Inspection on 09/07/08 for Whitchurch Lodge

This inspection was carried out on 9th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Whitchurch Lodge 13/07/07

Whitchurch Lodge 20/04/06

Whitchurch Lodge 21/06/05

Whitchurch Lodge 06/04/05

Whitchurch Lodge 08/12/04

Whitchurch Lodge 15/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Whitchurch Lodge 154-160 Whitchurch Lane Edgeware Middlesex HA8 6QL Lead Inspector Clive Heidrich Key Unannounced Inspection 9th July 2008 09:15 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 Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitchurch Lodge Address 154-160 Whitchurch Lane Edgeware Middlesex HA8 6QL 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) 020 8952 5777 020 8866 3288 Finbond Limited Mr Jamnadas Haridas Raithatha, Mr Mahendra Mehta Mrs Beatrice Anne Donlevy Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 32 13th July 2007 Date of last inspection Brief Description of the Service: Whitchurch Lodge is a care home providing personal care and accommodation for up to 32 older people. The registered provider of services at the home is Finbond Limited, a local organization run mainly by Mr. Raithatha, who is referred to as ‘the owner’ in this report. He visits the home a number of times each week. The home itself has been operating as a care home since 1965. The premises is a two-storey building that was adapted from local houses. It was significantly rebuilt in the mid-1990s. It blends in well with surrounding homes. The home is located within a residential area of Edgware, near Canons Park tube station, within the London Borough of Harrow. It is around five minutes walk from shops and a park, and has a bus stop outside the home for buses on the #186 route between Harrow and Edgware. The home has a driveway that can take about six vehicles. Five of the homes bedrooms are double rooms. All bedrooms are fully furnished. They have either built-in sinks or en-suite toilet facilities. The home has four communal bathrooms including a walk-in shower upstairs, and nine communal toilets. Access to the first floor is by stairs or a lift. The home has a large dining room, and a large main lounge that is arranged into two separate areas. The home has a fair-sized and accessible garden, with an extensive patio area. The home has a service user guide available and the current charges range from £450 to £600. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place to consider the overall quality of service experienced by people at the home. To enable this process, we sent the manager a number of surveys to distribute to people involved in the home. We consequently received surveys from four people living in the home, twelve relatives, advocates or carers, and two health professionals. Staff at the home confirmed that they had also received our surveys but none ended up replying. The views from surveys have been used throughout this report. Shortly before the inspection we found that we had not received pre-inspection paperwork. We found that the manager had not received it. Consequently the manager worked hard to complete this paperwork shortly after our inspection visit, which was appreciated. At the unannounced inspection visit, we were supported by an Expert-byExperience during part of the visit. An Expert-by-Experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with us to help them get a picture of what it is like to live in or use the service. They provided a report of their findings to us shortly after their visit, aspects of which we have used within this report. The inspection visit lasted for ten hours in total. During this period, we met with people who live in the home, staff working there, and some relatives and other visitors. Much of the environment was checked, and care practices were observed in communal areas. A number of records were analysed. Feedback was provided to the manager at the end of the visit. We are grateful to everyone involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: Surveys and feedback found that the majority of people feel that their needs, or those of their relative living in the home, are met by the services provided at the home. Comments included, “Whitchurch Lodge is run very efficiently”, “The staff show genuine care and kindness to the residents”, and “My aunt is looked after very well and they show compassion.” We found that the health and medication needs of people living in the home are appropriately addressed overall. The food provided is generally wellreceived. People living in the home can choose their own lifestyles, for instance Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 6 in having their pets with them, and privacy is respected. The home provides inclusive activities during weekdays, and visitors are made very welcome. The home has a consistent and experienced staff team, in terms of both care staff and those in other roles. There was good praise of the staff in general, including that they are responsive to requests and respectful to people living in the home. As one person commented, “The manager and her staff are always available to listen & help in every way.” We also found that where complaints about the service have been raised, the manager has taken them seriously, investigated promptly, and addressed any issues that are upheld. What has improved since the last inspection? What they could do better: We found that some of the equipment provided in the home was not being maintained sufficiently. Of particular concern was that the passenger lift took a large number of weeks to fix, which meant that a number of people living upstairs were not able to come downstairs during that period and use communal areas. As one relative noted, “The lift has been out of order for almost six weeks now. Those residents who are unable to walk have been stuck in their rooms 24 hours a day.” The issue was not notified to us in due course, which meant that we were not initially aware of the issue and hence unable to monitor progress. Other equipment we found concerns with included a washing machine, fans in the kitchen, and a stopped clock in the lounge. Whilst efforts were being made to address these issues, the overall effect of insufficient maintenance compromises the quality of life of people living at the home, and puts extra pressure on staff. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 7 We also found some areas of safety that were not being sufficiently addressed. At a practical level, a window in the temporary lounge upstairs was able to open too far, presenting a risk of people falling out. We also found that some risk assessments relating to people living in the home did not recognise their changed needs, which could result in their care becoming inappropriate. We found inconsistencies with staff being provided formal supervision meetings. Whilst some had received supervision appropriately frequently this year, others had received none, which fails therefore to provide a fair system of support to staff. We wrote to the owner about this separately, as progress in this area since the last inspection had not happened, and noting that enforcement actions would be considered should improvements fail to be made. At the time of drafting this report, a robust reply has been received. A full list of requirements and recommendations can be found at the end of this report. 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. The summary of this inspection report can be made available in other formats on request. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The service provides a reasonable standard of written guide about the home, for anyone considering moving in. The service considers, to a good standard, the individual needs of anyone requesting to move in. EVIDENCE: The manager explained a recent case of someone moving in on an emergency placement, as requested by a social services team. It was clear from the manager’s descriptions of the person that she knew a lot about the person’s individual needs, which she explained was due especially to having a good chat with them shortly after they moved in. There was also feedback and paperwork to show that the large amount of medication that the person had arrived with, had with their GP’s input been sorted out into what they should be taking on a daily basis. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 10 We checked the care file of this new person. Given that they had moved in on an emergency placement only a few days before the inspection, there was a reasonable amount of detail about their needs. This included an assessment undertaken by the home on the day of moving in, which included such individual information as the type of bread they like, alongside good details of for instance their physical needs. There were assessments of dependency and for falls-prevention in place. A care plan had been started, specifically around personal care and hygiene support, and it was encouraging to see that the manager was working on expanding this plan during the inspection visit. We also checked the pre-admission assessments of a couple of people who have lived a while in the home. We found the assessments to be sufficiently comprehensive, including for instance relevant details of the person’s life history, which can help inform staff should the person refer back to those time periods. All four people living in the home who replied to our surveys, noted that they received enough information to help make a decision about the home before moving in. The home has a Service User Guide that is distributed to new people, albeit the manager explained that she was in the process of revising it. A copy of the draft revision was sent to us shortly after the inspection. It clearly described the services that the home provides, and showed a fair standard of addressing equality and diversity issues. It would be useful if the guide could be provided in different formats, to help pro-actively address the needs of people who would want to see it but who could not manage plain text in English easily. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The service generally identifies and records the needs of people living in the home. Occasionally changed needs within safety assessments are not recorded about, which could lead to adverse outcomes for people. Health and medication needs are fully met overall. People living in the home are treated well in terms of respect and privacy. EVIDENCE: Survey feedback praised how well the home meets the different needs of people. For instance, seven out of twelve relatives, carers and advocates said that this happens always, with other responses also being positive. One person stated, “As far as I am aware, everybody is treated with the greatest respect.” Similarly, the same group of people, when asked about how well the home provides the support and care expected, had eight people from twelve stating that it always happens. One person noted, “He has the highest support and care possible.” Three others rated this as ‘usually’ and one as ‘sometimes’. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 12 We looked at the care records of three people in detail. We found care plans to be in place for each of them. These had all been signed by that person or their representative. The plans were sufficiently detailed as to show the person’s individual needs and how staff are expected to support them. The plans covered expected areas such as personal care, diet, mobility, night-care, and health needs, along with specific information where needed such as about communication, pressure care, and activity. There was some evidence of attention to cultural needs, for instance in respect of religious input, dietary restrictions such as for Kosher food, and language abilities. We also had feedback from a relative that the plan is followed in respect of a specificallyagreed diet. We noted further that the care plans are reviewed on a monthly basis, including with consultation. There are occasional updates to the plans where needed. We