Inspection on 17/07/07 for White Rose House

This inspection was carried out on 17th July 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 Rose House 14/07/06

White Rose House 14/09/05

White Rose House 11/05/05

White Rose House 22/11/04

Similar services:

Snydale Care Home

Abbey The

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 Rose House 165 Huddersfield Road Thongsbridge Huddersfield HD9 3TQ Lead Inspector Tracey South Key Unannounced Inspection 17th July 2007 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address White Rose House DS0000044462.V339395.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 Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Rose House Address 165 Huddersfield Road Thongsbridge Huddersfield HD9 3TQ 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) 01484 690100 01484 690101 whiterosehouse@meridiancare.co.uk Meridian Care Limited Mrs Joanne Hempstock Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That Mrs Joanne Hempstock obtains NVQ Level 4 in Care by May 2006 Date of last inspection 14th July 2006 Brief Description of the Service: White Rose House Nursing and Care Centre is a new, purpose built care home owned by Meridian Care Limited. The home is located behind the Holme Valley Hospital in Holmfirth and is built into the hillside. There are 60 single en-suite rooms for older people requiring nursing and personal care. Bedrooms are located on two floors, which are serviced by a passenger lift. People living in the home requiring personal care are accommodated on the ground floor and part of the first floor, while people requiring nursing care are accommodated on the second floor. Communal lounges and dining areas are also provided on each floor. The lower ground floor area provides service facilities, kitchen, laundry, staff areas and storage. The home is located just off the main Huddersfield road, along which public transport travels. There is a relatively short walk up a steep hill to the home. There is ample car parking at the home and a garden and patio area to the side of the home. The manager informed the Commission for Social Care Inspection on 17/07/07 that fees range from £358.80 to £650.00 per week. Additional charges include hairdressing, private chiropody, newspapers, toiletries, sweets, clothing and some selected activities/ hobbies materials. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit carried out to the home by an inspector on the 17th July 2007. The visit commenced at 09.40am and the inspector left the home at 5.40pm. During this visit the inspector spoke to some of the people living in the home, some of the staff and the home’s manager. The inspector read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a brief tour of the home and observed staff caring for people and serving lunches. The staff at the home also provided information that was requested by CSCI (Commission for Social Care Inspection) about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit surveys were sent out to obtain the views of people who live at the home, their relatives and people’s doctors. Twenty-one surveys were sent out to people living at the home, seven were returned. Some people received support from their relative/friend in completing the survey. Twenty-one surveys were sent out to relatives, fifteen were returned. Three surveys were also sent to the people’s doctors – one was returned. The inspector would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: The atmosphere at the home is warm and friendly and staff and people living at the home interact well with each other. People said the staff are “very friendly and helpful.” Relatives were asked as part of the survey they completed, what does the home do well, comments received include; “Those who enjoy their food are well catered for.” “Provides a high standard of basic care in an excellent environment.” “My mother is treated with privacy and dignity, which is excellent.” “As far as I am concerned Mum is very well looked after in all aspects of her care”. The care home is very clean and attractive”. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 6 People who want to move into the home have their needs properly assessed to ensure that White Rose House is the right place for them, in that their needs can be met. One relative wrote, “My father does not like to join in with other residents. This has been dealt with in a sympathetic way, i.e., meals in his room”. Another relative wrote, “I like the fact that residents can spend the day in their own room, in private, if they want, and many do.” There are a wide variety of activities available at the home. People living at the home said the activities person tries hard to involve everyone in doing some sort of activity. People said they enjoy the meals on offer and there is plenty of variety. White Rose House is still a relatively new building (it opened in 2004) that provides a homely environment for people to live in. The standard of décor remains good - planned redecoration programmes demonstrate the company’s commitment in maintaining high standards. All new staff receive induction training which helps them have a better understanding of how to care for vulnerable people. This training takes place within their first twelve weeks of starting work at the home. The home encourages people to make comments and suggestions about how things can be improved. The findings of quality audits are made available to all interested parties. What has improved since the last inspection? What they could do better: The home and the company should act on the views of those relatives who feel that communication between staff and relatives is not always good. One relative wrote, “A request to one member of staff is often passed on to a White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 7 second or third member. This is not satisfactory”. Another relative wrote, “Poor follow up regarding prescribed medication. Lack of awareness as to whether doctor has been or not.” Other comments received by people living at the home and their relatives that should also be considered by the home include, “Not pro-active in encouraging Father to come out of room (needs wheelchair) only seem to do anything when I have suggested they do – then a one off instead of trying next day.” “Residents seem to be sat around with no staff in the lounge. Staff always seem too busy to sit and chat to the residents.” “Shortage of drinking water. Residents seem short of drinks. Water can only be fetched from bath/shower room.” The nursing staff should ensure that people living on the nursing unit have their social care needs highlighted as part of the care planning process. This will ensure that they receive the right level of support to enable them to take part in social events, hobbies and interests even if this is as simple as listening to the radio or watching their favourite television programme. 