Inspection on 26/04/07 for White Hill House

This inspection was carried out on 26th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

White Hill House 10/04/08

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 Sally Newman Unannounced Inspection 26th April 2007 10:40 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 DS0000023059.V331009.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. DS0000023059.V331009.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 DS0000023059.V331009.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 24th July 2006 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 care staff on duty during the day and two members of staff sleep at the home at night, although there are no waking night staff. 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. DS0000023059.V331009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection of three days duration that included an unannounced visit to the home by two inspectors for 4 ¾ hours. Information held about the home by the Commission was reviewed and a questionnaire sent to the service prior to the visit was completed and returned. During the visit all eight service users were spoken to a visitor was seen in private and all staff on duty were spoken to. In addition time was spent with the deputy manager, a range of records was seen and three service users were case tracked. Surveys were sent to the service to distribute to service users and professionals involved with the home but at the time of writing this report none have been returned. Inspectors were advised that service users declined to complete any surveys. A tour of the premises was undertaken and the home’s approach to equality and diversity was observed. Feedback was provided to the deputy manager who undertook to pass relevant information to the manager. This home had previously been judged as providing a poor quality service. There have been improvements in care planning that have been implemented by the deputy manager and the bathroom has been upgraded. However, there are still significant shortfalls in relation to fire safety, the assessment of need prior to admission and night-time staffing arrangements. The deputy manager has been instrumental in implementing a range of improvements including staff training, quality assurance and recording generally. The Commission has received no complaints about this service since the last inspection. The home provides a homely atmosphere and most service users able to provide a view stated that they were happy living in the home. Interactions between staff and service users were observed as warm and attentive and staff were complimented by service users. Comments received included “very nice here very good”, “if you treat people nicely and are kind to them you get the same back, and this lot are kind to you they will get you anything” and “get on with staff quite attentive they come in for a chat. What the service does well: Provides a homely and relaxed atmosphere for service users. DS0000023059.V331009.R01.S.doc Version 5.2 Page 6 The furnishings and décor throughout the building is of a high standard. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by DS0000023059.V331009.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000023059.V331009.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 DS0000023059.V331009.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care needs of prospective service users are not assessed to an acceptable standard to ensure that the home can meet their needs. EVIDENCE: Evidence was obtained from discussion with the manager and staff, service users and from the reading of associated documentation. The most recent service user had been in the home a week. Documentation was seen which included a hospital transfer summary that contained only basic details. The manager had not been to visit this prospective service user according to the usual procedure because she had been in hospital in central London. The manager confirmed that she had received information over the phone but had failed to make any written record of important information. The DS0000023059.V331009.R01.S.doc Version 5.2 Page 10 care plan and assessment of needs had commenced on the day the service user moved into the home. The assessment currently being carried out had identified that this service user has a tendency to wander at night. She had managed to enter the bedroom of other service users and had disturbed them. This home does not provide any waking night staff however, in discussion, the manager stated that this service user was wandering as a result of initial disorientation and was not now causing any concerns. A requirement was made at the last inspection concerning the adequacy of night-time staff levels but no formal and documented review was provided. It will be a requirement that the night staffing arrangements are formally reviewed to ensure that the needs of service users are being met. It was apparent from discussions with staff and service users that prospective service users are able to visit the home prior to moving in whenever possible. DS0000023059.V331009.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are set out in individual plans of care and their health care needs are met. The arrangements for medication are appropriate and protect service users. Service users are treated with respect and their right to privacy is mostly upheld. EVIDENCE: Evidence was provided from care plans and associated documentation, from discussion with service users and staff and assistance from the deputy manager. Service users confirmed that they have access to a range of health care professionals including General Practitioners, District Nurses, Opticians and Hospital Specialists. The Chiropodist visits the home on a six weekly basis. DS0000023059.V331009.R01.S.doc Version 5.2 Page 12 Individual care plans documented details of health related appointments. One service user confirmed that if her G.P. states that she must have something the staff act upon his instructions without delay. It was noted that one service user had mucus developing in her eyes that did not appear to have been recognised by staff. The deputy manager undertook to contact the G.P. without delay. Care plans were well documented providing a clear overview of individual needs. Advice was given to record risks relevant to individual service users particularly in relation to the prevention of falls. The deputy manager was able to demonstrate that formats were available to record this information in a user-friendly way and that she would complete this work without delay. It was noted that the deputy manager had accessed ‘end of life’ documentation and associated guidance and which she stated had been very useful during the recent care of a dying service user. The arrangements for medication were seen and confirmed that professional guidelines are followed. The storage arrangements are appropriate and the records matched the stock of medication held. Service users can keep and administer their own medication where appropriate and they are provided with lockable facilities for storage of their medication. The inspectors were informed that alternative pharmacy facilities were being explored where staff training could also be accessed. Service users confirmed that they are treated with respect by staff at all times. They have access to telephone facilities and some had their own private telephone lines in their bedrooms. Service users stated that their privacy is respected although the manager was observed entering a service users bedroom without knocking. DS0000023059.V331009.