Inspection on 13/07/06 for Whitby Dene

This inspection was carried out on 13th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Whitby Dene 24/07/07

Whitby Dene 13/12/06

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 10:30 13th July 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.V288650.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 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) manager@whitbydene.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.V288650.R01.S.doc Version 5.1 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 10th November 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. The ground floor has a 20-bed dementia unit and a 10-bed Intermediate Care unit, which offers shortterm 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 to the front of the home. Each unit has its own dining room and lounges. All of the bedrooms have single occupancy and each has an 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 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, the monitoring of diabetes and other health care needs. General Practitioners, dentists, opticians and chiropodists are accessed as required. The fees range from £413 to £425 per week. 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.V288650.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between the 13th and 26th July 2006. Three visits were made between the hours of 10.30am and 5.45pm. The Registered Manager was present on all occasions. The inspection process took a total of sixteen hours. There were twenty service users in the dementia unit and twenty eight in the frail elderly unit. The Intermediate Care unit tends to vary on a daily basis and six service users were present on the first visit. There were seven admissions at the second visit but two service users had been readmitted to hospital. During the course of the inspection, three service users’ visitors were seen and a district nurse was carrying out the daily visit to the home. One social worker was assessing a service user for a nursing home placement and another was carrying out an adult protection investigation. At the last visit, the regular entertainer was present and arrangements were in hand for the garden party on the 29th July. An outing had been held to Kew Gardens a few days prior to this. All parts of the home were seen and the records examined included those for medication, care plans, staff records, complaints, training and food. Access was provided to the new computer system. Service users and staff in all units were met, including two Social Services occupational therapy staff in the Intermediate Care unit. There have been no major changes in the home’ environment since the last inspection, although improvements have been made to the dementia unit. One lounge has been adapted as a sensory/relaxation room, with music and lighting. Providing seating midway in two of the corridors has made additional communal space. Several service users were enjoying the opportunity of sitting in these busier areas where visitors, staff and other service users pass by regularly and may engage in conversation. The new computerised care planning system was seen in use. The system was introduced recently and was, at times, slow or not working. Staff were still getting used to using it and the ways in which it could be utilised, to benefit service users’ support and staff time, have not been fully developed. All of the visits to the home were carried out in exceptionally hot weather. Some service users were enjoying the garden, but staff were ensuring that they were not over-exposed to the sun and additional drinks were being provided. There have been changes to the staff team, although the staffing levels remain the same. The Activities Organiser had left the home just before the Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 6 commencement of this inspection and there was no replacement, although it was intended to advertise for the post. The Registered Manager informed the Inspector at the last visit of this inspection that an additional twenty hour post for activities had been agreed. Staff were providing some individual activities for the service users in the meantime. There were twelve requirements made at the inspection in November 2005, of which eight were completed and four have been repeated as not met or fully met. A further nine requirements have been made. What the service does well: What has improved since the last inspection? What they could do better: It has been an outstanding requirement for some time that service users are issued with the terms and conditions when being admitted to the home. The information from the Local Authorities can take a considerable time to obtain. While the Registered Manager has made efforts to try improve the situation, it still continue to be an outstanding requirement and service users should be aware of their financial obligations as near as possible to admission. With changes to the system for recording daily notes, which are recorded on the computer, the samples seen did not evidence that the recording was satisfactory. The Registered Manager was aware that action was required to improve the information documented and it must be demonstrated that health needs, accidents and incidents are appropriately recorded and monitored. The health requirements of all service users, including those on respite, needs to be recorded in sufficient detail to ensure that, where any changes occur, suitable action is seen to be taken with the appropriate professionals. Where specific concerns have been identified upon assessment, or highlighted by family members, staff must be made fully aware of the circumstances under which professional help must be sought. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 7 Medication errors were noted, including missed signatures and initials, which needed to be brought to the attention of senior staff. It was not shown at this inspection that that staff undertaking medication administration were fully aware of the procedures for dealing with errors and the systems in place to prevent reoccurrence. Although the majority of staff have received adult protection training, it was noted that several of the bank staff had not receive this training with the organisation. In order to support the safeguarding of the service users, it needs to be shown that all staff have a good understanding of adult protection and whistle blowing procedures. The home is large, with sixty en suite bedrooms and several communal areas, including a number of bathrooms. Sufficient domestic staff need to be employed to ensure that, where there are absences because of holidays or sickness, enough staff are available to provide cover. The dependency levels in the home are shown to be variable, with some service users with dementia in the frail elderly unit. There are also, from time to time, service users waiting to go to nursing homes whose dependency is high. It needs to be shown that the staffing levels are kept under review to ensure sufficient staff are on duty. The management cover also needs to be reviewed and it is recommended that the home has management cover for the coordination of the Intermediate Care unit and to deputise for the Registered Manager. Some progress has been made in consulting with, and involving service users, in the running of the home and this work is ongoing. However, a review of the quality of care has been outstanding for several inspections and needs to be completed. In order to keep service users and their families informed, a report of the quality assurance and monitoring carried out in the home, together with any future developments and improvements, is required. Although the systems for dealing with the service users’ finances were found to be maintained in good order, there are no formal audits. In order to protect the service users, their families and the staff carrying out the procedures, regular monitoring and audits need to be carried out. A long outstanding requirement has been for regular supervision of the staff team to take place. Progress has just started to be made in commencing supervision but this needs to be maintained to ensure that staff are supported. With all the changes to documentation in the home, the monitoring systems to ensure good record keeping, particularly for care planning, health and medication, need to be robust and seen to be maintained. While the majority of the maintenance schedules were in good order and upto-date, there was no record to evidence that all of the staff have attended fire drills. In a home for so many people with dementia or who are frail, it is essential that all staff are fully aware of, and practiced in, the procedures. A schedule of staff attendance needs to be provided to ensure that all of the staff Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 8 have attended the number recommended under London Fire and Emergency Planning Authority guidance. 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.V288650.R01.S.doc Version 5.1 Page 9 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.V288650.R01.S.doc Version 5.1 Page 10 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): 1, 2, 3, 4, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are given the opportunity to see if they like the home, prior to admission but are not always given the full information regarding fees they will be required to pay. Some inappropriate referrals are still being made to the frail elderly and Intermediate Care units, which need to be more carefully monitored. Because of the different disciplines involved, and many changes of service user, the provision of separate management cover for the Intermediate Care unit could be of great benefit to the unit. It would also support the senior and management staff to concentrate on the services for the permanent service users. EVIDENCE: The home has the information available to assist service users to make a decision about living in the home. The Registered Manager provided copies of the updated Statement of Purpose and easier to read Service Users Guide. An information sheet has now been made available regarding the Intermediate Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 11 Care unit, which can be given to potential service users in hospital. The requirements made at the two previous inspections for prospective service users to be informed of the fees payable, detailed in their terms and conditions and to be provided with a copy of the local authority agreement, have not been fully met. The Registered Manager said that receipt of the information on any fees payable by the service user takes a considerable time to be provided so that terms and conditions can only be provided without these initially. She has had discussions with the commissioning Local Authorities to try and get these made available earlier but has not yet been successful in doing so. Because the Local Authority agreement is a considerable length, she has made this available to service users and their representatives should they wish to see it. Staff confirmed that assessments of prospective service users are carried out when they make their initial visit to the home, where they have the opportunity to stay for a few hours to help them with their decision about moving into the home. This follows a needs-led assessment being carried out by the Local Authority’s social worker and a visit by senior staff to carry out an assessment in the service user’s home. Samples of the assessments were seen. There are, from time to time, inappropriate referrals. A small number of service users have been admitted to the frail older person’s unit who require support because of dementia, although a diagnosis may not yet have been confirmed. The Registered Manager said that, where appropriate, service users will move to the dementia unit and this will be undertaken when space becomes available. The Intermediate Care unit continues to provide a rehabilitation service, lasting for up to six weeks, for a maximum of ten service users. There were six service users present at the first inspection who were being provided with physiotherapy and occupational therapy services. One service user was due to go home that day, one the following week and two new service users were due to be admitted. One person expressed satisfaction with the service that had been provided, both from the professional staff and from the home’s staff. The Registered Manager said the inappropriate referrals to the Intermediate Care unit have lessened and the home now asks for further information if referrals are incomplete or not sufficiently informative. These are still made, however, particularly when the hospitals have an urgent need for beds. Two service users were readmitted to hospital shortly after arriving in the unit during the course of this inspection. The home is staffed by support workers from the home, with a maximum of two if the unit is full and during the busier periods. Regular support staff are used on the unit which aids continuity. However, it was noted that few of these staff have had specialist training to support the work but this is now planned. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 12 The Occupational Therapist and the assistant Occupational Therapist were met and discussed the running of the unit. Both are involved in the assessment and rehabilitation programme for the service users. The physiotherapist is funded by the Primary Care Trust and was met briefly. The professional staff need to be out of the home for long periods to carry out assessments. It has been noted at previous inspections that, because of the constant changes to the service user group, and the staff from different disciplines, the unit would benefit from overall management cover to coordinate the unit and provide better liaison. It has been previously recommended that consideration should be given to providing senior management for the Intermediate Care unit and this recommendation is repeated. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 13 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, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is going through the transitional stage of changing from paper to computerised records and it was not demonstrated staff were fully aware of how the system should be used. It is not yet established that the system, as it is being used, can provide for continuity of support in a way which is not time consuming. The monitoring systems for medication administration are not robust enough to ensure that all errors are noticed and insufficient action is taken with staff making the errors. EVIDENCE: A computerised system has been introduced for maintaining the care planning records and the information had recently been transferred from the paper records. The system provides the opportunity to produce records on all aspects of the service users’ care. An examination of the files showed that some handwritten records and some of the new, computerised, records were being updated simultaneously but each unit varied in the way it was keeping the record. Staff were not always clear about which paper records were still to Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 14 be maintained. During the inspection, the Registered Manager produced some guidance and said that the files would be reorganised. The system was, during two of the visits, not working or was extremely slow. Daily notes are typed into the system at the end of each shift and, if the computer system is not working, have to be handwritten. A handover book is in place so ensure that important and urgent messages are passed on. The staff confirmed that service users and their representatives have had the opportunity to discuss and sign the care plans, although have not been issued with copies of these. While the computerised system provides the opportunity to produce clear and uniform plans, it was not demonstrated that all of the staff have a clear understanding of how the system works in practice. Additional computers have been placed in the corridors so that staff can update the records whilst being in the same area as the service users. However, there is no handover period during which care staff have the opportunity to update or read the notes. There must be monitoring in place to ensure that staff use the records effectively and that maintaining them does not reduce contact time with the service users. The printing of all records would be both cumbersome and timeconsuming but an effective way of using the records, which ensures that service users’ care plans are easily accessible and that their current needs are known by the staff providing the support, must be found. Not all of the documentation had been produced for one new service user and better monitoring of the records is required to ensure that these are completed. The daily notes seen for one service user, who had experienced a number of falls, were not complete enough to show that regular monitoring had taken place, particularly through the night. This was discussed with the Registered Manager who is aware that recording needs to be improved and more detail is required to demonstrate that the necessary support has been provided. Health care needs are met from the local community services, including daily visits by district nurses. One district nurse was met during the course of the inspection. The Mental Health Team were also in the home visiting a number of service users with dementia. The majority of service users have general practitioners from one practice, and one general practitioner makes a regular weekly visit. Service users in the home for respite and Intermediate Care service are registered on a temporary basis with the practice. The Registered Manager said that permanent service users would have choice of an alternative practice if they wished. The computerised system has the facility for a “multidisciplinary report” which can provide a running record of the contact with health professionals. This is a useful reference for checking on the professional visits made to the service user. However, monitoring is required to ensure that Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 15 staff are following any changes in health needs with appropriate checks and observations. This was not evidenced in the files examined. It was noted in records seen that one of the general practitioners had prescribed medication for a respite service user, whose stay is the subject of a complaint, without visiting. The management of the home must ensure that the admission and care planning procedures highlight any areas where appropriate professional attention must be sought. None of the service users self-medicate. On two of the units, the medication administration was examined and errors in administration were found. Two small errors where noted in the stock