Inspection on 13/12/06 for Whitby Dene

This inspection was carried out on 13th December 2006.

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 13/07/06

Whitby Dene 10/11/05

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 Key Unannounced Inspection 11:10 13th December 2006 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.V313872.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. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 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) www.careuk.com 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.V313872.R01.S.doc Version 5.2 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 13th July 2006 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 and support for sixty older people. The ground floor has 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 older people. Two respite beds and one emergency bed are retained. There is a large enclosed garden and ample car parking. Each unit has its own dining room and lounges. All bedrooms have single occupancy, with en suite toilet and washbasin. There are assisted bathrooms and toilets in all areas. The home’s current staffing establishment is a Registered Manager, six team leaders, a team of senior carers, day and night support workers, an activities organiser, catering and domestic staff. A handyman and an administrator are also employed. The Intermediate Care Unit is staffed by support workers from the home, a physiotherapist, funded by the Primary Care Trust, and an occupational therapist, funded by the London Borough of Hillingdon Social Services. Regular visits from health professionals are also made to this unit in connection with providing support for the rehabilitative work. District nurses visit all areas of the home to give nursing input such as wound care, the monitoring of diabetes and other health care needs. General practitioners, dentists, opticians and chiropodists from the community are accessed as required. The fees range from £425 per week to £522 for respite care. Forty five of the fifty permanent places are funded by the London Borough of Hillingdon and the remaining five by the London Borough of Harrow. There are no privately funded places. The Primary Care Trust commissions the ten Intermediate Care beds. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced on the 13th December 2006 from 11.10am to 4.30pm. Additional visits were made on the 18th December, from 2.50pm, and the 4th January 2007 from 10.30am. The Registered Manager was present on all occasions. The inspection process took a total of thirteen hours. The home had, at the time of the first visit, fifty one service users. Some of the service users were enjoying musical entertainment by a pianist, which is a regular activity, in the dementia unit. Local school children had visited, earlier in the day, to sing Christmas songs. Some service users were spending their time in their rooms and others were sitting in the lounges or the corridors, where there is comfortable seating. Although a number of private conversations took place in the Intermediate Care unit and the unit for older people, only limited feedback was possible from the service users in the dementia unit. Two visitors were met in the course of the visits. Both were positive about the home’s support for their relatives. Records examined included the computerised care planning system, maintenance records, training files and medication administration. All of the communal areas of the home were seen, in addition to bedrooms in each of the units. In the Intermediate Care unit, the numbers of service users varied between six and nine during the three visits. The new occupational therapist, the part-time physiotherapist and the visiting nurse practitioner were met. There have been no major changes in the home since the last inspection. Progress has been made in a number of areas, and staff were seen to be working to ensure that the services provided are to a good standard. However, the size and complexity of the services provided, particularly in the dementia and the Intermediate Care units, requires continuing monitoring and reassessment to demonstrate that the staffing levels, training and activities provided are sufficient and are developed to enhance life for the service users in the home. For an assessment of all of the key standards, this report should be read in conjunction with the report of the 13th July 2006. There were thirteen requirements made at that inspection. All but two were met and these have been repeated. A further eight have been made at this inspection. What the service does well: What has improved since the last inspection? Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 6 Service users have access to a wider variety of meals and there is ongoing work to make more improvements, in consultation with the service users. Work on improving the standard of recording on the computerised care planning system has taken place. Service users and their families are being consulted about the standard and quality of care in the home. The outstanding training needs were in the process of being met. What they could do better: Although there have been improvements in the record keeping, there were a number of areas where gaps were found and robust monitoring procedures need to be in place to ensure that this does not happen. For planned admissions, it needs to be demonstrated that, in addition to having their needs assessed, service users, or their representatives, are fully consulted about their care plans, which should be generated before or upon admission. In the sample of daily notes seen, staff were not always recording fully when service users’ health needs should have been more closely monitored. Because of the computerised system, it is necessary to have systems in place for senior staff to check on the quality of recording. Better monitoring systems are in place for the medication administration and staff have received additional training. However, all