Inspection on 31/01/06 for White Hill House

This inspection was carried out on 31st January 2006.

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 26/04/07

White Hill House 24/07/06

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 Mike Murphy Unannounced Inspection 31st January 2006 11:00 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 DS0000023059.V281676.R01.S.doc Version 5.1 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.V281676.R01.S.doc Version 5.1 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 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.V281676.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 people over 65, one of whom has dementia Date of last inspection 15th September 2005 Brief Description of the Service: White Hill House is a small, privately owned and family run care home that is registered to provide care, support and accommodation for up to eight service users, one of whom may have dementia care needs.One of the registered proprietors, Mrs Anita Larkin, is also the registered manager of the home. White Hill House is situated on the periphery of the market town of Chesham, is a detached property set slightly back from the main road. At the front of the building there are car-parking facilities for approximately six vehicles and there are enclosed gardens to the rear of the home.With the exception if one bedroom, service users benefit from single room accommodation. The shared room was being used as a single room at the time of this announced inspection.The town of Chesham is a short distance from the home. DS0000023059.V281676.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by one inspector over a late morning to early afternoon on a weekday in January 2006. A senior and experienced care worker was in charge of the home at the time. The registered proprietor joined the inspector and care worker for the latter part of the inspection. The methodology included discussion with staff, the proprietor and residents, examination of documents, a walk around the home, and testing hot water temperatures in a hand basin on the ground floor and a bathroom on the first floor. The inspection finds that residents are well cared for and appear happy, secure and settled in the home. It is a clean, tidy, well furnished and generally well run home, with caring staff. However, it is disappointing to find that little or no progress has been made with regard to the requirements and recommendations of the announced inspection of 15 September 2005. For some matters this is because they are outside of the control of the home (a training agency and a pharmacist unable to provide a service within the timescale set in the report). The majority however have been within its control and a satisfactory explanation for failing to act has not been provided to CSCI. These matters will be followed up by CSCI. This inspection has a mixed outcome. While it finds that the eight residents are well cared for and have their needs met in a comfortable environment by caring staff, it also finds weaknesses which need to be urgently addressed by the proprietor (who is also the registered manager). The inspector would like to thank the residents, staff and proprietor for their time and hospitality during the course of this unannounced inspection. What the service does well: The home provides care in a small, homely and family style environment. The proprietor lives in the home and much of the accommodation is shared with the family. Residents report the food to be of a good standard. It is homemade and freshly cooked. DS0000023059.V281676.R01.S.doc Version 5.1 Page 6 The home maintains good relations with resident’s families. The home is a very pleasant building with good mature gardens. 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. DS0000023059.V281676.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000023059.V281676.R01.S.doc Version 5.1 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.V281676.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Standards in this section were not assessed on this inspection. They were fully assessed in the announced inspection of September 2005. The following matter identified on the announced inspection was followed up. There is a significant discrepancy between the home’s registration status and the wording of its contract with regard to termination of a place on the grounds of a diagnosis of dementia. It is not in the interests of current residents and their families or of prospective residents that this remains unresolved. EVIDENCE: The report of the September 2005 announced inspection described a discrepancy between the home’s registration status (which includes one place for a person with dementia) and a clause in its contract with residents which states that the contract may be terminated if a resident is suffering from ‘…dementia or is infringing the privacy or safety of others, or is a risk to him/herself…’. The subject was included in the report of the inspection but a requirement or recommendation was not made. This is addressed in this inspection. DS0000023059.V281676.R01.S.doc Version 5.1 Page 10 Since no changes had been made the subject was discussed again on this inspection. The discrepancy remains to be resolved by the proprietor. Either by requesting a change to the home’s registration status or altering the wording of the contract so that it is in line with its current status. In discussion the proprietor indicated that she would not wish to change the registration and it was agreed that a diagnosis of dementia should not of itself lead to termination of a place in the home. The home is now required to address this in its contract and other documents. DS0000023059.V281676.