Inspection on 20/03/06 for Whitbourne House

This inspection was carried out on 20th March 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 15/06/06

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 Announced Inspection 20th March 2006 1:00 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.V278111.R01.S.doc Version 5.1 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.V278111.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Whitbourne House Address Whitbourne Avenue Park South Swindon Wiltshire SN3 2JX 01793 523003 01793 523016 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 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any person outside the category of Older People who are receiving care and accommodation at the home as at 31st December 2003 may remain living in the home, subject to an assessment or review of their needs at least every 6 months that the home is able to satisfactorily meet their care needs. When the home has a vacancy after 1st April 2004, this vacancy must not be filled until such times as the home is able to recruit the full time equivalent of 18 care staff in substantive posts. Any such calculations must not include staff employed solely designated to work in the day care facility, the home manager and ancillary staff such as administrators, cooks, cleaners, housekeepers and gardeners. Full time equivalent is defined as working 37 hours per week 2. 3. Date of last inspection 22nd September 2005 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 40 older people some of whom need early stage dementia care and some need 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 fire safety equipment, call bell and security systems as well provision of new furnishing and fittings. All service users have single room accommodation although 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 but meals are prepared and cooked in a main kitchen and typically taken in a communal dining room. Each living area is allocated a core group of staff to help ensure more consistency of care. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following the recent refurbishment programme this service has changed its function to provide for older people who need dementia care and/or have difficulties associated with their mental health. An application has been made to the Commission to amend the category of registration and this is currently being processed. At the time of the inspection a newly appointed manager was in place. He took up post in December 2005. This announced inspection took place over 2 days and involved 3 inspectors. On the first day the lead inspector visited the home for the purposes of mainly progressing the requirements and recommendations made at the previous inspection. On the second day a specialist pharmacist inspector inspected matters relating to medication. Two other inspectors undertook further inspection activity in relation to the welfare needs of the residents, related documentation and implementation of policies and procedures. In carrying out their duties inspectors spent time talking to several service users and spoke to a visiting relative. They also met with approximately 10 staff both in private and while they were carrying out work tasks. One inspector sat in a lounge observing the interaction between staff and service users. At the end of the inspection the inspectors fed back to the manager their initial findings. Prior to the commencement of the inspection the Commission also obtained various pre – inspection documentation from the home manager and obtained, through sampling, the views of 6 people resident at the home and 11 relatives or friends. Their opinions have informed this report. The inspection took approximately 21 inspector hours. In total 26 out of 38 national minimum standards (NMS) were inspected. What the service does well: What has improved since the last inspection? A new manager is beginning to sort out some inherited difficulties to improve the service. The garden is better maintained. Person centred planning has begun. Monthly management reports as required by the Care Homes Regulation 2001 have been resumed. Agency staff appear to be making a good contribution to the running of the home, when it is short staffed. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 6 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. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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.V278111.R01.S.doc Version 5.1 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): 3, 4. The inspectors found substantial gaps were evident in the way the service currently meets the specialist needs of people in the early stages of dementia and older people who have difficulties associated with ageing and mental health. The new manager is working hard to improve the standard of assessment, care planning and other documentation but at the time of this inspection the proposed new systems were not sufficiently in place for the majority of service users. Standards of care in some cases were considered to be failing. EVIDENCE: The overwhelming number of comment cards stated that people using the service felt well cared for. Nine out of 11 people said that they liked living at the home. Examination of 6 case files show that residents in the home have been assessed for a place and each has a written care plan. However for a specialist service many of these plans are inadequate, lacking sufficient coverage or the required detail. The standard of case documentation varied depending on who was recording the information. The link between assessment, care planning and review was often poorly established and the Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 9 views of service users were either poorly documented