of the medication in the home, including the “as and when” medication, needs to be part of an audit trail so that, from receipt through to administration or disposal, the number of tablets in stock can be accounted for. It was not demonstrated that the home has had a regular programme of activities since the home has been without an activities organiser. Service users were not aware of what was available for them. A programme of regular activities, particularly for the service users in the dementia unit, must be in place as soon as consultation has been completed. It was noted, and brought to the attention of the inspector, that the overhead lighting in some the bedrooms was very low. One service user was not able to read comfortably in the light provided. Sufficient lighting, which meets the needs of the individual service users, must be provided. The concern about the lack of domestic staff on duty is ongoing. Sufficient staff need to be employed to cover for sickness, annual leave and training, particularly in view of the difficulties in getting bank and agency cover. The odour of urine is still prevalent in some areas of the home and needs to be addressed by good continence management and the replacement of carpets where it cannot be eradicated. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 7 Although there were a number of service user vacancies during this inspection, an ongoing review of staff numbers is needed to demonstrate that needs are being met, and choices can be offered, particularly when dependency levels rise. The specialist units, for Intermediate Care and dementia, could benefit from having dedicated management cover to improve and develop the services they can offer. Staff training opportunities have improved but there were still staff who require basic training courses, such as first aid. Training for some of the more specialised skills has not been undertaken. Sufficient training courses need to be provided to ensure that all of the staff have their core training needs met within the timescales of the requirement and specialised training, particularly for the staff in the Intermediate Care unit, needs to be provided. Where staff train elsewhere, evidence is needed to show that they have the appropriate training, or it must be provided by the home. 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.V313872.R01.S.doc Version 5.2 Page 8 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.V313872.R01.S.doc Version 5.2 Page 9 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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress has been made in providing service users with the information on fees as close to admission as possible. The Intermediate Care unit is providing a good standard of support for the service users able to benefit from the rehabilitation programme. However, inappropriate referrals are being made and more stringent procedures need to be in place before service users are admitted. Access to a range of appropriate training, to develop skills and further support the service users, is needed for staff who work in specialised units. EVIDENCE: It has been a requirement that service users should be provided with the information on fees payable, which must be detailed in their terms and conditions, as soon as possible after admission. Although the Registered Manager had continued to have difficulty in getting information from Social Services departments, she has demonstrated that she has pursued this so that service users and their representatives can receive the information as soon as Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 10 possible after admission. Service users and their representatives have access to the Local Authority contracts. Two of the files of newly admitted service users were examined. They were found to have been assessed appropriately initially but not all of the care plans had been completed fully on the computer system. In one case, there was no nutritional assessment and one had very little information in place. Care plans should be completed, with the service user, and their representative, so that their care can be agreed and they are aware that their needs can be met. One prospective service user met during the inspection was spending a day in the home with a view to moving in permanently. The service user was able to have lunch and spend time in one of the lounges and said that the day had been enjoyable. Where service users’ needs can no longer continue to be met by the home, appropriate referrals have taken place and three service users were awaiting nursing home placements. One service user had been transferred by the final visit to the home. The Intermediate Care had between one and four vacancies during the inspection. Service users stay in the home for up to six weeks with the support of the occupational therapist and physiotherapist, who were both met during this inspection. The unit has input from health professionals, including the district nurses. A Nurse Practitioner, who visits regularly, was also met. The current occupational therapist, who is employed by Social Services, had been employed in the home for two weeks at the commencement of the inspection. The part-time physiotherapist, who is employed by the Primary Care Trust, had been in the home for more than a year. The service users met expressed their satisfaction with the service and were pleased for the opportunity to be supported to return to their homes. However, it has been found that not all of the service users referred to the unit are suitable to undergo the rehabilitation programme and were being inappropriately discharged from the hospitals. There were three service users at the time of the inspection who were unlikely to be able to return home. Residential placements were being sought. The Registered Manager said that work is being undertaken, with the hospitals, to improve the assessment procedures and try to minimise poor referrals. There is no manager or Team Leader