Inspection on 11/10/07 for White House Residential Home (The)

This inspection was carried out on 11th October 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 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 Residential Home... 08/10/08

White House Residential Home... 01/11/06

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE White House Residential Home (The) The White House 29 Beverley Road Driffield East Yorkshire YO25 6RZ Lead Inspector Beverly Hill Key Unannounced Inspection 11th October 2007 09:30 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 Residential Home (The) DS0000067033.V352792.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 Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White House Residential Home (The) Address The White House 29 Beverley Road Driffield East Yorkshire YO25 6RZ 01377 257560 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) Accomodating Care (Driffield) Limited Mrs Rachel Helena Merrills Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20) of places White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: The White House is an adapted building with a purpose-built extension originally opened as a care home in 1986. It is situated in its own wellmaintained grounds and public transport to Driffield town centre passes the door. Staff cover is maintained throughout any 24-hour period and includes personal care, catering, laundry and maintaining a clean environment. Each service user is registered with a general medical practitioner who addresses their primary health care needs and can access the more specialised health services as required. The original building is on three levels serviced by a passenger lift. The top floor is for private use only. Communal areas consist of two lounges and a dining room set out with individual tables and chairs. There is also a well-used quiet area in the entrance with two easy chairs. The rear entrance doors give level access to the gardens provided with outdoor seating. There is a car park for approximately six cars. The home has sixteen single and two shared bedrooms. Fifteen of the bedrooms have en-suite facilities, two of them with showers. Two of the bedrooms are shared. The home has two bathrooms, one of which is unassisted and there are sufficient toilets on both floors. A Statement of Purpose and Service User Guide are available in the home. The fee level advised at the time of the visit was from £286 to £355 per week. The home also has a top-up fee of £33 per week dependent on the size of the bedroom. Items not covered by the fee are hairdressing, chiropody, newspapers, magazines and toiletries. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 1st November 2006 including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to people to gain a picture of what life was like for them to live at The White House and analysed the surveys returned from them. We also had discussions with the registered manager, the cook and care staff members. Information was also obtained from surveys received from staff members, relatives and visiting professionals. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. What the service does well: The staff team clearly enjoyed their jobs and spoke to people in a nice way, providing care that respected people’s privacy and dignity. There was a low staff turnover, which meant that there was consistency of care and staff got to know the people who lived there very well. People spoken with commented, ‘I’m happy here, they look after me well’, ‘the staff are friendly and caring, I have no complaints about them’, ‘three to four of the staff are wonderful’, ‘I’ve been here years and am very happy - the staff are lovely, patient and busy’ and ‘the staff are excellent, they’re caring, they look after me well’. The home provided a pleasant environment for people to live and work in. It had a friendly and homely feel, and was clean with no unpleasant odours. One relative stated, ‘with it being a small home I feel they get more attention as the staff are always around to see they are ok and get to know them as individuals and their special needs’. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 6 Staff made sure that people had access to health professionals. One GP commented in a survey, ‘caring attitude, staff are professional and appears well staffed’ and ‘the staff are always helpful and caring to their clients and involve district nurses appropriately’. Visitors were welcomed at any time of the day and this was confirmed in discussions with people and staff we met on the day. There were plenty of activities provided for people and staff ensured they were given choices about their lives. Staff showed good understanding of how to make sure people remained as independent as possible. People who lived at the home stated they liked the meals and drinks provided. The cook told us they had a good food budget and sufficient kitchen equipment. The manager ensured that any niggles or complaints were resolved quickly. The way the home recruited staff was good and made sure only suitable people were employed to care for the people that lived there. What has improved since the last inspection? What they could do better: The local authority completed assessments of peoples’ needs prior to admission to the home so the manager needs to make sure they consistently obtain them. They also need to make sure that their own assessments have more information about the persons’ needs and the effect this has on them. This will help them decide if the White House is the right place for people. They also need to write to people to let them know their decision. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 7 The home produces care plans that state how peoples’ needs are to be met by staff. These must include correct information and be more specific for the person so members of staff have clear guidance to how to look after people. Also when senior staff members check whether the care plans are still meeting needs they must check information written in other parts of the care file. Generally the staff completed risk assessments for particular activities for people who lived at the home and put in place steps to minimise the risks. They need to make sure all identified risks are dealt with in this way to give clear written guidance to staff. The home was unable to weigh some people because they only had standing scales. They need to purchase sitting scales or have alternative arrangements in place to monitor fluctuations in weight. It is especially important that people under the care of dieticians have their weight monitored. The way the home managed people’s medication must be improved so that it is stored properly. About half of the staff had received training in how to protect people from abuse. It was important that all staff received this training to enable them to recognise when abuse has occurred and know what to do. The home has sent out questionnaires to people to obtain their views about the service. These need to be checked and plans made of how the home is going to address any areas for improvement. The manager needs to plan staff-training needs by looking at supervision records, appraisals and training logs. A plan will assist her to make sure staff have the right skills and knowledge to complete their jobs and to ensure refresher training is completed. Care staff must have one to one discussions as part of their supervision as well as the observation that is already carried out. People told us that they didn’t get chance to speak to the proprietor, ‘I never see him, I think he comes around’. It is important that people who live at the home and staff who work there have the opportunity to speak to the proprietor to inform them of their views about the home. The way the staff monitors the health and safety of service users within the home could be improved, for example checking accidents reports for patterns and seeking advice about preventing access to some steep steps. 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 Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection White House Residential Home (The) DS0000067033.V352792.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 and 5 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People did not have comprehensive assessments of need completed by the home prior to admission. The basic information on the home’s in-house assessments and the system of not always obtaining those completed by care management could potentially affect the decision-making about whether they could meet needs. The home offered visits and trial stays so people could assess the services provided by the home. EVIDENCE: We examined three care files during the visit. One of the files was for a person who was privately funded and therefore only required an assessment completed by the home. This was in place although it contained basic information, for example under personal hygiene it stated, ‘minimal assistance’ but did not state what assistance was required. This was also the case for White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 10 eating and drinking which stated, ‘normal’ but did not specify what, ‘normal’ was. When the staff complete their own assessments there needs to be more information about the person’s needs to enable a decision to be made about whether the home is able to meet needs fully. However in discussion with the manager they were very clear about the level of need they were able to support within the home. The manager demonstrated this by describing a situation when they declined to admit a person, despite having a vacancy, because they felt their needs were beyond the scope of the home. The manager confirmed they visited people at home or in hospital to complete the homes in-house assessments prior to admission. There was evidence the home sometimes obtained assessments and care plans completed by care management as these were evident in one of the two other care files examined. However one file did not contain a local authority assessment or care plan. The manager had completed the home’s assessment but, as with the first one described, it contained basic information. People were encouraged to visit the home and look around and the home provided them with information about services. The first four to six weeks of any admission were seen as a trial period then a review was held, to discuss the stay and whether permanent residency was required. The manager stated that respite care gave people the opportunity to try the home and get to know staff and the homes way of working during regular visits before making any final decision about permanent residency. There was no one admitted for respite on the day of the visit but one person commented in a survey, ‘the home was recommended by the person who’s bed I took over when I came in’. The home needs to formally write to people following the assessment stating their capacity to meet the identified needs. The home does not provide intermediate care services. White House Residential Home (The) DS0000067033.V352792.