CARE HOMES FOR OLDER PEOPLE
The White House Residential Home Ashmans Road Beccles Suffolk NR34 9NS Lead Inspector
Iain Smith Unannounced Inspection 30th November 2005 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000065171.V269939.R01.S.doc Version 5.0 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. DS0000065171.V269939.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The White House Residential Home Address Ashmans Road Beccles Suffolk NR34 9NS 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) 01502 717683 01502 716333 Healthcare Homes Limited Mr Terry Mason Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places DS0000065171.V269939.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th June 2005 Brief Description of the Service: The White House is situated in a quiet residential area of Beccles but within close proximity of the shopping centre and railway station. The home has been registered since 1987 and is currently owned by Healthcare Homes. The White House is set in its own grounds. The main house is a Victorian building, which has been purpose extended and adapted to provide comfortable and good quality accommodation for up to 33 older people. The accommodation comprises twenty-one single and six double bedrooms, the majority of which have an en-suite toilet and wash hand basin. Communal areas, which include two lounges, a dining room and a conservatory, are located on the ground floor and toilet and bathroom facilities are available on both floors. The Registered Manager lives on site and is responsible for the day-to-day running of the home and is assisted by a senior staff team including a matron, deputy matron, senior care assistants and care assistants. Ancillary staff includes a cook, kitchen assistant, domestic and laundry staff. A separate day centre catering for local people living in their own homes operates from the same site and the facilities and activities are available to the residents living at the home and their families and friends. DS0000065171.V269939.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report is based on the unannounced inspection of the care home, the second inspection for the year 2005/2006.The inspection commenced at 12 midday and was completed at 14.45, a total of 2.45 hours. The registered manager Terry Mason and senior carer Julie Knights were present throughout the inspection and contributed fully to the inspection process. The inspection covered some of the core standards and the remaining standards not covered at the announced inspection. Therefore all the care homes for older people standards were assessed in the year 2005/2006. What the service does well: 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. DS0000065171.V269939.R01.S.doc Version 5.0 Page 6 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 DS0000065171.V269939.R01.S.doc Version 5.0 Page 7 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 the following standard(s): 3 and 4. Service users admitted to the home have their needs assessed and staff are trained to meet their needs. EVIDENCE: The care plans have been reviewed since the last inspection. The format of the care plan included assessments for communication, sleep pattern continence plan and nutrition. The care plan is taken to the prospective service users and completed prior to admission. This is used to ensure that each person is admitted on the basis of a full needs assessment. The manager stated that the home is able to meet the needs of each service user who is admitted to the home. This was evidenced in training records and demonstrated that staff individually and collectively have the skills and experience to deliver the services and care that the home provides. Examples were health and safety, prevention of vulnerable adults and infection control. DS0000065171.V269939.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 7,8,9 and 10. Each service user’s care plan ensures that their care needs are assessed and met. The medication policies and procedures ensure that service users are safe. EVIDENCE: Two care plans were examined and found to include the service user’s assessed needs. The care plan is taken to the prospective service user and the assessor, who may be the manager or the senior carer, completes the care, social and personal needs. This information is used to produce a more specific plan for each element of the main care plan. Examples of the information were sections for mobility, hygiene and communication. To ensure that the manager and staff were all aware of the procedure for the care planning, there were written guidelines at the front of the care plans to inform staff. The manager promotes and maintains service users health and assessed needs. This is demonstrated in the care plans with assessed needs for
