Inspection on 15/06/06 for Whitbourne House

This inspection was carried out on 15th June 2006.

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

Whitbourne House 05/07/07

Whitbourne House 20/03/06

Whitbourne House 22/09/05

Whitbourne House 24/03/05

Whitbourne House 03/02/05

Whitbourne House 02/02/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Whitbourne House Whitbourne Avenue Park South Swindon Wiltshire SN3 2JX Lead Inspector Stuart Barnes Key Unannounced Inspection 15th June 2006 10:00 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 Whitbourne House DS0000035476.V300132.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. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitbourne House Address Whitbourne Avenue Park South Swindon Wiltshire SN3 2JX 01793 523003 01793 523016 mmneaney@swindon.gov.uk 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) Swindon Borough Council Vacant Care Home 41 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (33), Mental disorder, excluding learning of places disability or dementia (2), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10) Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users accommodated under the category Dementia (DE) and Mental Disorder, excluding learning disability or dementia (MD) must not be aged under 55 years. 20th March 2006 Date of last inspection Brief Description of the Service: Whitbourne House is a care home for older people, which is owned and run by Swindon Borough Council and is located in the Park North area of Swindon. The local shops and amenities are a quarter of a mile away and there is a regular bus service to Swindon town centre that stops outside the home. The home provides social and personal care for up to 41 older people in need of early stage dementia care or in need of care due to their mental health needs. The service does not offer nursing care. Apart from offering long-term care the home also offers short-term/respite care for a period not exceeding 8 weeks in any one care episode. The service has recently undertaken a major refurbishment programme, which included upgrading the fire safety equipment, call bell and security systems as well provision of new furnishing and fittings. All service users have single room accommodation. If two residents wish to share, two rooms would be offered so that one could be used as a lounge. Bedrooms are located on the ground and first floor and a passenger lift gives level access. The home has a number of communal lounges and a spacious dining room and there is an enclosed secure garden area. Doors between each living area and at the entrance to the home are kept locked when not in use for reasons of ensuring safety. The home is divided into separate living areas each with its own lounge. Each living area is allocated a core group of staff to help ensure consistency of care. Meals are prepared and cooked in a main kitchen and typically taken in a communal dining room. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and involved 3 inspectors, one of whom was a specialist pharmacy inspector. It was carried out over 2 days. Before commencing the inspection and in line with the Commission’s current methodology the views of a small sample of service users and/or their family member, and paid health and social care staff were obtained. The manager was also required to submit specific information as part of the inspection. In total 25 out of 38 national minimum standards (NMS) were inspected of which 40 were found met and just over half had minor deficits. The inspection showed all round improvement in many areas. Fee levels for this service are subject to means testing. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. What the service does well: What has improved since the last inspection? What they could do better: There is a need to ensure all service users have a person centred care plan and that documents record service users views about matters that effect them. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 6 Health workers needs to be more involved in the assessment process and in the planning of care in relation to health issues. Assessments and care plans need to include health concerns. Documentation needs to be clearer about the involvement of health workers and their role in the care plan. Planning and providing more suitable activities is needed. The management of complaints and how to record them is currently very poor, so this area needs to improve. Arrangements need to be put in place to ensure night staff receive training in fire safety. 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. Whitbourne House DS0000035476.V300132.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 Whitbourne House DS0000035476.V300132.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. The service provides good information about its services but not enough about the specialist nature of the service, the stated terms and conditions or whether assessed needs can be met or not. Partnership working with families is improving; more partnership with health care professionals is needed. Care planning is getting better for a few. Assessing risk could be better as some important areas are not covered, but where done is done fairly well. While more relatives say they are happy than not happy with the care provided a small number of relatives have concerns about the way their family member is cared for. