Inspection on 19/05/05 for Whitchurch House

This inspection was carried out on 19th May 2005.

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

Other inspections for this house

Whitchurch House 22/07/09

Whitchurch House 27/05/09

Whitchurch House 25/11/08

Whitchurch House 27/11/06

Whitchurch House 14/12/05

Whitchurch House 25/10/04

Whitchurch House 14/04/04

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Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Whitchurch House Whitchurch Ross-On-Wye Herefordshire HR9 6BZ Lead Inspector Wendy Barrett Unannounced 19 May 2005 14:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Whitchurch House Address Whitchurch Ross-On-Wye Herefordshire HR9 6BZ 01600 890655 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Keith Brown Registered Care Home 29 Category(ies) of Old Age (29) registration, with number of places Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home may admit one named service user who has a learning disability Staff must be trained in the needs of people with a learning disability. There must be provision of access to activities as agreed in the needs assessment of the named service user.. Date of last inspection 25 October 2004 Brief Description of the Service: The Provider is registered in respect of Whitchurch House to offer residential services to older people over the age of 65 who may be too frail to continue to live in their own homes. Some may have developed some level of physical disability so for example may need to use a walking frame, some may experience occasional confusion associated with mild memory loss. Whitchurch House is a period property which has been extended and is registered to provide accommodation for up to 29 people. There are some bedrooms on the ground floor, others at first floor level. The first floor is in two separate areas, one served by a staircase and lift, the other by another staircase and chair lift. The home is situated in attractive gardens in a rural situation within walking distance of a church and nearby park attractions. It is within the flood plain and following extensive flooding in the area three years ago, in 2002 a floodwall protection system was installed around the home. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection. The visit to the home took place between 2.15pm and 6.45pm. The Provider and Care Manager designate were at work. A recently recruited staff member and two residents were interviewed. There was a tour of the premises. Some records and documentation were inspected. Other information used to write this report was gathered at an inspection undertaken on 2nd February 2005 and details contained in written responses submitted to the Commission by the Provider following the previous two inspections. What the service does well: What has improved since the last inspection? The Commission has received an application for registration of the Care Manager designate. Registration will strengthen the accountability of the Care Manager because it will invest legal responsibilities in respect of the management of the care. The staff recruitment procedure has been tightened up to make sure new staff are suitable to work with vulnerable adults. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 6 The accommodation is receiving ongoing attention to maintain it to a high standard. Care planning processes and the method of recording work to this end has been well developed. The records are regularly amended to show how staff identify emerging needs and how these receive attention to ensure they are met. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, and 5 There is good attention to providing enough information literature to help people decide if the home will meet their needs. Staff at the home assess the needs of potential residents so that they can also decide whether these can be met. EVIDENCE: There are examples of the required information literature in use e.g. samples supplied to the Commission and displayed at the home. Two residents had received support from their relatives in arranging their admission to the home. They both thought that their families had received written information and copies of contracts of residence. A sample of care records included evidence of detailed pre-admission assessment work, including consultation with the resident and relatives. The brochure contains an invitation to visit at any time in order to see the facilities offered. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8. There are thorough recording processes to show how health and personal care needs are addressed, including the management of risks. This structured approach to recording is supported by written policies and procedures for staff to follow. It identifies a service that responds quickly to emerging needs and consults the resident, relatives and other professionals appropriately. EVIDENCE: An action plan submitted by the Provider following previous inspections indicates satisfactory attention to previous related requirements. Care planning and risk assessment procedures have been further developed. Written records of care reflect ongoing attention to identified needs. They address aspects of health, personal and social care. Risk assessment is initiated appropriately e.g. a resident who recently slipped off the edge of his bed has been supplied with a new carpet specially chosen to offer better grip. Two interviewed residents were happy with the personal care they receive e.g. one commented that he has recently been offered more bathing opportunities. A resident had been consulted about managing his own medication. This is in line with the homes’ medication policy and procedures. This guidance was Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 10 updated in October 2004 with reference to relevant legislation. A copy has been supplied to the Commission. Individual care plans contain details of homely remedies following consultation with the G.P. A recently appointed care assistant explained that she was in the middle of an accredited 16-week course in medication management. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 There are regular and varied activities offered at the home that are designed to accommodate residents expressed interests. Residents should have information about future planned programmes i.e. advertised in the home, and recording systems should be developed to show how individuals actually benefit from social opportunties. Staff support residents in maintaining contact with their families and friends. Residents are offered choice about the service they wish to receive. EVIDENCE: A key worker system is being introduced to encourage the recognition of each resident’s individuality. An activities co-ordinator is employed and there is a monthly activity programme. Residents and visitors may appreciate it if this programme was displayed out in the home. Where residents prefer regular one to one time with staff e.g. looking at family photos, it should be recognised that this type of attention is a valuable aspect of care and should be structured into care plans. Residents are encouraged to maintain contact with their families e.g. a wedding anniversary party for one resident had been arranged by staff. His wife, who was in hospital, was due to spend the night at the Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 12 home with her husband following consultation with hospital staff and family members. There are examples of opportunities for residents to exercise control over their lives e.g. display of literature advertising advocacy services, a newsletter, information from residents about choice re: baths, meals. Menus are advertised. These show choices and residents confirmed that they had been consulted about their preferred choice on the day of the inspection. A resident commented that the menu had recently improved. A record of food reflected flexibility in order to accommodate any special dietary needs or preferences and care records included reference to nutritional needs. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 There has been work to familiarise staff with protection issues but this will need to be further addressed to ensure a positive atttitude to this essential element of their work with vulnerable adults. EVIDENCE: There are adult protection and whistleblowing policies and procedures at the home. Staff received training in adult protection from the local authority vulnerable adults co-ordinator in February 2005. A staff member who was interviewed during the inspection had not been available for this session and the Care Manager designate indicated that staff who had attended did not feel happy with it. Further guidance will need to be offered to ensure that all staff understand and accept their role in protecting vulnerable adults. The interviewed staff member had been CRB/POVA checked as part of her recent recruitment. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The home is furnished and fitted to a high quality with a pleasant and accessible garden. There are procedures in place for staff to monitor and maintain a safe environment. Residents have a choice of communal space. EVIDENCE: The house and grounds were clean, tidy and well maintained. A refurbished bedroom had received attention to safety factors i.e. covered radiator, window restrictor. A ‘snug’ sitting area was being developed into a comfortable space for residents to spend quiet time, or receive visitors in private. There were plans to request visits from the mobile library or increase the availability of large print books in the snug lounge. The Commission has received details of attention to the safety and maintenance of the environment e.g. flood procedure, fire risk assessment records. There had been a recent alteration to the fire evacuation point and a staff member was familiar with the new arrangement. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 15 A cleaning rota in the kitchen offered staff guidance in maintaining a satisfactory standard of hygiene in this area of the home. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Staffing levels are satisfactory and new staff are selected after careful vetting of their suitability to work with vulnerable adults. Records of staff induction/foundation programmes should confirm that they are in line with national specifications. EVIDENCE: Staffing levels are satisfactory for meeting the needs of current residents. Records reflect a satisfactory recruitment process, including checks to assess the suitability of the applicant to work with vulnerable adults. This practice was further confirmed from information provided by a recently appointed care assistant. A signed copy of an in house Code of Conduct was seen and staff are also familiarised with the Code of Conduct and Practice produced by the General Social Care Council (G.S.C.C.) An induction programme is in place. This will need to be checked against national specifications as it was unclear from a record seen whether it was in line with these. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, 37 and 38. There is a constructive working relationship between senior staff and the Provider in addressing all aspects of the management of the service. This clarity ensures that resident and premises safety is kept under regular review. Staff feel well supported through on site supervision and the provision of training opportunities. The Commission is kept informed of developments at the home. EVIDENCE: The Care Manager designate has submitted an application for registration with the Commission. The Provider was present at the home when this on-the-spot inspection took place. There was a clear understanding of the division of operational responsibilities. A staff member felt very well supported by the management and residents saw them regularly at the home. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 18 The Provider has submitted detailed action plans in response to requirements arising from inspections last year. There were examples of improvements already achieved by the new management structure e.g. revised care planning processes, menu improvements, updating of policies and procedures. One of the updated policies addressed issues of confidentiality and included guidance for staff in secure management of residents’ personal information. Reports required under Regulations 26 and 37 are being appropriately submitted to the Commission. Records at the home are well organised and securely stored. There is evidence of attention to safety factors affecting the premises e.g. flood procedure, fire risk assessment. Staff have health and safety training and are offered additional guidance through the provision of up to date policies and procedures. Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x 3 x x x 3 3 3 Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation none Requirement Timescale for action 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 12 Good Practice Recommendations The work already in place to address social care would be enhanced with a more structured approach to informal, one to one opportunities for those who prefer these to group events. Programmes of group activities should be advertised in the home so that residents can look forward to favourite events. Staff will need further guidance to ensure they have a positive attitude to their role in adult protection issues. Records of staff induction/foundation training should include reference to national specifications. 2. 3. 18 30 Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 178 Widemarsh Street Hereford HR4 9HN 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 Whitchurch House E52 E02 S24747 Whitchurch House V228933 190505 Stage 4.doc Version 1.30 Page 22 - 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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