Inspection on 10/11/05 for Whitby Dene

This inspection was carried out on 10th November 2005.

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

Whitby Dene 24/07/07

Whitby Dene 13/12/06

Whitby Dene 13/07/06

Whitby Dene 06/06/05

Whitby Dene 10/01/05

Whitby Dene 17/05/04

Whitby Dene 22/01/04

Whitby Dene 01/07/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Whitby Dene 316 Whitby Road Eastcote Ruislip Middlesex HA4 9EE Lead Inspector Ms Jane Collisson Unannounced Inspection 10th November 2005 12:30p 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 Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Whitby Dene Address 316 Whitby Road Eastcote Ruislip Middlesex HA4 9EE 020 8868 3712 0208 866 6792 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) Care UK Community Partnerships Limited Ms Razia Mehdiali Ghoghai Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 30 Older People (OP) 20 Dementia (DE) 10 Intermediate Care Beds Date of last inspection 6th June 2005 Brief Description of the Service: Whitby Dene is a purpose built care home owned and managed by Care UK. Located in a residential area of Eastcote, there are local shops within walking distance and Eastcote Station and shops are under a mile away. The home provides personal care for sixty older people. On the ground floor are a 20-bed dementia unit and a 10-bed Intermediate Care Unit, which offers short-term rehabilitation. The first floor has accommodation for 30 frail elderly people. Part of the provision is for respite care for two service users and one emergency bed is retained. The majority of the beds are commissioned through the London Borough of Hillingdon and a small number by the London Borough of Harrow. There is a large enclosed garden and ample car parking to the front of the home. There are lounges and dining rooms in each of the units. All bedrooms are single and each has an en suite toilet and washbasin. There are assisted bathrooms in all areas and additional toilets near to communal areas. The home has a Registered Manager, six team leaders, senior carers, day and night support workers, an activities organiser and ancillary staff. A handyman and an administrator are also employed. The Intermediate Care Unit is staffed by support workers from the home, a physiotherapist and an assistant, funded by the Primary Care Trust, and an occupational therapist and an assistant, funded by the London Borough of Hillingdon Social Services. Regular visits from a doctor are also made to this unit in connection with providing support for the rehabilitation work. District nurses visit all areas of the home, on a daily basis, to give nursing input such as wound care, diabetes treatment and monitoring of other health care needs. General Practitioners, dentists, opticians and chiropodists are accessed as required. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced on the 10th November 2005 from 12.35. Additional visits took place on 16th November at 9.35am, and 22nd November at 12.25pm, to meet with the Registered Manager, further service users and staff, and to check records. The inspection took a total of ten hours. The records examined included service user and staff files, and training records. The majority of the service users were seen on this inspection. In addition to the care, domestic and catering staff, the activities organiser and the Intermediate Care unit’s occupational therapist were met. Although several of the service users were able to express their opinions of the care and support in the home, those in the dementia unit were unable to do so. Fourteen requirement were made at the inspection in June 2005 of which seven were met and seven have been restated. An additional four requirements have been made. For an assessment of all of the key standards, this report should be read in conjunction with the unannounced inspection report of 6th June 2005. What the service does well: What has improved since the last inspection? What they could do better: Information for current and prospective service users is still required on the fees payable and details contained in the Local Authority contracts. This work is still under discussion with the local authorities and needs to be resolved. The information for the service users in the Intermediate Care unit has still not been completed and service users should be provided with basic information, until this is completed, so that that they are fully aware of the facilities and activities in the home. Although the majority of the care plans were in place, there were some gaps noted, and the risk assessments had not been fully documented with ways in which the risks could be minimised. These need to be reviewed to ensure that Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 6 service users at risk because of falls, poor nutrition or other needs, are assisted appropriately. With plans to change two of the lounges into activity rooms, it needs to be shown that there are sufficient staff on duty to provide cover for these areas. This is particularly so in the dementia unit where service users tend to wander and need to have good supervision. The choice of meals available is still of concern and this is an area where the Manager and staff are working to improve the situation. However, this has been an ongoing issue and needs to be resolved to provide a more varied menu and choices for all of the service users, including those who have special diets. Meals taken, particularly where service users have poor appetites or nutritional needs, must be seen to be recorded. Whilst there have been improvements in training, and courses are to be held shortly, there were still staff requiring updated training for manual handling and other basic courses. Information or training was also required for staff on the adult protection procedures. Training in dementia care is essential for the dementia unit. This has now been booked but it needs to be ensured that specialised training for staff working in this unit is ongoing. Staff supervision sessions have still not commenced and this is a long-outstanding requirement for the home which should assist with staff communication. Although there is some difficulty in gaining responses from the service users who are very frail or have dementia, consultation still needs to be seen to take place. Some work had commenced and an external trainer is booked to assist with this process. 