This inspection was carried out on 27th May 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 2 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 7 0 5 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 11 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 11 What we found:
We did this inspection to check what action the owner had taken to deal with the requirements we made after we inspected the home on 27th November 2008. The acting managers had sent us information after the inspection about how they intended to meet the requirements within the timescales set down in the inspection report. This indicated that the home intended to meet all the requirements within reasonable timescales. This report is set out using the topics of requirements from the last report as headings. Because we found that some requirements from the last Key Inspection had not been met, we have issued Statutory Requirement Notices. This is because we have concerns that people living at the home may be put at risk or not have their needs attended to correctly. We will check whether the owners have done what they need to, to put things right when we do our next inspection. If we then find further breaches of the regulations about the same things we may decide to take further formal action. What the care home does well: What they could do better:
CARRYING OUT A DETAILED ASSESSMENT BEFORE PEOPLE ARE ADMITTED TO THE HOME. We looked at the files of two people who had been admitted since the last Key Inspection and found that the home is now assessing peoples care needs more carefully before they come to live in the home. We therefore consider that this requirement has been met. PREPARATION OF A WRITTEN PLAN OF EACH PERSONS CARE THAT MUST BE KEPT UNDER REVIEW. The home told us that they were introducing a new system of care planning and that they had bought this system from an external provider. This provides them with preprinted forms on which to complete the care plans for people who use the service. We looked at the files of four people who live in the home. These were sampled at random. We found that only one of these had been fully transferred into the new system. One person who was new to the home since the last inspection, having been admitted in January 2009, had a pre admission care needs assessment. Whilst his records were set
Care Homes for Older People Page 4 of 11 up in the new format many of the forms had not been completed. We found an example of inaccurate recording that had potentially serious consequences. His falls assessment said that he had no previous falls but the front admission sheet indicated that he had been admitted following a fall. The home had not proceeded to carry out a falls risk assessment even though his risk of falling was detailed as being high. A second person admitted six weeks before this random inspection had some documents in the new format and the acting manager described her care plan as Work in progress. We found that the home had not yet carried out nutritional, pressure area or manual handling assessments. Another person with significant and changing care needs had not had his records changed to the new documentation. He had been admitted to the home some six months previously and there was a care plan in the old format that was a description of his preferred daily routine. Following an accident he had spent some time in hospital and a new assessment of his needs had been carried out before his return to the home. He was then readmitted to Whitchurch House. Changes identified in the assessment related to mobility, personal care and continence. After returning to the home he developed pressure area care needs. No new care plans had been developed about these aspects. Therefore there was no written instruction available for staff about how to meet his requirements in these areas. We spoke to one member of staff who was not aware that this resident had developed further pressure area care needs on another area of his body. We saw in his record that his weight had been taken but showed a significant weight loss in a two week period from 2nd to 16th April. There was no record of his weight having been taken since that time and no one had taken any action to seek professional advice about this weight loss. The home weighed him again during the inspection on two different sets of scales that gave two readings with 9 pounds difference. Both these readings were significantly below the reading on April 2nd. The fourth file we looked at had all their records converted into the new care planning format and there was a full plan of care in place for her. In the requirement made following our last inspection we asked the home to make sure that there was a care plan in place for each person who lived there by 31st January 2009. We do not consider that this requirement has been met and we have issued a statutory requirement notice. In this the home has been required to put a system in place to ensure that each service user has a written care plan that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health and personal care needs of the residents are met by 20th July 2009. REVIEWING THE MEDICATION POLICY. The home reviewed their medication policy promptly and provided us with a copy of this document with their response to the Key Inspection report. We consider that this requirement has been met. CARRYING OUT AN ASSESSMENT OF THE MOVING AND HANDLING NEEDS OF EACH PERSON LIVING IN THE HOME. Care Homes for Older People Page 5 of 11 We read