Inspection on 10/04/08 for White Hill House

This inspection was carried out on 10th April 2008.

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

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

Other inspections for this house

White Hill House 26/04/07

White Hill House 24/07/06

White Hill House 31/01/06

White Hill House 15/09/05

White Hill House 22/03/05

White Hill House 28/10/04

White Hill House 23/03/04

White Hill House 07/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE White Hill House 128 White Hill Chesham Bucks HP5 1AR Lead Inspector Joan Browne Unannounced Inspection 10th April 2008 10:00 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 White Hill House DS0000023059.V361093.R01.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. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Hill House Address 128 White Hill Chesham Bucks HP5 1AR 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) 01494 782992 01494 772420 jnalarkin@aol.com www.culwoodhouse.co.uk Mrs Anita Larkin Mr Julian Larkin Mrs Anita Larkin Care Home 8 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (8) of places White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 people over 65, one of whom has dementia Date of last inspection 26th April 2007 Brief Description of the Service: White Hill House is a small, privately owned and family run care home registered to care for eight older people. It is situated a short distance from Chesham. It is an Edwardian building set back from the main road. There are pleasant sloping gardens to the rear. Seven rooms are single and one is double. A married couple was using the double room at the time of the inspection. There are no waking staff during the night but the manager and a member of staff live at the home. The fees range from £595 to £625 per week. Additional charges are made for hairdressing, chiropody and newspapers. Information about the home can be obtained by contacting or visiting the home directly. White Hill House DS0000023059.V361093.R01.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 that the people who use this service experience adequate quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Joan Browne on 10 April 2008 and lasted for seven hours. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service. This document, which includes information from a variety of sources, was not completed within the required timescale. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document is referred to throughout the report. The registered manager/proprietor of the home and a senior care worker was in attendance throughout the visit. The majority of the service users spoken to were able to express their thoughts and feelings about the care they receive. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of residents, two family members and with care staff. Further information was gathered from records kept at the home. All residents living in the home were Caucasian and reflect the population of the area in which the home is situated. The home’s staff were aware of the Laws regarding equality and diversity. A number of requirements and recommendations of good practice were issued on this visit Please see Health and personal care outcomes, Complaints and protection outcomes, Environment outcomes, Staffing Outcomes and Management and Administration outcomes for full disclosure. Feedback was given to the manager and the senior care worker about the findings of this visit. We (The Commission) would like to thank all the residents and care staff that made the visit so productive and pleasant on the day. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: To ensure risk assessments are developed for all people living in the home and they should clearly demonstrate what measures are in place to minimise any identified risks to protect individuals’ vulnerability. A record must be maintained for the administration of controlled medication to ensure that there is a clear audit trail of medication in stock. The home must review the storage cupboard of controlled medication to ensure it complies with current regulation. Maintenance work must be carried out to ensure people using the service safety. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 7 The home must ensure two written references are obtained before appointing a member of staff. The home must establish a regular programme of staff training to ensure that all staff have the appropriate skills and competence to perform their roles. The home must ensure that a supervision framework is established to support staff’s practice. 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. White Hill House DS0000023059.V361093.R01.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 White Hill House DS0000023059.V361093.R01.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): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People can decide whether the care home can meet their needs because they or people close to them have been able to visit the home and obtain clear and up to date information about the home. EVIDENCE: The home has a combined statement of purpose and service user’s guide. We were told that the document was reviewed in February 2008. The document was examined and it details what the prospective individual can expect and the services the home can provide. However, the document did not reflect the views of the people living in the home and a copy of the home’s complaints procedure was not included. It is recommended that the statement of purpose should be reviewed to reflect the views of the people using the service and a copy of the home’s complaints procedure should be included in the document. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 10 The home’s annual quality assurance (AQAA) states “that residents can only be admitted once a full assessment of needs has been completed and a care plan package put in place to ensure individuals’ needs can be met.” The preadmission assessment for the most recently admitted resident to the home was examined and was generally completed satisfactorily. The assessment was of a tick box format covering the following areas: personal care, physical health, mental health, behaviour, social and leisure needs, and medical needs. We were told that the manager was responsible for undertaking assessments and she involves the individual and their family or representative. A trial period of four weeks is offered to ensure that the placement is appropriate. A copy of the statement of terms and conditions and contract was seen detailing what was included in the fees. The home does not provide intermediate care. White Hill House DS0000023059.V361093.R01.