DS0000065171.V269939.R01.S.doc Version 5.0 Page 9 nutrition, prevention of pressure sores, with using the Waterlow Scale assessment and ensuring service users have access to other professionals. The medication policies for the home are in place. The policy is adhered to be staff. One member of staff stated that the practices have been reviewed and all staff who are responsible for the administration has stopped the practice of secondary dispensing. Part of the lunchtime medicine round was observed to assess that this practice has ceased, which it has. The Medication Administration Record (MAR) sheets were examined and found to include signatures of staff following the administration of the medication. The senior carer stated that Boots are providing a new drugs trolley in the near future. The death and dying policy was assessed. The policy has been written as bill of rights. There is a list of rights including that of the right to die in peace and dignity. The home has had a number of deaths recently and one staff member stated that every member of staff is made aware of this policy through their induction programme. DS0000065171.V269939.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 15 Meals are planned and prepared specifically to meet the needs of the service users. EVIDENCE: Lunchtime was observed. There are two dining areas where service users can sit and have their meal. One dining room accommodated those service users who were independent and could manage to feed themselves. The adjacent room offered more space for the service users who required assistance. The lunch consisted of either chicken pie or sausages with a selection of vegetables. There was fruit and cream or ice cream for pudding. One service user stated that ‘ the food is very good’. DS0000065171.V269939.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 17 and 18 The home has the appropriate policies in place for the protection of service users. EVIDENCE: The service users were able to access an advocate if required. The manager stated that previously a service user had had an advocate from social services. There were no service users requiring this service currently. The policy for the protection of vulnerable adults (POVA) was examined and found to be relevant for the home. The induction programme included this policy and the manager and senior staff were responsible for the training of staff. The policy was based on the ‘No Secrets’ document and leaflets for POVA were seen in the home. DS0000065171.V269939.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 21,22,23,25 and 26 Service users live in a safe, well maintained environment. There is specialist equipment to enable service users to maximise their independence. EVIDENCE: The majority of the 21 single bedrooms have en suite facilities. There are three shared rooms. The service users have access to toilet areas near to the communal areas. There are five communal areas downstairs and upstairs has two toilets in addition to the en suite rooms. The home has service users who require assistance with moving and handling. There is equipment in the home to ensure that service users are able to maximise their independence. Wheel chairs are available and there are two Oxford Hoists for staff to use. Two standing hoists are situated next to the bath areas. The home was warm and comfortable. One bedroom heater was not working although the engineer was on site on the day of inspection attending to the
DS0000065171.V269939.R01.S.doc Version 5.0 Page 13 repair of the heater. The emergency lighting system was seen throughout the home to ensure that provision is made in the case of a power failure reviewed since the announced inspection. The infection control procedures have been reviewed since the announced inspection. The home has provided additional linen bags to take to service users rooms to place the dirty linen in. This practice ensures that laundry is not carried by staff and reduces the possibility of cross infection. DS0000065171.V269939.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Staff are employed in sufficient numbers to meet the needs of the service users. EVIDENCE: The staff rota evidenced that there was a team leader in charge of the staff on duty in the morning with an additional two care staff. Two housekeepers were undertaking domestic duties in the home and a chef was in the kitchen preparing the meals. The matron was currently on secondment to another home in the company. The registered manager, team leaders and care staff were in sufficient numbers to meet the needs of the service users. Training that the cleaning nurse to for staff was evidenced in the homes records. The manager stated housekeeping staff were commencing their NVQ level one training for and support. One senior carer has recently been trained by the district administer insulin. The home has two diabetics currently. DS0000065171.V269939.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34 and 35. There is clear leadership in the home to ensure service users receive quality care through training and development. EVIDENCE: The manager is currently undertaking a business-coaching course to enhance their existing knowledge and skills in finance, personal development and accountancy. Meetings for staff take place on a monthly basis. One housekeeper stated that ‘we are involved with the staff meetings and talk about the home and what is going on’. The manager stated that all service users fees were administered through the head office. The home does not generate the invoices or collect the fees. There is a small amount of cash on the premises for a number of service users. This
DS0000065171.V269939.R01.S.doc Version 5.0 Page 16 is kept safe in a locked cabinet and a record of each transaction is made. The manager stated that the majority of service users relatives administer any cash required to pay for services for example the hairdresser. Staff supervision is undertaken for all staff. The manager currently completes the supervision but the senior carers will be made responsible in the future for supervising the care staff. Appraisals are held annually. DS0000065171.V269939.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X X 3 3 3 X 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 X X X DS0000065171.V269939.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000065171.V269939.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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