specifically responsible for the Intermediate Care unit, although there are now regular care staff, two of whom were met. Although receiving support and guidance from the professional staff in the unit, they confirmed that they have had no specific training for their roles. The Registered Manager said that this is being planned for the future. The senior care staff who work on the unit are to become Care Coordinators. It needs to be demonstrated that the care staff working in their various roles have the required skills for the work they perform. Through their Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 11 individual training and development plans, it needs to be shown that they are suitably trained for the responsibilities they undertake. With the high number of admissions and discharges, liaison with different health professionals, and need for consistent staff supervision, the unit could benefit from dedicated management cover, and the previous recommendation is repeated for consideration. The current occupational therapist and the physiotherapist have provided guidelines to support staff to assist the individual service users when the professional staff are not on duty. An emphasis on retaining independent living skills, such as pouring drinks, rather than being served, was being promoted and was observed. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress was seen to have been made in the overall standard of recording on the computer records but needs frequent monitoring to ensure that all of the required information is recorded. Service users and their representatives are not seen to be fully involved in the care planning processes and it needs to be demonstrated that there is consultation at all stages of care planning and review. EVIDENCE: At the last inspection, the home had changed its care planning documentation to a computerised system. The samples of care plans seen had, in some cases, insufficient detail regarding the service users’ health and welfare needs. Progress had been made with improving the recording, and the samples seen were fairly satisfactory. The need for good monitoring procedures is apparent, however, from examples seen where insufficient details were recorded. One service user’s notes showed that, after being recorded as unwell, the subsequent entries did not evidence that close monitoring of the service user’s condition had taken place. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 13 Night staff are required to make regular checks on the service users throughout the night and record when this is done. Although a two hourly check is the company’s “standard”, the notes seen on the computer were less frequently recorded. The Registered Providers’ representative, on the monthly visit reports which take place under Regulation 26, had also observed this. One staff member said that the night staff take turns to enter the information through the night. However, it can be seen that an excessive amount of time may be spent in carrying out this recording. It was not clear from the files examined if all service users needed, or wished, to be checked every two hours. It is recommended that the night support practices are evaluated to ensure that the needs of individual service users are being met, and they and their representatives are consulted. Where service users are unwell, or have conditions which require regular supervision, then senior staff must ensure that appropriate recording has taken place and the outcomes monitored. The care plans seen in the Intermediate Care unit, which have input from the occupational therapist and the physiotherapist, were seen to be thorough and satisfactory. These included a 72-hour settlement review. The computer system is sometimes slow and was seen to be time consuming. During the inspection, the information on risk assessments was lost and was going to need to be reinstated. Daily notes have to be recorded manually when the computer is not working. The standard of recording on most of the daily notes examined had improved from the previous inspection. Staff said that they had got used to the system and, as there are computers located in the corridors, staff can update information whilst being near to the service users. Although it is recognised that the computer system is new and may require some adjustments, the value of recording all of the information on the computer, and keeping written information, is not wholly apparent. A manual system of recording personal care was being introduced in one unit to monitor bathing, for instance. A regular evaluation of the system, and how well it meets the health and welfare needs of the service users, should to be undertaken. The involvement of the service users who are able to participate in their care planning, or their representatives where they are not, needs to be demonstrated. The service users met were not able to say how they had been involved. It was a requirement that the health needs of all service users, including those on respite, needed to be recorded in sufficient detail to ensure that, where any changes to their health needs occur, suitable action is seen to be taken with the appropriate professionals. No issues were brought to the attention of the Inspector during this inspection and the Registered Manager confirmed that she had spoken to one of the general practitioners regarding this. Where service users are in the home for short-term stays, staff must be aware of Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 14 their medical needs. It was noted that one service user did not have a care plan completed after being in the home for a few days although an assessment had been carried out. Preliminary care plans should be completed before service users are admitted, and agreed with them or their representatives, so that all staff are fully conversant with their needs. The Registered Manager reported at the final visit that changes were taking place to the way in which referrals to the district nursing