or assumed. In some examples the views of service users, their relatives, care staff and other paid staff were often presented as one viewpoint and were not always clearly documented. In some cases written risk assessments were carbon copies of a generic risk assessment rather than personalised. In one example the copy was exactly the same as a person admitted months before the person being assessed. This generic approach to assessing risk undermines seeing people as individuals. More than one member of staff confirmed that there is no expectation placed on staff to involve and consult with service users as part of any assessment/care plan process. Furthermore those staff who are closest to the resident i.e. key workers may not always be active participants in the formal process of review. One staff member who key works a service user admitted they had not looked at the risk assessment that was in place for this person. Several relatives have reported their concerns about the standard of care the service currently offers. They cite a lack of permanent staff, overuse of agency staff and a lack of sufficient understanding of people who have needs associated with dementia and ageing. Some relatives report that staff on duty at weekends do not know where to get the information they request or give the help they ask for. These critical views contrast with the written comments from 6 relatives who praise, some highly, the standard of care provided in the home. A recent complaint has highlighted poor attention to recording fluid intake and the inspectors found evidence that where care plans indicated a person needs turning to prevent bed sores there was no way of knowing whether the person had been turned and when. In one case it was noted that a record states the resident will need to be checked at night but does not specify why, when or the frequency. It follows that any agency staff (or newly appointed staff member) would lack the required information to ensure a consistency of care. Another record states a person that was receiving a specific medication with an instruction to staff to ensure that the person maintains an adequate diet. There were no records to show when the monitoring of meal intake should take place or who had the responsibility to check this. A feature of the inspection was the detachment of the support staff and the supervisory staff from access to, “champions” of best practice in dementia care. Some staff conveyed an impression that they have been overwhelmed with coping with the changes in the service. The inspectors have concluded that in some cases staff were working outside their level of understanding and competency and struggling to deal with the amount of personal care and supervision required in a service of this type and design. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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, 9 11 Care planning and the recording of important documentation on case files are haphazard and not always done to a satisfactory standard. It was almost impossible to establish from the care plan whether the care needed was being given as prescribed. Inspectors are concerned that, in this service, there are no written protocols in place about how the service manages requests for end of life care. As result it appears that some service users close to death are not getting the care and attention they may need. Increased training for staff should ensure that the handling of medication is safe for residents, however they may be at risk from the poor recording of doctors visits and instructions. EVIDENCE: Since the last inspection the home has started to update service users care plans into a new format. The inspector examined three new care plans that had recently been updated. The format used was clear and the care plan was split into abilities, strengths, wishes, and special requirements together with health and personal care needs. However the standard of recording did not give the reader any information in a person centred way. Information was vague, such as, “requires supervision with washing”, but no details on how the supervision should be provided. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 11 The inspector was particularly concerned to find one service user had a fluid and turning chart in their room and this action was not reflected in their care plan. Records kept in the fluid and turning chart were poor and the inspectors could not determine the frequency of the turns or the amount of fluids taken. This matter was brought to the attention of the manager during the inspection. The care plan had not been reviewed since November 2005. In another example fluid inputs were not being recorded though staff stated the fluid was being given. The manager confirmed that care staff are responsible for developing service users care plans. Care planning notes fail to adequately state what interventions staff must make and when. Examination of the ‘daily record’ notes relating to specific residents show that staff record details associated with personal care, falls and some behavioural challenges. Yet in several cases there was no evidence of any systematic monitoring of falls or record of what action are taken to ensure greater protection. In another example case documentation was unclear as to its meaning. For example a night time care plan stated “commode” but it was not clear what this meant. The inspectors were concerned that in view of the specialist nature of the service the individual care plans should be the responsibility of more senior staff who have sufficient understanding of the needs of people with dementia and associated mental health needs arising from ageing. Service users care plans highlighted those at risk from falls. However risk assessments had not