Inspection on 22/09/05 for Whitbourne House

This inspection was carried out on 22nd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Whitbourne House 05/07/07

Whitbourne House 15/06/06

Whitbourne House 20/03/06

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 Unannounced 22 September 2005 nd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 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 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 OP Old age 40 registration, with number of places Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Any persons 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 Date of last inspection 24 March 2005 Brief Description of the Service: Whitbourne House is a two storey purpose built care home that provides care and accomodation for up to 4O older people over 65 years. It has recently changed its function to provide care to mainly older people in need of dementia care and older people who experience mental disorder. The home includes a respite care/short term care unit that accomodates up to 9 people for a period of typically less than 1 month. Additionally there is a specialist day care facility for people with dementia that is intergrated within the home. This centre is used by those who live in the wider community. The home also has a smaller day care facility for those who live at the home. The home is situated on the outskirts of Swindon town in the Park South area. It is owned and managed by Swindon Borough and was fully refurbished and upgraded during 2005. Those living in the home have their own single bedrooms and there is a vertical passenger lift between the floors for easy access. The home has a large well maintained and secure garden which includes a paved area suitable for those who use wheel chairs. There is ample car parking. Typically the home is staffed by a minimum of 6 care staff per shift covering the main house. At busy times there may be more staff on duty. Additionally there are support staff who clean, house keep, administrate and garden. At night, 4 awake staff cover the whole of the service. Day services are staffed separately. The home does not provide nursing care. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This short focussed inspection, which was unannounced was for a period of 6 hours. Time was spent progressing the requirements and recommendations of the previous inspection, checking who was on duty, sampling 4 case files and tracking the care arrangements and viewing the refurbished accommodation. In total 17 standards were inspected out of a total of 38 of which 6 were satisfactory. Shortfalls identified in the report partly reflect the fact that the refurbishment programme had not been fully completed at the time of the inspection. Only 22 service users were placed at the home at the time of the inspection. Three ‘immediate’ requirements were made on the day of the inspection. 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. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 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 standard(s) 1, 2, 3, and 4 The home provides good information about the services it provides, including its terms and conditions of residency. Assessment of need falls short of the required standard. It is too soon to confirm that the care staff can individually and collectively demonstrate the necessary skills and experience to meet the needs of people with dementia or similar conditions, but extra training is being provided to them. EVIDENCE: The statement of purpose and service user guide has been updated to include recent changes to the service. Terms and conditions of residency are explicit and copies of these were seen in various case files. The inspector observed several interactions between staff and service users that appeared patient and compassionate. It was also observed that the care staff were using quiet tones and gentle touch, when engaging with service users. There is evidence to show that in recent months care staff have been provided with awareness training in dementia care but it appears that the care staff are on somewhat of a learning curve and need more help and support to undertake the specialist function they perform when caring for older people with dementia and/or mental disorder. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 8 Assessment documentation lacks sufficient detail and does not fully capture the everyday needs people have that arise from having dementia. They tend to read as placement assessments more than ‘person centred’ needs assessments. Not all assessments seen give enough focus as to what the person can do for themselves or how, or in what way, the person can, for example, communicate whether they are tired, cold, hungry or contented. The registered person is failing to ensure that people assessed for a place (or their representative) is informed as to the outcome of their assessment, including which needs the home can meet and which needs the home cannot meet. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 The home benefits from good working relationships with health care services. Like assessment documentation, some of the care plans lack sufficient detail or focus and they are not person-centred enough. EVIDENCE: Care plans do not seem to promote the person’s skills, interests or independency in those areas where they can be independent. Care plans appear to be weighted in the delivery of personal care at the exclusion of other needs. Some details appear very brief and rather functional. For example it was noted that for one recently admitted person their daily notes were brief records of 8 days, which did not adequately convey need or any required interventions. Care programmes describe mainly problems and do not give enough detail of what staff should do. For example, one case file states a person, “needs prompting with their personal care” but it did not specify in what way. Another document states someone, “has a small appetite” but it does not make it clear whether this is a problem area or not that requires staff intervention or not. In another person’s assessment it states the person “needs support with their activities of daily living to increase their confidence and quality of life” but the persons care plan did not appear to connect with these needs. In another file a care worker reported there were, “some little red Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 10 marks around the ankle” and left instructions for colleagues to, “observe very closely”. There was no evidence in the notes that any such observations had been made. The case notes for another resident acknowledge their poor health and associated difficulties including outbursts of verbal aggression, but there was no written guidance about how staff should best respond. In most case files day care (day time) needs were not sufficiently detailed or specified. The person in charge said that staff do not always record what they do and that staff know what is meant because it is discussed at a handover meeting when the shifts change. Staff report that they review care plans periodically. In one example the review period was recorded as 18 months. In another it was 15 months. Some reviews are more regular. More guidance is needed as to how often care plans should be reviewed, who should be involved in reviewing them and what is the main purpose of such review. The person in charge at the time of the inspection was not able to confirm that the recommendation made at the previous inspection about involving service users more in their care planning had been actioned. Case documentation shows that service users are supported to access a range of health care and specialist staff. The home benefits from having a good working partnership with Victoria Hospital staff and with local doctors. Case documentation shows that residents can access the district nurse, dietician and other specialists such as an NHS chiropodist on a referral basis. The service user guide and statement of purpose promote privacy and dignity. Comment has already been made about the way staff showed compassion and respect to the users of the service. Case files indicate peoples preferred form of address and staff were observed to knock on bedrooms before entering. Toilets and bathrooms have locks. Mail is given to residents unopened and doctors examine residents in the privacy of their own rooms, if needed. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were fully inspected on this occasion. EVIDENCE: Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were fully inspected on this occasion EVIDENCE: Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The recent refurbishment of the premises has greatly improved the home. However there were some areas where safety was being compromised due to some of this work being unfinished. Rooms occupied by residents were found to be well equipped. Several service users praised the standard of accommodation. EVIDENCE: Most areas have been redecorated and most rooms refurbished with new fabrics and furnishings to a high standard. All rooms occupied by residents appeared clean and airy. A new and much improved call bell system has been fitted, as has a water sprinkler system to prevent the spread of fire. Toilets and bathrooms have been upgraded, including provision of a range of adaptations to aid mobility and lifting. Improvements have been made to the dining facility and the kitchen. At the time of the inspection there was a small amount of remedial work to complete the upgrade and refurbishment programme as a result of flood damage. Some bedrooms were not occupied by residents pending re-carpeting. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 14 The inner front door is kept locked using a numerical keypad or other device. Other final exit doors are also kept locked. This prevents service users leaving the home unless authorised to do so. This measure is clearly in place to ensure safety. However such a restriction of liberty merits wider consent and agreement than was evident in the service users case documentation. Staff reported that they were not aware of how the (new) fire alarm system worked. It was observed that the middle fire escape into the rear garden had its lower steps blocked off as a safety measure to prevent service users climbing the stairs from the patio area. This well intentioned measure compromises fire safety and the person in charge was asked to immediately remove the obstacle and not to use it again to restrict the stairway. It was also noted that the rear garden was not secure and that various scrap items including beds and old radiators were placed in areas where there was potential for them to be a hazard. The proposed use of Room 42 as a bedroom was discussed with the person in charge. This room is considered unsuitable for use as a bedroom due to its design and location. It was noted that as a temporary measure the day centre had been relocated within the home. Five further risks to safety were identified; 1) The placing of square edged laminated shelves in some residents bedrooms at head height where it is possible residents may fall against and injure themselves. 2) The absence of any locking mechanism of the door into the laundry. 3) Staff reported their concerns that the macerators for clinical waste did not have an external overflow and this work area needed some extra ventilation. 4) Two fire escapes were in need of a general tidy and sweeping due to the collection of saw dust and other waste materials. 