Inspection on 05/07/07 for Whitbourne House

This inspection was carried out on 5th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 15/06/06

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 Unannounced Inspection 5th July 2007 01:30 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.V336756.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.V336756.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 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 Mr Mark Mac Neaney 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.V336756.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. 15th June 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.V336756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Overall this report confirms this is a much improved service. This inspection was carried out over 3 days totalling approximately 20 hours. On the first day of the inspection was an unannounced visit when the inspector spent 4 hours mainly observing care workers and residents using the Commission’s short observational framework (SOFI) methodology. The other two days involved examination of randomly selected case files plus other documentation and talking to residents and visiting relatives. Time was also spent observing a mealtime and the medication round. A tour was made of the premises including viewing most bedrooms and the grounds. Three care workers were interviewed including an agency worker. Other staff were spoken to informally as they went about their work. Staff recruitment and training records were checked. Time was also spent with the homes manager and the administrator progressing the recommendations and requirements made at the previous inspection. Checks were also made on how resident’s money was being safeguarded. The register of complaints, incidents and accidents records were examined along with the fire safety logbook. A number of management reports were seen including the most recent quality assurance findings. The service was also required to provide the Commission with detailed information about the service and the people living at the home. The Commission also sent survey forms to 20 relatives and 20 residents to get their views and we contacted a small number of health care workers and care managers with patients/clients at the home to get their views. The views of residents’ relatives and others have therefore informed this report. In total 31 out of 38 NMS were inspected of which 3 were commendable, a further 23 were met and 5 showed a minor shortfall. Fees levels are subject to local authority means test and vary depending on the care package required. What the service does well: This is a well managed care home that is now providing good all round standards of care and comfort, in most of the key standards, to those residing at the home. Residents and their families are beginning to benefit from the specialist nature of the service. Staff are very well managed and supported. It can be seen that many care workers try their best to meet resident’s needs and engage them in a positive way. Residents and relatives report good satisfaction levels with meal arrangements. The service is good at safeguarding resident’s moneys if a resident or their family are unable to do this for themselves. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 6 Staff communication and accountability is much improved. The number of staff who have gained a relevant National Vocational Qualification far exceeds the required quota. 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. The summary of this inspection report can be made available in other formats on request. Whitbourne House DS0000035476.V336756.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.V336756.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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 1. 2. 3. 4. Quality in this outcome area is good. The service provides a range of information, though some relatives say they do not get the information they need. The assessment process is much improved. Residents and their relatives express positive views about the care provided by the home and the home has now has effective working relationships with local specialist services, including health care departments. Care workers appear to have an improved understanding about dementia care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a detailed service users guide and the statement of purpose, both of which have been updated to take account of some staff changes and to explain the nature of the service. Four relatives indicated in their, ‘Have Your Say’ (HYS) leaflets that they are not provided with enough information about the service. This suggests that the information that is available is either not being passed on or that relatives do not know who to ask for the information they need to that information is not being displayed for visitors to see. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 9 Three case files were selected for the purpose of evaluating the service people receive and whether there was the required documentation in place. Written terms and conditions of residency were found in two of the case files examined. In respect of the other file the person had been admitted as an emergency and a decision had not yet been taken as to whether this person would be offered a permanent place. The manager stated that if a permanent place was offered then written terms and conditions would be drawn up. In some cases information may be available to the home because the person has been an attendee at the day centre or has used the respite care facility. In one case a person who was admitted as an emergency had information in their case files that was provided by the care home where they previously resided. A much improved aspect of this service is the way the assessment process takes place. Not only is it more person centred but also it is more comprehensive and detailed. Examination of the files show that information is gathered from a variety of sources including where appropriate specialist health care departments