also found records of recent formal review meetings that involve the relevant social worker and involved family. Survey feedback from relatives, carers and advocates confirmed their input. We considered the health assessments in place for some people. We typically found assessments on manual handling, falls prevention, and dependency. These were of a reasonable standard, insofar as they prompted for actions to be taken where concerns arose. However we also found that the standard of reviewing was sometimes insufficient. This was because the reviews did not alter the findings of the assessment despite other evidence at this inspection to show that changes had in fact taken place. For instance, for one person who had had four recorded falls in the accident book in the previous three months, there had been no change to their falls risk-assessment since March 2007, despite monthly reviews. In particular, the question in the assessment on whether they have a history of falls did not refer to falls in the accident book during the recent monthly reviews. Another person’s assessment continued to rate them as continent despite feedback that they were not. Consequently actions to address changed needs may not have taken place. This was all explained to the manager, who agreed to address the issue. We additionally found no risk assessment in terms of people who have bedrails on their beds to prevent them rolling off. We noted that there was a concerning gap between one person’s mattress and their bed-rail, where they could get lodged and become injured, which would be picked up on and addressed through an assessment. The lack of assessment also fails to record consideration of possible restrictions to the person’s freedom of movement. This was also explained to the manager, who agreed to address the issue. The care files showed input from a variety of health professionals. These included, for instance, the district nurse, the GP, and a physiotherapist. A professional’s file included good evidence about a recent dental service visiting a number of people in the home and carrying out work where needed. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 13 Feedback from people using the service was very positive about health support. All four people who replied stated that they always receive the medical support they need, one noting that, “Medical supervision is quite good.” Feedback from health professional surveys was also positive. Both respondents stated that people’s health care needs are usually met by the home. One stated that the home always seeks advice and acts upon it to improve people’s health, the other rating this as ‘usually.’ A couple of relatives commented within surveys about possible shortcomings, in terms of continence support at the home appearing insufficiently timely. We noted that there were no lingering offensive odours around the home. We found care plans in this area to be sufficient. We found monitoring charts however to be lacking in information on some days, which should be improved on. Nonetheless we found no evidence to confirm that continence needs are not met. Indeed, the manager’s pre-inspection paperwork suggested good practice in some connected areas, for instance, “night staff are amazing at noticing offensive urine, which means a relevant antibiotic can be given at the start of a problem.” We noted that some people living in the home were using pressure-relieving equipment, which we found to be appropriate to their care needs. The manager was full of praise for the visiting District Nurse team, noting that, “They are very quick when asked to assess for pressure-relieving equipment.” We were satisfied with the medication support provided to people. The general medications and records of four people were checked in detail. The records included a photo and room number of each person, which helps to ensure that medications are not given to the wrong person. The medications are supplied by a pharmacist in ‘Nomad’ pre-packed weekly containers that should help staff to administer the correct medicines at the correct time. We found that all of these people’s prescribed medication was available in the home, except for one person. In their case, one medication was missing, but we judged that the home was taking prompt action, including liaison with their GP, about it. The home was not at fault for the medication being missing in the first place. We found that the administration of medicines was being recorded correctly, and that this process was up-to-date. This included for medicines that have to be stored separately to the pre-packed ‘Nomad’ containers. We saw a Controlled Drugs register that recorded each occasion of medication being offered. These were signed by two staff members, which is good practice. It was noted that some handovers included a stock-check of controlled drugs. We found that these medications were being securely stored. We found that the home has facilities to store as-needed medications, and medications that need cooler temperatures. We also found that the dates of Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 14 opening liquid medications, to enable appropriate disposal in due course, was taking place. We were informed that no-one self-medicates any tablets, however the home would support this if requested and assessed as capable. We found that some people have prescribed creams and inhalers in their rooms, either to assist the person to have quick and easy access where self-medicating, or to assist carers to have access due to frequent use. Whilst this helps support people to have medications as prescribed, there was nothing written in their files to show that safety for them and others had been considered, particularly as none of these medicines were found to be kept locked in people’s rooms. Written assessment is recommended. We were informed through the pre-inspection paperwork that the pharmacist undertakes unannounced checks of the medication systems in the home, and that no concerns arose from the last such