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The current service user guide and statement of purpose does not provide sufficient information about the specialist nature of the service and needs to be updated to reflect recent changes in the way the home is run. Three case files were examined in depth. Documentation shows that each person had a pre admission assessment and risk assessment in place. The service however had Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 9 not remembered to write to the people assessed for admission to outline which needs the home is able, or not, to meet as the case may be. The manager said this information was passed on verbally at the 4 weekly placement review. However this method of communication does not comply with the current care home regulations. In respect of one person the case documentation confirmed that the persons placement had been reviewed and that they were happily placed in the home that was meeting their needs. The two other files indicated the people were appropriately placed. There was evidence in the case documentation, supported by comments from visiting relatives to confirm that the service strives to engage the service users own families in partnership with the home. One of the assessments appeared to be more of a summary of placement needs than ‘person centred’ assessment. For example it mentioned an unspecified hearing impairment, an unspecified heart problem and stated a person had a N.M.S.E. score without indicating its relevance to the person being assessed. Important documentation is not always dated and sourced, including admission documents. There were care plans in place to support the assessment. None of the case files examined had a written contract or personalised terms and conditions of residency, though some of this information is included in the service user guide in a generalised way. Since the last inspection additional training has been provided to selected staff in recording and person centred documentation. Personalised risk assessments are in place. The case files seen showed insufficient attention is given to aspects such as managing medication, history of falls, preventing pressure ulcers and the impact of sensory loss. Neither did they show sufficient collaborative multidisciplinary involvement in assessment and decision making in respect of on going needs. One health care worker raised a concern about the service not fully appreciating the difference between past or present illness associated with mental health and Alzheimer disease. Managing end of life care is still underdeveloped. The service is working hard to improve the skill levels of the care staff. This is being achieved by providing extra training and support and so as to ensure staff have more knowledge and understanding about dementia care needs. The inspectors note that some progress has been made since the last inspection but more progress is still needed before inspectors can confirm that the service meet the specialist needs which arise from Alzheimer’s and deteriorating mental health. Three relatives expressed concerns that “insufficient staff” (at busy times) hinders the needs of their family member being adequately met at all times. Staff employed at the home also endorse this view. However all 8 relatives that returned their comments cards stated that they were satisfied with the overall care provided. Whitbourne House DS0000035476.V300132.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. The new care plan format is much more person centred and a considerable improvement on the previous format. The impact on hearing loss, and other health factors are not being adequately covered in care plans. When fully introduced the new format for care planning will benefit service users and staff. The reasons for the restriction of people’s movements or the need for staff to administer their medication is not adequately explained. Staff are getting better at dealing with poor health but there is still room for more understanding of health care issues. Improvements have been made to the medication arrangements which should ensure that medicines are handled and recorded appropriately. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: Examination of 3 files case documentation shows that care plans promote family contact. One case file shows a service user was actively involved in planning their care and for another a family member was actively involved in the process. Relatives also confirm they are invited to placement reviews and Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 11 other decision making meetings. The impact of hearing loss, certain health factors including the tendency to have falls are still not adequately covered in 2 of the care plans seen. There appears to be a blanket policy that staff will administer all medication and that all service users will have their movement restricted, without adequate explanations as to the reasons why. Care plans are being periodically reviewed depending on changing needs. A new format has been introduced which covers abilities, strengths, wishes, feelings and special requirements. This format includes attention to peoples personal care needs and promotes dignity and choice. However the manager said only 8 i.e. less than 20 of the current occupancy have had their care plan drawn up using the revised format. The staff member that has responsibility for writing the plans said everyone living in the home should have a plan in the new format before September 2006. One care plan showed a good partnership with the service users family and clearly identified which aspects of medical each would facilitate e.g. family will organise eye care, the care home; foot care. Examination of each person’s daily notes shows better recording of health issues, such as reporting a service user was suffering increased pain. More case files detail fluid intake and staff