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home matches the expectations of service users. Service users are supported to maintain contact with family, friends and representatives. Service users are helped to exercise some choice and control over their lives. The food provided is plentiful and mostly enjoyed by service users. EVIDENCE: Formal group activities are arranged on an infrequent basis. Those service users spoken to were generally happy with this arrangement and preferred to pursue individual interests such as reading, crosswords, using the garden and T.V. Some service users have regular visitors who take them out. One service user indicated that she would like more opportunities to go out. A mini-bus was available to the home the day after the inspection and the manager was planning to take those service users who wanted to out to the pub or a garden centre. She confirmed that this had been a spontaneous and unplanned event, which was why service users did not know about the arrangement before hand. DS0000023059.V331009.R01.S.doc Version 5.2 Page 14 A record of events and activities has been implemented by the deputy manager. This records library visits, church visits, hairdressers and activities organised on a one to one basis such as board games. Special religious events and birthdays are celebrated in the home. One service user advised that they have a regular visiting reader, because she has partial sight. In addition, some relatives have provided entertainment on the piano in the home. Most service users have regular visitors who can visit their relative in private at any time. It was noted that a visitors’ book was not available at the time of the site visit. One visitor was spoken to in private. He confirmed that he often calls unannounced and he is always made to feel welcome. He stated that his relative would not wish to be encouraged into playing bingo or similar type activities and prefers to spend time on her own and to take regular walks in the garden. He could not see how the service could be improved. The meals provided were complimented upon by the majority of service users. It was acknowledged that a choice is rarely available for the main meal of the day, however, there was confidence that an alternative would be made available if preferred. One service user did indicate that they would prefer a more regular opportunity to choose their main meal. Service users were asked their preference for both breakfast, which is served in bedrooms, and tea each day and a plentiful supply of fresh fruit was observed to be available throughout the home. It was noted that one service user was vegetarian and another was diet controlled diabetic. Staff demonstrated a sound knowledge of these considerations and both service users confirmed that their needs were appropriately met. The service user who was vegetarian advised that “there is a wonderful variety of meals”. Food storage was seen and different food types were stored appropriately. Food is temperature probed before and after cooking and fridge and freezer temperature checks are maintained. It was noted from a previous Food Safety inspection on 28.3.06 that the two dogs living at the home had access to the kitchen and food preparation areas. This was considered unacceptable and a potential health risk to service users. Although the dogs were not observed in the kitchen dog fouling was evident in the garden and must be addressed. DS0000023059.V331009.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concerns and complaints are taken seriously and acted upon appropriately and service users are protected from abuse. EVIDENCE: Information provided by the service prior to the visit stated that no complaints had been made about the service during the last twelve months. The deputy manager confirmed that a format is available to record complaints should they be made. All service users are provided with a leaflet that details the complaints procedure and a brief overview of the process is detailed in the Statement of Purpose. All service users indicated overall satisfaction with the service and confirmed that they would speak to the manager or the deputy manager if they had any concerns. One example was provided where service users had raised a concern that had been addressed promptly. No written record of this concern or the action taken had been made. All care staff have now received training in protection of vulnerable adults issues. Staff spoken to demonstrated a sound understanding of the potential for abuse and the forms in which it can take. They were also clear that they would speak to either the manager or the deputy manager if they had concerns. DS0000023059.V331009.R01.S.doc Version 5.2 Page 16 DS0000023059.V331009.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a generally safe and well-maintained environment. The home is homely, clean and hygienic. EVIDENCE: This home provides a warm and homely environment for service users. Information provided by the service indicated that since the last inspection the bathroom has been upgraded, a shower and toilet have been replaced and two bedrooms have been redecorated. In addition, redecoration has taken place in the kitchen, conservatory and hallway. Gas fires have been replaced in some communal rooms and the electrical installation has been upgraded. Grab rails were observed throughout the building. Service users must have a good degree of mobility as there is no elevator or chair lift available. DS0000023059.V331009.R01.S.doc Version 5.2 Page 18 A requirement of the Fire Officer report of October 2005 that directed that the office space be removed has not been implemented. The manager advised that she had consulted with a private contractor who contradicted the advice of the Fire Officer. It was made clear that private consultants had no legal authority. In view of the delay since the Fire Officer report and the observed practice of wedging fire doors open the manager must consult with the Fire Authority to clarify the appropriate action as a matter of urgency. Clear feedback to this effect was given to the manager before the inspectors left the building. The home was observed as clean throughout with no offensive odours in evidence. Staff were observed wearing protective clothing to promote infection control. There is a cleaning schedule and rota in place and a record of maintenance issues is kept with completion of the work noted. DS0000023059.V331009.