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 Rose House DS0000044462.V339395.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 Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are properly assessed prior to moving into the home to ensure that their needs can be met. EVIDENCE: Surveys received from people who live at the home indicate that they received enough information about the home prior to them moving in. One person wrote, “I made a brief visit but did not have a meal”. The manager explained that people’s needs are assessed prior to them being offered a place at the home. The purpose of the assessment is to make sure that the home will be able to meet the person’s needs. Community Care Assessments were seen in place in respect of those people who are funded by the local authority and/or the health authority. The manager and nursing staff undertake pre-admission assessments in respect of those people who are self funding. The manager was reminded to White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 10 ensure that the documentation used when assessing people includes their name and it should be signed and dated by the person completing the form. Surveys completed by relatives indicate there are a number of people at the home who have dementia despite the home not being registered to admit people with this type of illness. The manager explained that people are not admitted to the home when their primary care need is that of dementia but she acknowledged there are some people who’s mental health has deteriorated in the period of time they have been living at the home. The manager went on to explain that peoples’ care needs are kept under regular review and there have been occasions when peoples’ needs can no longer be met and as a result, they have been reassessed as needing more specialist care. White Rose House DS0000044462.V339395.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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ care plans are detailed and outline the level of support and care each person requires in ensuring their health and welfare needs will be met. Medication systems are well managed and peoples’ rights to privacy and dignity is acknowledged by caring staff. EVIDENCE: Surveys asked people living at the home if they receive the care and support they need. Four people responded “always”, three responded “usually”. Those people who spoke with the inspector during this visit gave positive feedback about their life at White Rose House. They said they were happy living at the home and that the staff were kind and helpful. Relatives’ surveys asked if the care home meets the needs of their friend/relative. Six relatives responded “always” and comments made included, “This is a trauma for my father to lose his independence. In my White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 12 opinion staff treat my father as an individual and with respect”. Three relatives responded “usually” and comments made include, “Basic needs are catered for, the home is kept very clean but I do feel it lacks that extra care and stimulation…..” “Residents seem to be sat around with no staff in the lounge. Staff always seem too busy to sit and chat to the residents”. Four peoples’ care documentation was examined in detail; two people live on the nursing unit and two on the residential. Three of those people moved into the home within the last few months; the fourth person has lived at the home for almost two years. Each person has a care plan in place that describes their individual needs including the support they need from staff. People who receive nursing care did not have any social care needs identified within their care plan where as those who live on the residential unit did. The manager was asked to address this as people who receive nursing care should have their social care needs met. There was evidence that care plans are reviewed on a monthly basis and amendments are made to the plan, as individual’s needs change. The manager was advised of one person’s plan which had not been updated to reflect recent weight loss and that the person was being weighed on a more regular basis. The manager said she would make sure it is amended. Risk assessments have been carried out to identify any risks to the individual. Where a risk has been identified a care plan is produced to minimise the risk. Manual handling plans used to identify the support people require with their mobility, do not describe in detail the exact assistance people need. Only brief details such as ‘two staff required’ is recorded. To enable staff to support each individual with their mobility, clear instructions, as to the level of support and assistance/equipment required needs to be recorded. People living in the home said that they have access to other health care professionals such as doctors, chiropodist, and opticians. Care records also record visits and support given by other health care professionals. Surveys from people living at the home indicate that the majority feel they receive the medical support they require, although one person wrote, “last medical request took four weeks to change medication”. Surveys received from peoples’ doctors indicate good communication links between the home and the doctor’s surgery. The surveys confirmed that doctors are able to see their patients in private and that there is always a senior member of staff to confer with. A sample of three peoples’ medications was checked during the visit. This showed there to be good systems in place for the recording, storing, administration and disposal of medications. The medication record sheets were neat, tidy and easy to follow. Only senior staff who have received training are authorised to administer medication. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 13 Observations throughout the day confirmed that staff are polite and courteous with people living at the home, their relatives and any other visitors to the home. White Rose House DS0000044462.V339395.