such as Victoria Hospital alongside the input of other key people including relatives, care managers and specialist health care workers. The nature of the service is that some residents have difficulties in expressing their wishes and that care workers must interpret need based on the information available to them. While the care plans are more person centred they could be further improved if they recorded more of the person’s views, as spoken, so as to avoid the tendency of care workers to speak for the person when they can speak for themselves or others c an speak for the person. Comments about the way the home meets people’s needs were very positive. For example one relative in their HYS leaflet told the Commission, “My mum is consulted about what her needs are.” Another person said, “The care home meets my husbands needs – he is happy at the home.” Someone else said, “ The care given to my mum is excellent.” Another relative said, “ the care is very good – [it] fulfils all my mothers needs. Another person commented, “staff are very caring in sometimes difficult and stressful situations.” People living at Whitbourne House also express positive views. One man being assessed said he hoped he could stay at the home. Others comments include, “staff are always ready to help [me]” and, “staff are kind.” Since the last inspection progress has been made in fermenting improved working relationships between the home and the local specialist services, including health care services. There is evidence which confirms that care workers have been improving their skills and increasing their knowledge about dementia and mental illness in relation to old age (see under staffing). One apparent unmet need is that black people do not take up residency at this home. The reasons for this are unclear. Whitbourne House DS0000035476.V336756.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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 7. 8. 9. 10. Quality in this outcome area is good. The system of care planning has improved and is now more person centred. In some cases care workers are sometimes missing opportunities to write down the resident’s views or write down how the care plan should be monitored and by whom. There have been too many medication errors occurring. The home works hard to ensure all residents are treated with respect and in a dignified manner, though some care workers were observed to talk loudly about private matters when in a communal area. The home is now better at recognising its limitations in providing ‘end of life’ care to those who are very poorly. As a result it has improved its liaison with health care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of selected case documentation shows that each person has a detailed care plan which also includes a night time care plan. Typically a night time care plan will indicate if the person requires hourly checks or two staff to move them, or when they would like a drink and any toileting needs the person may have. Day plans not only outline any tasks that may be required they include comments about psychological and social needs. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 11 For example in one care plan it said, “Always use a calm approach”. In another, “[give] reassurance after their visitors depart.” Plans also include information about health matters, though some plans are still not always specific enough about how often or when such needs should be monitored and who should undertake the monitoring. Comments seen in case files such as “kitchen staff [are] aware of Mrs X preferences” or “ X prefers to drink her tea in a cup with spout and “encourage fluids” do not give staff who are unfamiliar with the person enough information to be able to deliver basic care without reference to others. If residents cannot articulate their needs it is possible that some needs will not be fully met, unless they are sufficiently detailed in the documentation. It is not always clear when a care plan has been reviewed and what were the views of the person being cared for, if reviewed. Consideration should be given to separating health assessment documentation from other assessment documentation as the volume of paper work makes monitoring or auditing a challenge. This separation of paperwork may enable a better focus and be easier for staff to access the information they need. Care plans are quite good at validating people’s independence and self respect, with comments like, “likes to get up for his breakfast” or “needs reminding of his loss of his [wife] as he forgets” or “stay with [x] while he gets dressed as he forgets the order in which he needs to do things.” Care plans are used to prompt staff to remember to keep the person’s GP informed of any involvement with hospital staff. Documentation confirms that plans are being reviewed regularly, though not always monthly. For example one persons plan was reviewed eight times in the previous 12 months. Another person’s plan was amended seven times. The manager said the home is working hard to review everyone’s care plan at least once every calendar month. Supervisors need to ensure that this happens or find out why it is not happening and take corrective action. The system for recording peoples weight could be better as it is not clear if everyone is weighed on admission. Weighing people on admission provides a benchmark where subsequent weight gain or weight loss can be measured. Without such a record it is guess work until a person is weighed. A new innovation in the service is the introduction of a “residential impact assesment” It is the policy of the home that no resident keeps or administer their own medication for reasons of safeguarding others. The home has a detailed medication procedure which staff are expected to follow. Staff that administer medication cannot do so unless they have received the required training. There is always a second person that assists with medication. Their duty is to check the medication before it is given to the person. However four medication errors have been reported to the Commission since the last inspection that has been caused by staff error. When medication errors are made the home has disciplined some but not all of the staff making them. Case notes indicate that these errors are reported to the resident’s family when they occur. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 12 It is also apparent that care workers have sought medical advice at the time. This open reporting is commended. Paradoxically care workers have also reported medication errors made by the pharmacist and a local doctor. The home has as number of policies that promote dignity and self-respect. Care workers confirm that these areas are covered in their induction programme. Staff were seen to be respectful, dignified and polite when talking to the people who live at the home. They were seen to knock on doors before entering bedrooms. Some people were called by their first name and some more formally which suggest care workers use peoples preferred names and confirms that not everyone is treated in the same way. Care workers were observed to discretely cover up exposed people when sitting in communal lounges or lying on the bed. There are some areas where some improvement is possible because of some of the challenges that exist. For example care workers were observed to talk loudly to people about the need for toileting in a room with strangers (and other residents). It was also observed that a care worker spoke loudly to a colleague about a resident’s immediate health care need in the dining area during lunch. – A conversation topic that would have caused offence in a restaurant! Consideration should be given as to whether the essential caring task of toileting can be more discrete. Another challenge according to relative feedback is that on occasions people loose items such as glasses, teeth and clothing. As one HYS leaflet stated, “there is a need to ensure washed clothes are correctly returned … this can cause distress to families and to residents.” Staff report that they work hard to trace missing items and sometimes items cannot be found, which they also find upsetting and difficult. The impression gained is that staff work hard to minimize these losses. At the same time progress has been made in the recording of care interventions such as turning charts, fluid intake and tissue care. This improvement is further endorsed by a health care specialist. The home has received several letters of appreciation from relatives praising the care provided during the end stages of life. For example one said, “ Thank you for the loving care shown to our mother and to us during the last few days of her life.” Other relatives wrote, “Thank all the staff for their the outstanding level of care” and “Thank you for making [our family member] last few weeks very comfortable.” Discussion with the manager indicates that the home has developed better protocols with health care professionals about the limitations of the service in respect of end of life situations including ‘end stage’ dementia. This is partly because the home cannot lawfully provide nursing care. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 12. 13. 14. 15. Quality in this outcome area is good. Overall this is a much improved area. Care staff are working harder to engage with residents in social interactions of all sorts. However greater awareness is needed that many residents prefer quality time with a care worker or the option to undertake activities spontaneously more than having pre-planned structured activities. Care workers try hard to support the residents to make choices and decisions for themselves. Many residents complimented the standard of the meals at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The arrangements for activities are much, much better than at previous inspections as evidenced by the short observational framework for inspection (SOFI methodology). It is apparent that care workers now understand the need to sit and be with residents and engage them in social interaction of all sorts. Working patterns now allow this to occur, so there has been a cultural shift away from seeing care as just delivering personal care to delivering a more holistic approach. Observation of one group shows that interactions between staff were mostly positive or passive rather than negative or withdrawn. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 14 Analysis shows that the percentage of engagement for three residents that were observed were between 85 and 91 over a 1 hour period. In the other group five residents were observed and the levels of engagement were found to be more inconsistent: being between 42 and 100 . Put together theses scores indicate high levels of engagement for most people. However the observations also show some learning points. Quieter residents are getting less attention than noisy ones. People with their eyes shut are assumed to be asleep and miss out on social niceties, including touch. One person asleep in a high chair was left in an uncomfortable position for 45 minutes. The distribution of engagement between care workers and residents is not evenly distributed with one resident getting 100 during the observed period and two others hardly any engagement or much less. Supervisors need to help care staff learn to share out their affections and indulgences more evenly ensuring everyone gets some quality time. People’s views about activities are a bit mixed. Only two out six residents said there were enough activities in the home – yet four residents said they did not want to take part in the activities “out of choice”. One resident commented that there was not enough entertainment. Relatives also speak of their wish for more activities and the need to encourage more socialising. Discussions with staff illustrate the challenge of planning and providing some activities because residents decline to participate in them when the time comes to start them. Special events are birthdays are remembered by staff and celebrated. It can be clearly seen that care workers are making much more effort to engage residents, but