check. They had also provided recent refresher training to staff who administer medication. We found people living at the home to be appropriately dressed in presentable clothing, where it was clear that they need support to dress. The Expert-byExperience confirmed this observation. We also briefly met with the hairdresser who comes into the home, and noted that the hair of a number of people living in the home looked more attractive after the hairdresser’s input. We checked the bathing records of one person relative to their care plan, and found that the plan was addressed for the month of June, which is encouraging. Surveys from people using services found everyone stating that staff listen to and act on what they say. On person living upstairs in the home verbally confirmed this, particularly that staff attend when called. Other comments directly from people living in the home included that they are happy in the privacy of their own room, and that “we are treated well here.” The Expert-byExperience noted that staff were seen to be attentive to people living in the home. We observed similarly, for instance, staff providing appropriate support to people at lunch, including sitting to help people to eat whilst talking with them, and people being offered and accepting blankets from staff. Comments from relatives, carers and advocates included, “The care home is very kind and respectful to my relative. If any problems arise there is always someone to talk to”, “All the staff at Whitchurch Lodge seem very caring. They always spend time with the residents and are very attentive” and “The staff on the whole are good and care about my mother.” Another relative was particularly praiseworthy of the home for when they support their relative to wear jewellery, as “this shows they value her as a individual.” The two surveys from health professionals also both noted that the care service always respects people’s privacy and dignity. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 15 A couple of relatives, and the Expert-by-Experience, noted that staff do not talk to people living in the home as much as they could. One person stated, “When residents are in the lounge, it seems that carers often sit around and do not interact with the residents. I feel staff should be encouraged to talk to residents as much as possible.” Whilst it is not in doubt that staff are responsive to requests and uphold good standards of dignity, consideration should be given to whether staff interact sufficiently with people overall outside of providing task-based care such as meals support and personal care. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The service aims to enable people living there to have choice and control over their lives. Consequently people living there can reasonably experience their lifestyle preferences, and are provided with good support for activities where wished for. The home welcomes visitors, and provides a degree of community support. People receive reasonable meals that appeal to them. EVIDENCE: Survey feedback from people living in the home was that activities are always or usually arranged by the home that they can take part in. One person living at the home told us that there is enough to do, whilst another clarified that the activities co-ordinator is “very useful, for instance for local trips.” A relative similarly praised the role of this worker, citing examples of how the worker had worked closely with their mother and how this showed that her mother was valued as an individual. The Expert-by-Experience noted that the activity co-ordinator was seen to include everyone in the home, not just those in the lounge, and that everyone Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 17 seemed to participate. Individual work was also prepared for certain people living in the home, at a level to meet their needs, and so the standard of organized activities was seen to be strong. Pre-inspection paperwork included that the home enables people to move in with their pets where possible, and that “as a home we have to be prepared to look after the pets needs as well, this may include visits to our local vets.” This is a long-standing strength of the home, and the pet seen during the visit appeared to enhance the stay of the person without impinging on overall standards of care. Pre-inspection paperwork included that the home provides, “entertainment, birthday celebrations at the end of each month and a huge amount of creative work has taken place in the home, aside from games, quizzes and reminiscence sessions.” The quizzes are noted to be “made up of service users, staff, friends and family members.” We noted that there were records and photos of people in the home occasionally going out on trips, such as to the Beck Theatre last year. The manager explained imminent plans for this year. The Expert-by-Experience additionally noted feedback that some relatives take people out. Records showed us that where requested, the home supports religious people such as priests to visit the home. 7 from 11 surveys from relatives, carers and advocates found that the home always helps their friend or relative keep in touch with them. Other replies were also positive. One person noted, “I am informed of any problems.” The manager noted that for people living in the home who have not bought a direct phone line in their room, there is a handset in the lounge for anyone wishing to make or receive a call. We noticed that visitors were warmly greeted and supported by staff. The Expert-by-Experience noted that they were made to feel very welcome. Conversely, we also saw written evidence advising staff about a person who was not entitled to visit. The manager explained reasons why, and these were judged to be appropriate in terms of people’s safety. 