service are made, which may result in fewer visits for the permanent service users. However, the district nurses for the Intermediate Care unit would still be visiting on a regular daily basis. A requirement was made at the previous inspection for all staff who undertake medication administration to be shown to be competent, with a clear understanding of the procedures for dealing with errors and the systems in place to prevent reoccurrence. Since then, ten staff have completed a distance learning course on medication administration. A further twelve staff will be commencing this training. Staff have undertaken competency tests under direction of the team leaders. The medication in two of the units was checked. A four weekly blister pack system is in use in the units with permanent service users. A system of auditing daily is in place. However, while the majority of the medication administration was satisfactory, not all of the PRN (as and when) medication, such as paracetomol, was able to be stock checked. The recording of the number taken was not apparent and some of the signing may have been initials or “R” for refused. An audit trail of medication must be possible, from receipt through to administration or disposal. In the Intermediate Care it is not possible to use a blister pack system, due to the irregular length of time that the service users stay in the home. The medication checked was found to be recorded and administered satisfactorily. Senior staff reported that the only medication errors had been gaps in signing which are picked up on the daily audits and reported. While service users who were able to communicate their views said that they were well treated, a small number expressed their unhappiness at being in residential care. However, none expressed any concerns about the way in which they were treated by staff and said that they were able to use the lounges, or stay in their rooms, as they wished. A visitor, whose relative had been in the home for respite, was very happy with the care provided. One Intermediate Care service user, who did not wish to stay, was supported to exercise the right to leave, with efforts being made to maximise the person’s safety. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With the lack of an activities organiser for some months, evidence regarding a choice of regular activities was not demonstrated. An initiative to involve all of the staff team, and ascertain the wishes of the service users with regards to activities, is now being undertaken. A programme of regular activities is needed, as soon as possible, to interest and stimulate the service users, particularly those in the dementia unit. More choice is being made available at meal times, but needs to be advertised more widely as not all of the service users were aware of it. Visitors confirmed that they feel welcome in the home. EVIDENCE: The home had been without an activities organiser since before the last inspection in July 2006. An appointment had recently been made and the new organiser was due to commence just after the first visit of this inspection, working thirty hours a week. The home has been involved, in the meantime, in an Activities Based Care system. This is an initiative to involve all of the staff in supporting the service users, including the ancillary staff. Two staff, in addition to the new organiser, are to be involved in the programme. Some of the kitchen staff said that they had been encouraged to have more contact with the service users. The new activities organiser had been set the task of Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 16 ascertaining the activities enjoyed by individual service users. A number of the service users who were spoken to during this inspection were not aware of any activities being on offer. When the new programme has been prepared, ways of publicising the activities need to be considered. As part of the activities organiser’s role is to fund raise for activities, it needs to be demonstrated that sufficient time is available to provide a good quality programme of activities, including individual time for the service users. The sensory room, in the dementia unit, is available as a relaxation area for the service users but was not seen to be used by any service users during the three visits to the home. A regular programme of activities, particularly for the service users in the dementia unit, needs to be in place as soon as possible. Although only two visitors were seen during this inspection, service users confirmed that their relatives and friends are free to visit. The bedrooms are sufficiently spacious for service users to have visitors in their rooms, although there are areas around the home where private meetings can be held. Since the last inspection, a more extensive choice of meals is being offered. The alternative available during the inspection visits included a choice of four main lunchtime meals, which were meat, fish, vegetarian and a salad. Three vegetables in addition to potatoes were being served. The cook said that they had tried to provide the type of food that the service users enjoy and had introduced favourites such as scones and tea cakes to the menu. Diabetic cakes were being offered and the menu now indicates which of the dishes are suitable for diabetics. However, the colourful menus for the tables, which were being introduced at the last inspection, have not yet been used because of the changes to the menu. Having these in place would support service users to make choices, which should be encouraged. While the majority of the service users were complimentary about most of the meals, there have been some concerns about the evening meals. The staff were working to improve them and changes were to be made. The kitchen staff reported that all of the kitchen equipment was in satisfactory order. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress has been made with providing staff with the training and information they need to support them to safeguard the service users. Few formal complaints have been made but the recording of all concerns, including those about meals, would provide evidence of how they have been addressed. EVIDENCE: Two complaints have been recorded since the last inspection which had been answered and the outcomes recorded. Service users spoken to during the inspection said that they did not have any major complaints, but comments were made regarding the meals during the inspection and staff were aware that service users were not happy with the food provided in the evenings. It would be good practice to have in place a system to show that their concerns are being noted and followed up. It was a previous requirement that all of the staff must have, by training or other methods, information about safeguarding service users under the adult protection procedures. The previous timescale had not been fully met. The Registered Manager has arranged training with the London Borough of Hillingdon’s safeguarding adults officer for those who had not undertaken any training in the past. She has also acquired a video and workbook which will be used for staff induction. Whitby Dene DS0000027127.V313872.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users were generally satisfied with the home’s communal areas and their bedrooms. These are comfortably furnished and suitable for entertaining visitors. However, in the bedrooms checked, the lighting provided was not sufficient for reading comfortably. A regular audit of rooms, and consultation with the service users, would ensure that all bedrooms suit service users’ individual needs. The lack of cleaning staff during the inspection was a concern and sufficient staff need to be recruited to ensure that the full complement are on duty daily. EVIDENCE: The home has sufficient lounges, dining rooms and small sitting areas for the service users to have a choice of where they spend their time. The rooms are pleasantly furnished and comfortable. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 19 Each bedroom has its own en-suite toilet and washbasin and there are assisted bathrooms close by in each area of the home. Bedrooms are large enough to have sufficient seating to entertain visitors and there are some communal areas which could be used for this purpose. One service user was concerned about the lack of sufficient lighting for reading by and was found to have a main light with a 60w bulb. In some bedrooms these were seen to be as low as 40w. Although dimmer switches are available to vary the light, the lamp shades in use do not allow for bulbs of a higher wattage to be used. The layout of the room, and positioning of the beds, does not permit for lights beside the bed. An audit of each service user’s bedroom needs to be undertaken, which takes into account their needs and wishes. An audit during the evening should be included to check that the lighting is sufficient at all times. The provision of shades which can take a higher wattage bulb, over-bed lighting, and suitable lights to read by, need to be considered for each individual service user. There was still a faint odour of urine in some areas of the home. Although the carpets are being cleaned on a regular basis, this should not be necessary with good continence management and this needs be monitored to see if improvements can be made. The Registered Manager was aware of the cause of the concern in one area of the home and steps were being taken to address this. Where the odour cannot be eradicated from the carpets, these need to be replaced. Insufficient domestic staff were on duty on each visit of this inspection and sufficient must be employed to cover for sickness and annual leave. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As the numbers of service users in the home fluctuate, and the levels of dependency can be variable, the staffing levels need to be kept under regular review to ensure all of the service users’ needs are being met. The views of the service users and staff team should be taken into consideration when reviews take place. Progress has been made in supporting staff to undertake National Vocational Qualifications and to complete the outstanding core training. However, training in more specialised areas, such as rehabilitation, would enable staff to develop their skills. EVIDENCE: The Registered Manager said that, although there were a number of service user vacancies during this inspection, the staffing on each of the units has remained at the same level. On each shift, there are three care staff for up to thirty service users on the first floor. On the ground floor, there are three care staff in the twenty bed dementia unit and two staff in the Intermediate Care unit, which is for up to ten service users. A Team Leader is allocated to each of the floors, on each shift, to oversee the supervision of the staff, management of the unit and to monitor the support of the service users. Team Leaders are also involved in the assessment of prospective service users, one-to-one supervision of staff and some are involved in training. There are four staff and a Team Leader during the night. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 21 As the home has been without an Activities Organiser, the staff have also been responsible for carrying out the activities. The dependency levels of the service users vary, and three were awaiting transfer to nursing care at the time of this inspection. The Team Leaders are responsible for the management of the home in the absence of the Registered Manager. The hours usually worked by the manager are Monday to Friday, during office hours. It has been previously recommended that the Registered Providers look at providing additional management hours. The need for a Deputy Manager, and separate management of the Intermediate Care, should be kept under consideration to provide for the development of the services and for staff support. New staff had been recently recruited and some were met during a manual handling session being held as part of their induction. There had been some shortfalls on the rota during the recent weeks when staff had not arrived for work and there was difficulty in getting staff at short notice. Agency staff are not generally used and the home has a bank of staff. New staff are generally recruited to the “bank” before being offered permanent posts. On each of the three visits to the home on this inspection, there was a shortage of cleaning staff. The staff member working in the laundry had also resigned. There was not a full complement of staff on any of the visits, and two domestic staff were on duty instead of four on one occasion. Staff reported that there had been no cover for one weekend. There is a difficultly in recruiting bank staff for this role and agency staff are not used because of the necessity for Criminal Records Bureau disclosures, which are not always sought by domestic agencies. Some of the problems during this inspection were caused by sickness absence and annual leave. In order to provide for sufficient domestic staff in the home at all times, the domestic staffing establishment needs to be sufficient to cover for annual leave, training and sickness absence. This was a concern at the last inspection and is one that the Registered Providers need to resolve. Some staff who were spoken to during the course of this inspection felt that the staffing levels were, at times, insufficient for activities and providing personal care at certain times of the day which may not be compatible with the wishes of the service users. While the transfer of the care plans on to the computer has standardised the information being held, it was observed that, to have care plans monitored regularly and thoroughly, sufficient senior staff time needs to be allocated. An evaluation of the staff time available, to carry out all aspects of the work required, needs to be undertaken regularly, particularly when the home is full or dependency levels rise. It should be demonstrated that the views of staff, as well as service users and their representatives, are being taken into account when staffing levels are discussed. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 22 At the previous inspection, in July 2006, there was a requirement for more training to meet the specialist needs of service users. Training is now being provided in a variety of ways and there is now an emphasis on distance learning courses. Two of the Team Leaders are involved in staff training and new staff were receiving manual handling induction training from a suitably trained Team Leader. The staff also undertake the annual manual handling refresher courses. A course in dementia is to be commenced and there is a training video, on dementia, available when staff have induction. The Registered Manager had just acquired a new system, on a laptop computer, which contains programmes for training and then assessing staff competency. As mentioned elsewhere in this report, the specialised training for staff working in the Intermediate Care unit is still outstanding and needs to be part of the staff’s development programmes. Not all of the staff had their basic training completed. Although some of the shortfalls related to new or bank staff, there were some permanent staff needing first aid training. A number of bank staff are student nurses or employed elsewhere and may have undertaken appropriate training in their other work. However, not all had produced evidence of this. Where this is not forthcoming, the home will need to ensure that they have the training appropriate to the work they perform. A training and development plan for each staff member, which establishes the areas where training is required, would provide the evidence of this. The home has not met the National Minimum Standard target of having of having 50 of the staff qualified to National Vocational Qualification Level 2 or above. Fourteen of the current staff team of sixty eight have the qualification. A further eighteen staff were enrolled to commence the qualification in January 2007. One Team Leader is undertaking the National Vocational Qualification Level 4. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress has been made in obtaining the views of service users and their relatives and friends and providing reports on the development of the home. Financial management has been improved with the undertaking of a Care UK audit. Staff awareness of health and safety measures needs to be monitored. Staff are being supported by regular supervision sessions. EVIDENCE: The home has had a Registered Manager for more than two years and this has provided stability and continuity. She has the Registered Managers Award and National Vocational Qualification Level 4. Every effort is being made to comply with the Care Home Regulations 2001, and steady improvements are being made. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 24 However, the home’s specialist Intermediate Care and dementia unit would benefit from dedicated management cover to support them to develop their full potential. The addition of a Deputy Manager’s post, for instance, with responsibility for one or both of the units, could help to establish regular programmes to improve the wellbeing of the service users and support the development of the staff. With the additional monitoring required to ensure that the computer system is meeting the needs of the service users, it needs to be demonstrated that the home’s management and senior cover is fulfilling all of the tasks required. While the staff met were generally positive about working in the home, and enjoyed their work, there were some concerns about the level of staffing at busy times. In particular, the lack of cleaning staff was a concern. It is recommended that an evaluation of the roles and responsibilities of staff, in consultation with them, is undertaken to demonstrate that all areas, including management time, are sufficient. Copies of the result of the service