more awareness is needed that for some people that prefer socialisation i.e. quality time with a person more than structured pre planned activities that are task orientated. Visitors are made to feel welcome. Two very frequent visitors confirmed that care workers make them feel welcome and that they can sometimes have a meal and that they are included on tea rounds; something observed during the inspection. They praise the caring qualities of the staff; one said they are marvellous and very caring. HYS leaflets also make similar favourable comments such as; “they [staff] give great support and care.” Personal centred planning promotes autonomy and choice within the confines of each person’s limitations and safety considerations. People living in the home are encouraged to bring items of endearment to place in their room. Preferred routines are indicated in care plans. People are supported to make decisions about what to do, what to eat and when to go to bed. People can choose whether to stay in their rooms or use any of the communal areas. Residents were seen, on what was a warm day, to control ventilation by shutting/opening windows and the patio doors without reference to staff. So it can be seen staff try to support residents to make decisions for themselves. One area where choice is effectively denied is the option to exit the home due to the use of security locks or to manage their medication. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 15 Meals are taken in one of two dinning areas, if not taken in the resident’s own room. The main meal is usually mid day. It was observed that people get a choice of menu and that they are helped to select their preferences by staff taking them plated options so they can visually choose. Menus are also written up in large letters on a wipe board. Staff serving food were observed to wear plastic aprons. Most care workers were observed to be relaxed, considerate and patient with residents during meal times. After lunch the inspector asked at least six residents about the meal they had. No one made any adverse comments. Some residents praised the meal by saying, “It was really good” or “there was enough food on my plate.” Records show relevant staff receive training in basic food hygiene. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 16. 18. Quality in this outcome area is good. Good progress appears to have been made in providing a consistently satisfactory service to those living at the home. While care workers appear to know what to do if a resident is vulnerable to abuse more care workers need to attend a relevant course in safeguarding adults. Resident’s monies are being appropriately handled. Recruitment of staff includes proper safeguarding checks, such as Criminal Record Bureau checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are fewer complaints about this service when compared to the previous year. Records in the home show there are more compliments than complaints. Health care professionals also confirm that the home is now much less complained about and that their patients and/or the families of patients seem happy with the service they get. Not all relatives confirm in their HYS leaflets that they know about the complaints procedure. The home cannot reasonably be expected to inform every relative of the procedure but it would further improve the management of complaints and the resolution of concerns if the contact details of who to complain to were displayed in communal areas or in other conspicuous places for all to see. One relative stated that they had used the complaints procedure and that the matter of concern, which they had, was resolved. However they said that they did not get a written acknowledgement of their complaint and their complaint was not recorded in the complaints book. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 17 The manager thought that the person in question may have raised the matter verbally and that as it was addressed it was nor recorded. He had no knowledge of having received a letter from this person. If he had received one he said it would have been acknowledged. Lessons have been learnt following an investigation into a complaint that was made before the last inspection but which had not been concluded at the time. Progress has been made to ensure there is better protection of people who are vulnerable due to their infirmity, illness or their condition. This includes improving the protocols for reporting concerns and interventions, having clearer service objectives, ensuring more effective recording and communication and improving management and supervision systems. A significant proportion of staff have not yet received training in safeguarding adults; something the current manager is keen to address in the coming year. Records show that only 18 staff has undertaken such training, some of whom are no longer employed at the home. Discussion with care workers indicates that never the less they know what they should do if they have any concerns that a resident is being abused or harmed in any way, by anyone. There is also a detailed ‘whistle blowing’ procedure in place which staff can use to report any concerns. Meetings are arranged with supervisors where issues of concern can be raised in private. If appropriate there are resources that can be called upon to investigate any complaint, including using an independent person to do so. There are good systems in place to ensure the proper management of any monies that the home holds on behalf of residents. This includes periodic financial auditing and proper accounting systems. One example of the protective nature of the system is that any visiting hairdresser is not permitted to take money from a resident. Instead the hairdressers will bill the home, which will arrange payment to the hairdresser. The financial records of two people selected at random were checked. The money held on their behalf reconciled with the account record. Receipts were available for money spent and there appeared to be no unusual or excessive spending patterns. Staff, including bank and agency staff report that they are informed as to the local protocols for dealing with allegations of abuse and that they have access to the General Social Care Councils code of practice, which they are expected to follow. While there is evidence that confirms all staff are checked by the CRB the records in relation to agency staff does not provide the date when such checks were carried out. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 19. 21. 23. 24. 25. 26. Quality in this outcome area is good. The home provides a good overall standard of accommodation and comfort though in a small number of areas there was some dirty paintwork evident. The laundry area lacks suitable storage space and is not entirely adequate. There are plans to further improve the garden area and provide a large conservatory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most of the accommodation was viewed including residents’ bedrooms, bathrooms, toilets, communal lounges, the two dining areas and the unit where respite care is provided. A tour was also made of the grounds and garden. Except in rooms where people were sleeping, visual checks were made on windows to ensure they had restrictors designed to ensure peoples safety. All were in place. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 19 Generally the accommodation was found to be clean though in one or two areas some dirty ‘scuff’ marks were evident on the paintwork, especially along corridors. This suggests that these areas are not getting wiped as often as needed. Toilets and bathrooms were generally clean and properly equipped with hand washing facilities. The main concern with the building appears to be the lack of suitable storage space, especially in the laundry. The laundry has no blinds on the doors/windows, which makes it institutional. There is no good place where staff can iron clothes or linen. The laundry area is not kept locked when not in use. Staff said that people who lived in the home never went into the laundry, even if someone was working in there. However this should not be taken for granted. It was observed that the respite care facility appeared rather small and compact for the number of people accommodated. However it was confirmed that the week following the completion of the inspection the day care element of this service was to be relocated thus freeing up some space for those who receive respite care. The garden area now benefits from improved security fencing and provision of a new BBQ area. There are plans to erect a large conservatory in the garden area to bring the outside, inside. Discussion with the manager suggests that proper consideration has been given to ensure the safety for residents while this work will be carried out. Arrangements for ensuring fire safety appear satisfactory with quarterly fire drills, periodic servicing of equipment and the installation of a sprinkler system. Staff report they receive fire safety training, which is further confirmed by the staff training record. The manager confirmed there are plans to improve the fire exit that leads into the garden from the first floor. Agency staff confirm being told what to do in the event of a fire occurring. It was noted that one room was no longer being used as a bedroom as it formed part of the fire escape route. On the first day of the inspection three toilets had ‘do not use’ notices on the door as they were blocked. These were repaired within 24 hours. It was observed that care workers assisted several residents to walk around the grounds in a relaxed manner on a pleasantly warm day. When doing so they were seen to be chatty, friendly and engaging with the residents. People living at the home were also seen to be sitting on their own or in very small groups in the shade in a relaxed and safe manner. Also care workers were discretely observing them. The home has a detailed infection control policy. Care staff confirmed that they are provided with protective clothing to help reduce infection. Training records confirm that care workers are provided with basic infection control training. It appeared that the home has not been successful in eliminating an unpleasant odour in one bedroom and therefore a new floor covering is now needed in this room. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 20 Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 27. 28. 29. 30. Quality in this outcome area is good. Proving sufficient numbers of permanent staff presents a challenge to the management of the home and sometimes the home has to rely on agency staff or bank staff to supplement the permanent staff. This can result in some residents having a lot of different carers or having to wait when they need attention. However the staffing situation is much improved because it is more skilled, better trained and better supported than previously. Residents and relatives praise the staff for their caring qualities and health care workers also say the staffing situation is much improved. Recruitment checks are done well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the staff rota and discussion with the manager and other staff indicates that on occasions the home is still reliant on deploying either bank staff or agency staff to ensure adequate staff cover. However it appears that more bank staff rather than Agency staff are now being used. This helps residents because the Council selects these bank staff. As one bank worker put it, “this means we get the same recruitment checks, same induction and can access the same training courses as permanent care workers”. Agency staff are sent by private recruitment organisations and may at first be less familiar with the homes routines and expectations. Typically their training and supervision is determined by the agency and not the home. However this still means that people who may be confused or experience disorientation are having lots of different people providing them with care. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 22 As one relative put it in her HYS leaflet, “permanent staff seem to know the clients very well but I feel the [other] staff are not so familiar. There were also hints that on occasion some residents have to wait longer than they would like for attention. One resident said, “if they [staff] are not too busy they will listen to you.” Another resident indicated that on occasions staff were not always available to assist me in the lift when needed. It was reported by the manager and by other staff that, “the staff team has changed dramatically in the past 12 months.” When asked to explain in what way it was said that staff have gained more confidence and have a better understanding of the needs of people with dementia care or mental health needs. This comment is borne out by the views of relatives and visiting health and social work staff. Reported changes in working practices by housekeepers has also resulted in improving the way the service responds to the basic needs of the residents. Many staff have had the opportunity to attend a training course tilted, “Yesterday, Today and Tomorrow.” It is apparent this course has been well received by those who have attended it. Some care workers talk about it having changed their practice and their perception, stating it has helped them better understand dementia care. Though some people have made some comments about the effect of staff shortages overall the feedback about the caring qualities of the staff from residents and their families has been very positive. For example, a relative commented in her HYS leaflet, “Most [care workers] do have the right skills and experience to look after people properly.” Another said, “In general I feel the staff do a very good job caring for clients who can be difficult at times.” Current residents also praise the personal qualities of the staff. One said, “The staff are very kind and helpful.” Another commented, “the staff are kind …always there to help me.” Visiting health care staff also confirm improvements in staffing. As one visiting health care worker said “ The staff are much more caring and now understand more about meeting the needs of the residents. There has been a big improvement in the last year and they are getting more support and training.” Another said, “we have regularly meetings with the staff where we talk about residents and we have been able to provide staff with training, which has been well received.” Records how that over 80 of current staff have a relevant National Vocational Qualification, some at Level 3 or Level 4. This is a high percentage when compared to other care homes. Discussion took place with the manager about the need to recruit staff with mental health expertise and experience. The manager explained that there is a local shortage of such staff and this presents a challenge to all similar care homes but that he hopes he will have some success in the coming year. He indicated that the emphasis in the past year has been putting effort into supporting staff that genuinely want to assist people who had dementia care needs as he recognised that not every worker found it easy to do so. As a result the service has a core of staff who understand better understand people with dementia care needs. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 23 The method of inducting care workers has improved in the past year. There are two systems of induction. In effect new recruits work through a comprehensive checklist drawn up by the manager. This checklist is designed to ensure compliance with reporting and recording systems, policies and procedures and familiarisation of the building. New recruits also undertake a common induction standard using a workbook. This induction covers values and some of the technical aspects of the work. The service continues to benefit from having its own dedicated staff development worker based in the home. This innovative concept has enabled care workers to develop their understanding and skills. The recruitment records of three randomly selected staff selected were checked. It was found all three workers had the required criminal record bureau check (CRB) which was satisfactory as well as two written references, health declaration and a detailed job description. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 31. 32. 33. 35. 36. 37. 38. Quality in this outcome area is good. This inspection shows that while some challenges remain and there is still room for further improvement this is now a very well managed service. It is a service where it can be seen that both the standards of care and the management of the staff have improved considerably in the past 12 months The home is now providing a good all round standard in most areas. It is a service that has a strong improvement focus, which includes action planning, quite robust quality assurance mechanisms as well as a commitment to involve residents and relatives in giving their views. There is open communication with staff at all levels and an effective staff supervision structure in place, though bank staff and agency staff do not always get the supervision they need. The understanding of dementia care needs has greatly improved and staff morale appears good. Detailed policies and procedures underpin safety, respect and dignity and accountability. This judgement has been made using available evidence including a visit to this service. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 25 EVIDENCE: The current manager holds a relevant National Vocational Qualification level 4 award and is considered by the Commission to be a suitable and fit person to manage this service. Since the last inspection the management arrangements within the home have been further strengthened. Accountability of staff appears much stronger with an improved supervisory and management focus. There is evidence of strong leadership and a strong improvements focus. There is a stronger focus on ensuring quality, with improved self monitoring and more quality assurance surveying. Examination of the most recent quality assurance survey undertaken by the home shows that over 50 care workers report improved team working. Almost 85 of care workers indicate in their survey that the service has improved and that the staff team as a whole are more aware of the residents needs. These findings replicate the findings of this inspection. The homes own quality assurance survey also shows good satisfaction levels from external health and social care workers, as well as residents and their families or friends. The parent organisation i.e. the Department of Adult Care has recently been accredited with the Investors in People award. The current management action plan for the service was examined. It identifies key objectives, priorities, targets, dates, measurable criteria as well as progress made and evidence of compliance. There is also a business action plan that details priorities. If residents have no one else to manage their money and need extra support there are detailed policies and procedures to ensure that proper records and accountabilities are in place (see under protection). Checks were made in respect of two staff that were interviewed as part of the inspection. It was found that they both had an active ‘personal performance and review’ system in place. There was evidence to show that they both were able to meet at least every two months with a supervisor to talk about work issues. (unless absent due to sick leave). However the arrangements for supervising bank staff appears much looser with only occasional joint team meetings and little evidence of one-to-one meetings. The manager said that there are plans to provide bank staff with one-to-one supervision sessions but this is complicated because some of them choose to work in more than one care home run by the council. Bank staff do however attend regular staff meetings and meetings about residents. The system of communication between staff is quite well developed. Each work group or department meets usually monthly with a manager or supervisor. At these meetings any concerns are discussed. For some work groups two meetings are arranged with a duplicate agenda’s so all member of the work group can attend and the home remained adequately staffed. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 26 Examination of the minutes of these meetings show that typically the agenda covers; residents needs and circumstances, staff issues, training events, and policies and procedures. A recent meeting covered changes arising from the Mental Capacity Act 2005. There is a detailed policies and procedure file that underpins safe working, practices. These include key areas such as moving and handling, fire safety, managing medication, first aid, food hygiene, infection control and preventing abuse. Some of these policies were last updated in 2004 and time is approaching when they should be reviewed again to ensure they are up to date and still relevant. There is a well established reporting system in place for recording accidents, incidents and near misses. If a resident has a fall a record is kept, even if, at the time, there is no apparent injury. Significant incidents are being reported to the Commission in accordance with statute. Each of the resident’s files that were examined included a written assessment of risk. There was also a written risk assessment covering the premises and fire prevention. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 27 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 3 3 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 3 3 Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1)(d) Requirement Timescale for action 15/12/07 2. OP4 12(1)(a) 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. Note; This requirement was made at the previous inspection with a deadline set for 15/07/06 but it has not been fully complied with in all cases. A new time scale of 15/12/07 has been set. Where people are admitted into 15/12/07 Whitbourne House Care Home and have their medication managed by care staff the reasons why must be recorded in the person case documentation. Note; This requirement was made at the previous inspection with a deadline set for 15/07/06. The manager reported that its implementation had been delayed due to the implementation of the Mental Capacity Act 2005. A new timescale of 15/12/07 has been set. DS0000035476.V336756.R01.S.doc Version 5.2 Whitbourne House Page 29 3 OP18 13(6) 4 OP26 16(1)(f) The manager must draw up a 15/12/07 training plan that ensures that all relevant staff who have not attended training in safeguarding vulnerable adults do so in the next 12 months or if appointed after the date of this inspection within 6 months of the commencement of their employment. Measures must be taken to 15/12/07 ensure that extra facilities are provided for storing laundry. 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 OP36 Good Practice Recommendations It is recommended that agency staff be invited to attend any relevant staff meeting and are provided with one to one supervision. This recommendation was made at the previous inspection but it was found that it had not yet been actioned so it is repeated. It is recommended the service user guide be displayed in a prominent place for visitors to read. It is recommended that details on how to complain be displayed in several prominent positions for the benefit of visitors and residents. Consideration should be given to separating out health assessment documentation from other assessment documentation. It is recommended all residents be weighed on or soon after admission for the purpose of benchmarking future weight loss or gain. Consideration should be given as to how to ensure quieter residents do not miss out on staff attention due to the demands made by noisier residents. It is recommended that blinds or curtains be provided in the laundry to ensure privacy and an alternative room be DS0000035476.V336756.R01.S.doc Version 5.2 Page 30 2 3 4 5 6 7 OP1 OP16 OP4 OP4 OP4 OP26 Whitbourne House found for staff to iron. Whitbourne House DS0000035476.V336756.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V336756.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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