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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. To ensure people using services health care needs are not compromised staff responsible for the administration of medication should be appropriately trained. Risk assessments need to be more comprehensive with detailed action planning on the measures that have been put in place to minimise or control any identified risks to promote their safety. EVIDENCE: The care of two residents was case tracked. Plans seen provided an overview of the individuals’ needs and evidence was seen indicating that the plans were being reviewed regularly however, the review process was not clear. Plans were not signed by the resident or their relative to indicate their involvement in deciding what care they received. However, the member of care staff undertaking the development and monthly review of the care plans had signed White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 12 and dated them. Residents spoken to during the inspection were confident that they were receiving the appropriate care and support. The daily log for a particular resident did not inter-relate with the care plan. For example, the care plan stated that the individual enjoyed participating in certain activities and staff should be supportive. There was no evidence recorded in the daily log demonstrating how staff were supporting the individual to ensure social needs were being met. The daily report writing consisted of eating and drinking and personal care given. In the daily log for a particular resident the following was noted: “X all in a pickle this morning was very wet. Given a wash and helped to get dressed.” Because residents have access to their records staff are reminded to write with a positive slant. Residents spoken to confirmed that they have access to a range of health care professionals such as the dentist, optician and the chiropodist. We were told that residents were registered with three local general practitioner’s surgery of their choice. Staff said that the support from the district nurse was excellent. Evidence was seen to demonstrate that the nurse was supporting the home. For example, pressure relieving equipment, mattresses and cushions for the promotion of tissue viability and prevention or treatment of pressure sores was provided. We noted that the record relating to individuals’ weight gain or loss was not regularly maintained. The records seen indicated that individuals’ weight had not been monitored since January 2008. A recommendation is made in this report to ensure that residents’ weights are monitored monthly. Information contained in the home’s annual quality assurance assessment (AQAA) indicated that those residents who were at risk of pressure sores, falls, and other identified risks such as, wandering, risk assessments had been developed. The risk assessments seen for the two residents whose care was case tracked needed to be more comprehensive with supporting evidence detailing how identified risks would be managed. We observed that two residents were provided with bedrails. There were no risk assessments in place identifying any actual or potential risk to these residents. Evidence seen indicated that the development and review of the care plans and risk assessments in place was not consistent and further work is needed in this area to ensure evaluation of care is documented in a meaningful and understandable way. The home uses a monitored dose medication system. The medication administration records sheets were examined and there were no unexplained gaps. The controlled drug register was checked and we observed that the register did not give a clear audit trail of medication administered. For example, twenty-eight temazepam tablets were recorded, as being received however, there was no record indicating the balance remaining and which member of staff had given and witnessed their administration. A requirement is made to ensure that a record is maintained for the administration of controlled medication. It is further recommended that the administration of White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 13 controlled drugs by authorised staff members should be witnessed by another designated appropriately trained member of staff. The balance of controlled drugs should be checked at each administration and also on a regular basis e.g. monthly. On the day of the inspection we were told that two residents were self-medicating their own medication. The home had provided a lockable storage cupboard in their bedrooms to store the medication. The individuals were spoken to and said that they were pleased with the support they were receiving from staff to promote their independence. We noted that the home’s medication was stored in two safes. This means that the home’s storage cupboard for controlled medication does not meet the current standard set in the Misuse of Drugs (safe Custody) Regulations. It is required that controlled drugs must be stored in a metal cupboard with specified double locking mechanism and fixed to a solid wall or a wall that has a steel plate mounted behind it to comply with current legislation. Training records for staff members made available to us at the site visit indicated that some staff had not had any formal training in the safe handling and administration of medication. It was noted that a recently appointed staff member was administering medication and there was no written evidence available to support that the individual had been appropriately inducted and deemed competent in the safe handling of medication. It is required that all staff should have training in the safe handling of medication and a record of staff training should be maintained. It is further recommended as a good practice that the home should retain a list of staff members authorised to give medication including a record of their approved initials. Residents spoken to were happy with the way that staff delivered their care and respected their dignity and rights. We observed residents being treated in a friendly but respectful manner by staff. Individuals have access to telephone facilities in private and some had their own private telephone lines in their bedroom. Residents’ attire on the day of the inspection was clean and tidy with attention to detail. We observed that two beds were not fitted with headboards. This was brought to the manager’s attention to be addressed. Information reflected in the home’s annual quality assurance assessment (AQAA) indicated that improvement had been made to ensure that information was obtained on individuals’ religious needs, death and dying. This should ensure that their wishes are complied with. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home are encouraged to follow their interests and be part of the local community. Nutritious meals and snacks are provided in pleasing surroundings. EVIDENCE: The home does not have a formalised activity programme in place. Residents spoken to said that the home’s daily routine was flexible and they were able to exercise their choice in relation to leisure, social activities and cultural interests. The home’s annual quality assurance assessment (AQAA) reflected that residents are able to take part in activities in the local community. For example, one resident was attending a local sewing club. Arrangements were in place to support those residents who wished to promote their religious needs to do so. A car service was in place to take residents to church. Staff said that residents were encouraged to participate in board games, quizzes and flower arranging. They are also provided with the opportunity to visit another care home in the area to participate in activities if they wished to. On the day of the site visit residents were observed enjoying the garden. One particular White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 15 resident was provided with a mobile alarm to enable independence and to summon for help if it was needed. Residents spoken to during the site visit confirmed that they are able to have visitors at any reasonable time and links with the local community are maintained in accordance with their wishes. Staff support family members to take residents on holiday if they wished to. Relatives spoken to confirmed that they were able to visit at anytime within reason and staff were always welcoming and provided them with refreshments. The home encourages residents to handle their own financial affairs for as long as they wish to and are able to and have the capacity to do so. Information on how to contact external agents for example, advocates to act in their interests is available to residents and relatives. It was evident that residents are made aware of their entitlement to bring personal possessions with them if they wished to. Some bedrooms contained personal belongings such as, chairs, family photographs, mementoes and small pieces of furniture. Residents are offered three meals each day and hot and cold drinks with snacks were provided throughout the day. A choice of main course is not available although the staff and residents said that an alternative would be provided if a resident did not like what was on offer. We were told that residents are given choices with the teatime menu. Some residents spoken to said that they have an input to the menus through the user questionnaires that they are requested to complete. One particular resident spoken to said that a suggestion was made for more tinned fruits to be on offer and the suggestion was acted on. All residents spoken to said that they enjoyed the food. The midday meal was observed and this appeared to be a social activity. The table was appropriately set with tablemats, napkins and condiments. Water or fruit juice was available. Lunch consisted of sausages, mashed potatoes and vegetables. One resident required a soft diet and another was a vegetarian. There were no residents requiring special diets on cultural grounds at the time of the visit. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 16 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a complaints policy, which should ensure that people using the service would be confident to use it. Policies and procedures in the safeguarding of vulnerable adults are in place but staff’s knowledge and skills in the safeguarding of vulnerable adults would need to be updated regularly to ensure that people using the service are cared for by staff who are appropriately trained to protect them from any potential harm or abuse. EVIDENCE: The home has a complaints policy and procedure. The home’s annual quality assurance assessment (AQAA) states the following: “ A brief guide to complaints can be seen in the service user’s guide.” We found that this was not the case and it was recommended that a summary of the home’s complaints procedure should be included in the home’s combined statement of purpose and service user’s guide. The residents and relatives spoken to said that they felt able to raise any concerns and said that they would be dealt with promptly. The AQAA reflected that since the last key inspection the home has not had any complaints. The Commission for Social Care Inspection has not received any complaints since the last inspection about the service. The home has a copy of the Buckinghamshire’s multi agency strategy for the protection of vulnerable adults. We were told that a senior staff member had undertaken a train the trainer course in the safeguarding of vulnerable adult. The training records seen indicated that staff have not had any updated White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 17 training in the safeguarding of vulnerable adult for sometime. The AQAA reflected that in the plans for improvement staff were to undertake updated training in the safeguarding of vulnerable adults. Staff spoken to were sensitive to the need to protect vulnerable adults. The home has not had any safeguarding of vulnerable adult referrals or investigation and the Commission has not been made aware of any investigation. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 18 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 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People stay in a home that is homely clean, pleasant and hygienic. Some maintenance work has been identified as needing attention to ensure that residents’ safety is not compromised. EVIDENCE: The home is homely with a number of sitting areas, although there are a number of steps within the home. The gardens are attractive and offer shady seating areas. There are a number of trip hazards going from the house to the garden and the home is really only suitable for those who can walk independently. At the previous inspection a requirement was made for the manager to consult with the fire authority in respect of the area used as an office and the practice White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 19 of wedging open fire doors. A fire report was seen evidencing that a fire officer had visited the home on the 26 October 2007. As a result of the visit a requirement was made for an additional smoke detector to be installed in the area used as an office. It is pleasing to report that the requirement had been complied with. We were told that an environmental health inspection was carried out