Inspection on 16/10/07 for White House Nursing Home, The

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 House Nursing Home, The 28/11/06

White House Nursing Home, The 19/09/05

White House Nursing Home, The 03/05/05

White House Nursing Home, The 19/10/04

White House Nursing Home, The 04/05/04

White House Nursing Home, The 06/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE White House Nursing Home, The 274 Malden Road New Malden Surrey KT3 6AR Lead Inspector Jon Fry Key Unannounced Inspection 1:30 16 & 23rd October 2007 th 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 House Nursing Home, The DS0000026255.V354172.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 House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White House Nursing Home, The Address 274 Malden Road New Malden Surrey KT3 6AR 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) 0208 949 0747 020 89190759 thewhitehousenursinghome@btopenworld.com Mr Badru Manji Mrs Sater Manji Mrs Lesley Elizabeth Carnegie Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2006 Brief Description of the Service: The White House Nursing Home provides residential and nursing care for up to twenty five older people. The home is situated on a main road close to public transport, shops and other amenities. Accommodation is provided in single bedrooms. A copy of the service’s Statement of Purpose and Service User Guide can be obtained on request. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We spent nine hours in the home over two separate visits. We spoke to twelve people who live at the home, two relatives or friends of individuals, the manager, the home administrator and two staff members. We looked at records and documents kept at the service including two people’s care plans. Completed surveys were received from six relatives or friends of people living there. The home completed an Annual Quality Assurance Assessment (AQAA) to tell us about the service provided, how it makes sure of good outcomes for the people using it and any future developments being planned. What the service does well: What has improved since the last inspection? What they could do better: White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 6 The challenge for the home is to continue to make the care and support provided even more person centred. Care plans could be made better by containing much more individual information about all areas of their lives. Care staff should see occupation, engagement and ensuring well being as very important areas of their work. There is a strong foundation to build on in terms of the homely feel that the service already has. Looking at how people living there can take even more ownership of the home and how staff become more person centred may help the service to develop. 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 House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 7 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 House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. People using 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. Good information is available to prospective users of the service. Satisfactory assessments are completed before people move in but these could be improved to capture better quality information. EVIDENCE: One person said “I couldn’t live on my own anymore – my family found it” and “they made me feel welcome and said to treat it like my own home”. Another person said “somebody put me here and it’s frightening to me” but “the people have been very kind”. One individual said “ I heard of it by reputation” and “It’s nice and handy for visitors”. Three out of the six relatives or friends who sent in surveys said that they ‘always’ get enough information about the home. Three people said ‘usually’. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 9 A guide is available which tells people about the home and the service it offers. This is available in normal type and can be produced in large print on request. We saw that the administrator is working on a picture format for the guide to make more user friendly for people using it. Assessments are completed before someone moves into the home. Individuals can visit with their family to help them in making a decision about living there. We have recommended that the service look at the assessment format in use to make sure that it captures good quality information about the person. A questionnaire could also be used to ask relatives or friends about the person if they are unable to provide the information themselves. This information may be important in personalising the service to the individual. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 10 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 and 10. People using 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. Care plans are generally well maintained but could be made to be more individual and person centred. Individual health needs are met. Arrangements for the handling, storage and administration of medication are good. EVIDENCE: Four out of the six relatives or friends who sent in surveys said that the home ‘always’ met the needs of the individual. Two people said ‘usually’. One person commented “all very helpful” and another person said “I feel they adapt adequately to my friends changing needs sometimes in trying circumstances”. One individual said “they are thoughtful and observant”. People we spoke to said that staff treated them with dignity and respect. Comments included “all very kind and caring”, “most staff are very helpful” and “I’m treated with respect”. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 11 We looked at the care plans for two people. Each care plan sets out how their needs are to be met, this document is reviewed regularly. The plans could be improved to contain more individual information and to include more about social and emotional needs. The activities co-ordinator has started to record some good information about people living there and the things they like to do. This needs to be reflected in the care plan so that everyone can see and use this important information. Life story work may also help staff and other people living at the home ‘see’ the person better. Care plans seen for areas such as personal hygiene included phrases such ‘requires strip wash daily and a general bath weekly’ and ‘wear appropriate clothes according to temperature’. Staff should review these and make sure that specific person centred information is recorded. For example, when does the person like a bath, which bathroom do they use, what toiletries do they prefer and who do they like to help them? We have recommended that the staff team start to discuss care planning around sexuality. Some of the information recorded such as ‘nursed in single room’ may not address the person’s needs (if any) properly. Daily notes kept by staff should also be discussed. We saw that some of these contain very repetitive and general statements such as ‘personal care attended’ and ‘satisfactory day’. Notes kept by staff need to contain good quality information which can then be used to evaluate and review the care being provided. We saw that health needs of individuals are being met. “I see the Doctor anytime I need to” and “I’m attended to quickly if I am ill” were comments from people living at the home. Records of appointments with the GP and other healthcare professionals are kept well. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 12 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 and 15. People using 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. The home offers a good range of activities. There is scope to improve this by making sure there is a detailed social care plan for each person and involving all care staff in delivering this important aspect of care. People living there generally enjoy the food provided to them. EVIDENCE: People we spoke to were positive about the activities on offer to them. “Plenty to do”, “I go down the shops”, “the new activities person is good” and “I’d like to get out a bit more” were some comments from individuals. We saw that some good work around activities and occupation is being done by the home’s activities co-ordinator. Things going on include baking, gardening and bingo. Individual time is provided for people to go to the local shops, play scrabble and just chat. The activities person was busy arranging taxi cards, books from the local library and planning a shop at the time of our visit. One person living there is a prolific painter and their work is displayed in White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 13 the home. There is a laptop computer for people to use as part of a project with the Local Authority. A number of people are already using this and one person said they were enjoying having computer lessons. Care plans do contain some information about people’s interests and activities they may enjoy. These were seen to need some work as some of the information was not up to date and were not ‘live’. The information being collected separately by the activities person was better and much more personalised. As stated previously, this information needs to be seen and used by everyone. It is recommended that all care staff be encouraged to see engagement and occupation as an important part of their job even when the activities person is there. Some suggestions were made by relatives or friends in surveys for developing activities. These included “more outside interests – garden parties in summer or more help from local schools” and “more stimulation and interest maintained with current affairs and events”. Two people felt that different music could be played and the TV turned off at times in the main lounge. It is strongly recommended that life story books be developed with people living there and these could then be shared with others in the home. This may also help staff to relate to people as individuals and encourage more interaction. Staff may wish to develop their own life story books as part of this process also. Most people spoken with said that they enjoyed the food offered with comments including “very satisfactory - down to earth grub”, “very good”, “it’s fine” and “I only have to ask for a cooked breakfast and I get it”. One person said “good food but I long to get in the kitchen myself” and another individual said “not too bad”. One relative or friend of an individual said they would like “better quality food” to be served. We found that the menus displayed in the hallway did not actually reflect what was being served. The home has told us that it has reviewed these since the inspection took place and is also working on producing menus in picture format. These developments are important to help give people real choice each day in what they want to eat. There may be opportunities to improve the mealtime experience further. Ideas such as protected mealtimes and staff eating their meals with the people who live there should be considered. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 14 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 and 18. People using 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. Individuals are protected from abuse. Concerns about the care provided are listened to and acted on. EVIDENCE: Records are kept of any concerns or complaints received and we saw that they have not received any since the November 2006 inspection. The complaints policy and procedure is part of the guide for the people living there. People we spoke to said that they knew how to voice any issues they had. Comments included “I’m able to talk to the manager”, “the managers are very helpful” and “I speak to matron”. Four relatives or friends of people living at the service said they knew how to make a complaint. One person said they could not remember how to do this and another individual did not answer this question. A record of compliments is kept and feedback included “thanks for all your kindness” and “thank you for your care and kindness”. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 15 Care staff have training that teaches them how to recognise and report abuse. The Local Authority procedure is available for staff to follow in the event of any allegations being made. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. People using 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 at the home enjoy a clean, comfortable and safe living environment. The bathrooms could be further improved for the benefit of people living there. EVIDENCE: People spoken to were generally happy with the environment. Comments from individuals included “fine”, “it’s got all I want” and “ok”. We saw that the home generally provides a pleasant and well maintained place for people to live. Within the last year, five bedrooms have redecorated, new carpets have been fitted in the upstairs hallway and a refreshment bar for White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 17 visitors created. A new staff room was just being finished at the time we visited. A new ‘wet room’ style bathroom is being created on the first floor. We thought that other bathrooms needed work to make them more comfortable for the people living there. We found that some bathrooms did not have locks fitted. The home has told us they are now fitting them which is essential for people’s privacy and dignity. The service should look at making sure that supplies of incontinence pads are suitably stored in cupboards and that any clinical waste bags are stored away from communal bathrooms in use by the people that live there. People toiletries should be kept in their room unless they request otherwise. The practice of having communal bath foam or shampoo should stop immediately. These are all practices that undermine the homely feel of the service. We think that the current practice of having a separate staff toilet, and the reasons for it, should be discussed amongst the staff team. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 18 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 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are generally enough staff on duty to meet the needs of people using the service. People living at the home are protected well by the recruitment procedures. There is a staff training and development programme in place. EVIDENCE: Feedback about the way the staff carried out their duties was positive. Comments included “very kind and caring”, “the staff are first class”, “the staff are marvellous” and “very pleasant”. Two people we spoke to said that they felt that there could be more staff on duty. This was discussed with the management at the time of inspection and they have said they will keep this under review. Relatives or friends of individuals said “my relative seems happy especially with the staff” and “the care staff are always kind, helpful and courteous”. Staff have access to training and recent courses attended include manual handling, medication and bereavement. New staff receive induction training to Skills for Care standards and over 50 of staff have the NVQ Level 2 award. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 19 We found that the home needs to review the mandatory training received by staff to make sure that everybody is up to date in areas such as Food Hygiene and abuse awareness. We have strongly recommended that the service looks at further training for staff in dementia care and person centred planning. The activities co-ordinator should also have opportunities to attend training in areas such as reminiscence and providing activities for people with dementia. We saw that the necessary recruitment checks are carried out for new staff and good records are kept of these. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using 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 live in a home that is well run. There are good arrangements to make sure that the health and welfare of people using the service is protected. EVIDENCE: Comments from relatives or friends of people using the service included “the matron in charge is well qualifed and has the necessary experience” and “the manager and staff has always provided the utmost support”. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 21 The manager has considerable knowledge and experience of running a care service for older people. She is supported well by an administrator who makes up a stable management team for the service. We saw that there is a quality assurance system and surveys have been given to people using the service and the results collated. A meeting of individuals and their relatives or friends took place in June 2007. This involved discussions about food and how to empower the individuals who live there. There is opportunity to look at how the people living there could be even more involved in the daily life of the home. We have recommended that meetings for people living in the home take place at least every two months to ask for their opinions. A system for regular individual staff supervision is in place but needs development to make sure that all full time staff receive this at least six times per year. Health and Safety checks take place to make sure people are kept safe and good records are kept of these. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 2 X 3 White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 23 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 OP21 Regulation 12 (4) Requirement In order to ensure the privacy and dignity of people living at the service, locks must be fitted to all bathrooms and toilets in the home. Clinical waste bags for disposal must not be stored in communal baths or toilets. Incontinence supplies need to be stored in cupboards. The mandatory training for care staff in areas such as abuse awareness and food hygiene needs to be reviewed to ensure that it is up to date. Timescale for action 01/01/08 2. OP30 18 (1) (c) 01/03/08 3. OP36 18 (2) This will make sure that people living there benefit from always having appropriately trained staff on duty. In order to ensure that care staff 01/03/08 receive regular support and guidance to help them do their jobs well, formal staff supervision should take place at least six times annually (pro-rata for part-time staff) with full records kept. DS0000026255.V354172.R01.S.doc Version 5.2 Page 24 White House Nursing Home, The 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. Refer to Standard OP3 Good Practice Recommendations The service should review the assessment format to make sure that it captures good quality person centred information. A questionnaire could be developed for relatives or friends of individuals to be used where appropriate. The home should look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person orientated and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered. Better background information about the person and their life should be recorded. The staff team should discuss care planning around sexuality. The content of daily notes should be discussed to make sure that good quality and useful information is being recorded. Life story books should be developed with the individual and their family or friends. These books should be used to help communication and engagement. Staff may wish to develop their own life story books to share. The service should look at the mealtime experience for the people living there and ideas to enrich this further. This could be through protected mealtimes and staff eating alongside the people who live there. The practice of having a separate staff toilet and the reasons for this should be discussed within the staff team. Care staff should receive training in dementia care and person centred care. The activities co-ordinator should receive specialist training to develop their own role and practice. DS0000026255.V354172.R01.S.doc Version 5.2 Page 25 2. OP7 3. OP7 4. OP12 5. OP12 6. 7. OP21 OP30 White House Nursing Home, The 8. OP33 It is recommended that the home look at developing systems for consultation with people living at the home. These may include regular meetings, a user committee or representation at management meetings. White House Nursing Home, The DS0000026255.V354172.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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