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Standards in this section were not assessed on this inspection. They were fully assessed in the announced inspection of September 2005. Two care plans were examined. Care plans record the outcome of the assessment of needs and provide a concise summary of residents care. The home liaises with healthcare services as required. This aims to ensure that residents needs are met and that progress is monitored. EVIDENCE: Two care plans were examined. Care plans contained an assessment of residents’ needs and a summary plan of care to meet needs. It was noted that neither of the care plans examined had a photograph of the resident in the space allowed for this. One plan had an excellent summary of key information provided by a friend of a resident – including reference to recent falls. This needs to be supplemented by an updated falls risk assessment – ideally carried out by a physiotherapist with specialist knowledge. The senior care worker was planning to arrange this. DS0000023059.V281676.R01.S.doc Version 5.1 Page 12 Not all pages had the name of the resident and some sections were not signed and dated in the spaces provided. DS0000023059.V281676.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Only standard 12 was assessed on this inspection. Other standards were fully assessed in the announced inspection of September 2005. The pace of home life is considered to match that preferred by residents. The mix of activities is based on the interests and abilities of individual resident’s who appear satisfied with the current level of activity. While the present daily routine may meet the wishes of current residents it is important the home keeps it under review and that the range and level of activities is adjusted as the needs of residents change. EVIDENCE: The routine for the majority of residents is personal care in the morning after which they may sit in the lounge or in their room reading, resting or watching television. Coffee is served mid-morning and lunch at 1.00 p.m. Lunch is a two course meal and an alternative - such as leek or cauliflower gratin - is available for those who do not want the dish of the day. Resident’s rest after lunch and may continue reading, chatting, listening to music or watching television for the afternoon. In good weather some residents relax in the garden. Afternoon tea is served at 3.30 pm and supper at 6.00 pm. The level of activity varies according to the interests and abilities of residents in this small home. Some attend local activities – bowling or a sewing club. DS0000023059.V281676.R01.S.doc Version 5.1 Page 14 Some go to a local church. Two attended a pantomime over the Christmas period. In 2005 the home organised tea and coffee mornings with another home in the business. Some games – such as chess and quoits - are available for those interested. One resident has a particular interest in music and attended concerts in Chesham Park over the summer. One resident said that she was very happy in the home and that she could keep in regular contact with friends and was able to continue attending a local club One recently admitted resident expressed unhappiness at the amount of time she was spending in her room. This was jointly discussed with the senior care worker and the resident. The care worker explained the reasons for the current position and the action the home was taking to enable the resident to move downstairs. It was expected that the resident would be able to join others in the lounge over the following two or three days. The resident accepted this. Ideally a falls assessment by a physiotherapist would be carried out during this period. It was noted that another resident, who, due to a medical condition, had appeared to spend a lot of time in his room at the time of the announced inspection four months earlier was now mobile, his health had improved and he was much more spontaneous in interactions with staff. DS0000023059.V281676.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not assessed on this inspection. They were fully assessed in the announced inspection of September 2005. EVIDENCE: DS0000023059.V281676.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home is a pleasant building which provides comfortable accommodation for residents. Recent inspections have identified a number of health and safety matters which compromise the health and welfare of residents. The proprietors have been slow in effectively responding to these and the concerns for the health and welfare of residents remain. EVIDENCE: The home is a pleasant building situated on the outskirts of Chesham. Chesham Metropolitan line station is about half a mile away. There is parking space for a few cars at the front and a very pleasant garden to the rear. The home is the residence of the proprietor and her family and some areas are private. The ground floor includes the living room, dining room, kitchen, a conservatory, WCs, and a small flat which has been used as shared accommodation but was occupied by one resident at the time of this inspection. All bedrooms are on the first floor which is reached by stairs. Seven of the eight bedrooms are single and all bedrooms have ensuite (sink and wc) DS0000023059.V281676.R01.S.doc Version 5.1 Page 17 facilities. The home does not have a lift, therefore is not suitable for residents with significant impairment of mobility. The home is pleasantly furnished and generally well maintained. Grab rails are in place in key locations. It is noted that new flooring has been fitted in the hallway and a new carpet fitted on the stairs and first floor corridor and that a new boiler has been installed. Coach locks are fitted to the outside of bedroom doors. The proprietor states that these are to prevent confused resident from going into other residents bedrooms. This is not an acceptable method of dealing with this problem – the incidence of which fluctuates and which is not a constant problem in this home. It could equally lead to a resident being inadvertently locked in their room by someone outside. Concern and recommendations that these be removed has been expressed in previous inspection reports: January 2004 (p10), October 2004 (p27), March 2005 (p26), and September 2005 (p26) but no action has been taken to date. They must be removed and alternative means of locking doors provided. It was stated that one resident would be very distressed if the lock was removed from her door. In the case of this one resident the home should review the position with her. If it appears that she would be distressed or expresses an objection to the lock being