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. People living at the home are offered a range of activities and are able to make their own choices about how they spend their time. Meals provided are generally good, varied and served in a pleasant environment. EVIDENCE: Surveys sent to the home asked people if there are activities arranged by the home that they can take part in. Two responded ‘always’, one said “I don’t know” and one person responded ‘never’. People also wrote, “There are activities arranged but my husband is not able to take part in them because of his condition”. “Activities for my mother are now more limited as her hearing and sight are both very poor”. “I don’t want to mix with other residents”. “Activities are arranged every weekday and special social events have been well received”. Those people who spoke with the inspector said they have control over their lives in respect of the choices they are able to make about how they spend their time, when they rise and go to bed and whether or not they join in White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 15 activities etc. People explained how there are a number of activities to join if you wish to. One lady said she enjoys taking part in the quizzes. Another lady said the activities co-ordinator works very hard in encouraging people to join in with activities. Documentation in place records a number of different activities due to take place within July 2007. The manager explained that the home receives a number of visitors on a daily basis and the visitors’ book confirmed this. She also spoke of the good relationship the home has with relatives and friends of people living at White Rose House and how supportive they are in terms of their involvement with the home. Relative surveys asked if the care home helps their relative or friend keep in touch with them. Four responded, ‘always’, four said, ‘usually’, one said ‘sometimes’ whilst two relatives felt they ‘never’ do. Comments received include, “My father has been at White Rose House for just over three weeks, there have been several occasions where information about Dad needs to be passed on and the staff have been very efficient as my Dad is very forgetful.” “Help not needed, has own telephone and regular visits from family.” Surveys also asked relatives if they are kept up to date with important issues affecting their relative/friend. Eight responded ‘always’, five said ‘usually’ and two responded ‘sometimes’. Comments include, “I am made aware of any incident involving my Dad.” “If sickness is affecting the home I have been informed. However, I have been shocked when visiting to see bruises – the result of a fall, on further investigation it had been entered in the accident book but I would have expected to have been informed”. There is mixed views about the quality of food at the home in the surveys received from both people living at the home and their relatives. Some people said there is a good choice and variety of foods whilst others said, “the food chain is poor” and “meals often cold”. Staff were observed serving lunches on both the ground and first floor accommodation. Meals are transported from the main kitchen in the basement of the home by heated food cabinets. Staff were on hand to serve lunches as soon as it arrived. The meals on offer were steak pie and chips or ham salad. The meal looked and smelt appetising and everyone spoken with said they enjoyed their meals. One visiting relative who was assisting her relative with their meal said the meals are generally good and she could only think of one occasion when the meal was poor. The majority of people take their meals in the main dining areas although there are some who prefer to have their meals in their own room. Staff offer assistance to people according to their individual needs. One member of staff was seen feeding two people at the same time. This is not appropriate and the manager was advised of this at the time of the visit. She confirmed that she would speak to the person involved to ensure such practice is not repeated. White Rose House DS0000044462.V339395.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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are protected from abuse and they can be confident that their complaints will be listened to and acted upon. EVIDENCE: Responses received from people living at the home indicate that they know how to make a complaint and who to speak to when they are not happy about something. People spoken with on the day of the visit told the inspector if they weren’t happy about something they would speak to the person in charge. One person said when she has spoken to staff about things she is unhappy with, they make every effort to put things right. The complaints procedure is displayed in the front entrance of the home as well as in peoples’ own rooms. It is also available in the home’s statement of purpose. The manager keeps a log of any complaints received and there was good evidence that peoples’ concerns had been taken seriously and the appropriate action had been taken to resolve the matter wherever possible. Twelve of the fourteen surveys returned by relatives indicate they know how to make a complaint. The manager explained how she welcomes peoples’ views about the home and invites them to comment on how things can be improved. A suggestion box has recently been introduced to assist people with this. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 17 In order to ensure that people are properly protected against the risk of abuse and neglect all staff must be suitably trained so they are able to identify and report poor practice including abuse. The manager explained that apart from recently appointed staff everyone working in the home has received training about protecting vulnerable people in care. A date has been arranged for all new staff to take part in this training on 2nd August 2007. White Rose House DS0000044462.V339395.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 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 offers people a homely, comfortable and clean environment. EVIDENCE: Surveys asked people living at the home if it is clean and fresh. Six responded ‘always’ and one responded ‘usually’. Comments received from relatives include “Modern building with few stairs, bright and warm. Well designed generally”. “The care home is very clean and attractive.” “The laundry service is excellent…..” “The home has been recently decorated throughout and is clean throughout”. A tour of the home was carried out which included a small number of bedrooms, communal areas and the basement. The standard of cleanliness in the home is good and there were no unpleasant odours noted in any part of White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 19 the home. Peoples’ bedrooms are personalised with the occupant’s own belongings and memorabilia. A comment was made in a relative’s survey that indicated the smoking room is also used as an activities room. Recently imposed legislation regarding smoking in