seemed more aware of the importance of recording this. However this is still a bit hit and miss with some staff recording fluid intake and others not. Staff need more guidance about when and how to record fluid intake and a template specific for this purpose. In one example there was a record of fluid intake maintained by staff but the care plan did not refer to keeping a record. Users of the service reported they were getting access to plenty of fluids and inspectors observed staff offer all residents an ice cream during a very hot afternoon. Work is in hand to draw up an end of life protocol with health care workers but this work is in its early stages and has yet to make an impact on the service. There was some recording that suggests staff are unsure about how to respond to reports of “loose bowels” that last more than a day. There is evidence to show that care staff seek to promote personal dignity when carrying out personal care tasks. Service users are being supported to access health care services including specialist doctors, general practitioners, opticians, chiropodists, and it can be seen staff take more care to comment on well being of service users. However assessing the risk of health related issues is underdeveloped in relation to falls, tissue viability, MRSA and medication needs. Service users who smoke encounter difficulties about where to go, especially when it is raining. One service user and their relative confirm that care staff provide care respectfully and with dignity. Medicines are stored securely in a room with adequate shelving and cupboards. Facilities for hand-washing would be useful. All appropriate records were kept, including risk assessments for self-medication. All medication changes and dose changes are confirmed by fax. Letters were seen informing families using the respite service of the importance of supplying medicines in original containers. If these are not available a new prescription is obtained. Staff have undergone medication training and information is available to them in the form of patient information leaflets. A new medication policy is being produced. Whitbourne House DS0000035476.V300132.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Depending on their capability service users can make choices and staff work hard to encourage them to do so. Service users views about meals vary. Some praise the meals provided; others less so. The service is failing to provide sufficient activities but plans are in hand to address this deficit. Relatives are welcome to visit the home. There is room to improve the way the service consults with service users about the running of the home. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The home held a fete in May with the aim of raising funds to purchase some wheelchairs. On the 1st day of the inspection a local vicar took a non-denominational service. At present there are insufficient activities available to the users of the service. This is something the management are aware of and are planning to rectify, within a person centred approach. There is no designated activity coordinator in post but there are plans to use a volunteer to undertake an activity role and offer an informal befriending service. Attention to activities and hobbies is understated in both assessments and care planning. Local people visit the home daily to attend a day centre, but residents at the home do not use the day centre unless they were using it before their admission. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 13 Case records show people have different routines for going to bed/getting up, bath times and meal arrangements. They also include information about preferences. Inspectors observed service users seeing their visitors in private and also two relatives confirmed that when visiting they, “feel able to relax in the home” and that they feel at ease. Care plans show that staff promote choice. This is typically mainly about meal options, bedtimes, what to wear, where to relax and how to furnish/refurbish their bedrooms. Service users can, and do, personalise their rooms. The service is good at supporting people to manage (or have managed) their own money. On balance more people praise than criticise the food arrangements. Four service users said the food was good. Only 1 person criticised the meal arrangements. The catering staff are able to take a caring interest in the welfare of the service users and the catering manager impressed as a person who would take forward any concerns- a view confirmed by the manager. Meal times ensure that the period between meals is not too long. Staff confirm as do two ,he menu. The catering manager reported that on occasions some service users might miss out on a meal if Agency staff forget to attend to them or if the Agency staff don’t know that they need assistance with feeding. The manager said any such event would be a very rare occurrence and there was no other evidence to confirm that this happens. Service users do not have the opportunity to have a resident’s meeting- not even those who attend for short term care. Inspectors observed service users using their own key to lock their bedroom. Whitbourne House DS0000035476.V300132.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The management of complaints is poorly managed. The system is not capturing all the complaints it receives and there appears to be confusion as to what constitutes a complaint. Decision making in respect of restricting movement and who manages medication is poorly recorded. Some relatives find it difficult to identify permanent staff and this inhibits issues of concern being raised when they are fresh in peoples minds. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The service has signed up to the local protocols for reporting abuse of any vulnerable adult. A current referral under these protocols raises concerns about how the service engages with the protocol. However an independent investigation is under way and the Commission are not in a position to determine this matter now. Training records show selected staff receive abuse awareness training and it dealing with alleged abuse is covered in National Vocational Qualification training which most staff have completed. There is no complaint record in the home-despite this concern being raised at the last inspection. The manager was not aware of the nature of 4 complaints made before he took up post because there is no record of them in the home. It is evident that people say they complain about this service but these complaints are not captured in the home as a complaint and are not recorded. For example 4 out of 7 relative comment cards said they had previously complained. One relative confirmed that when they complain the manager takes appropriate action. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 15 The service is not delivering on its own complaints policies and procedures. The absence of getting informed consent to restricted movement and administering medication is an indicator of poor awareness of rights. Inspectors were told of plans to send staff on a customer course. More than one relative said they felt a bit confused as to who were staff or not as agency staff wear uniforms but the other care staff do not. They said this makes it more difficult to identify who talk to if they have a particular problem. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 16 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): 19, 26. All round the standard of the accommodation is good but those living on the first floor have difficulties accessing the garden area. Visitors are finding it difficult to exit from the first floor. Most service users like their bedrooms and the home was clean and tidy. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The home benefits from a recent comprehensive refurbishment and is ideally located for easy access to the town centre with its easy access to hospital, the doctors’ surgery and other civic amenities. Fire safety is much improved but the training records for some night staff show some gaps in fire safety. Relatives talk or comment about difficulties exiting the 1st floor due to locked doors. Agency staff seemed fire aware. Inspectors found evidence of remedial repairs and portable appliance testing being carried out. Garden security has improved with new locks on the garden gates. The garden was well maintained and those service users on the ground Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 17 floor were able to access it with limited restriction. Service users on the first floor however were not able to access the garden unless assisted by staff. Many service users told inspectors they liked their bedrooms and confirmed they were able to personalise then, but 2 service users commented that they would like bigger wardrobes. More than 4 relatives have commented on their difficulty in exiting the building from the first floor when staff are not at close hand. In one example a relative said they were left with no option but to use the alarm pull cord because they were waiting so long to get out. From direct observation the home was found to be clean and tidy including service users bedrooms, toilet areas and bathrooms. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 18 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, 28, 29, 30. Evidence suggests that on occasions there are insufficient care staff being deployed in the home. Agency staff are used sometimes in considerable number and these staff play an important contribution to the way the home cares for its residents. Agency staff that are deployed on a frequent basis would benefit from access to some of the training and support provided to permanent staff including one to one supervision and attending staff meetings. The secondment of a learning and support worker to the home is beginning to show positives outcomes for service users. Inspectors found morale more upbeat and a staff team more confident in its specialist function and more willing to embrace its specialist function. Many staff have attended dementia awareness training and fire safety training but the understanding of mental illness is still under developed. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: Some evidence points to difficulties in deploying sufficient numbers of staff to work in the home during busy times or at weekends. Relatives talk about delays in the front door being answered and not being able to find staff when you want one. Agency staff report that on occasions they find it difficult to access permanent staff when they want one. Four out of 7 relatives comment cards highlight their worries about the number of staff on duty. The views of agency staff appear mixed. One agency staff member talked of being well integrated into the home and very content at work, while another claimed Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 19 permanent staff off load work onto them and take long breaks. The manager said he was not aware this was happening but said it could be possible. On the day of the inspection the home was dependant on using agency staff to provide sufficient cover. Examination of the rotas showed there were 6 agency staff working the shift and only 2 permanent care staff that were employed by Swindon Council. However it was evident that