removed and replaced by an alternative lock then an exception may be made in this case and the fact recorded in the resident’s care plan. The home should also seek the advice of the fire service on this individual room (The fire service expressed no objection to the lock remaining when the matter was raised during a joint inspection with this CSCI inspector in 2004 and expressed no concerns during the most recent inspection in 2005). The home was last inspected by the fire authority in October 2005. The report of the inspecting officer made recommendations with regard to the hazards in the office, a door on staff accommodation on the second floor, and records of staff fire training. The home now records attendance at staff fire training in individual records. It is recommended that in addition it list all attenders on a single sheet with a summary of the training provided. The proprietor believes that the recommendation on the staff door does not need action because it is a private area and does not form part of the regulated areas of the building. It was agreed that the recommendations will require further clarification with the fire authority. It was noted that two fire extinguishers were free standing on the floor (one on the ground floor and one on the first floor (which appeared to have been badly installed by the contractors)). These pose both a physical hazard and might not be immediately to hand in the event of fire. The laundry is located outside of the home, adjacent to, but quite separate from, the kitchen to the rear of the home. One washing machine was out of order at the time of inspection but the second machine was working well and DS0000023059.V281676.R01.S.doc Version 5.1 Page 18 the inspector was informed could wash at 80 degrees Celsius if required. The home has a contract with PHS for the removal of clinical waste. Hot water temperature regulating valves are not fitted. Water temperatures are tested regularly and records maintained. Records of about 20 readings were inspected and showed a range of around 39 to 44 Celsius. Three hot water outlets in areas to which residents have access were tested – of the hand basin in a ground floor wc and a sink and bath tap on the first floor. Readings were 57.9 Celsius on the ground floor and 59.6 Celsius on the first floor. These are far in excess of the 43 Celsius recommended in areas to which residents have access. The reason given was that the heating had been turned up over the weekend in response to the cold weather. Hot water temperature regulating valves should be fitted, and if they had been, would prevent the hot water exceeding the recommended limit - independent of changes to the central heating. Hot food temperatures are recorded on the menu record on about 50 of occasions. A modification to the record form was suggested in order to ensure that staff remember to check and record the temperature on every occasion. A certificate and report of PAT testing carried out in October 2005 was provided for inspection. A certificate of the house wiring was still not available. DS0000023059.V281676.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not assessed on this inspection. They were fully assessed in the announced inspection of September 2005. EVIDENCE: It was noted that POVA first or CRB’s have not yet been obtained for some staff. DS0000023059.V281676.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not assessed on this inspection. They were fully assessed in the announced inspection of September 2005. EVIDENCE: DS0000023059.V281676.R01.S.doc Version 5.1 Page 21 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 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 1 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X DS0000023059.V281676.R01.S.doc Version 5.1 Page 22 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. 2. Standard 29.3 36 Regulation 19 18.2 Requirement That CRB checks are in place for all staff (Timescale for November 30 2005 not met) The system for formal staff supervision should be instigated to ensure that each member of staff receives supervision at least six times a year.(Timescale for December 31 2005 not met) The registered manager must ensure that staff engaged in the handling of food have up to date training in food safety The registered manager must ensure that a valid certificate of compliance with relevant regulations is held for the electrical wiring (Timescale for November 30 2005 not met) The registered manager must ensure that the temperature of hot food is tested and records retained The registered manager must ensure that the temperature of hot water in areas to which residents have access is close to 43 degrees Celsius. The registered manager is DS0000023059.V281676.R01.S.doc Timescale for action 28/02/06 28/02/06 3 38 13 (4) 31/03/06 4 38 13 (4) 07/02/06 5 38 13 (4) 07/02/06 6 38 13(4) 30/03/06 10 2 5(c) 14/02/06 Page 23 Version 5.1 required to revise the contract and other documents and ensure that it is consistent with its registration status with regard to the admission and care of residents with dementia. 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. 4 5 Refer to Standard 24 38 9 38.2 38.2 Good Practice Recommendations It is recommended that the coach locks which are fitted to residents’ bedroom doors are removed. It is recommended that the home record accidents using the Health & Safety Executive (HSE) forms It is recommended that the home arrange periodic visits by a pharmacist in support of good practice in the storage, control and administration of medicines It is recommended that the registered manager record the content and staff attendance of fire training in a summary record as well as in staff individual training records. It is recommended that the registered manager modify (by inserting new columns) the current form for recording the temperature of hot food so that staff are prompted to record the temperature on all occasions. DS0000023059.V281676.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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.V281676.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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