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an adequate number of staff on duty during the day who demonstrate a sound knowledge of service users needs. Staff training has improved and ensures that service users are safe. The recruitment policy and practices protects service users. EVIDENCE: As a small home the staff team consists of five care staff in addition to the manager. The number and skill mix of staff on duty is considered adequate to meet the assessed needs of service users. The manager is not included on the staff rota despite the fact that she undertakes personal care and at certain times represents one of two members of staff on duty. There are concerns about the night-time staffing arrangements which do not include waking night staff. Currently there are two members of staff and the manager asleep on the premises as they all live within private accommodation within the home. This arrangement will change imminently with the departure of one member of staff. This issue has been addressed earlier in the report and has resulted in a requirement to review the current arrangements. All staff undertake a variety of tasks including personal care, cleaning and cooking. DS0000023059.V331009.R01.S.doc Version 5.2 Page 20 Staff training has improved and all care staff have now received relevant core training to reflect their responsibilities. The last recruited member of staff is completing induction training that has been recorded. Two care staff have an NVQ qualification and another has just registered for NVQ training. The deputy manager has recently registered for the Registered Managers Award. The services of Skills for Care have been accessed and an analysis of training needs is being undertaken. All staff now have an individual training profile and a training plan for the home has been developed. Five staff files were seen. All staff recruited since the last inspection had undergone the necessary checks in relation to references and criminal record bureau checks. Up to date photographs were in evidence as were interview questionnaires for recently recruited staff. DS0000023059.V331009.R01.S.doc Version 5.2 Page 21 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed appropriately and is run in the interests of service users. Service users financial interests are safeguarded and the health, safety and welfare of service users are safeguarded. EVIDENCE: The registered manager has managed the home for many years. She has no formal qualifications and has not registered for either NVQ training or the registered manager award stating that she does not have time to do so. DS0000023059.V331009.R01.S.doc Version 5.2 Page 22 Information provided by the service prior to the visit indicated that there are a range of policies and procedures in place that have been reviewed regularly. There is now a system for seeking the views of service users that involves the use of questionnaires. This has been devised and implemented by the deputy manager and examples were provided where the service have responded to suggestions and comments. This was confirmed in discussion with service users. The deputy manager has devised and implemented a management audit tool that consists of a thorough assessment of the systems operating in the home and is carried out every three months. She has also commenced recorded staff supervision and is awaiting formal one to one supervision for herself and a relative of hers who also works in the home from the manager. Service users manage their own financial affairs or have support from relatives. Any expenses undertaken on their behalf is invoiced directly to them. All staff providing personal care had undertaken moving and handling training. In addition, all staff had received fire safety, first aid and health and safety training. The deputy manager advised that the new staff member will receive any required updates to her training as soon as it can be arranged. A legionella and asbestos check have been undertaken and appropriate action has been implemented where necessary. The electrical installation has been checked and portable appliances have been tested. Hot water outlets are checked and the results are recorded. As a result of a health and safety inspection on 22.2.07 risk assessments have been completed in respect of obstructions and trip hazards throughout the home. Fire safety records were seen and included regular checks and servicing of equipment. It was noted that the last fire drill was undertaken on 12.8.06. The deputy manager produced a fire risk assessment for the building that was carried out on 29.11.06. Accidents are recorded and it was noted that no accidents have been recorded since the last inspection. The deputy manager advised that the call bell system had been checked by their electrician but because this was an informal arrangement no report had been provided. DS0000023059.V331009.R01.S.doc Version 5.2 Page 23 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 DS0000023059.V331009.R01.S.doc Version 5.2 Page 24 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 1 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 DS0000023059.V331009.R01.S.doc Version 5.2 Page 25 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 OP27 Regulation 18 Requirement The manager must demonstrate that the night staffing levels meet residents’ needs and undertake risk assessment for all residents with regard to their night care and their vulnerability at night. This is an outstanding requirement and an extended timescale has been given. To ensure that the garden to which service users have access is kept free from dog mess. The registered manager must consult with the Fire Authority in respect of the area used as an office and the practice of wedging open fire doors. Timescale for action 31/05/07 2. 3. OP19 OP19 13(4)(a) 23 14/05/07 14/05/07 DS0000023059.V331009.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000023059.V331009.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000023059.V331009.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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