8 from 12 surveys from relatives, carers and advocates found that the service always supports people to live the life they choose. Other replies varied but no-one stated this as ‘never’. One person noted, “My relative by her own choice will not leave her room” within their positive response. We saw that people were free to move about the home, although with the lift not working at the time, some people could not come downstairs. This is referred to in more detail under standards 19-26 and 31-38. We saw records that people were able to refuse medical support such as from dentists if they chose to, and that one person living in the home speaks with health professionals directly. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 18 The manager explained that people are provided choice with meals, insofar as a menu book is taken round each afternoon for options at supper and the next day’s lunch. This can sometimes include options not on the menu. One person living at the home confirmed, “I ask for what I want which suits me & I get it.” The Expert-by-Experience similarly noted, that there was a proper meal in the evening for those who wished it. They also found from feedback that soup is regularly provided for supper despite not appearing on the menu, which they found positive as in their experience some older people prefer soup as an evening meal. Surveys from people living at the home were positive about the meals provided. Two people from three stated that they usually like the meals, the third rated this ‘always’. Discussions with people living at the home during the inspection confirmed this perception, one person relating it to their mother’s cooking. We found the menu to be sufficiently nutritious. The manager explained that they were about to switch to a summer menu, and that she had spoken to people about their likes and dislikes for this. The Expert-by-Experience noted that the food did not appear particularly appetising, despite being mostly eaten, including through respectful staff support where needed (see standard 10). She also noted that portions of the dessert course were all the same and that no options were provided, such as on size of portion or whether with custard or not. Similarly fresh fruit did not appear to be available as an alternative. Personalization in this respect was not enabled. This should be considered. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. People living at the home, and their visitors, can be confident that any complaints raised will be taken seriously, promptly investigated, and addressed where upheld. The home has systems in place to aim to prevent abuse and to address any allegations. Most staff have had training in this area. EVIDENCE: Surveys by people living in the home showed that they know who to speak with if they are not happy with the service. Eleven from twelve relatives, carers and advocates similarly stated that they know how to make a complaint, with all bar one expressing satisfaction with the process. Details of the complaints procedure are available within the Service User Guide, and as notices within people’s rooms. The manager also noted that the process is explained to people when they move into the home. We found seven complaints recorded in the complaint book since the last inspection. These included one from someone living in the home about the behaviour of another person there. It was upheld and caused actions to be taken. Three were by relatives, about the behaviour of staff and about how an incident was handled. Others were by staff. All included records of investigation, and of actions taken by the home in consequence, which were both appropriate and timely. One further complaint was passed directly to us, Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 20 about maintenance issues including the lift not being fixed promptly. This was found to be upheld, however the owner was able to show that, at the time of discussing the complaint, the issues were being addressed and resolved (see standard 38 for further details). The home has an adult protection policy in place. The manager demonstrated a reasonable understanding of adult protection and the procedures to be followed. It was noted within pre-inspection paperwork that there have been no safeguarding referrals since the last inspection, and similarly no restraints. The manager discussed a pertinent case where the use of a seatbelt on a wheelchair may help prevent falls for one person, however it incurs a restriction of their movement which could impact negatively on them. Whilst the manager could apply appropriate principles to this specific case, it highlighted that there has been no specific training on the Mental Capacity Act for employees at the home. This should be addressed, to help ensure that the rights of people living in the home are respected and that decisions made on anyone’s behalf are appropriate. We found that a majority of staff are undertaking NVQ training. We checked with a visiting assessor that this does include a component on abuseawareness, therefore the majority of people including non-care staff have had training to support them to act appropriately should they witness or be told about anything that could be abusive. The manager explained that they are planning on providing a separate training course on abuse-prevention, either through a local council’s funding support or through privately-purchased training. It is recommended that this update training specifically include anyone who has not had recent NVQ training in this area. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. People who use this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are provided with a comfortable living environment that is kept clean and hygienic. They are provided with reasonable bedroom facilities although standards of bedding can be inadequate. Whilst the décor of the home is kept generally well-maintained, some equipment can become inoperable. In the case of the home’s passenger lift, this resulted in inconvenience for people living upstairs for too long. EVIDENCE: The Expert-by-Experience noted a light and airy lounge that leads and looks out to a fairly extensive patio and garden area with good garden furniture. The lounge had a well-kept fish tank and a bird in a cage. There was also a smaller and separate part of the lounge that can act as a quiet area. The whole lounge Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 22 area was noted to have been recently and pleasantly refurbished, including carpets, curtains, and walls. The Expert-by-Experience was also invited into a couple of bedrooms. She noted plenty of personal possessions and rooms with sufficient space. She also noted a substandard pillow and bed-cover in one room. This matched our findings, for instance, one pillow on a bed that was very lumpy and presumably unpleasant to sleep on. The provision of pillows and beddings must be kept appropriately comfortable for everyone living in the home. We received a complaint shortly before the inspection that included about the passenger lift having been out-of-action for a number of weeks. This matched survey feedback from a number of relatives, such as “Things which break are often not replaced quickly enough. In one specific case, the lift has been broken for about 8 weeks.” The issue was resolved shortly after the inspection, and is referred to further under standards 31-38. It was noted that a makeshift lounge had been set-up in a vacant double-bedroom, for people who were not able to use the stairs, which we consider as an adequate temporary communal-area given the circumstances. The complaint also raised about the home’s main washing machine being broken, albeit that staff were coping with the washing demands. The manager confirmed, before the final drafting of this report, that a new washing machine had been bought and was in use. As per standard 38, equipment in the home must be kept in good working order at all times. We noted other pieces of equipment that were broken, such as a clock in the lounge that did not work and showed a set time of 1:10pm. This could confuse people living in the home. Conversely, we saw that a number of lights were fixed by a maintenance company during the inspection visit. We also saw new coffee-tables in the lounge, and new garden furniture, and were told of a new barbeque that had been successfully used for people in the home a few weeks before the inspection. The Expert-by-Experience stated that she was impressed by the general cleanliness of the home, and particularly of the wash basins in the bedrooms and the toilet visited. She also noted that she found no offensive odour during the visit. This matched what we saw, and the views of people obtained directly, for instance surveys from people living in the home generally finding it always fresh and clean. Similarly, a relative noted “more recently, the smell of urine has become very rare in public areas, due I believe to frequent carpet cleaning.” On this point, the manager noted in pre-inspection paperwork, that a professional carpet company has been called in when necessary, in addition to good work from the domestic team. Pre-inspection paperwork notes that the Department of Health’s ‘Essential Steps’ infection-control guidance has been used. Seven staff are listed as Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 23 having had infection-control training, and the subject matter is also covered within the NVQ training that most staff have had. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are provided with a consistent and experienced staff team in sufficient numbers to meet their overall needs. The work force has a strong and improving standard of achieving relevant qualifications, although basic and refresher training to underpin this is sometimes lacking. The home’s recruitment procedures protect people living in the home. EVIDENCE: We considered the recent rosters of who actually worked at the home. We found staffing levels of six morning and five afternoon/evening carers being consistently kept to, including when cover was needed for sickness and holiday. No agency staff are used. We also found there to be other support staff working regularly, including an activities worker, domestic staff, cooks, and a maintenance worker. We received positive feedback about staff being available, for instance, through surveys from people at the home stating that staff are always or usually available to them when needed. We found that there has been low turnover of staff, with one person leaving and one starting since the last inspection a year ago. The manager noted within pre-inspection paperwork, “We still continue to have a very good and Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 25 loyal group of staff, and this is very much appreciated by the management,” a sentiment that a few relatives also expressed. Records and feedback from the inspection showed a strong degree of work at the home to help staff to achieve relevant National Vocations Qualifications (NVQs). We found that eleven of the twenty-two people employed for care purposes, have completed an NVQ in care at level 2 or higher. Most other care staff were working towards an NVQ, with some progressing from level 2 to level 3 for instance. A few have completed at level 4, the standard expected of a manager. Additionally, all domestic staff and some other non-care staff are progressing or have qualified at a relevant NVQ. This all shows a strong investment in relevant qualifications for the work-force. Eight from twelve surveys from relatives, carers and advocates found that they feel that care staff always have the right skills and experience to look after people properly. The four other people’s comments were also positive. People living at the home were all complementary of staff’s abilities when asked. We found that there was only one person who has started working at the home since the last inspection. Checks of their recruitment records revealed that all appropriate checks had been undertaken, including a Criminal Record Bureau disclosure and two written references from previous employers. The reference forms supplied by the home lacked a space for people to date and sign. Consideration should be given to adjusting the form, to