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 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current format of care plans did not provide care staff with sufficient up to date information and this could mean that people’s care needs may be missed. The current system of storage and recording of specific medication places people at risk of receiving it at the wrong temperature. People receive care and support that promotes their privacy and dignity. EVIDENCE: Three care plans were examined in detail and on the whole covered the areas highlighted in assessments. The care plans in their current form were scripted with the same standard need for each service user, which was then individualised with tasks for staff. However only some sections had been individualised, which meant that some plans had incorrect information. For example one person had a care plan for ‘weight management’ that told staff to administer specific food supplements but the person had not had these White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 12 prescribed for her. The same person had a care plan for pressure relief that told staff to change a pad for incontinence every 2-3 hours but a later plan for continence promotion stated the person was continent. Another care plan advised staff that the person required a diabetic diet and monthly blood monitoring tests but the person was not diabetic. If the home are to continue to use scripted care plans they must be individualised to fully reflect the persons need or they will be confusing to staff and needs may not be fully met. Some care plans did not always contain the full instructions staff would need to support the person and all referred to, ‘the resident’ throughout instead of the person’s name. There was some evidence of changing needs reflected in care plans but this was inconsistent and mainly due to an evaluation process that did not take into account information written in other parts of the care file such as daily records, health visits and dependency monitoring. The evaluation for all three care plans examined had, ‘no change’ written in month after month but changes in need were seen documented in daily notes, for example with mobility needs, increases in dependency levels and pain management issues. Care plan evaluations need to be a true reflection of how the plan is meeting needs and whether changes need to be implemented. There was some evidence that the service user and the person formulating them signed care plans. The manager confirmed they were aware of some of the care plan shortfalls and planned to review them with her deputy. There was evidence that people’s health and social care needs were met in ways that promoted privacy, dignity, choice and independence, which was confirmed in discussions with people. Personal care was given behind closed doors and privacy screening was available in shared rooms. People spoken with stated, ‘they look after me very well’, and one person when asked about how staff promoted their dignity stated, ‘they help me in a nice way, no concerns there at all’. Relatives commented, ‘it is noticeable that all the ladies are very clean and presentable’, ‘they cater for the individual needs of the residents without stereotyping’, ‘we are more than happy with Mum’s care’ and ‘they make Mother as comfortable as possible’. Peoples’ general health was monitored and there was evidence of referral to appropriate health professionals for advice and support. One GP commented, ‘The staff are always helpful and caring to their clients and involve district nurses appropriately’. Weight could only be monitored if people could use standing scales, which meant that staff had no means of keeping a record of the weight of a proportion of people living in the home. This was especially important for one person who was under the care of a dietician and whose mobility fluctuated. Risk assessments were in place for some activities for example using the bath hoist, mobility and falling out of bed. However the assessment tool had a scoring system but no code to identify the level of risk and the control White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 13 measures used to minimise the risk were not fully completed. The manager and staff members had not received any training in how to complete risk assessments. However one person had information about their risk of developing pressure sores and what staff must do to prevent them detailed in their care plan despite not having a formal risk assessment and when spoken with, staff were clear about her needs. So despite the lack of a risk assessment in this instance, the service users’ needs were met. Staff stated they had the time and opportunity to read care plans and risk assessments. People received the medication they were prescribed for. However there were some areas of medication management that needed improvements. •Medication stock and the trolley were stored in the laundry room, which would become hot when the driers were activated. There was a window for ventilation but the temperature needs to be monitored, as medication must not be stored above 25°C. •Some eye medication was stored in the fridge but was clearly labelled, ‘do not refrigerate’. •The medication administration record was not signed when staff applied prescribed creams to people, as these were kept in peoples’ bedrooms. •Some products with a limited shelf life did not have the date of opening recorded on the container. •A container of inhalers was stored on a unit in the dining room and was easily accessible. All medication must be stored securely. •Information regarding the changes to anti-coagulant dosage should be in writing and maintained with the medication administration record. The manager needs to check with the pharmacist the current system of placing anti-coagulants in blister packs as most have stopped dispensing these in this way. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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. The home had flexible routines, promoted choice and individual decisionmaking and provided well-balanced meals, which met people’s nutritional needs. EVIDENCE: The home employed an activity coordinator for three hours each Monday and Wednesday. Via discussion with people and staff members, and examination of records it was evident that the home provided a range of activities. People told us they participated in cards, bingo, dominoes, quizzes, chatted with each other and staff took them on walks into the town centre. Some people liked to do their own thing and watch television, read or listen to music. One person told us the library visits to exchange books and a religious service is held monthly on a Wednesday. Another stated, ‘There is plenty to do what we want to do’. Mondays tended to be more games and activities and Wednesdays was reserved for 1-1 work and walks into the town centre. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussion with staff and a relative White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 15 spoken with. We observed the way staff received visitors and this was done with warmth and knowledge about them. Four surveys returned from relatives commented that they were always kept informed of important matters, ‘the slightest change in condition, or doctors/nurses visits are recorded and I am informed by telephone if it is not one of my visiting days’. Staff spoken with had an understanding of how to promote independence and choice, ‘We always ask people what they want to do or wear, we hold up choices’, ‘We treat people as individuals’, ‘We have a notice board in the entrance for meals, we read it out to them and tell cook if they want something different’ and ‘One person likes to have a sherry and another likes to have a bean bag warmed up for her feet’. People spoken with confirmed this, ‘I like to go to bed early, we can get up when we want’, ‘We can have anything we like in sandwiches’, ‘I don’t like to mix with people’, ‘It’s a nice home, friendly and not too big, you can sit where you like’ and ‘Staff help me get washed and dressed’. One relative told us in a survey, ‘Staff do not get upset if a resident asks for a particular member of staff, they realise residents are human and can have likes and dislikes. The staff do not take it personally’. Another stated, ‘They present a homely atmosphere’. Bedrooms were personalised and people stated they could bring in their own pictures and ornaments. Some people had installed their own telephones and several had their own bedroom furniture and chairs. People managed their own money and one person was able to safely manage a part of their medication. People spoken with enjoyed the meals provided by the home. Some comments were, ‘We are well fed, I’m enjoying the meal today’, ‘The food is quite good, we get plenty to eat and drink, I don’t like sausages so they didn’t give me it’, ‘I enjoy the food’, ‘The food is great most of the time - you can make suggestions at meetings, tell them what you want’. We observed one choice at lunchtime and the meals were well proportioned and presented. People confirmed they could have alternatives if they did not like the menu of the day and described times when this had happened. A care manager with the local authority stated that at a review a service user told her she was pleased with the variety of meals and the preparation and presentation of food. The dining tables were nicely set out with tablecloths, placemats and settings. The cook advised that special diets were catered for, for example diabetics and those requiring a soft consistency. One person told us that they had appointments with a dietician because of their small appetite and had food supplements to enhance their dietary intake. Menus were rotated and included seasonal changes and suggestions from people. Local produce and fresh fruit and vegetables were used. Good monitoring records were maintained and the cook stated they had sufficient equipment and a manageable budget. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided an environment where people and their relatives felt able to complain. The home protected service users from abuse by staff training and adherence to policies and procedures, although not all members of staff were fully aware of local procedures. EVIDENCE: The home had a complaints policy and procedure that was on display. The manager confirmed they only ever received minor complaints and these had been dealt with straight away. These were documented in a ‘niggles’ book available for that purpose. Formal complaints would be responded to in writing within set timescales. People spoken with stated they felt able to complain if they were unhappy, ‘I tell them what I think - I would certainly complain’, ‘I would complain to the manager. I don’t really complain but I would do if I was really unhappy’, ‘ I’m satisfied with the home, you can’t please everyone but I would complain if needed’. People knew the manager’s name and stated they saw her daily. There was evidence in minutes from service user meetings that people felt able to complain. Surveys from relatives stated they were aware of how to complain. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 17 The manager confirmed that approximately half of the staff team had completed safeguarding adults from abuse training with an external provider. Some care staff and ancillary staff were still to complete the training and this was confirmed in discussions with them. Those spoken with stated they would report any incidents of suspected abuse to the manager or person in charge of the shift but some of their information was limited. The home used the multi-agency policy and procedure regarding safeguarding vulnerable adults from abuse and the manager was fully aware of the referral and investigating procedures. However the manager and deputy manager had organised refresher training for themselves with the local authority, due in November. Policies and procedures were in place regarding the management of service users’ money. The home’s recruitment procedure ensured the safeguarding of service users through the obtaining of written references, checks made to the protection of vulnerable adults register and enhanced disclosures from the Criminal Records Bureau. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 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. The home provided a clean, homely and well-maintained environment for people to live and work in. EVIDENCE: Generally the home provided a comfortable, homely and clean environment for people. The White House was an adapted property with a purpose built extension. Formerly a private residence it now provided accommodation for a maximum of twenty people. It was within walking distance of the town centre and public transport passed the door. The home had well-tended grounds, with a garden and a patio area at the rear. Garden furniture was provided and level access was available from the rear external door. The premises appeared to be in good structural condition. Records were maintained of repairs required and when they were completed. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 19 Since the last inspection one of the sitting rooms had been re-decorated and a new carpet fitted in one of the bathrooms. Part of the kitchen had had new flooring and repairs had been made to the roof. There were two communal sitting rooms and an area by the front door provided with seats. One person said they liked to sit in the entrance to watch people coming and going and to look out for their relative when they visited. A separate dining room was spacious and well laid out to give people freedom of movement and staff the space to assist where necessary. The local authority had provided a grant, which the home was utilising to upgrade the dining room and facilities. New dining tables and chairs had already been purchased and the room was due to be re-decorated shortly. The home had eighteen bedrooms, sixteen of which were single. One of the shared bedrooms was used as a single room at the choice of the resident. People were encouraged to bring in small items of furniture, pictures and ornaments to personalise their bedrooms and this was seen to varying degrees. The bedrooms had privacy locks and lockable facilities. People spoken with were happy with their home and bedrooms, ‘It’s clean and tidy and my clothes are ready when I want them’, ‘I like the home, it’s small and homely, you can sit in any of the two lounges. I mainly sit in that lounge, you can talk to people in there’, ‘my bedrooms alright, I’ve brought in my own photos and pictures, a few things that I wanted’, ‘It’s very good (the cleanliness), they work very hard’. Surveys received from people also commented on the cleanliness of the home. The laundry was small but seen as adequate for the size of home. It was located off the dining room and staff confirmed they used an alternative route of transporting linen to the laundry than through the dining room. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 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. Generally the staff training in place ensured members of staff have the required skills to care for older people. The recruitment processes ensured only appropriate staff were employed to care for vulnerable people. This helped to secure the safety of people that live in the home. EVIDENCE: The home had sixteen people living there at the time of the visit. Rotas showed that there was two care staff on duty throughout the day as well as the manager and two staff at night. The manager completed care tasks from 7.15am until 10.15am to support people to get up and when she was not on duty a third staff member fulfilled this role. The manager completed approximately twenty-one care hours and nineteen management hours per week and the deputy manager completed twenty-one care and three management hours per week. The care hours provided for the current number and needs of the people that live at the home was in line with those recommended by the residential care staffing forum. Should the numbers or needs of service users increase the staffing hours will need to be re-calculated. There were sufficient catering and domestic staff employed in the home. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 21 People spoken with were complimentary about the staff, ‘I’m happy here, they look after me well’, ‘the staff are friendly and caring, I have no complaints about them’, ‘three to four of the staff are wonderful’, ‘I’ve been here years and am very happy - the staff are lovely, patient and busy’ and ‘the staff are excellent, they’re caring, they look after me well’. A survey from a relative was equally complimentary, ‘the care my mother gets is first class and all her needs are met. I cannot fault the home in any way’. Another commented, ‘with it being a small home I feel they get more attention as the staff are always around to see they are ok and get to know them as individuals and their special needs’. We observed that the manager and staff team had built up good relationships with people and were observed speaking to people in a friendly and caring way. The staff office was located on the main corridor and people were observed popping in and out to speak to the manager or to receive support from them. Files of the four latest members of staff to be recruited were examined and all contained application forms, two written references, protection of vulnerable adults register checks and enhanced