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. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 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 Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 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): 2, 3, 4, 6, Better information for the service users in the Intermediate Care unit needs to be in place. Staff need to ensure that all of the information to support newly admitted service users, based on a full assessment, are in place. EVIDENCE: Service users and the representatives are not being fully informed of the terms and conditions. The requirements made at previous inspections regarding information on the fees payable, and having copies of the commissioning authorities’ agreements, being available to the service users has not yet been met. The Registered Manager said that further negotiations have been taking place with the Local Authority to provide these. A requirement that care plans need to be produced, following assessment, to demonstrate that the service users’ needs and choices have been taken into account, was made in June 2005 and was partially restated from the previous inspection. In the files examined of newly admitted service users, most of the information was in place but one night care plan had not been completed. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 9 It was a requirement that all staff working with service users with dementia should be suitably trained, with specialised activity training and more advanced courses in dementia care available for those working on a regular basis in the unit. This was not completed within the timescale given but the Registered Manager has arranged for four days of dementia training to be undertaken shortly, so that all of the staff can participate. The home’s Intermediate Care unit continues to provide a facility for up to ten service users, who have been in hospital, to have rehabilitation before returning to their own homes. The occupancy of the unit is about 70 of capacity. The service users spoken to in the unit were complimentary about the support from the home’s staff, and the occupational therapist and physiotherapist and their staff. There is no separate manager for the unit, and not always the same care staff, although the senior care staff are consistent. As there have also been a number of changes of occupational therapist and physiotherapist, the continuity of the unit is more difficult to manage. The occupational therapist and the social worker from the local authority, who liaises with the home, were met on the last visit of this inspection. Both are fairly new to the service. The Registered Manager said that there are sometimes inappropriate referrals made by the hospital for people who are unable to benefit from the rehabilitation offered. This was supported by the Intermediate Care staff met on this inspection who said that referral information was sometimes inaccurate. The home has now provided a better referral form to try and improve this situation. The unit currently comes under the supervision of the team leader on duty on the ground floor, who also has responsibility of supervising the 20-bed dementia unit. It has been previously recommended that, because of the number of different disciplines involved in this unit, who are working under different employers, that consideration should be given to having separate management cover for the unit. A team of care staff who are also specifically dedicated to the unit would provide a better degree of consistency. This is again recommended. New information was due to be provided to service users who use the unit as some service users had said they were not fully aware of the services provided. The Registered Manager said this information is still being produced in conjunction with the Primary Care Trust. It is recommended, in the meantime, that the home produces a simple guide to the facilities, such as mealtimes and activities, to ensure that new service users are fully aware of them. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 Although most of the information is in place for the service users’ care and support, the risk assessments need to be improved. The many changes of documentation have not assisted in maintaining the records to a consistent standard. EVIDENCE: The care plans sampled showed that service users are assessed in a variety of ways and the plans included risk assessment tools for dependency levels, pressures areas, and nutrition. A new one was introduced, during the period of the inspection, to assess the likelihood of falls. It was not fully demonstrated that the risk assessment scores, particularly where a very high risk is recorded, have been translated into care plans appropriately. The strategies for minimising the risks were not included in the risk assessment for falls. Staff felt that training was required to fully understand the new risk assessments but, because the forms are new, this had not yet been given. Although most of the files sampled had all of the care plans in place, one had no night care plan and one had no detail of the service user’s interests. The care plans seen had been reviewed regularly but need to be completed when gaps are noted. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 11 A number of different systems and documentation are in place at present. Although these will, in time, be replaced by the new computerised system, these changes have not aided continuity. Service users’ visits by professionals and health care staff, such as chiropodists, are recorded in the care plans’ multidisciplinary notes. The Registered Manager said that the relationship with the General Practitioner is good and that reviews of medication take place appropriately. District nurses visit the home daily. It was noted in the records on the frail elderly unit that a number of the service users may have early dementia. The Registered Manager said staff from the Woodlands mental health unit visit monthly to assess service users referred by the home. Where service users’ health is giving cause for concern, assessments are requested so that more appropriate provision, such as homes with nursing, are being made. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 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, 15 The standard of meals is variable, with little real choice offered. Further involvement of service users, families and staff needs to take place to ensure that improvements can be made to support both nutrition and to make the meals a more enjoyable experience. EVIDENCE: Service users are given the opportunity to join in activities provided, from Monday to Friday, by the Activities Organiser. These include weekly bingo sessions and a sherry afternoon. These are attended by an average of thirteen service users. Four canal trips had been held through the summer. Service users can also enjoy manicures and some one-to-one sessions. The service users in the EMI unit were seen to have “singalongs”. The Activities Organiser is responsible for fund-raising to fund the activities and outings. Work is due to commence on changing one of the small lounges to a relaxation room for the EMI unit, but the staffing required will need to be kept under review to ensure that this can be used to its fullest potential. It has been a previous concern that there were insufficient staff to provide activities, including one-to-one time, for all of the service users. There also needs to be more organised activities at weekends, particularly for those twenty service users in the dementia unit. It is strongly recommended that consideration is Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 13 given to providing additional resources to provide activities, on a daily basis, for the dementia unit. Another small lounge has recently been allocated as an activities room. This room may be quite small for some activities, such as bingo, and present a health and safety hazard if too crowded. The appropriate risk assessments need to be undertaken and service users should be consulted to see if they find the change acceptable. Visitors are welcome to the home, although none were met on the visits to the home undertaken on this inspection. There are small areas of the home where private meetings can take place, although these are also the smoking areas. A room is set aside for more formal meetings. The Registered Manager said that involving the families and friends of service users in regular meetings had proved difficult, with only a small attendance when they have taken place. Invitations had been sent for a recent Bonfire Night party but only seven relatives had attended. An initiative to assess strategies for service users and representatives’ involvement, with an external trainer, is due to be held in December with a view to trying to improve the situation. Several service users gave various opinions of the meals provided, which ranged from satisfactory to poor. One service user said that the desserts were nice but the main courses were not. On the first visit, a lunch of minced beef pie, carrots, cauliflower and mashed potatoes was being served. The alternative was a small vegetable grill, which looked unappetising, with the same vegetables. There is a lack of protein in meals of this type. The dessert was apple pie, with the diabetic alterative of tinned fruit and cream. The evening meal, which is served between 5 and 5.30pm, was fish fingers and tinned tomatoes. There was no alternative except sandwiches with the sandwich fillings available on the unit. In one unit, this was jam although the staff member said that they could obtain cheese from the kitchen. There is no evening snack advertised and, as breakfast was taking place in one of the units after 9.30am, there can be a gap of at least sixteen hours between meals offered. The National Minimum Standards guidance is that there should be a gap of no more than twelve hours. If breakfast is served so late, and lunch is at 12.30, service users may not have an appetite to eat well. Staff said that service users are offered tea and biscuits at night but a sandwich could be made if required. It was recorded on a recent Regulation 26 visits, by the Registered Providers’ representative, that there were concerns about the tea menu and that action was required to revise the menu. It was mentioned that alternatives, such as soup and a roll, a variety of sandwiches in additional to a hot alternative, would be more popular. The presentation of desserts could also be improved and the cook had started to address this by providing more attractive individual portions. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 14 At the third visit to the home, the main meal of the day was corned beef and chips, or egg and chips, served with tinned tomatoes. The activities organiser said that she had carried out a consultation regarding the meals with some of the service users and a subsequent meeting was held recently with the cooks and team leaders to discuss this. The Registered Manager said that changes are planned. The new menu needs to be kept under review and it is recommended that staff are asked to keep notes after meals about the service users’ reaction and, in for those service users who cannot express their opinions, the staff make a judgement as to whether the food was enjoyed. It was noted that the last inspection there were similar concerns about the menu, particularly the second lunch choice which is usually a vegetarian option. Menus are still not displayed in larger print which does not assist the service users to make choices. The Registered Manager said that there had been a small rise in the budget, which was recorded as being £15 per week per service user at the last inspection. The Registered Providers must ensure that there is a sufficient budget for providing a nutritious, wholesome diet, with diabetic and vegetarian service users also being offered a choice of meals. Choices should be well displayed, with real alternatives offered at each meal. The timing of mealtimes should also be considered to ensure that service users have a sufficient gap between meals, during the day, to want to eat the next meal. An evening snack needs to be offered to ensure that service users do have to not go more than twelve hours between meals. It should also be advertised so that service users know they are entitled to request a snack and what is on offer. The recent notes of one service user, in the dementia unit, recorded that she had not eaten well, refused meals or that “all meals were given”. This information is insufficient to record the service user’s nutritional intake, particularly as her nutritional risk assessment was recorded as a “high risk”. It was required at the last two inspections that the home needs to show that the meals are recorded in sufficient detail to ensure that their nutritional needs are being met in accordance with Regulation 17 (2), Schedule 4 (13) of the Care Homes Regulations 2001. This included any special diets provided. There still no evidence of this being carried out in sufficient detail, apart from a record of the meal chosen, and needs to be addressed. Improvements in the choices of meals, and consultation over menus and meal times, would enable service users to have greater choice and control over their lives. Some service users prefer to stay in their bedrooms, or not to join in the activities, and said that this is respected. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The procedures are in place for service users to raise concerns, but none have chosen to do so. Many would be unable, because of dementia, to make their complaints known but further work could be carried out in the frail elderly and Intermediate Care units to ensure that service users feel confident about doing so. EVIDENCE: Only one complaint has been made since the last inspection. This involved the poor care of a respite service user’s clothes. The Registered Manager has taken appropriate action to deal with this complaint. One service user in the Intermediate Care unit did not feel that it was appropriate to make a complaint when only in the home a short time. It is recommended that service users in the unit are invited to comment, at the end of their stay, to see if any improvements could be made. There have been no issues of adult protection in the home. The records showed that approximately one third of the staff had attended Protection of Vulnerable Adults training. The Registered Manager said the subject is discussed in team meetings but she would check the training records and make arrangements for further training if it is required. It needs to be demonstrated that all of the staff have been made fully aware of the procedures, including whistle blowing, to be followed. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is generally maintained in good condition, providing a comfortable environment. Changes are being made to use two of the smaller lounges for activities which need to be kept under review to ensure that they meet the service users’ needs and sufficient staff are on shift to make the best use of the facilities. EVIDENCE: The home is generally well maintained and pleasantly furnished. Bedrooms are of a good size, with service users have their own en suite toilet and wash basin. There have been no major changes since the last inspection. Work on providing a sensory and relaxation room in the smaller lounge of the dementia unit has not commenced. The Registered Manager said that there is now a budget for this work to begin and some research has been carried out into the type of facility which would be best suited to the home. As there are currently no special facilities for people with dementia, this work needs to be undertaken as soon as possible to ensure that the current service users benefit from the changes. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 17 The home was found to be clean but there is currently a shortage of domestic staff. The Registered Manager has recruited new staff who are waiting for references and Criminal Records Bureau disclosures to be received. The Registered Manager discussed the possibility of replacing carpet with non-slip floor covering in one bedroom where incontinence is a concern. This has been discussed with the service user’s family, who are in agreement. New service users should be offered the alternative of a carpet should rooms with floor covering become vacant. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 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, 30 The numbers of permanent staff have improved, which should resulting greater continuity for the service users and the development of the staff team. The staffing levels still need to be kept under review as the needs of service users change, particularly when there are service users awaiting transfer to homes with nursing. EVIDENCE: Progress has been made with recruiting a permanent staff team, and no agency staff have been used for some time. The home has a bank of staff, some of whom are student nurses, to use to cover training, annual and sick leave. There are vacancies for cleaning, laundry and kitchen staff at the present time. Care staff work six hour shifts only. The team leaders undertake seven hour shifts and are allowed two and a half hours per week additional time for administrative tasks. The current staffing levels for the ground floor units are one senior care worker and two care workers on the dementia unit, where there are twenty service users, and one senior and one care worker on the Intermediate Care unit where there are up to ten service users. On each shift, a team leader supervises both units. On the first floor, where there are thirty frail elderly service users, each shift has a team leader, one senior and two carers. These staffing levels need to be seen to be kept under regular review as the needs of service users can change, particularly when service users are awaiting transfer to nursing homes, or additional service users require assistance with feeding. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 19 A copy of the current training records was supplied. Although the majority of the care support staff have had updated manual handling training, not all had. The Registered Manager said that training sessions are already been booked for November. It needs to be monitored to ensure that all of the staff have updated manual handling training, particularly as the home uses bathing and lifting equipment for its less mobile service users. Two team leaders have now undertaken manual handling “training for trainers” two-day courses to enable them to train the staff, which should assist in keeping staff up-to-date in the future. Specialised training, to assist the staff to work with people with dementia, has not taken place as required at the last inspection. However, the Registered Manager arranged, during the course of this inspection, for four days of dementia training to take place in the near future. New staff undertake the three day induction, which includes manual handling, health and safety, basic first aid, and infection control. This is carried out by a Care UK trainer. A new induction pack has been introduced for staff since September 2005 which meets the Skills for Care (formerly TOPSS) standards. Training for food hygiene, health and safety and fire awareness were also to be held shortly and the Registered Manager said that all statutory training should be up-to-date by the end of these sessions. This needs to be evidenced in the training records. None of the staff have a training and development record to show their individual needs. This needs to be considered as part of the overall supervision, appraisal and training programme. The Registered Manager said that there had been difficulty in meeting the target of having 50 of the care trained to NVQ Level 2. There are approximately fifty care staff in post. Eighteen staff have been placed on the NVQ course for Level 2 or 3, and five already have the qualification. Five of the team leaders are undertaking NVQ Level 4, mainly in care. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 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, 32, 35, 37, 38 While improvements have been made to the management of the home, there are a number of areas where the requirements of the Care Home Regulations 2001 are still not being met. This includes the regular supervision of staff. EVIDENCE: The Registered Manager has been in post since mid-2004. There was a long period prior to this with several changes of management, which did not assist in providing consistency for the service users and the development of the staff team. There are improvements in the running of the home but the changes required are only happening slowly and they need to be accelerated if they are to prove beneficial to current service users and staff. These include the improvement of meals, staff supervision and improvements to the dementia unit. Staff were generally positive about the management of the home, but the number of changes to systems and documentation are not always seen as helpful. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 21 There are some concerns about communication with staff raised in the home which need to be addressed. The commencement of supervision sessions and weekly unit meetings should be used to address the concerns. Consultation has taken place on the menus and an external trainer will be looking at further involving service users and their representatives. The Registered Providers need to provide quality assurance and monitoring procedures which result in regular reviews of the quality of care and how this will be developed. When complete these need to be provided to the service users and the Commission for Social Care Inspection. Service users’ finance records are maintained by the home’s administrator and were found to be kept in an orderly manner. However, there had been no audit by the company for two years and it was not noted on the two most recent Regulation 26 by the Registered Provider’s representatives as to whether any finance records had been checked. All but six of the service users have sums of money brought into the home by relatives, which are small sums for hairdressing, newspapers and toiletries. The six service users who have their money controlled through Care UK have limited amounts available, as they require them, and an application has to be made for larger sums. The administrator said that interest-bearing separate accounts are held, by Care UK, for the service users whose finances they control. A system is in place for service users’ relatives to be issued with receipts when cash or cheques are brought to the home. It has been an ongoing requirement, for several inspections, that regular supervision is carried out with the staff. This is to assist them to better support the service users, particularly those whom they key work, and for their own personal development. It is a requirement