help ensure a date and signature are supplied. We also checked the induction records of the above person. A detailed induction book that matches the national induction standards was used. It was signed up to around a fifth of the way through. Management stated that it was completed but was not signed off in other areas as certain formal training courses were being waited for. Records of a completed induction are a legal requirement, to evidence that new staff are provided with sufficient training to enable them to do the job capably. Induction records must be completed for all new staff. We also considered the training records of an established staff member. These showed good attention to training up to and including 2007, including for fire safety, manual handling, dementia care, abuse-prevention, and emergency first aid. However there had been no training since the last inspection, which the manager confirmed as applicable to the workforce as a whole, with the exception of the NVQ training for many staff. Much documentation was provided to show that specific training courses, for instance on abuseprevention, dementia, and manual handling, were being actively sought. Where people do not have recent NVQ qualifications, there must be evidence of pertinent training being provided relative to the demands of the job. This help ensure that all staff provided to people in the home are sufficiently capable. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. The home is run by an experienced manager. Financial interests of people living there are appropriately safeguarded. The care provided is generally in the best interests of people living there, however equipment is not always maintained effectively and safely, which can have a detrimental effect on people living and working in the home. Additionally, some staff do not receive sufficient supervision and support. EVIDENCE: The manager has worked in this role in the home for many years. She continues to undertake the NVQ level 4 and Registered Managers’ award and hopes to complete this in the near future, having previously been awarded a Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 27 City & Guilds Advanced Management in Care award. Records showed that two other senior staff have completed the NVQ level 4 in care qualification. We found the manager to have a very open approach. She was keen to address any issues raised. Her feedback, the standard of pre-inspection documentation, and the feedback of relatives generally finds her as responsive in her role, and therefore able to set a strong standard of care. We were notified in June about the lift in the home not working, some five weeks after the initial breakdown. Whilst the manager and owner have worked with us from the time of notification, we are concerned that the notification was not received “without delay”, as written in our notification forms. Providing notifications promptly helps us to monitor that serious issues are resolved appropriately. Notifications, including for fire detection, call system or lift not working for more than 24 hours, must be notified to us without delay. We found records of monthly reports by the owner about the conduct and quality of the home. These were being kept up-to-date, and covered appropriate areas such as checks of medication, complaints, staffing levels, and maintenance. The manager noted that the owner visits most days, at different times of day, and that he talks to people living there and to staff. It would be good practice to additionally include in the monthly report consideration of the views of people living at, working at, or visiting the home, in a confidential manner. The manager noted that surveys have been sent off to involved people at the home, as part of the new quality assurance programme being set up there. A staff member confirmed receipt of the home’s survey. The manager noted within pre-inspection paperwork that they hoped for “good feedback over the next year, so that where improvements have to be made the home can show their determination to do just what is requested.” Plans are also in place to ask people their views in informal and formal group settings. The home looks after amounts of money on behalf of some people living there. We checked the records kept on behalf of one such person. They were accurate and with receipts. They are signed by two people at each expenditure, such as for private chiropody, hairdressing, newspapers and toiletries. It was noted that the home had funded the person for a period of time when their immediate money had run out, until further funds for the person were acquired, which shows flexibility. We were also shown that items of value can be locked away in the home on behalf of people living there, with a record kept of such undertakings. We checked the supervision records of a number of staff. Those we saw were of a good standard, considering a number of areas of support and work and being signed by both parties. In terms of the required frequency of six Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 28 sessions per year, we found that those records available met that target, but that some records were not available and did not meet the target according to feedback. This repeats the findings of previous inspection reports, and so we have separately written to the owner to ask him how he will ensure improvements are made here and to inform him that we are considering further enforcement actions. To ensure a fair system of support to all staff, checks must be made to ensure that all care staff receive at least six supervision sessions a year. It is positively noted that we received a detailed improvement plan in this area from the manager before the final drafting of this report. Pre-inspection records confirmed that all major equipment checks, such as for gas systems and hoists, are being professionally inspected in a timely manner. We checked the accident book for the home. It contained a number of records, mainly of falls that certain people living in the