CARE HOMES FOR OLDER PEOPLE
Whiteacres Residential Care Home 40 Whitehill Road Ellistown Leicestershire LE67 1EL Lead Inspector
Keith Williamson Unannounced Inspection 9th January 2008 09:20 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 Whiteacres Residential Care Home DS0000068031.V356900.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. Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Whiteacres Residential Care Home Address 40 Whitehill Road Ellistown Leicestershire LE67 1EL 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) 01530 260415 01530 260415 genesishomes2003@yahoo.co.uk Genesis Homes (Essex) Ltd Mrs Melanie Partridge Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (18), Old age, not falling within any other category (18), Physical disability over 65 years of age (9) Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. No one in the category PD(E) may be admitted into Whiteacres Residential Care Home when there are already 9 persons of category PD(E) accommodated in the home. No one in the category OP may be admitted into Whiteacres Residential Care Home when there are already 18 persons of category OP already accommodated in this home. No one in the category DE(E) may be admitted into Whiteacres Residential Care Home when there are already 18 persons of category DE(E) already accommodated in this home. No one in the category MD(E) may be admitted into Whiteacres Residential Care Home when there are already 18 persons of category MD(E) already accommodated within this home. No person to be admitted to Whiteacres Residential Care Home in the categories OP, PD(E), DE(E), or MD(E) when18 persons in total of these categories/combined categories are already accommodated in this home. 29th October 2007 Date of last inspection Brief Description of the Service: Whiteacres is a home situated on the main road in Ellistown, a village in the North of the County of Leicestershire. The home can accommodate upto 18 people, and is registered to admit residents within the Dementia (DE) Mental Disorder (MD), Old age (OP), Physical Disability (PD) groups. The home has 18 single bedrooms some having en-suite facilities. A number of bedrooms are under the current regulation size, though this has been recognised appropriately with information contained in the Statement of Purpose. Resident accommodation comprises of 2 lounge areas and a dining room, bedrooms are split between both floors in the home and a passenger lift services both floors of the home. The home is situated on a bus route to Leicester and Coalville, and is closely situated to shops and green areas. The weekly fees range from £319 to £379 per week - this information was provided on the day of the visit. There are additional costs for expenditure such as hairdressing, private chiropody, toiletries, newspapers, and the social fund that pays for outings, outside entertainments etc. A copy of the latest Commission for Social Care Inspection, inspection report is available from the home. Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes.
The focus of the inspections is on outcomes for residents and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting a sample number of Residents and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation, in this case three residents were chosen. This inspection took place over one day, commencing at 9.20am and took four hours to complete. An opportunity was taken to look around the home, view records, policies and care plans and to talk to residents and staff. Information was gathered prior to the site visit from sources such as residents and their relatives. Further information was obtained from the Annual Quality Assurance Assessment (AQAA), which gives information on the home, and is filled in by the registered manager. Eight of the residents were seen and two spoken with during the visit. The inspector spent two hours observing the care of five residents. The period of observation was carried out between 9:40 pm to 11:40 pm. within one of the communal lounges. What the service does well:
Care plans are good, include medical, dental and chiropody information, and are reviewed on a regular basis. Staff talk to the residents with respect, and also respect their privacy and dignity. A visiting nurse commented positively on the staffs’ care of residents’ pressure areas. Meals continue to be produced in line with residents’ preferences and dietary needs. The complaints procedure is widely available in the home, as well as the Statement of Purpose. The wording of the information requires to be clarified to enable all to be able to use it. There has been one complaint recorded since the last visit to the home. This was recorded accurately, and acted on by staff within set timescales. There is an ongoing plan of refurbishment for the home this enables the tracking of the improvements made in the home.
Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 6 The laundry area has been recently refurbished and chemicals were safely stored there and in the home Staff showed an awareness of Control of Substances Hazardous to Health (COSHH) issues. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Whiteacres Residential Care Home DS0000068031.V356900.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 Whiteacres Residential Care Home DS0000068031.V356900.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, 3 & 6 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The information provided to prospective residents to the home, is incomplete and incorrect, resulting in a lack of clear information for people. EVIDENCE: The Statement of Purpose, which sets out the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing, was available for inspection on this occasion. This document has not been updated to include the feedback of the annual quality assurance questionnaires sent to residents’ relatives and supporters. Further clarity needs to be given to the other information contained in the document, as it is misleading. The Resident Guide has also yet to be updated.
Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 9 The home does not provide facilities for intermediate care. Whiteacres Residential Care Home DS0000068031.V356900.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 & 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The administration of medication, health care, care planning and reviewing have all improved greatly. However risk assesments need to be updated to lessen risks for residents and staff. EVIDENCE: Care plans continue to have individual detail of residents’ personal care and past life history. Care plan reviews are completed periodically, and some plans are signed by the resident or relative. Risk assessments were again viewed, these have not been amended and are not detailed enough to be fully understood by staff and state specific risks and how they need to be managed. Moving and handling practices were seen to
Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 11 have improved with three residents being assisted whilst the visit was taking place. Care Plans continue to include medical checks, with evidence of dental and chiropodist visits. A district nurse visited and spoke highly of the staffs’ attention to residents pressure area care. Medication administration records (mar charts) were again viewed, these have improved and all medication had been signed for. Mid term medication audits, are now in place. Bulk medication was looked at; again these were now accurately administered and recorded within the mar charts. There was evidence that the privacy and dignity are still recognised, with two of the residents being hoisted, having their dignity respected, and there clothes placed appropriately. Staff spoke and responded to residents’ requests respectfully and appropriately. Whiteacres Residential Care Home DS0000068031.V356900.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 & 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Activities are poorly planned resulting in a lack of stimulation for a number of residents in the home. EVIDENCE: Some activities are taking place on a small group basis, however these are not planned in advance, and do not lend toward good practice in caring for residents with Dementia. There is a charge over and above the fees, for the Social Fund. This was used in the past to provide specific equipment and entertainment for the residents. Limited evidence could be found of community contact, where residents go out of the home to clubs or groups they knew of, prior to coming into the home. Meals continue to be produced in line with residents’ preferences and dietary needs. There is currently no choice to the main meal served at lunchtime, a second choice item, would enhance the choices presented to residents.
Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 13 Comments received from relatives indicated, “Whiteacres was extremely helpful and provided all needed info to answer all of our questions”. “The staff don’t always listen, sometimes resistance is felt, as though its too much trouble”. “I am always able to participate in activities, which is key to my day”. “The food has always been of good quality and variety”. Whiteacres Residential Care Home DS0000068031.V356900.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 & 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Complaints’ recording has increased, and is now acted on promptly. However the recognition of, and dealing with abusive residents, is poorly recognised resulting in residents being placed in danger in the home. EVIDENCE: The complaints procedure is available in the foyer of the home, as well as the Statement of Purpose. The wording of the information requires to be clarified to enable all to be able to use it. There has been one complaint recorded since the last visit to the home. This was recorded accurately, and acted on by staff, within the timescales set in the homes’ complaints policy and procedure. Whilst looking at the daily records of the residents the inspector became aware of a number of incidents where residents and staff had been abused by another resident. Recording of these incidents was not clear, with information being recorded in different places, so no concise record was available. The current staff group are unsure of the Adult Protection strategies, and have allowed these abuses to continue over a period of months. The need for further Adult Protection training was highlighted at the last visit to the home.
Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The premises are suitable for the stated purpose, being well maintained and offering a good standard of accommodation. EVIDENCE: A number of improvements have been made in the home with carpets being replaced throughout the home; and dining chairs being replaced. There is an ongoing plan of refurbishment for the home this enables the tracking of the improvements made in the home. Staff showed an awareness of Control of Substances Hazardous to Health (COSHH) issues. The laundry area has been recently refurbished and chemicals were safely stored there and in the home.
Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 16 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, 29 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. A lack of consistent planned training and low staffing numbers continues to put residents in danger in the home. EVIDENCE: The staff rota was looked at in depth. There is still a lack of staff, to enable safe caring to take place in the home. At peak times there are two care staff on duty, with a number of residents requiring two staff this, does not protect the remaining residents in the home. All of the present staff group now have the correct (pova)first and Criminal Records Bureau checks in place. Staff training remains poor and does not protect the residents in the home. Some training is planned for later this year, however no firm evidence exists of the training being booked for a particular date, in line with the requirement at the last report. There is no plan for staff training. Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 17 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): 33, 36, 37 & 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Improvements are needed to the information, record keeping and supervision of staff to ensure the safety of residents in the home. EVIDENCE: There has been no change to the quality assurance by the Responsible Individual. There has been no quality assurance information added to the Resident Guide, and none of the questionnaires that have been circulated to residents relatives, been collated or comments fed back to staff. Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 18 Staff supervision has not been undertaken since the registered manager has been off on leave. The current acting manager does not receive regular planned and recorded supervision from the Responsible Individual. Record keeping is poor with daily records not reflecting other records in the home. Issues that require to be reported on to the Commission for Social Care Inspection (under Regulation 37) are not being sent, leaving the residents and staff in a vulnerable position. Safe working practices have improved with the staff being seen using the correct procedures while hoisting residents. Some health and safety checks performed by the staff were also checked. The Control of Substances Hazardous to Health (COSHH) was good, all chemicals being locked away appropriately, with staff showing a good knowledge of the need over safety in this area. The first aid box was also seen; this is checked by the handyperson on a regular basis. Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 19 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 1 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X 1 1 1 Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 (1) b Requirement The Statement of Purpose needs to be clarified, and have the latest outcomes for the quality assurance exercise added. This is to ensure prospective residents and their families have accurate information on which to base a stay. 2 OP7 15(1) 13 (4) (c) Risk assessments must include details of ‘how’ staff observe and support individual residents in relation to mobility and safety. This is to enable all staff to understand and meet resident’s individual needs. 3 OP12 16 (2) m A planned and researched activities programme must be put in place. This is to ensure that staff are aware what activities suit residents cared for in the home. 10/03/08 10/03/08 Timescale for action 10/03/08 Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 21 4 OP18 13 All staff receive refresher Adult Protection Training and are fully aware of this procedure. This is to protect the residents in the home. 19/02/08 5 OP27 18 Staffing levels need to be reviewed and increased to ensure that residents’ needs are met and there is protection of residents from challenging behaviour. The revised rota needs to be sent to the Commission for Social Care Inspection. 19/02/08 6 OP30 18 (1) a A training plan, reflecting the needs of staff must be produced and put in place. This is to ensure that staffs have the right qualities and qualifications to care for residents. 10/03/08 7 OP33 24 Effective quality monitoring systems must be put in place, to ensure the development of the home is continual, and is to the benefit of residents. All staff must be appropriately supervised, and aspects of practice, the philosophy of the home, and career development covered. This would ensure staff employment policies, induction and training were all put into practice in the home. 10/04/08 8 OP36 18 (1) a 19/02/08 9 OP36 26 (1) The Registered Person must visit
DS0000068031.V356900.R01.S.doc 19/02/08
Page 22 Whiteacres Residential Care Home Version 5.2 the home, and keep a written record of such visits. Copies of these must be sent to the inspector. This is to ensure the acting manager is fully supported in the home. 10 OP37 17 Accident reports must correlate to entries in the daily records, and accurately reflect the accidents in the home. This is to ensure that records are completed appropriately for health and safety purposes. 19/02/08 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 OP15 Good Practice Recommendations Giving a choice of main meals would enhance the quality of life experienced by residents in the home. Whiteacres Residential Care Home DS0000068031.V356900.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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
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