users’ questionnaires and a Quality Improvement plan have been provided to the Commission for Social Care Inspection in the past year. A user-friendly report has been produced in July 2006 in relation to the questionnaires and interviews of service users. Forty six had participated. The areas of discussion were food and mealtimes, activities, quality of care and the home environment. Comments, both positive and negative, were included in the report. The Registered Manager said that a new round of surveys for the service users would commence in January or February 2007. An external consultant is used to facilitate this. A sample of the proposed questionnaire for relatives and friends was made available. Although the financial records were found to be maintained in good order at the last inspection, there had been no regular audit of the accounts by the company. It was a requirement that the financial records of the service users must be audited at regular intervals and this has taken place. A number of requirements and recommendations were made which the Registered Manager confirmed she had actioned, which included regular checks by her. The accounts are also examined on the regular visits undertaken on behalf of the Registered Providers. Regular one-to-one supervision had not been taking place in the home up until the last inspection. At that time, schedules were being drawn up to ensure that supervision took place with all of the staff on a regular basis. Staff spoken to confirmed that they do have supervision and it is planned to take place every six to seven weeks. The Registered Manager has a newly introduced system to monitor the supervision of staff. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 25 The door to the laundry, which is a fire door and should remain closed, was found to be propped open on the first visit of this inspection. The staff member on duty was reminded of the importance of keeping the door closed to minimise any risk in the event of fire. A fire in the tumble drier had taken place in the home since the last inspection. On the two subsequent visits, it was found to be closed. The Registered Manager reported, and provided evidence, that the Registered Providers are looking at fire procedures for the home in relation to the new fire legalisation introduced in October 2006. She is aware that a new fire risk assessment is required to comply with this. The home reports appropriately to the Commission for Social Care Inspection, under Regulation 37 of the Care Home Regulations 2001. Records of falls are maintained and these are monitored by the home and by the Registered Providers. The risk assessments could not be fully examined on this inspection because of a computer error. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 26 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 3 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 2 X X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 12 (2)(3) 14,15 Requirement New service users must be shown to have their needs assessed, and have care plans generated, which take into account all of their needs and wishes, shown to be agreed with them, or their representatives. The care plans, including the daily notes, must be monitored on a regular basis to ensure that they reflect fully the health and welfare needs of the service users and the outcomes of any concerns, such as poor health. A system to ensure that there is an audit trail of all medication, from receipt through to administration or disposal, must be in place. A programme of regular activities, particularly for the service users in the dementia unit, must be in place as soon as consultation has been completed. Information, to support service users to maximise their choices about the meals available, must be provided. Lighting, which meets the DS0000027127.V313872.R01.S.doc Timescale for action 28/02/07 2 OP7 12(1) a,b 15 (2) b 28/02/07 3 OP9 13 (2) 28/02/07 4 OP12 4 (1)(c) 16 (m)(n) 28/02/07 5 OP15 12 (2) (3) 28/02/07 6 OP23 23 (2) (p) 31/03/07 Page 28 Whitby Dene Version 5.2 7 OP26 OP27 18(1) a 23(2) d 8 9 OP26 OP27 16 (2)(k) 18 (1)(a) 21 (1) 10 OP30 18 (1) (c) (i) individual needs and wishes of the service users, must be provided in bedrooms. Sufficient domestic staff must be employed to ensure that there are enough staff to cover holidays and sickness. (Previous timescale of 30/09/06 not met) Where the odour of urine cannot be eradicated, the carpets must be replaced. It must be evidenced that the staffing levels, including those of the management staff, are kept under review. This must be carried out for all areas of the home, to ensure that there are sufficient staff on duty, at all times, to supervise and support the service users, particularly when higher dependency levels have been identified. (Previous timescale of 30/09/06 not fully met). All of the staff must be shown to have undertaken the required basic and specialised training courses they require for the roles they perform. 28/02/07 31/03/07 31/03/07 30/04/07 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 OP27 OP7 Good Practice Recommendations The need for a Deputy Manager, and separate management of the Intermediate Care, should be kept under consideration to provide for the development of the services and for staff support. That the practice of checking on service users every two hours should be evaluated, to ensure that individual DS0000027127.V313872.R01.S.doc Version 5.2 Page 29 2 Whitby Dene 3 OP16 4 OP31 service users’ needs and wishes are taken into account. 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. That an evaluation of the roles and responsibilities of staff, in consultation with them, is undertaken to demonstrate that all areas, including management cover, have been fully considered to be sufficient. Whitby Dene DS0000027127.V313872.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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.V313872.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!