the files of four people and found that three people had moving and handling risk assessments in place although the fourth person, who had been admitted about six weeks previously, did not. The home needs to continue to pay attention to this aspect of assessment to ensure it is carried out for everyone who lives in the home. Sufficient improvement has been made to consider this requirement has been met. REVIEWING THE ARRANGEMENTS FOR THE MANAGEMENT OF CONTROLLED DRUGS KEPT IN THE HOME. At this inspection we were told that the home has not had any controlled drugs prescribed for residents since we last inspected. They have reviewed their systems for the management of these and have made sure that staff administering medication have received training in this area. They do not have a controlled drugs register but gave their assurance that they would purchase this record in the event of need. This requirement is considered to be met. ENSURING THAT EACH PERSON EMPLOYED IN THE HOME KNOWS HOW TO PROTECT VULNERABLE PEOPLE FROM ABUSE. The home arranged two training sessions with Herefordshire Council in this area of practice so that the staff group now have the right level of training. This requirement is considered to be met. ENSURING THAT ALL STAFF INVOLVED IN THE PREPARATION OF FOOD COMPLETE TRAINING IN FOOD HYGIENE. There has not been any training in this topic since the last inspection. The home has arranged to see a skills broker to discuss training needs for the home and stated their intention of ensuring staff who are involved in the preparation of food do food hygiene training. Whilst they have extended the hours of the cook, who has a suitable qualification, during the working week, there are still times when care staff prepare food. We spoke with one carer who told us that she has not completed food hygiene training although she does prepare teas at the weekend. We do not consider that the requirement has been met and it is repeated in this report under Regulation 18. ENSURING THAT ALL PEOPLE WHO WORK IN THE HOME RECEIVE FIRE SAFETY TRAINING AT REGULAR INTERVALS. There have been a number of in house training sessions in fire safety since the last inspection and most staff have taken part in one of these. They were led by the acting managers, who themselves have no training in the management of fire safety. We asked what their fire safety risk assessment said about staff training in this area but it did not cover this topic. The acting managers showed us a sheet from the front of the fire log that indicated staff should receive training in this area once every three months. This requirement is considered to have been met. We have, however, made a
Care Homes for Older People Page 6 of 11 recommendation about review of the homes fire safety risk assessment. ENSURING THAT THERE IS AT LEAST ONE PERSON TRAINED IN FIRST AID IN THE HOME AT ALL TIMES. There is no training matrix available in the home to enable ready access to information about training of staff in first aid. The deputy manager confirmed that there had not been further training in this area since the last key inspection. He also indicated that his own first aid training had expired. We looked at some staff files and found that there was only one member of night staff with current first aid training and identified night shifts in the week of our inspection where there was no member of staff on duty with current training in first aid. We were told by senior staff that, when they are drawing up the rotas, they do not take into consideration whether there is anyone on the premises who has training in first aid. In the requirement made following our last inspection we asked the home to make sure that there was at least one first aid trained person in the home at all times by 31st January 2009. We do not consider that this requirement has been met and we have issued a statutory requirement notice. In this the home has been required to put a system in place to ensure that staff appointed to work in the home, have been suitably trained in first aid to ensure the safety and well-being of people living in the home and that they are not put at any unnecessary risk of harm by 20th July 2009. 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 11 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 11 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 8 13 Regulation 13 (1) (b) 20/07/2009 The home must ensure that people living in the home are weighed regularly and that a record is kept of their weight. Professional advice must be sought when significant changes are recorded. This will help to ensure that their health is promoted and that advice and treatment is received where necessary. 2 30 18 Regulation 18 (1) (c) All staff who are involved in the preparation of food should complete training in food hygiene. This will help to ensure the health and safety of people living in the home. 30/09/2009 Care Homes for Older People Page 9 of 11 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 1 8 The home should ensure that the scales used for weighing the people who live there are calibrated so they can be certain that the weights recorded are accurate. The home should review its fire safety risk assessment paying particular attention to the training that staff need to ensure that they have the necessary knowledge to protect the people who live in the home in the event of a fire. 2 38 Care Homes for Older People Page 10 of 11 Reader Information
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