some of the agency staff had been deployed at the home for several months, one for several years and they knew it quite well. According to the agency staff member who had worked at the home for several years he was not being provided with one to one supervision and had not practised a fire drill, though he knew what to do if the fire alarm sounded. Another agency staff member said they did not get an induction when they were first deployed at the home. Supervision of “permanent” agency staff is not transparent. These staff are not invited to staff meetings. Two of the permanent staff said they like working at the home a lot. Since the last inspection the council had seconded a staff development worker to the home. This appears well received by staff at all levels. Staff report that the deployment of the seconded training and development officer is making a difference. Records also show that staff are receiving statutory training and National Vocational Qualification training at level 2 or above. This includes 20 staff booked for fire safety training and several staff have attended report writing and planning care training courses since the last inspection. Examination of staff records confirm that training is being provided to 23 staff on awareness training and specialist training on dementia care. Staff records also show that staff are getting one to one supervision meetings and that specific training needs are considered at these meetings. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 20 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, 33, 34, 35, 36, 37, 38. The evidence points to a much better managed resource than when previously inspected, but there is still room for improvement. Staff training and support has increased and there is a clear focus on improvement. Quality assurance systems need to be more robust and include an annual development plan. Managers need to be kept up to date with Department of Health guidance and practice. Record keeping is improving. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The council has been awarded the ‘Investors In People’ accreditation. Investors in People accreditation has an improvement strategy but there is no annual development plan or systematic quality assurance (QA) system which focuses on outcomes for service users. Managers of this service convey an Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 21 improvement focus as evidenced by the deployment of the learning and development worker offering staff extra training. There was evidence to show that the manager has written to the relatives of the service users to seek their views about the service provided, especially in relation to a range of activities and any concerns or worries they may have. Senior managers of the council undertake monthly monitoring visits and a copy of their recent reports were found in the home. Copies of incident and accident reports were also available in the home and appeared satisfactory. The manager confirmed that compliance with some requirements have been delayed either because they needed more time or were awaiting action of others outside the control of the service. Since the last inspection extra management resources have been put into the home. Discussion with the manager suggests the service is not being kept fully aware of relevant Department of Health (DOH) guidance re: policies and procedures affecting people who may be resident in the home. Record keeping is beginning to show evidence of improvement; with documents written more clearly and in a person centred way. However recording systems for complaints is poorly managed and some basic admission information is incomplete. The service continues to provide good financial systems designed at protecting service users from financial abuse. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 22 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 1 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 2 2 Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 23 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 OP4 Regulation 13(7) 15(1) Requirement No resident should be restricted from going out of the home unless they have agreed to be so restricted and that there is also a detailed, written assessment of any risk to them (or risk to others). This risk assessment must state why service users restrictions are necessary and that there is no alternative measure that can be safely taken. All service users assessments must be personal to the individual service user. If the service user lacks capacity to agree such a restriction, any restriction must be agreed on their behalf by a responsible and caring family member or other appropriate representative and endorsed by the service users care manager. The details of any service such assessment must be placed on the service users file and reviewed from time to time. Note; this requirement was made at the previous inspection and the date for complying with the requirement was set after the DS0000035476.V300132.R01.S.doc Timescale for action 20/06/06 Whitbourne House Version 5.2 Page 24 2. OP4 12(3) 3. OP4 18(1)(c) 4. OP4 18(1)(c) 5. OP12 16(2)(n) commencement of this inspection. In consultation with relevant health and social care staff, service users and others who represent them must draw up a protocol to deal with requests for ‘end of life’ care and how service users care should be managed. This protocol must give consideration to the availability of any extra staffing that may be needed at these times. Note; this requirement was set at the previous inspection. Some progress has been made. The Commission is willing to agree an extension of the