public places prohibits this and the manager was advised to make alternative arrangements for activities to take place in another room. The manager explained that a number of bedrooms have recently been redecorated and plans to redecorate communal areas are in place this demonstrates that the organisation is keen to maintain a good standard of décor throughout the home. The laundry is sited in the basement of the home. Designated laundry staff are employed and the inspector spoke to two staff who explained their role. At least once a week they double up on the same shift – this enables them to keep the laundry up to date and clear any backlog. Comments received from relatives about the laundry were mixed as some felt it was an excellent service others said clothes go missing despite them being labelled. The staff explained that they try their best to return clothes to the right person and this is made easier when clothes are labelled. The staff said they can recognise most peoples’ clothing but there are occasions when some items are returned to the wrong person. White Rose House DS0000044462.V339395.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. People’s needs are met by trained staff who have undergone a thorough recruitment process before they are allowed to work in the home. EVIDENCE: Comments from relatives about whether they feel the care staff have the right skills and experience to look after people properly include, “The staff are always cheerful and polite.” “Some of the carers do not demonstrate an adequate grasp of the English language to deal with the needs of aged vulnerable residents.” “During my visits all staff seem to be very competent” “Seems a large number of staff – not much in personal contact.” “Senior carers good and helpful.” The manager explained that staff are deployed over the two floors of accommodation. The nursing unit is staff by one nurse and four carers on a morning and 1 nurse and three carers on the afternoon. The residential unit has six care staff on a morning and five on an afternoon. Nights are covered by one nurse and four staff between the two floors. Care staff are supported by domestic and kitchen staff. The home also employs a handyperson, an activities co-ordinator and an administrator. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 21 People living at the home said the staff were kind and helpful towards them. A visiting relative said that staff interact well with people living at the home and demonstrate a caring attitude when helping people. Staff explained that they do try and make time to chat with people in and amongst their duties. There is currently 64 of the care staff who have NVQ (National Vocational Qualification) level 2 in care. All remaining staff are registered and working towards achieving an NVQ. The majority of ancillary staff have also completed an NVQ. The recruitment files of five members of staff were audited in detail and found to contain the required information and recruitment checks. These checks are necessary to help protect people from potentially unsuitable staff. The manager explained that all new staff receive induction and mandatory training. Induction training takes place within the first twelve weeks of appointment and mandatory training such as movement and handling, food safety and fire safety within the first few weeks of starting work at the home. Staff confirmed that there are good training opportunities for them to take part in and there was good evidence of training certificates in staff files. White Rose House DS0000044462.V339395.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 and 38 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 is well managed and the health, safety and welfare of people living at the home and staff is promoted and protected. EVIDENCE: Ms Joanne Hempstock is the registered manager at White Rose House and has achieved a Registered Manager’s Award. It was anticipated that she would have achieved an NVQ level 4 in care qualification, but having only recently returned from maternity leave in May 2007, completion of this qualification has been put back. Ms Hempstock is confident she will complete it within the next five months. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 23 Staff gave positive feedback about the manager saying she is approachable and supportive. It was clear when reading minutes taken at staff meetings that Ms Hempstock is keen to promote positive working and effective communication systems in the home based on better outcomes for people living there. The company provides quality assurance by carrying out customer surveys on an annual basis. The manager explained that staff promote the use of feedback cards, care reviews and welcome suggestions. The results of the most recent quality audit are available in the home. Meetings take place specifically for those people who live at the home. Such a meeting took place in June this year when people at the home met with the chef to discuss menus. Menus were revised as a result of this meeting. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Three peoples’ finances were checked during the visit and were found to be correct. There is evidence of routine maintenance and servicing of equipment in the home. The home carries out weekly fire safety checks and these are recorded. It was noted that the main kitchen door was wedged open, as the Dorguard was not working properly. The Manager explained that a request has been made for a swing free door to be fitted. The manager was asked to follow this up promptly. White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 White Rose House DS0000044462.V339395.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Pre-admission assessments completed by staff at the home should be signed and dated by the person completing it. It should also include the name of the person being assessed. All people, whether they live on the residential unit or the nursing unit, should have their social care needs addressed as part of the care planning process to ensure they receive the right level of support in respect of their interests and preferences. Care plans should be amended at any such point, as people’s needs change. Manual handling plans should describe, in detail, the exact level of support the individual requires in terms of their mobility. The manager should continue to work toward completing the NVQ level 4 in care. DS0000044462.V339395.R01.S.doc Version 5.2 Page 26 2. OP7 3. 3. OP8 OP31 White Rose House Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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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