in January 2008 and it was required that daily temperature recordings should be re-instated. The home has complied with the requirement made and daily food temperature records have been re-instated. There is no passenger lift or stair lift in the home and therefore, it is not suitable for those who are not independently mobile. There are a number of steps throughout the home, some of which have handrails. There is an assisted bath and shower, which have recently been upgraded. Individual rooms vary in size. Most rooms have been personalised and the residents spoken to said that they enjoyed their rooms. During the tour of the building we observed that in one particular bedroom the radiators were not fitted with covers. A requirement is made in this report for the radiators to be assessed for the risk they present to the person using the bedroom and action taken to minimise any identified risk. The carpet on the stairs was frayed and posed a trip hazard. A requirement is made for it to be assessed for the risk it present to the people living in the home and action taken to minimise any identified risk. We observed that the toilet in the conservatory area was being used as a storage area to store cleaning equipment. This practice should be reviewed because it could pose a risk to residents and visitors using the toilet. The pavement outside the coach room was uneven and posed a trip hazard. A requirement is made for it to be assessed for the risk it presents to the people living in the home and action taken to minimise any identified risk. The laundry facilities are situated in a separate area from the kitchen. There are infection control policies and procedures in place. However, staff required updated training in this topic. The home was clean, hygienic and free from offensive odours. We were told that the home has a contract with a reputable agency to remove the clinical waste weekly. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Lack of formal processes in relation to people’s care needs during the night and weaknesses in the home’s recruitment and training procedures have the potential to put people using the service at risk of harm. EVIDENCE: The home employs two part-time and three full time staff members who cover the rota. They have a generic role and undertake care, cooking and cleaning duties. There are no staff awake at night. The registered manager and one member of staff sleep in the home at night. The manager states that she goes to bed late and checks all residents at 02:00. No records of checks carried out were available at the time of inspection, which means that checks are not recorded. We were told by residents that “staff were very kind and helpful”. The accident record showed that one resident was found outside the home and was taken to hospital by ambulance. The home’s staff were not aware that the individual had left the building. The time of fall was recorded as between 12:30 and 07:30. At the two previous inspections requirements were made for the manager to demonstrate that the night staffing levels meet residents’ needs and undertake risk assessments for all residents with regard to their night care and their vulnerability at night. We were told by the manager that the staffing level provided at nights meets residents’ needs. Risk assessments seen did not detail the measures that were in place to protect residents’ White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 21 vulnerability at night. One risk assessment stated that the individual was checked regularly throughout the night. There were no written records available to support this. The home was caring for residents who had the potential to wander and poor mobility who may be liable to falls. It is required that night risk assessments be developed for all residents and they clearly demonstrate what measures have been put in place to minimise any identified risk to protect their vulnerability. The manager told us that when she is away arrangements were in place to cover her at nights. It is recommended that the arrangements in place should be formalised to ensure that residents are in safe hands at all times. To date only one member of staff had achieved the national vocational qualification (NVQ) level 2 in direct care. The home’s annual quality assurance assessment (AQAA) stated that a further one member of staff was working towards achieving NVQ 2 and another staff was working towards achieving the registered managers award. The recruitment documentation for four staff members was examined. All had completed an application form and PoVA first checks and criminal record bureau (CRB) clearances had been obtained. However, only one reference was obtained for two staff members. In the case of a third staff member that had been employed at the home for sometime there was no evidence that two references had been obtained. An immediate requirement was made for references to be obtained for these staff members within seven days. We observed that recruitment records for staff members were all held in one folder. To comply with confidentiality and the data protection act 1998 it is recommended individual records be held for staff members and they are kept secure. The training and induction records for the two recently appointed staff members were examined. The evidence seen indicated that only one member of staff had completed an induction programme. The training records seen for all staff indicated that mandatory training such as, moving and handling, infection control, health and safety, food handling and hygiene, safe handling and administration of medication and safeguarding of vulnerable adult needed to be updated. The manager was aware of the training shortfall and had made arrangements to engage a training company to provide training. A requirement is made for a system to be put in place to ensure that all staff have an induction programme, which is recorded and mandatory updated training is undertaken by staff on a regular basis to ensure that staff are trained and competent to do their jobs. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 22 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 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home aims to ensure that it is run in the best interests of people using the service. Inconsistency in the development of risk assessments, recruitment and training practices, lack of written evidence to validate regular staff supervision and formal processes in relation to people’s care at night can have an impact on service delivery and outcomes for people using the service. EVIDENCE: The registered manager is experienced in managing a care home and has worked in the care sector for nearly thirty years. She has not undertaken the National Vocational Qualification in Care and Management at Level 4. And has not undertaken periodic training to update her knowledge skills and competence whilst managing the home. A requirement is made for the manager to undertake the national vocational qualification (NVQ) in care and management at level 4 and to update her knowledge and skills. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 23 There was no evidence of staff meetings being held but we were told that the staff meet as a group every day. Residents and staff spoken to said that the manager was approachable. The home has developed an internal quality assurance system and a resident satisfaction survey. Residents spoken to said that their views are regularly sought and any suggestion made is acted upon. The annual quality assurance assessment (AQAA) reflected that the home’s policies and procedures have been reviewed during the last year. We did not receive the home’s annual quality assurance assessment (AQAA) within the agreed timescale. All sections of the AQAA were not completed and the information gave limited evidence of the current situation within the service. The evidence made to support the statements was sketchy. Although the home aims to ensure that it is run in the best interests of people using the service. Inconsistency in the development of risk assessments, recruitment and training practices, lack of written evidence to validate regular staff supervision and formal processes in relation to people’s care at night can have an impact on service delivery and outcomes for people using the service. We were told that the home does not hold any money on behalf of residents and all expenditure made on their behalf is invoiced to them. There was no evidence to indicate that the home has a formal supervision framework in place. Staff spoken to confirmed that they do not have one to one supervision but daily meetings take place as a group to discuss issues. No written records are kept of meetings taking place. A requirement is made in this report for all staff to receive formal supervision. Training records seen indicated that some staff have had first aid training. We were told that there was always a qualified first aider on each shift. Some staff needed to undertake updated training in food hygiene and handling, health and safety, fire awareness and moving and handling. The annual quality assurance assessment (AQAA) reflected that maintenance checks had been undertaken for all equipment used in the home. We observed that a loft ladder that was used by the maintenance person was not put away after use. It is recommended that equipment used by personnel should be put away after use to prevent any potential risk of harm to people living in the home. White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement A record must be maintained for the administration of controlled medication to ensure that there is a clear audit trail of medication. The home must review the controlled medication storage cupboard to ensure it complies with current legislation. To protect people using the service from any potential risk of harm or abuse the home must ensure that staff undertake regular updated training. The frayed stair carpet must be assessed for the risk it presents to people using the service and action taken to minimise any identified risk. The uneven pavement outside the coach room must be assessed for the risk it presents to people using the service and action taken to minimise any identified risk The bedroom radiators on the first floor must be assessed for the risk they present to the person using the bedroom and DS0000023059.V361093.R01.S.doc Timescale for action 31/05/08 2 OP9 13(2) 31/07/08 3 OP18 18(1)(c) (i) 31/05/08 4 OP19 13(4)(a) 31/05/08 5 OP19 13(4)(a) 31/05/08 6 OP19 13(4)(a) 31/05/08 White Hill House Version 5.2 Page 26 7 OP27 13(4)(c) 8 OP29 19(1) Schedule 2 (5) 18(1)(c) (i) 18(1)(c) (i) 9 10 OP30 OP30 11 OP31 9 action taken to minimise any identified risk. Night risk assessments must be developed for all people using the service and they should clearly demonstrate the measures in place to minimise any identified risks to protect individuals’ vulnerability. Two written references must be obtained for staff members before commencing employment to ensure they are of integrity and good character. To ensure that staff induction programme must be formalised and recorded. All staff must have updated mandatory training to ensure that they are knowledgeable and competent to perform their roles. The manager must undertake the national vocational qualification in care and management at level 4 and update her knowledge and skills 31/05/08 17/04/08 31/05/08 31/05/08 31/05/08 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 Refer to Standard OP3 OP7 Good Practice Recommendations The home’s statement of purpose should reflect the views of people living in the home and it should include a copy of the home’s complaints procedure. To comply with best practice guidelines care plans should be signed by people using the service or their relative to ensure their involvement in deciding what care they receive. Care plans should inter-relate with the daily log to ensure that people’s identified needs are being met. DS0000023059.V361093.R01.S.doc Version 5.2 Page 27 3 OP7 White Hill House 4 5 6 OP7 OP8 OP9 Ensure risk assessments are more comprehensive detailing how identified risks should be managed. The home should ensure that people using the service weights are maintained monthly. The administration of controlled medication by authorised staff members should be witnessed by another designated appropriately trained member of staff. The practice of storing equipment in the toilet in the conservatory area should be reviewed to minimise any potential risk to people using the service and visitors to the home. To comply with best practice the home should retain a list of staff members authorised to give medication including a record of their approved initials. The night cover arrangements in place when the manager is on leave should be formalised to ensure that residents are in safe hands at all times. All night checks should be recorded appropriately. To comply with confidentiality and the data protection Act 1998 records for staff members should be kept in individual folders. Equipment used by personnel should be put away after use to prevent any potential risk of harm to people using the service. 7 OP19 8 9 OP9 OP27 10 11 OP29 OP38 White Hill House DS0000023059.V361093.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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