been completed to minimise the risk to the service users. Medication is stored securely and appropriately, however further shelving is required to store food supplements off the floor. The pharmacy provides printed medication administration (MAR) records, which are completed at the time of administration. Photographs are used to aid identification. In some cases written additions or alterations to the MAR chart were not signed or checked. It was also difficult to trace some of the alterations back to the doctor’s instructions, as these were not consistently recorded. Although selfmedication is not suitable in most cases, a small number of medicines are held by residents for their own use. These must all be individually risk assessed and reviewed. One eye drop had not been dated on opening. The home had difficulty sometimes establishing and obtaining the correct medication for respite residents. A separate procedure for staff to follow for respite cases would help them ensure that the medication they received was accurate. A new training program for all staff involved in medication has recently been started. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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. Service users, relatives and staff working in the home report a lack of sufficient daily activities take place; a view the inspectors agree with. Visitors are welcome but some have commented that when they visit at weekends they cannot always find the staff easily and that it can take a long time for the doorbell to be answered. The majority of service users report being content with the amount of involvement they have in running the home. Best done is the involvement of service users in menu planning and freedom to choose when to go to bed. However a significant minority of current service users would like to be more involved. Arrangements for menu planning and food options appear good. EVIDENCE: A significant number of service users comment that they would like more activities citing bingo and scrabble as 2 examples they would like to be able to do more. Relatives also express a view that there is a lack of activities in the home. Two relatives make a connection between the lack of available activities at weekends and the lack of sufficient staff deployed throughout the service. More than 50 (6 out of 11) of the service users who completed a comment card stated they would like to be more involved in the running of the home. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 13 Options to go out of the home are restricted for reasons of personal safety but for some residents this causes them distress and there does not appear to be any managed strategies in place about how best to help people with dementia connect with the ‘external’ world. The new manager has already canvassed the view of relatives and has a plan to introduce a gardening project, which may help alleviate boredom and go someway to meet this need as it could involve visiting garden centres. Care staff report that the person who co-ordinated day activities has a new job role so less activities have been provided of late. Staff report that some activities take place on a weekly basis. Case documentation hardly shows any activities are undertaken by service users. In a good care home varied activities should be made available every day and not be seen as a weekly option. The home welcomes visitors. Service users confirm they can receive visitors in their own room. The home provides various quiet lounges. The home operates a four-week rotating menu and service users able to express a view were generally satisfied with the quality and quantity of meals provided in the home. Discussion with the cook confirmed service users are offered a choice at each meal. To ensure service users are able to make an informed choice on what they eat service users are offered the choice of meal at the table. The cook confirmed service users special diets, wishes, likes and dislikes are catered for. The cook gave examples of alternatives meals being provided to service users. It is a requirement that these meals are recorded. The home needs to review the meal times to ensure there is no more than twelve hours between breakfast and supper. An environmental health officer’s inspection was carried out in August 2005. This inspection identified 12 requirements one of which remains outstanding. It is a requirement that the environmental health requirements are met in full and the home must ensure refuse bins for food are provided in sufficient numbers for the needs of the home. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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. While complaints are taken seriously inspectors found that the manager was not being made fully aware of the number of recent complaints. Staff show an awareness of what to do if someone alleges abuse has occurred and they are provided with relevant guidance. EVIDENCE: Service users and their representatives are provided with details on how to complain and whom they can complain too. There is a detailed written complaints procedure in place. The inspectors were told that since the last inspection there have been 4 complaints made to the council and 2 made to the Commission. Details of the complaints made to the council were not available in the home at the time of the inspection. The newly appointed manager confirmed such details were with the central complaints team. Requests to this team to provide the Commission with details of these complaints have so far been unsuccessful. The inspector also came across documentation that indicated that a person had complained to a senior staff member on duty about the conduct of a staff member. The newly appointed manager informed the inspectors that he had not been informed of the nature of the complaint, had no knowledge of it and that he would expect to be so informed. This clearly is not happening and has the potential to place service users at risk. The newly appointed manager is aware of the need to improve the management of complaints and as a first step has written to all relatives inviting them to report any concerns they have to him when they arise. The home has a written policy on the protection of vulnerable adults. Staff are provided with details of the policy and protocols as part of their induction. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 15 People in the home have good working knowledge of these procedures and the home benefits from being part of the local authority that can provide specialist guidance and support if it is needed. The service appears to have a good understanding of issues arising from lack of capacity and the involvement of advocates and others in protecting service users from harm. Examination of case files confirm that, where relevant, staff in the home appear to have good and effective working relationships with advocates, solicitors or family members to ensure the wider protection of property and money. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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, 20, 21, 23, 24, 26. The home is ideally located and when everything works as intended provides a safe environment but this was not found to be so at the time of the inspection. Management systems to ensure equipment works properly have been ineffective. Toilets and bathroom area were found to be pleasant and clean. There is scope to further improve the comfort and safety in the dining area. For the second consecutive inspection aspects of fire safety fell short of a satisfactory standard. Bedrooms are well equipped and spacious. EVIDENCE: The inspectors toured the communal areas of the premises and at the invitation or with the permission of the occupants viewed a number of bedrooms. The home is ideally located within easy access of the population it serves. The recent refurbishment programme has greatly improved the home ensuring service users have bigger bedrooms with modern furnishings and improved furnishing and fabrics. Everywhere has been redecorated and carpets have been replaced in most areas. But not everywhere was safe. Despite the previous inspection raising concerns about fire safety and the security of the Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 17 building both these areas were not safe. Records showed that when the fire brigade were called to deal with a fire alarm sounding they were unable to gain entry to the building due to the main door being locked. This was due to a fault in the fire alarm system not activating the door opener. It was also found that faults in the fire alarm system identified by the maintenance person in October had not been rectified. Furthermore records show that the person responsible for carrying fire safety checks recorded having done so on a day that the person said they did not work i.e. Christmas Day. No satisfactory explanation has been received as to the inaccuracy of this record. Records also state that on occasions escape routes were found “partially blocked” and the fire extinguishers did not appear to have been serviced in the previous 12 months. There was also a record to show that “staff took part in a questionnaire on fire safety the response to which would give cause for concern.” The two garden gates were not secure. Toilets and bathrooms were found to be clean and well equipped. Staff report some difficulties with the amount of available storage space – partly due to the day centre being temporarily out of use. It was noted that a laundry area had no sink and that some of the dining room chairs had arms that were loose. The chairs in the dining room appear somewhat low for people who need a higher seat. Service users and staff reported favourably on the refurbishment programme saying it had greatly improved the home. A view concurred by the inspectors. The home employs two laundry assistants who provide laundry cover seven days a week. The laundry room is situated well away from any food preparation areas. The laundry room has been updated as part of the refurbishment programme. There are two commercial washers and two commercial dryers, which are sufficient for the needs of the home. The laundry room contained a disinfecting sluice and a macerator for soiled incontinence pads. The inspector was advised that these are to be removed from the laundry area to reduce the risk of cross infection with clean laundry. The laundry assistant confirmed they had received training in infection control. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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, 30 The number of staff who have a relevant National Vocational Qualification is impressive: but this is yet to translate into a skilled and competent work force in all areas of care. There are some concerns about the availability and number of staff on duty. Inspectors cannot confirm the service was safe at the time of the inspection. EVIDENCE: The evidence points to some staff deployment deficits. Relatives indicate that staff are not easily available at weekends and they say that it can take a long time for someone to answer the doorbell. They also say they may be in the home for some time before they see staff. Service users talk about there not being enough activities and one relative connected this with there being less staff on duty at weekends. The manager reports that at the time of the inspection there were 9 permanent staff members on long term sick. Records provided by the manager shows that in a 6 week period commencing January 1st 2006 agency staff covered the equivalent of over 210 shifts of 7.4 hours. Seven relatives in their written comments to inspector raise concerns about staff deployment or the numbers staff on duty when they visit. Records also show that the take up of National Vocational Qualification training (level and above) has been outstanding with 100 of substantive staff having achieved this award. This has yet to be translated into a demonstratively competent and knowledgeable staff team in aspects of dementia care, care of conditions associated with ageing including end of life care, care planning and the recording key decisions and interventions. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 19 Paradoxically training records given to the inspector by the manager show poor take up of skill based and awareness raising courses. For example, these records show that approximately 28 staff have received equality awareness training, 23 moving people training, 11 fire safety awareness, 9 first aid training, 5 medication training and 2 dementia care training. Inspectors spoke to 2 agency staff who were working in the home and they confirmed they had relevant qualifications to undertake their role. However neither was able to produce photo identification to confirm who they were. It was observed how attentive these 2 agency staff were to the group of residents in their charge. While inspectors observed good interaction between residents and staff and also noted evidence of patient, respectful and kind interventions by staff the poor standard of care planning, the absence of ‘end of life’ protocols with relevant health care workers and families, the absence of sufficient person centred planning, poor attention to fire safety and insufficient quality audit means that inspectors cannot confirm this was a safe service at the time of the inspection. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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, 35, 36, 38. The newly appointed manager appears to be working hard to improve the home and to progress its specialist function. Aspects of quality assurance are developing and service users financial interests are properly safeguarded. There is scope to further improve the arrangements for supervising staff. There has been a lack of sufficient auditing of standards by management. Activities are under developed. EVIDENCE: The application by the current manager of the home to be registered by the Commission as a ‘fit person’ to manage this service has not yet been determined. Inspectors were impressed by the new managers determination to improve the home and steps he has already taken in a short period of time to ensure improved person centred care planning, dealing with complaints and the development of work teams. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 21 The corporate organisation has obtained the ‘investors in people’ award, which is a nationally recognised quality assurance award. The manager confirmed that there was no annual development plan for the service for 2005 that reflects of the service aims and outcomes for service users. Work has started to review the provision of day activities but this has not been translated into an action plan. The manager confirmed his intention to do this in the coming months. He also has a plan to develop a directory of resources and needs. Service users criticize the service for the lack of activities. One staff member expressed a view that without a designated activities worker attention to activities has diminished. Staff report difficulties in finding time to actively involve service users in leisure and learning. There is some evidence to show that management periodically reviews various policies and procedures though the overall impression is that this is done haphazardly and that the process is neither efficient nor effective. This particularly applies to policies in relation to assessment, care planning and supervision of staff. The staff supervision arrangements during 2005 fell short of what was required. Examination of numerous records of supervision meetings show an inconsistent methodology is being used and in some case there appears to be insufficient focus on staff performance and understanding of their job role. The new manager has put a system in place to ensure this aspect of management is better monitored for 2006. There has been a failure to ensure that each month a senior manager visits the home and reports to the responsible individual as to the conduct of the home. However this now seems to have been established on a firmer footing in the 2 previous months and therefore the inspectors will not include it is a requirement in this report. When such visits have been made it appears that some key areas have not been checked. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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 X X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 1 3 3 X 3 3 X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 1 X 1 Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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 OP30 Regulation 14(2) 15(1) Requirement Timescale for action 20/06/06 2 OP4 13(7) 15(1) Care staff must be given more training and guidance in how to assess needs, and how to record daily events and staff interventions and when to make changes to the care plan, and when to review care plans. Note; this requirement was made at the previous inspection with a timescale for compliance set for 24/11/05 No resident should be restricted 20/06/06 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 such restrictions are necessary and that there is no alternative measure that can be safely taken. All such 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 DS0000035476.V278111.R01.S.doc Version 5.1 Whitbourne House Page 24 3 OP4 12(3) 4 OP4 18(1)(c) 5 OP4 18(1)(c) 6 OP12 16(2)(n) 7 OP15 17(1) 8 OP15 12(1)(a) appropriate representative and endorsed by the service users care manager. The details of any 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 with a timescale for compliance set for 24/11/05 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 such care should be managed. This protocol must give consideration to the availability of any extra staffing that may be needed at these times. All relevant staff must be provided with the training they need if they are providing ‘end of life’ care. 