This inspection was carried out on 22nd July 2009.
CQC found this care home to be providing an Adequate service.
The inspector found no outstanding requirements from the previous inspection report,
but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Whitchurch House Whitchurch House Whitchurch Ross-on-Wye Herefordshire HR9 6BZ one star adequate service 27/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Philippa Jarvis Date: 2 2 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Whitchurch House Whitchurch House Whitchurch Ross-on-Wye Herefordshire HR9 6BZ 01600890655 01600890655 whitchurchhouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Keith Arnold Brown care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 29 Date of last inspection Brief description of the care home The Provider is registered in respect of Whitchurch House to offer residential services to older people who may be too frail to continue to live in their own homes. Some may have developed some level of physical disability and some may experience confusion associated with memory loss. 2 7 1 1 2 0 0 8 Care Homes for Older People Page 2 of 13 Brief description of the care home Whitchurch House is a period property which has been extended and is registered to provide accommodation for up to 29 people. There are bedrooms on both the ground floor and 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 of the River Wye and in 2000 a floodwall protection system was installed around the home. There are folders of information about the service that are available in each bedroom. A supply of brochures describing the service is also displayed in the front entrance. Each resident is charged individually according to their needs and the service should be approached for guidance regarding this. Additional charges are made for hairdressing, chiropody, magazines and newspapers. Care Homes for Older People Page 3 of 13 What we found:
At the last random inspection carried out on 27th May 2009, we found that the owner of Whitchurch House had not taken the required action to deal with requirements made at the Key Inspection carried out on 27th November 2008. We therefore issued two Statutory Requirement Notices. This was because we had concerns that people living in the home may have been put at risk or not have their needs attended to correctly. We also made a new requirement at the random inspection. We did this inspection to check what action the owner of the home had taken to deal the Statutory Requirement Notices and the requirement. This report is set out using these topics from the Statutory Requirement Notices and the requirement as headings. Whilst carrying out this inspection we identified other areas of concern that we are drawing to the attention of the owner of the home, some of which are subject to requirement. These areas are set down under additional headings. What the care home does well: What they could do better:
PREPARATION OF A WRITTEN PLAN OF EACH PERSONS CARE THAT MUST BE KEPT UNDER REVIEW. THIS REQUIREMENT WAS SUBJECT TO STATUTORY EREQUIREMENT NOTICE. We asked to read a sample of four care plans. These were each in place in the new format that has been brought into use by the home. We therefore consider that this Statutory Requirement Notice has been complied with. FURTHER CARE PLANNING ISSUES IDENTIFIED AT THIS INSPECTION. There were some aspects of the care planning process that continued to need development to ensure that all care was provided in an appropriate and safe manner. - We read one care plan that had been written on 3rd April 2009 but there was no evidence of it having been reviewed since that time. The guidance in the national minimum standards indicates that the plans should be reviewed at least once a month. The other care plans had either been written more recently or had been reviewed. - We read one care plan that contained a falls risk assessment that did not take all the
Care Homes for Older People Page 4 of 13 indicators into account. If this had been done appropriately the risk would have gone up from MEDIUM to HIGH. We discussed with members of the management team about their practice in completing the boxes and we found that they were following different practices: some were only completing one box in each section and others were completing more than one which led to the overall risk outcomes being variable. One person had been referred to the falls practitioner which is good practice. We found that their falls risk assessment had not been reviewed after each fall. - We found that some information that should have been in residents personal files was detailed in the communal communications book. This was not then translated into care plan instructions for individual residents. - We found that the daily record at the back of each persons file was not well detailed. For example for one resident we found no record in there as to why they had been referred to a GP for a prescription for a certain condition or of the circumstances leading to their referral to a district nurse for bruising to their legs. - There was a lack of specific guidance in the care plans as to how to provide care in some areas. For example we read one care plan that said, Maintain healthy and regular bladder and bowel functions but there was no guidance about how to do this. A bowel chart had been put into the file but there were only two entries on this over a period of several weeks. We also found an entry in the communications book that said Please ensure that ... drinks plenty of fluids. This is .. GP instructions as she has high blood pressure. There was no guidance in the care plan about encouraging fluids or fluid monitoring. ENSURING THAT THERE IS AT LEAST ONE PERSON TRAINED IN FIRST AID IN THE HOME AT ALL TIMES. THIS REQUIREMENT WAS SUBJECT TO STATUTORY REQUIREMENT NOTICE. The home had not been able to find a suitable training course for staff to take before our inspection, but had training arranged for the staff group on 17th August 2009. In the meantime the home has made robust efforts to ensure that one of the staff who has received training in first aid is on each shift. We were provided with a staff rota that showed the trained first aider on shift until 17th August. There were a small number of shifts where the home had not been able to provide this cover but had made sure that the person on call was trained in first aid. We consider that this Statutory Requirement Notice has been complied with. ENSURING THAT THE PEOPLE WHO LIVE IN THE HOME ARE WEIGHED REGULARLY AND PROFESSIONAL ADVICE SOUGHT WHEN SIGNIFICANT CHANGES ARE RECORDED. Since the last random inspection, the home were aware that there were differences in the calibration of the scales in the home and they had taken this into account when weighing the people who lived there. The home told us that they had reviewed the adequacy of the sets of scales that they had available in the home. They had decided that they needed to replace these as they were not suitable for use with the people living in the home. They had therefore ordered a new set of scales that were due for delivery on 22nd July 2009. We were shown the delivery note to confirm this. Care Homes for Older People Page 5 of 13 We read the records of four people and found that they each contained information to show that the residents had been weighed regularly and the weight recorded. We were told that there were no residents where there were concerns about their weight and therefore no referrals to health care professionals had been made. We