home had had. There were no major accidents reported. The manager noted that the local Environmental Health team had undertaken a food safety visit in early summer. They had highlighted a few issues such as needing a temperature probe to check hot food with, and better lighting for the kitchen. A 4-star rating was ultimately given. We noted that the kitchen appeared to be excessively hot when visiting at one stage. When asked, we were told that there are fans there but that they only work intermittently. The complaint we had previously received (see standard 16) included that some equipment such as the tea urn in the kitchen was often broken, albeit that this was ultimately reported by the manager as being an electrical socket fault that had since been fixed. Alongside break-downs of the lift and the washing machine in other parts of the home (see standards 1926), we are concerned about the effective maintenance and appropriateness of equipment in the home, which can have a clear knock-on effect on people living there regardless of good efforts by the work force to compensate. Equipment provided at the home for use by people living or working there must be maintained in good working order at all times. We checked the windows in the room being used as a makeshift lounge upstairs by people whilst the lift was out of action. One large window opened to approximately 45°, so presenting as wide enough for people to climb out of and hence as a safety risk. This was discussed with the manager, who noted that requests had been made to install window-restrictors where necessary but that the work was yet to be undertaken. Following the visit, we received many written assurances that the action would be undertaken. Windows upstairs must always have restrictors effectively fitted so as to prevent anyone from unsafely climbing out of them. Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 29 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 X 18 3 2 3 X X X 2 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 30 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 OP7 Regulation 13(4) Requirement Where a risk assessment about anyone is reviewed, the review must accurately reflect any changes in their needs and abilities. This is to help ensure that any actions needed to address changed needs are taken. Where anyone has a bed-rail on their bed to prevent them rolling off, there must be a written riskassessment about the scenario establishing that this is the most appropriate option and that safety factors are sufficiently addressed. The provision of pillows and beddings must be kept appropriately comfortable for everyone living in the home. Records of a completed induction are a legal requirement, to evidence that new staff are provided with sufficient training to enable them to do the job capably. Induction records must be completed for all new staff. Where people do not have recent NVQ qualifications, there must DS0000017565.V365973.R02.S.doc Timescale for action 30/09/08 2 OP7 13(4) 31/08/08 3 OP24 16(2)(c) 31/08/08 4 OP30 18(1)(c) 30/09/08 5 OP30 18(1)(c) 30/11/08 Whitchurch Lodge Version 5.2 Page 31 6 OP33 37(1)(e) 7 OP36 18(2)(a) be evidence of pertinent training being provided relative to the demands of the job. This help ensure that all staff provided to people in the home are sufficiently capable. Notifications, including for fire detection, call system or lift not working for more than 24 hours, must be notified to us without delay. Providing notifications promptly helps us to monitor that serious issues are resolved appropriately. Formal supervision sessions must be provided at least six times a year to each care staff member. This is to help ensure a fair system of support to all staff. Previous timescales of 01/06/06, 31/03/07 and 31/10/07 not met. Equipment provided at the home for use by people living or working there must be maintained in good working order at all times. This is to help facilitate appropriate and safe care. Windows upstairs must always have restrictors effectively fitted so as to prevent anyone from unsafely climbing out of them. 31/08/08 31/08/08 8 OP19 OP38 23(2)(c) 31/08/08 9 OP38 13(4) 31/08/08 Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 32 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 OP9 OP10 OP10 Good Practice Recommendations Written assessment is recommended where people keep prescribed medications in their rooms, to show that safety for them and others has been considered. The intermittent recording of toileting support, for people who have continence-support needs, should be improved on. Whilst it is not in doubt that staff are responsive to requests and uphold good standards of dignity, consideration should be given to whether staff interact sufficiently with people overall outside of providing taskbased care such as meals support and personal care. Consideration should be given to supplying people with personalised meals in the dining room, rather than set meals from the kitchen, for instance in terms of portion size and enabling better choice at the point of meal delivery. There has been no specific training on the Mental Capacity Act for employees at the home. This should be addressed, to help ensure that the rights of people living in the home are respected and that decisions made on anyone’s behalf are appropriate. It is recommended that update training on abuseprevention specifically includes anyone who has not had recent NVQ training in this area. The reference forms supplied by the home lacked a space for people to date and sign. Consideration should be given to adjusting the form. It would be good practice to additionally include in the monthly provider report, in a confidential manner, consideration of the views of people living at, working at, or visiting the home. 4 OP15 5 OP18 6 7 8 OP18 OP29 OP33 Whitchurch Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lodge DS0000017565.V365973.R02.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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