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. In consultation with service users and those who represent them an urgent review must be undertaken to consider how best to provide a range of suitable activities for people resident at the home. A record must be kept of all meals given to service users that are an alternative to the main menu. Meal provision should be so arranged that service users do not have to wait longer than 12 DS0000035476.V278111.R01.S.doc 20/06/06 20/09/06 20/06/06 20/06/06 30/04/06 30/04/06 Whitbourne House Version 5.1 Page 25 9 OP15 13(4)(c) 10 OP16 17(1) 11 OP19 23(4) 12 OP19 23(2)(c)( 4) 13 14 OP19 OP19 23(2)(o) 21(4) hours between mealtimes. The responsible individual must ensure that the recommendations of environmental officer of health following their inspection in August 2005 be carried out in full. 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. Appropriate corrective action must be taken at all times to ensure that any faults with fire safety system are promptly repaired or made good. Any breakdown of the fire safety system and fire fighting equipment including the fire detection system, or the lift or the call bell system that lasts longer than 24 hours must be reported to the Commission with out delay and confirmed in writing. If not already done so the home must ensure that the 2 garden gates are made secure. The responsible individual must ensure that persons competent to undertake such work routinely service the fire detection system every 3 months in accordance with the relevant British Standard BS 5839 PART 1. The responsible individual must ensure that a competent person services all fire extinguishers in the home by 1st April 2006 and at a period not less than annually thereafter. The persons recording when the fire alarm system is tested DS0000035476.V278111.R01.S.doc 30/04/06 30/04/06 30/04/06 30/04/06 30/04/06 20/03/06 15 OP19 21(4) 01/04/06 16 OP19 17(1) 30/04/06 Page 26 Whitbourne House Version 5.1 17 18 OP19 OP9 23(4)(d) 13(2) should ensure that the record is accurate. Further training in fire safety must be provided to those staff that need it. All eye preparations must be dated on opening and discarded after the appropriate time. All self medication processes must be risk assessed and regularly reviewed A written record must be kept of all GP and healthcare professionals visits, changes to residents’ medication and any specific instructions for the use of medication. A separate, detailed medication procedure for the admission of respite residents must be adopted to ensure that they receive correct and timely medication. 30/04/06 30/04/06 19 OP9 13(2), 13(4)(b) 13(2) 30/04/06 20 OP9 30/04/06 21 OP9 13(2) 30/04/06 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 It is recommended that all written care plans are reviewed at least once every calendar month, and that where practicable to do so, the service user should be actively involved in such a review. Note; this recommendation was made at the previous inspection It is very strongly recommended that all service users have a care plan/service user plan modelled on a person centred approach. DS0000035476.V278111.R01.S.doc Version 5.1 Page 27 2 OP7 Whitbourne House 3 4 5 6 7 8 OP3 OP7 OP3 OP4 OP14 OP36 9 10 OP26 OP19 11 12 OP9 OP9 Assessment of risk in relation to each and every service user must be individualised and not a generic assessment. The views of service users should be recorded in their assessment of risk, service plan or any other relevant documentation. It is strongly recommended that when undertaking any assessment or plan of care the views of the service users key worker be sought. It is very strongly recommended that, ‘champions’ of best practice in dementia care be recruited as role models for staff to learn from. Further consideration should be given as to how best to support residents who wish for more involvement in the running of the home. It is strongly recommended that managers responsible for this service undertake an urgent review of this service and satisfy themselves that care staff are being properly guided and supported in carrying out the duties that they are expected to perform. If any deficits are found then an action plan should be drawn as to what corrective action is needed. A sink should be fitted in the laundry area, without further delay. It is strongly recommended that where staff identify any faults with the fire detection, system, lift, call bell system or in any other essential equipment that needs repair the staff follow up any verbal requests to the contractor in writing. Written additions and alterations to the medication administration record should be signed, dated and checked by two members of staff. Consideration should be given to the appropriate storage of food supplements, as they are currently stacked on the floor. Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 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. Extracts may not be used or reproduced without the express permission of CSCI Whitbourne House DS0000035476.V278111.R01.S.doc Version 5.1 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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