5) It was observed that wheelchairs were stored in unsafe areas i.e. under stairs cases leading to a fire escape and in corridors. Additionally documentation in the form of correspondence written by the local environmental officer indicated that when they carried out a food safety inspection in August 2005 there were a number of contraventions of the relevant legislation and some good practice recommendations. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were fully inspected on this occasion. EVIDENCE: Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 Because the current acting manager is not yet registered with the Commission or indicated their intention to do so the Commission is unable to verify their ‘fitness’. Some important safety aspects are being compromised due in part to issues arising from the refurbishment programme. EVIDENCE: Following the promotion of the previous post holder the current manager of the home is in an acting up position pending the post being advertised. At the time of the inspection the acting manager had not made an application to be registered as a ‘fit person’ to manage such a home. The last report from the registered person as to the conduct of the home was received by the Commission in July 2005 i.e. no reports had been received for the 3 months prior to the inspection. There is a detailed health and safety policy in place which staff are expected to follow. It can be seen from comments under ‘Environment’ that some safety Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 17 considerations are being compromised. There is a detailed health and safety policy file which staff are expected to follow. Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 1 2 3 2 2 2 2 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 x x x x x x 1 Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP19 OP19 OP38 OP22 Regulation 16(2)(k)( o) 23(4)(d) Requirement Ensure all unwanted items in the garden are removed by 5 p.m. on 28/09/05 Ensure relevant staff are inducted in the functioning of the fire alarm system by 5 p.m. on Friday 30/09/05 Urgent plans must be made to store wheelcahirs when they are not in use in the store located in the day centre. The registered person must review the current system of assessing the needs of service users so as to ensure that they reflect a person centred approach to identifying need. Care staff must be given more training and guidance in how to assess needs; how to record record daily events and staff inventions; and when to make changes to a care plan and when to review it. 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 assesment Timescale for action 28/09/05 30/09/05 3. 23(2)(l)(n ) 14(2) 28/09/05 4. OP3 0P4 24/11/05 5. OP3 OP4 14(2) 15(1) 24/11/05 6. OP38 OP4 13(7) 15(1) 24/11/05 Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 20 7. OP19 23(4) 8. OP21 23(2)(k) 9. OP19 OP38 OP19 OP38 13(4) 10. 13(4) 11. 12. 13. OP19 OP38 OP21 OP31 23(4) 16(2)(k) 8(2) must state why such restrictions are necessary and that there is no other alternative measure that can be safely taken. All such assessments must be personal to the individual service user. If the service user being assessed 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 such assessment must be placed on the service users file and reviewed from time to time as to its findings. No obstacles must be put across the external concrete staircase to restrict service users from using these stairs, unless the method used has been agreed in writing with the local fire safety officer. An external overflow system must be fitted, if it is practicable to do so, to the maserators in the sluice room. Measures must be taken to ensure that any shelving in rooms used by residents does not place them at risk of injury. Subject to the approval of the fire officer a lock or similar device must be fitted on the laundry door so it may be kept locked when not in use. Fire escapes must be kept clear of debris at all times. Additional ventilation must be provided in the sluice room. The registered person must ensure that without further delay a person is appointed to manage the home and that such a person submits an application to the 24/09/05 24/12/05 24/11/05 24/11/05 24/10/09 24/12/05 24/12/05 Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 21 14. OP31 26(2) 15. OP19 23(5 14(4)(c) Commission to be registerd as a fit person to manage Whitbourne Care Home. The registered person must ensure that the Commission receives each calendar month a report as to the conduct of home as required by Regulation 26 of the Care Homes Regulations 2001. The registered person must give further consideration and act on the requirements and recommendations outlined in the report from the local environmental officer of health dated 12 August 2005. 24/10/05 24/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 OP4 OP7 Good Practice Recommendations Consideration should be given to using the document titled Quality Dementia Care in Care Homes published by the Alzheimers Society as a working tool to improve standards of assessment and care planning. 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 activley involved in such a review. Consideration should be given as to how best to ensure service users are active participants in their care planning and review process:and how best to record their involvement. Note: this recommendation is carried forward from the last inspection 2. 3. OP6 Whitbourne House DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 22 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire 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 DD51_D01_S35476_WHITBOURNEHOUSE_V246168_220905_STAGE4.doc Version 1.40 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!