9. OP38 13(4) The levels of staff must be adequate to meet service users need. An audit reflecting the actual number versus the required number (with reference to the residential homes forum guidance) must be submitted to the Commission. Criminal Record Bureau Records must be securely stored. The Commission for Social Care Inspection must be notified of any incident mentioned in Regulation 37. Hot water must be delivered at a safe temperature. COSHH items must be appropriately stored. 31/08/05 30/07/05 06/07/05 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 OP15 OP20 OP31 OP31 Good Practice Recommendations Fresh fruit should be available for service users to help themselves. It is suggested that fruit is served on the tea trolley to facilitate this. The use of communal space should be reviewed to enable lounges to be less crowded. The manager should balance management and clinical responsibilities to ensure competent management of the home. It is again strongly recommended that a deputy manager be employed to assist in the management of the home and meeting service users needs. The White House Nursing and Residential Home I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire, AL7 3BQ National Enquiry Line: 0845 015 0120 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 I52 S19591 White House V236364 050705 Stage 4.doc Version 1.40 Page 21 - 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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