did find, in one file, that the persons weight had been recorded on one occasion in metric and on another in imperial. This made it difficult for direct comparisons to be carried out. We consider that this requirement has been met. MEDICATION Whilst reading the care plans we identifed some issues around medication practice that we looked into further. This lead us to identify a number of areas of medication practice that need attention. We found that: There was no individualised guidance available for staff about the circumstances in which they should administer as required or PRN medication to the people prescribed them. We found a situation where the direction on the record of medication administration said to administer one or two tablets to the resident. There was no record kept of how many of the tablets were actually given to the resident on each occasion. There was no system to allow full stock control of medication in the home by recording the quantity of medication received, administered and returned to the pharmacy. There was one situation where there was lack of clarity about the system for administering a medication to one person who lived in the home and where there were 48 individual envelopes of untaken tablets waiting to be returned to the pharmacy dating back to 08/04/09. For this person the record of administration was incorrectly recorded as the medication having been administered. We found medication that had not been used by a resident for three months and needed to be returned to the pharmacy. We found loose tablets in the bottom of a medication box that we could not identify to the individual people prescribed them. Some medication was stored in the controlled drugs cupboard. Whilst these were lower schedule controlled drugs where full special arrangements do not apply, it is good practice to use full contolled drug storage and recording procedures. This includes recording in a controlled drug register. The home does not have such a register. In the CD cupboard we found a bottle of a medication that was unnamed and with no date of opening and further medications that were correctly stored in there but where there was no stock control, no date of opening and no guidance for use of as required medication. STAFF TRAINING We were provided with a copy of a staff training matrix that had recently been written. This confirmed the recent food hygiene training that had taken place in the home. However, it showed that there were significant gaps in training in relation to topics we would expect staff to have received training in. We confirmed with the deputy manager
Care Homes for Older People Page 6 of 13 that this information was full and correct. We identified major shortfalls in relation to moving and handling, fire safety and health and safety training. There were also only three staff detailed as having a national vocational qualification (NVQ). We were told that a member of the management team had recently met with a representative from Herefordshire Council to discuss training and the availability of suitable training courses. SERVICING OF EQUIPMENT. We saw a hoist in one corner of the dining room. We were told that the hoist was kept there, on charge, so that it would be ready for use in the event of need. Because no staff were detailed on the training matrix as having completed hoist training we looked for evidence that the hoist was fit for use, that is that it had been serviced. There was no sticker on the hoist as we would expect to confirm the date of service. Furthermore, there was no evidence in the relevant file to confirm that it had been serviced. The managers said that the owner of the home kept some information about servicing in his own home and that it was possible that this information was kept there and not in Whitchurch House. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Regulation 15(2) The home should keep the care plan of each person living in the home under review. This will help to ensure that the staff working in the home have a good understanding of peoples changing care needs and how to meet them. 04/09/2009 2 8 13 Regulation 13(4) 04/09/2009 Falls risk assessments must be reviewed in cases where the person has experienced a fall since the risk was previously considered. This will assist the home in reviewing whether there is any further preventative action they can take following each fall. 3 9 13 Regulation 13(2) The home must ensure that the records of the receipt and administration of medication are fully and 21/08/2009 Care Homes for Older People Page 9 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action accurately completed at all times. This will provide a full and accountable record of medications administered to each person living in the home. 4 9 12 Regulation 12(1) The home must ensure that all aspects of each persons care that need attention are detailed in the care plan. This will ensure that staff have explicit guidance about all steps that have to be taken to meet each persons social and health care needs. 5 9 13 Regulation 13(2). 21/08/2009 The home must ensure that there is individualised written instruction about the circumstances in which As Required medication should be administered to people living in the home. This will ensure that all staff who administer medication have guidance about the circumstances in which it should be given. 6 9 13 Regulation 13(2). The home must ensure that all medication held by the home is stored in a safe and organised way. This will help to reduce the risk of medication being
Care Homes for Older People Page 10 of 13 04/09/2009 21/08/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action administered inappropriately. 7 9 13 Regulation 13(2). 21/08/2009 The home must ensure that medication is returned to the pharmacy on a regular and timely basis. This will help to ensure that excess stocks of medication are not held in the home. 8 30 13 Regulation 13(5) The home must make arrangements for safe systems of work, including moving and handling. This will help to ensure that people who live and work in the home are protected from injury. 9 38 13 Regulation 13(4). 04/09/2009 The home must ensure that equipment used in the home is serviced regularly. This will ensure that the equipment is fit for use and help protect the residents from risk of accident or failure of equipment whilst in use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 04/09/2009 1 7 Consideration should be given to the content of the recording in the daily record to ensure that all relevant
Page 11 of 13 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations information is detailed in this record. 2 9 It is good practice to record Schedule 3 controlled drugs in a CD register. This will help to ensure the safe management of these medications. The home should ensure that it has a system in place to ensure that all staff receive training that is appropriate for the work they are to perform. The home must undertake a training needs analysis for the staff group that indicates shortfalls in training. This will enable the home to have a full understanding of the training needs of the staff group. All records relating to the care home should be held in the home. This will ensure that they are available for inspection. The home should review its practice for the recording of accidents. This will help to ensure that full and detailed records are maintained. 3 30 4 37 5 38 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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!