of the Care Homes Regulations 2001 that this takes place. The systems were in place at the last inspection but it had not commenced. At this inspection, a list for each of the team leaders of the staff they are due to supervise has been prepared. However, it was confirmed that individual supervision sessions have not taken place and no staff appraisals have been held. One staff member said that some unit meetings had taken place. Information recorded on the Registered Providers’ Regulation 26 visits says that “evidence of staff supervision should be accessible”. The Registered Providers’ representatives must check on the visits that the home is running in accordance with the Care Home Regulations 2001 and examine the appropriate records to ascertain that this is happening. It was noted that some team leaders will have ten staff to supervise. It needs to be shown that the team leaders, and the staff they will be supervising, have sufficient time on their shifts for this work to be undertaken without detriment to the care of the service users. The home took part in a pilot scheme to maintain all care records on a computerised system. The scheme is now operating in other Care UK homes but it may be some time before it is used in Whitby Dene. Different paper Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 22 systems are being used and, in the files examined, a variety of paperwork was in place which does not aid consistency. The Registered Manager said that she hoped to have uniform systems in place by January 2006. On the first visit of the inspection, the laundry door was found to be propped open. The Registered Manager was informed that this door should be closed, particularly as the laundry is on the route from the staff room to the fire escape. There was no fire signage to signify that it should be closed at all times. This was rectified by the third visit to the home. The Registered Manager was asked to ensure that contact is made with the London Fire and Emergency Planning Authority to give advice about fire signage. Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 23 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 2 2 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X 3 1 3 3 Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 24 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 OP2 Regulation 5 (1) (b) Requirement Prospective service users must be informed of the information on fees payable which must be detailed in their terms and conditions. (Previous timescale of 31/8/05 not met) The service users must be supplied with a copy of the Local Authority agreement, where appropriate. (Previous timescale of 31/08/05 not met) Care plans, which include how the risks to service users can be minimised, and for all aspects of the service users’ care and support, must be in place. Staffing levels must be kept under review in the dementia unit to ensure that sufficient staff are on duty to supervise service users in all areas of the unit and provide appropriate activities. Improvements in the choices of meals, and consultation over menus and meal times, must take place service users to have greater choice and control over their lives. DS0000027127.V262968.R01.S.doc Timescale for action 28/02/06 2 OP2 5 (3) 28/02/05 3 OP3& OP7 13(4), 15 (1)(2)(b) 31/12/05 4 OP12 18 (1) (a) 28/02/06 5 OP14 16 (2)(i) 12 (2) 31/01/06 Whitby Dene Version 5.0 Page 25 6 OP15 17(2),Sch 4 (13) 7 OP18 13 (6) 8 OP30 13 (5) 9 OP30 18 (1) (c) (i) 10 OP33 24 (1) (2) & (3) 11 OP36 18 (2) The home must show that service users have a balanced and varied diet and meals must be recorded in sufficient detail to ensure that their nutritional needs are being met. These records need to include those on the special diets provided, such as vegetarian and diabetic. (Previous timescale of 31/07/05 not met). All staff must have, by training or other methods, information about safeguarding service users under the adult protection procedures. All staff must have manual handling training and updates, including those working for the homes bank. (Previous timescale of 31/08/05 not fully met). The Registered Manager must ensure that all of the staff undertake the core training courses and have updates as required. (Previous timescale of 31/08/05 not fully met). A review of the quality of care is required to provided on a regular basis and a report provided to service users and the Commission for Social Care Inspection. (Previous timescale of 31/08/05 not met). Regular supervision is required to commence for all of the staff, on a regular basis. (Previous timescale of 31/08/05 not met). 31/01/06 28/02/06 31/01/06 31/01/06 28/02/06 31/01/06 Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 26 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 OP6 Good Practice Recommendations That, for the Intermediate Care department, the home produces a simple guide to the facilities, such as mealtimes and activities, to ensure that new service users are fully aware of them. That consideration should be given to providing separate management cover for the Intermediate Care unit. It is strongly recommended that consideration is given to providing additional resources to provide activities, on a daily basis, for the dementia unit. That more accessible information is provided to the service users to enable them to be better informed about the menus and choices of food available. That the management and staff look at ways to encourage the service users and the representatives to voice their comments, concerns and grumbles so that these can be recorded and action taken. 2 3 4 5 OP6 OP12 OP15 OP15OP16 Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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 Whitby Dene DS0000027127.V262968.R01.S.doc Version 5.0 Page 28 - 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. 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