disclosures from the Criminal Records Bureau. This robust recruitment system ensured that only suitable members of staff were employed to work with vulnerable people. Staff induction had been an orientation to the home and working alongside more experienced staff. However new staff members had started the skills for care induction standards and the manager or deputy signed off their competency when completed. From information provided during the visit, six out of fourteen care staff had completed a national vocational qualification in care at level 2, which equated to 42 of the care staff team. A further five staff were either progressing through the course or were enrolled ready to start. This was a good achievement and when those progressing complete the course the home will have exceeded the required 50 of care staff trained to this level. Each staff member had an individual training log and certificates were held of completed courses. The staff, apart from those recently employed, had completed mandatory training except infection control. The manager needs to complete a training plan for the coming year with information gained from supervision and appraisals. Training logs need to be consulted to ensure refresher training was also planned for. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is improving and developing systems that monitor how the quality of the service is assured and how the health, safety and welfare of people are promoted. This will allow for more consultation with people living at the home. Staff supervision in its current form observes practice but does not fully develop staff. More work is needed in this area. EVIDENCE: The manager had been in post since March 2005 and secured her registration with the Commission in December of that year. She had a background in the care sector including work in nursing homes, residential homes and hospitals. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 23 She held a National Vocational Qualification (NVQ) in care to level 3. She was working towards the management section of the Registered Managers Award and will start NVQ Level 4 in care once this has been completed. Staff spoken with felt supported by the manager and surveys commented on her supportive and approachable manner, ‘she’s lovely and very professional’, ‘problems will always be sorted out’ and ‘we get good support’. Service users and a relative spoken with knew the manager’s name and we observed people approaching her to tell her things or ask questions. She was patient, often repeating her answers when required and obviously knew people very well, chatting about their relatives and plans for the day. One person told us, ‘the manager is lovely, she comes round to see us’. The manager is due to have a planned absence from the home shortly and the proprietor needs to put in place alternative management arrangements and let the Commission know in writing what these are. Service users and staff spoken with stated they thought the proprietor visited the home but they did not usually speak to them, ‘I haven’t seen the owner, I’m quite happy though’, ‘I never see him, I think he comes around’, and ‘no, we don’t have discussions with the owner’. The proprietor must fulfil responsibilities in line with regulation 26 of the Care Homes Regulations and visit the home unannounced each month. They must speak to people living and working at the home, inspect the premises, examine records of events and any complaints and prepare a report of the visit to be held on file. The home was working towards gaining Quality Development Scheme (QDS) status with the local authority. This means they are developing methods of monitoring the quality of the service they provide and when an effective system is in place it will increase the amount of funding they receive from the local authority for each service user funded by them. The new system had just started and the home had made a good start in sending surveys out to professional visitors, such as GP’s and district nurses in August and service users and relatives in October. Results will need to be checked, any areas for improvement identified and plans produced for these. The home held service user and staff meetings regularly to consult on views. One person stated, ‘we make suggestions at residents meetings and tell them what we want’. There was evidence that all care staff members received observations of their practice by the senior staff or deputy manager and had a short discussion about it. This was good practice as part of supervision but more formal 1-1 discussions need to take place at least six times a year to cover the requirements of standard 36 and to ensure staff are monitored in their work. Staff supervision needs to cover all aspects of practice, the philosophy of care in the home and career development needs. There were policies and procedures on handling service users’ finances. Relatives or people themselves managed finances although the home managed White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 24 a small amount of personal allowance for nine people. This was usually for small purchases, hairdressing and chiropody. People can have lockable facilities in their bedrooms to store items should they choose to. Records for money held in safekeeping within the home were maintained, though these were not inspected. Generally the home was a safe place for people to live in and staff to work in. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarm tests completed. Staff had policies and procedures to guide their practice and completed health and safety, moving and handling, fire and first aid training. Safety posters were on display in the home. We noticed that on the first floor there was a door to some steep steps leading down to the ground floor. The door was not locked, as it was a door leading to a fire exit. The manager needs to check with the health and safety officer what can be done to make this safer. The manager needs to look at accidents more closely and check out why they have occurred and how they can be prevented in the future. For example we noticed in the accident book that four people had spilt hot drinks over themselves. Two people had hospital beds with fixed bed rails and protectors in place to prevent them from rolling out of bed. Basic bed rail risk assessments had been completed. These need to be much more thorough and be in line with up to date health and safety guidance so the manager assesses the ongoing need for them. A check of the bed rails needs to be built into regular maintenance checks. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 Requirement Timescale for action 30/11/07 2 OP3 14(1)(d) 3 OP7 15 4 OP7 15 The registered person must ensure a comprehensive needs assessment is completed for all service users and copies of care management assessments and care plans are obtained for people funded by them prior to admission. This will ensure the home has full information in order to make a decision about their capacity to meet the identified needs. The registered person must 30/11/07 ensure that the home formally writes to service users or their representative following assessment stating their capacity to meet the identified needs. The registered person must 31/12/07 ensure that care plans are individualised to fully reflect the persons needs, contain up to date information and have clear tasks for staff. This will avoid confusion and the risk of needs not being fully met. The registered person must 30/11/07 ensure that care plans are evaluated and updated DS0000067033.V352792.R01.S.doc Version 5.2 White House Residential Home (The) Page 27 5 OP8 12(1)(a) 6 OP8 13(4) 7 OP9 13(2) 8 OP18 13(6) 9 OP30 18 10 OP33 24 effectively taking into consideration information documented in other parts of the care file. The registered person must ensure service users have their weight monitored. Care Plans must set out how frequently this must happen. Sit on scales must be provided for service users who are unable to weight bear or alternative arrangements must be in place for these service users. The registered person must ensure that risk assessments are completed when a risk is identified with clear steps on how the risk is to be managed. These must be evaluated regularly or when needs change. The registered person must ensure that all medication is stored securely, is stored at the correct temperature, has the date recorded of opening on time limited medication and topical products are recorded when applied. The registered person must ensure those remaining staff that have not had safeguarding adults training receive it to ensure all staff including ancillary staff are equipped with the knowledge required to protect people. The registered person must ensure that a training plan is produced based on information gathered during staff supervision and appraisals. Training logs to be audited to capture any shortfalls in mandatory training. Shortfalls to be included in the training plan. The registered person must ensure the continued DS0000067033.V352792.R01.S.doc 31/12/07 30/11/07 30/11/07 31/12/07 31/12/07 31/12/07 Page 28 White House Residential Home (The) Version 5.2 11 OP36 26 12 OP36 18 (2) development of the quality assurance system so that results of ongoing consultation are checked, any problems identified and plans of how they are to be resolved produced. The registered person must complete at least monthly, unannounced visits to the home in line with their supervisory responsibilities under regulation 26 of the Care Homes Regulations. They must speak to people living and working at the home, inspect the premises, and examine records of events and any complaints to gain an opinion of the standard of care provided. The registered person must ensure that care staff are supervised appropriately in line with national minimum standards i.e. formal and documented 1-1 supervision discussions covers all aspects of practice, philosophy of care in the home and career development needs. 30/11/07 31/12/07 13 OP37 26 14 OP38 13(4) All care staff to have one supervision session covering these points by timescale for action date. The registered person must 30/11/07 prepare a report of visits to the home required under regulation 26 of the Care Homes Regulations. The reports must be held on file and available for inspection. The reports for visits in November and December 2007 to be forwarded to CSCI. The registered person must 30/11/07 ensure: More comprehensive risk assessments for the use of bed White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 29 rails are completed reflecting up to date health and safety guidance. Accidents are audited to check for patterns and ways to minimise them. Health and safety advice is sought regarding access to a steep set of stairs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP28 OP31 Good Practice Recommendations Information regarding the changes to anti-coagulant dosage should be in writing and maintained with the medication administration record. The home should continue to work towards 50 of care staff trained to NVQ level 2 and 3. The manager should continue to work towards completion of the Registered Managers Award. White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 White House Residential Home (The) DS0000067033.V352792.R01.S.doc Version 5.2 Page 31 - 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. 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