control. Night staff are responsible for checking medication stock but the systems in place are not sufficiently robust for the errors to have been noted. A monitoring sheet to show which senior staff member is responsible for medication was not signed on two occasions and a number of non-signings were noted on service users’ records. While staff said that they would check that the medication had been given, even if not signed for, there was no evidence of this. A staff member had been asked to sign retrospectively on one occasion where gaps were noted. Although a number of senior staff are participating in a distance learning course on medication, and all of the senior staff who carry out medication administration have been on training, it must be shown that errors are dealt with appropriately and action taken to prevent reoccurrence. The Registered Manager took action to improve the monitoring of the medication administration. None of the service users spoken to during the course of the inspection had concerns about the way in which staff provide their personal care. All have their own en-suite toilet and washbasin where care can be provided in private. In the new computerised care planning system, details of service users’ wishes, with regard to cremation or burial, can be recorded. This does not necessarily show their wishes with regard to cultural needs upon death or wishes with regard to terminal illness although the Registered Manager said that this could be added to the care plans. She also said that information on resuscitation, for instance, is known for a small number of service users and should be recorded in care plans. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. While there was no Activities Organiser at the present time, some activities were still taking place. The concerns about the lack of staff to provide activities has been addressed with additional hours being provided. Progress is being made to consult service users about the menu they prefer and to provide a better choice for service users with special dietary needs. EVIDENCE: The Activities Organiser had recently left the home after working in the home for some years. The Registered Manager said that the post, which is for thirty hours, would be advertised in due course. In the meantime, staff were being asked to provide the activities, with an additional member of staff being on duty, and a small number of individual activities were observed. An external trainer has been has provided to train staff to support service users with activities. It has been a previous concern that, in addition to providing activities for up to sixty service users, the Activities Organiser also had to fund raise for outings and materials for activities. The ratio of three support staff for thirty service users on the first floor, and three for twenty service users with dementia on the ground floor, does not allow for many activities on a oneWhitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 17 to-one basis, such as going out to the local shops. On the third visit to the home, the Registered Manager was able to report that an additional twenty hours for an additional Activities Organiser have been authorised. A barbecue had been held just prior to this inspection and a garden party is planned for the end of July. Outings, using community transport, are also planned for the summer months and the first, to Kew Gardens, was held during the inspection. The regular entertainer was in the home on the third visit. There is a facility for recording the activities undertaken by service users on the new computerised system, but the samples seen did not indicate that many activities had taken place and the Registered Manager said that staff do not always record these. As many of the service users are unable, because of dementia, to give information or express an opinion, it is important that evidence is available to show that opportunities have been extended to them. Service users are free to have visitors as they wish. The bedrooms provide sufficient space for visitors to be seated comfortably and two chairs were observed in most rooms. There are also some communal areas where service users could meet with visitors, including smoking areas, and a small private room for holding meetings is on the ground floor. The Registered Manager said that she had not been very successful in involving service users’ families in meetings and activities, but will continue to try and improve this situation and has had the help of Care UK Project Worker to improve service user and family involvement. Service users are offered the opportunity to exercise choice over their lives in a variety of ways, which may include staying in their rooms rather than using the lounges and a number were seen to do so, including those in the dementia unit. Requests to visit the garden were seen to be accommodated. The discussion with service users about the meals was generally positive, although one service user said that it could not be expected that everyone would like all of the meals. The Registered Manager said that a meeting had taken place with the service users and catering staff to discuss the menus and changes were being made. These include a better choice of menu for the diabetic service users, which will be identified on the new-style menus. These are being produced in a brighter format, and will be laminated so that they can be easily displayed. A new supplier has been sourced, which has provided a better variety and quality of food. More hot food has been introduced for the evening meal and the new menus will show the diabetic alternatives available. On the first day of the inspection, a meal of minced meat pie, potatoes, carrots and diced swede was served. The introduction of a third vegetable would improve choice and support a more varied diet and nutritious diet. This should be considered to ensure that the recommended five portions of fruit and Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 18 vegetables each day, recommended by nutritionalists, can be achieved. An alternative to the meat pie was available was available although the advertised choice of “cheese and onion fingers” had been changed to another vegetarian option. Few service users seem to choose the second option which appears, from the menus seen, to always be vegetarian. Consideration should be given to providing a wider choice of meat and fish. Should vegetarian service users be admitted, they also should be offered a menu with choices. The dessert was peach crumble and there was a fruit pie for the diabetic service users, both served with custard suitable for the diabetics. For the evening meal, hot dogs or burgers, with Angel Delight for dessert, was being served. Meals should now be recorded in the daily notes of each service user, but in the records checked there was some inconsistency. The Registered Manager took action to bring this to the attention of the staff. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 19 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, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is satisfactory but further work is still required to encourage the service users to be forthcoming and confident about voicing their smaller concerns. EVIDENCE: Two complaints have been received since the last inspection in November 2005. One had been dealt with by the local authority. The other complaint, concerning respite care, was in the process of being answered by the Registered Manager. None have been received directly by the Commission for Social Care Inspection. One service user felt that it was not worth complaining about small issues and many of the service users, because dementia or frailty, would not be able to voice their concerns. It was recommended previously that the management and staff look at ways to encourage the service users and their representatives to voice their comments, concerns and grumbles so that these can be recorded and action taken. As work is being carried out to involve service users, this is an area which should be addressed. The Registered Manager said that, at the recent elections, postal votes had been obtained for those service users who wished to have them and two cars had been made available for service users preferring to vote in person. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 20 Not all of the staff have had Protection of Vulnerable Adults training, although these are generally those employed on the staff bank. The subject is covered in the induction training and the London Borough of Hillingdon’s adult protection officer has provided additional training. In view of the vulnerable service user groups that the home accommodates, particularly in the dementia unit, this should be extended to all of the staff. There has been one issue of adult protection raised since the last inspection and this was in the process of being investigated by a London Borough of Hillingdon’s Social Services social worker under the Borough’s adult protection procedures. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable and pleasantly decorated and furnished. There are sufficient communal areas for those service users able to do so, to chose a quiet area or one with activities, such as television or music. EVIDENCE: Some changes have been made to the dementia unit since the last inspection and one of the two lounges has been decorated and fitted with sensory equipment, lights and music to make a “snoozelam” style relaxation area. This was not seen in use. Improvements have been made by providing an additional seating area in the hallway. This has proved popular with service users who seemed to enjoyed the interaction with passers-by, whether staff or visitors. Photographs have been added to bedroom doors, and activities, such as a large jigsaw and reminiscence pictures, were seen. Orientation boards had been delivered and were fitted by the end of the inspection. The other lounge in the unit had also been decorated and it was confirmed that service Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 22 users had been involved in choosing the colours for this. The seating has been rearranged ensure it is not so crowded and to try and encourage service users, who are able to do so, to communicate. All of the communal areas are pleasantly decorated with comfortable furniture. The garden, which is maintained by the handyman, makes a pleasant, secure area in which to enjoy the better weather and there was a large canvas pergola erected to provide shade. All of the bedrooms are single and provide sufficient space for two comfortable chairs to accommodate visitors. Each room has its own en suite toilet and washbasin. There are assisted bathroom facilities in every unit and all have the equipment to assist service users to use them. Hoists are available. All of the equipment was seen to have been serviced in November 2005. On the first day of the inspection, there was only one cleaner on duty and areas of the home appeared not to have been vacuumed. The carpets had not been shampooed recently because of holidays and illness of staff and there was a faint smell of urine in areas of the home. Carpets are usually shampooed on a regular basis to keep this under control. This is a timeconsuming task and individual continence management needs to be introduced to try and improve this situation. Where the odour cannot be eradicated, the replacement of carpets needs to take place. Sufficient cleaning staff must be employed to ensure there are enough staff employed to cover holidays and sickness. The laundry was found to be clean and tidy on this inspection. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 23 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. The size of the home, varying levels of dependency among the service users, and use of senior staff to provide training all need to be taken into consideration when reviewing the staff team, which needs to be continually under review. While basic training needs are being met, the training in specialist areas, such as dementia and rehabilitation, needs to be provided on a regular basis. As the home specialises in these areas of support, it is essential that staff have the opportunity to develop a good level of knowledge and skills. EVIDENCE: The home has a large team of more than seventy staff, including a team of bank staff to cover for holiday, sickness and training. No agency staff are used. The majority of the care staff work a maximum six hour shift. The home has two team leaders on duty on early and late shifts, one on each floor. In addition, three