deadline. All relevant staff must be provided with the training they need if they are providing ‘end of life’ care. Note; this requirement was set at the previous inspection. Some progress has been made. The Commission is willing to agree an extension of the deadline. All relevant staff must be trained in how to write up the interventions they carry out when delivering a persons care plan. This must include how to record fluid input, turning bed bound residents and all other aspects of personal care. Note; this requirement was set at the previous inspection. Some progress has been made. The Commission is willing to agree an extension of the deadline. In consultation with service users and those who represent DS0000035476.V300132.R01.S.doc 20/09/06 20/12/06 20/09/06 20/09/06 Whitbourne House Version 5.2 Page 25 6. OP16 17(1) 7 OP1 4(1) 5(1) 8 OP3 14(1)(d) 9 OP3 14(1) 10 OP4 12(1)(a) them an urgent review must be undertaken to consider how best to provide a range of service suitable activities for people resident at the home. Note; this requirement was set at the previous inspection. Some progress has been made. The Commission is willing to agree an extension of the deadline. The responsible individual must ensure that a register of complaints is kept in the home and it includes what actions have been taken in relation to each complaint received. Note; this requirement was set at the previous inspection. Since the inspection the service has indicated that it will ensure records will be kept in the home. A new timescale has been set. The statement of purpose and the service user guide must include information about how the service aims to meet the needs of people needing dementia care and/or needs associated with a mental illness. That, following an assessment for care, the registered person must confirm in writing the extent to which the service can or cannot meet the persons assessed needs. Where relevant assessments must include needs associated with a history of falling, use of medication, MRSA, tissue viability and sensory loss. Where people are admitted into Whitbourne House Care Home and have their medication managed by care staff the DS0000035476.V300132.R01.S.doc 30/07/06 15/08/08 15/07/06 15/07/06 15/07/06 Whitbourne House Version 5.2 Page 26 11 OP33 24(1) 12 OP27 18(1) 13 OP30 23(4)(a) reasons why must be recorded in the person case documentation. The registered persons must 30/12/06 undertake a review as to the quality of the care provided in the home and submit to the Commission a report as to their findings by the end of 2006. The registered person must 15/08/06 review the current deployment of staff so as to ensure it is adequate at busy times, including weekends. All night staff must receive fire 15/07/06 safety training including how to prevent fire and what to do if the fire alarm sounds 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. Refer to Standard OP7 Good Practice Recommendations The views of service users should be recorded in their assessment of risk, service plan or any other relevant documentation. This recommendation was made at the previous inspection and is being repeated as it had not been actioned. It is strongly recommended that when undertaking any assessment or plan of care the views of the service users key worker be sought. This recommendation was made at the previous inspection and is being repeated as it had not been actioned. It is very strongly recommended that, ‘champions’ of best practice in dementia care be recruited as role models for staff to learn from. This recommendation was made at the previous inspection and is being repeated as it had not been actuoned. All service users should be provided with stated terms and DS0000035476.V300132.R01.S.doc Version 5.2 Page 27 2. OP3 3. OP4 4 OP2 Whitbourne House 5 6 OP3 OP14 7 OP15 8 9 10 11 12 13 15 OP9 OP36 OP37 OP4 OP4 OP16 OP9 conditions of residency, a copy of which should be sent to the person representative if the resident lacks capacity to understand the document. Further consideration should be given as to how best to involve health workers in the assessment of people who receive a service at Whitbourne House. Further consideration should be given as to how best to support residents who wish for more involvement in the running of the home. This recommendation was made at the previous inspection and is being repeated as it had not been actioned. It is recommended that when service users have meals in their room a system is put in place that enables staff to check whether the person has eaten their food or not and that if assistance with feeding is needed that staff are made aware of this. Written additions and alterations to the medication administration record should be signed, dated and checked by two members of staff. It is recommended that agency staff be invited to attend any relevant staff meeting and are provided with one to one supervision The manager of the home should ensure that all admission documentation is fully completed, easy to read and accurate. Care staff should be given guidance as to what to do when a resident has loose stools for more than 24 hours. The manager should ensure all residents have an up-todate, written, person centred care plan by September 1st 2006 The registered person should give further consideration to the difficulties visitors have in finding staff when they visit the home and in exiting the building from the 1st floor. Hand-washing facilities in the medication room would ensure that medicines are always handled in a hygienic manner. Whitbourne House DS0000035476.V300132.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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