staff work with the thirty service users on the first floor, three in the twenty-bed dementia unit and one or two, depending on occupancy levels, in the Intermediate Care unit. Staff can be called upon to help on other areas if the Intermediate Care unit is not full. From 8pm to 8am, there are four night staff and a senior on duty. There have been no changes to the senior, care support or domestic staffing levels in the home. Two team leaders had left since the last inspection but Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 24 have been replaced. In addition to the support staff, the home has a catering and domestic team, a maintenance man and a full-time administrator. There is a low level of vacancies among the staff team, although the two Activities Organiser posts are to be filled as mentioned elsewhere in the report. One service user was having an assessment for a nursing home during the inspection and had been admitted to hospital by the second visit. A number of service users in the elderly frail unit appear to have the symptoms of dementia and their needs will be required to be kept under assessment. This may mean that their needs are higher and, consequently, the staffing levels need to be reviewed on a regular basis. The Registered Manager had the staff training records updated during the inspection and the majority of staff were up-to-date with their basic courses. Two of the team leaders are undertaking more intensive “training for trainers” which will enable them to update the staff in the home as and when required. One team leader had completed the course, which includes for manual handling, health and safety, fire awareness and food hygiene, and another will be doing so. This will also have an impact on the amount of time that they will have to allocate to their work as team leaders and this must be taken into consideration in the review of staffing levels. A sample of four recruitment files was examined and seen to be kept in good order. All were found to have the necessary information for safeguarding service users, such as Criminal Records Bureau disclosures. A good range of basic courses has been provided but staff also need to conversant with the illnesses and disabilities affecting older people. Although the home has a dementia unit for twenty people, it was noted that only fifteen of the current team have dementia training and this was carried out in 2004. Training to understand and support service users with dementia should be ongoing in specialist units. The home has not yet achieved the target of having 50 of the staff trained to National Vocational Qualifications Level 2 or above. However, action is being taken, by gaining access to new National Vocational Qualifications assessors, to improve the number of staff with the qualification, which had been as high as 47 , so that the target can be met. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 25 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, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a period of management stability, which has assisted with improving the overall running of the home. However, there are still some outstanding issues which have long been outstanding, such as regular supervision of the staff and the production of a review of the quality of care. Dedicated management of the Intermediate Care unit and staff able to deputise for the Registered Manager should be considered to support the diverse service user group and large staff team. Some aspects of the record keeping in the home needs to be further monitored, including ensuring that all records of maintenance are filed. While the financial records for service users are kept in good order, auditing is required to safeguard all concerned. Better recording of attendance at fire drills is required to ensure all staff are fully aware of the procedures. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 26 EVIDENCE: The Registered Manager has now managed the home for two years and this has provided stability after a number of management changes. She has the Registered Managers Award and National Vocational Qualifications Level 4. The home was found to have a more relaxed atmosphere and staff were generally positive about the its running. However, the home is large, with two specialist units, one with a continually changing service user group. Team leaders are involved in the day-to-day running of the units, assessments, supervising staff who work directly with service users, and are two are now involved in staff training. The Intermediate Care unit has no direct management cover and there is no Deputy Manager. Some requirements have not been fully met at inspections possibly because of the volume of work involved, although improvements have been made. In order to ensure that all of the National Minimum Standards and Care Home Regulations 2001 can be met in this busy environment, additional management cover needs to be considered. To improve service users’ and relatives’ consultation, a Care UK Project Worker has been involved in meeting with staff and the Registered Manager to increase the involvement of service user’ and their representatives. There has been some progress in obtaining the views of the service users by the sending of questionnaires to service users and their families. These have not yet been collated to form the basis of a review of the quality of care. This is a long outstanding requirement and needs to be completed. There are a number of audits carried out in the home and the Registered Manager was able to produce reports on various audits which had been carried out, including one on medication. Service users are involved in consultation meetings and one had been held regarding the menu. These reports need to be amalgamated into forming a review of the quality of care, which looks at any deficiencies in the service, how it can make improvements and how it is to develop in the future to meet the needs of the service users. The systems for supporting service users with their finances were examined with the Administrator. Six of the service users have their finances managed through Care UK and others have their personal allowances maintained by their funding local authority. Service users’ families bring in small sums of money to pay for hairdressing, newspapers, toiletries and any personal items the service users may wish to purchase. The system was found to be well maintained but Care UK have not carried out an audit for at least two years and the Registered Manager does not monitor the system. In order to safeguard both service users and staff, these tasks need to be carried out regularly. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 27 The lack of formal supervision for staff has been an outstanding requirement for the last two inspections. This has also been noted on the regular monthly visit reports carried out by senior Care UK staff. This has now commenced and a folder was seen for reach member of staff. However, the National Minimum Standards of six sessions a year is unlikely to be met at the present rate. However, two senior staff are new to supervision and have had recent training to carry out this task. It was discussed with the Registered Manager that new staff particularly need regular supervision to assist them to develop their skills and to identify training needs. She has introduced a monitoring system to try and ensure the Standard will be met. The Registered Providers must ensure that there is sufficient staff time available for staff to have regular supervision. The policies and procedures were not examined on this inspection. While staff, recruitment, and financial records are maintained in good order, more work must be carried out in ensuring that the service users’ records are completed and easy to access. It must also be demonstrated that the maintenance records are all completed and evidence is provided that the checks have been undertaken. The health and records examined showed that small electric appliance testing was carried out in March 2006 and the Landlord’s Gas check in February 2006. The hoists and assisted baths were noted to be examined in November 2005, and Legionella testing was completed in September 2005. While the maintenance person keeps a schedule of the servicing required, some of the records were not initially available. It is recommended that, for ease of monitoring, the maintenance records are kept with a schedule of all the frequencies and dates on which the work was carried out. This should ensure that all of the documentation is available for inspection and it can be checked that it is all up-to-date. The fire records were examined and found to be in order except for the recording of attendance at fire drills. The London Fire and Emergency Planning Authority’s guidance of a minimum of four drills for night staff and two for day staff needs to be evidenced to ensure that all of the staff are familiar with the fire procedures and have taken part. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 X 3 X 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 2 2 2 Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 29 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 as soon as possible after admission. (Previous timescale of 28/02/06 not fully met) The recording of service users’ daily notes must be in sufficient detail to ensure that any changes to health and welfare are recorded to ensure their wellbeing and provide evidence that their needs are being met. The health needs of all service users, including those on respite, must 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. All staff who undertake medication administration must be shown to be competent, with a clear understanding of the procedures for dealing with errors and the systems in place DS0000027127.V288650.R01.S.doc Timescale for action 30/09/06 2 OP7 12(1) a,b 31/08/06 3 OP8 12(1) a,b 17(1) a 31/08/06 4 OP9 13 (2),17 (3)(i) S.3 30/09/06 Whitby Dene Version 5.1 Page 30 5 OP18 13 (6) 6 OP26 18 (1) a 23 (2) d 18 (1) a 7 OP27 8 OP29 18 (1) c (i) 9 OP33 24 (1) (2) & (3) 10 OP35 18 (6) 11 OP36 18 (2) 12 OP37 17 (1,2,3) to prevent reoccurrence. All staff must have, by training or other methods, information about safeguarding service users under the adult protection procedures. (Previous timescale of 28/02/06 not fully met). Sufficient domestic staff must be employed to ensure there are enough staff to cover holidays and sickness. It must be evidenced that the staffing levels, including those of 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 service users, particular when higher dependency levels have been identified. Training to meet specialist needs in the home, such as dementia, rehabilitation, physical disabilities and common illnesses must be part of the ongoing training programme. The review of the quality of care must be completed and made available to service users and the Commission for Social Care Inspection. (Previous timescale of 28/02/06 not met). The financial records of the service users must be audited at regular intervals in order to safeguard service users and all those concerned with the maintenance of the system. Regular supervision sessions are required to be maintained for all staff. (Previous timescale of 31/01/06 not fully met). Monitoring systems to ensure good record keeping, particularly for care planning, finances and medication, must be maintained. DS0000027127.V288650.R01.S.doc 31/10/06 30/09/06 30/09/06 31/12/06 30/09/06 30/09/06 31/10/06 30/09/06 Whitby Dene Version 5.1 Page 31 13 OP38 23 (4) (e) A schedule of staff attendance at fire drills is required to ensure that all staff have attended on the required basis and have knowledge of the procedures to be followed. All staff should be shown to have taken part in fire drills within the timescale. 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP6 OP15 OP16 Good Practice Recommendations That consideration should be given to providing separate management cover for the Intermediate Care unit. That service users should be offered alternatives which are not always vegetarian and that additional vegetables are offered to support nutritional guidelines to be met. 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. Whitby Dene DS0000027127.V288650.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection West London Area Office 11th Floor West Wing 26-28 Hammersmith Grove Hammersmith 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.V288650.R01.S.doc Version 5.1 Page 33 - 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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