CARE HOMES FOR OLDER PEOPLE
Whitecliffe House 30-40 Whitecliffe Mill Street Blandford Dorset DT11 7BQ Lead Inspector
Amanda Porter Key Unannounced Inspection 10:45 1st February 2007 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 DS0000020446.V328515.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. DS0000020446.V328515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Whitecliffe House Address 30-40 Whitecliffe Mill Street Blandford Dorset DT11 7BQ 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) 01258 450011 01258 488905 whitecliffehouse@coltencare.co.uk www.coltencare.co.uk Colten Care Limited Mrs Julie Schooling Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places DS0000020446.V328515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 19 service users who require nursing care. Mrs Schooling must obtain an NVQ 4 in management by 01/09/07. Mrs Schooling must complete a course in adult protection issues within six months and provide evidence of completion to the CSCI. 7th March 2006 Date of last inspection Brief Description of the Service: Whitecliffe House is situated centrally to all major routes into Blandford and is a five-minute walk to the town centre. Adjacent to the home is a Doctors surgery. The home is registered to provide both personal and nursing care to older people, nineteen places are available for people requiring nursing care and the remaining twelve for those with personal care needs. Whitecliffe House is an older style building, which has been extended and adapted to provide a full range of accommodation and ample communal space. There is a passenger lift to all three floors making access possible for all service users. All rooms have en suite facilities. There is a communal lounge, dining room and shared garden area with seating. Visitors are always welcome and offered generous hospitality and there is a high standard of hotel style catering and domestic services. Limited parking is available at the front of the home or on the street. Colten Care Limited owns the home, a company who have a number of care homes in Dorset and adjoining counties, and is managed on a day to basis by the Registered Manager, Mrs Julie Schooling. Colten Care Limited aims to provide residents with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. At the time of the inspection the weekly fees range from £680 to £780. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_peop le_choos.aspx DS0000020446.V328515.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 1st February 2006 and took approximately four hours. The purpose of the inspection was to assess all of the key standards. The Registered Manager, Mrs Schooling, and her staff were on hand to aid the inspection process and were very helpful throughout. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • 8 comment cards completed by residents and 1 by a GP. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Four residents, one visitor and four members of staff were spoken with and asked their views on the service provided at Whitecliffe House. Comments received in comment cards and through discussion included: “On the whole my relative is very happy and all do their best to make his life as comfortable as possible.” “The home is clean and well run.” “The staff always make me feel welcome.” “Excellent care.” “It’s a good place to work and residents are well looked after.” What the service does well:
The home provides a comfortable environment in which to live. Residents are supported with daily living by competent and caring staff. Residents say that staff are very kind and considerate and their privacy and dignity is respected at all times. Residents’ health needs are well met by the home and community health professionals. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise choice and control over their lives as far as possible. DS0000020446.V328515.R01.S.doc Version 5.2 Page 6 Meals are wholesome, nutritious and planned around the likes and dislikes of residents. The complaints procedure can reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. Whitecliffe House is well maintained and the standard of the environment is good providing residents with an attractive and comfortable place to live. The home is clean and free from any unpleasant odours. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. This service has an ongoing training programme for staff, which means that residents will be cared for by a number of well-trained staff. The management style within the home is good, with the manager demonstrating an approachable and professional manner and forging robust multi disciplinary relationships to ensure good quality of care for the residents. What has improved since the last inspection?
The home carries out thorough assessments prior to residents moving in and this includes finding out about social interests, hobbies as well as health and personal needs. Details are included about who was involved in the assessment and where it was held. Assurances are given that individual needs can be met. Since the last inspection the medication administration charts have been reviewed and now include information about any known allergies the resident may have. The home has introduced the role of “Social Carer”, which means that residents who are unable to attend the group activities have the opportunity of one-to-one time with a member of staff. A thorough quality assurance audit has taken place at Whitecliffe House, which helps to ensure the home is run in the best interests of the residents. However residents would be more aware of this if they were able to access an annual development plan for the home.
DS0000020446.V328515.R01.S.doc Version 5.2 Page 7 Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Whitecliffe House. 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. DS0000020446.V328515.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 DS0000020446.V328515.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. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: The care documentation for two residents was reviewed. Both files contained a pre-admission assessment. Since the last inspection the paperwork used for the pre-admission assessment has improved and now documents that a full and informative assessment had taken place. Sufficient information was gained so that a care plan could be drawn up for staff to follow, to ensure that the resident’s care needs could be met appropriately. The Registered Manager wrote to each prospective resident giving assurance that their needs could be met. DS0000020446.V328515.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 good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place to make sure that staff have most of the information they need to meet residents needs. However to ensure that accurate information is passed to staff these plans must be updated as changes occur. The health needs of the residents are well met with evidence of good support from community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. DS0000020446.V328515.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care documentation for two residents was reviewed. Files contained a variety of assessments including: • Moving and handling • Nutrition • Activities of daily living • Risk of falls • Environmental risks • The risk of pressure sores. Information from the assessments was used to formulate plans of care. Most of the care plans clearly set out individual care needs and how they are to be met. However some care plans did not reflect the changing needs of the resident and were not up to date. Care plans were reviewed regularly but residents and/or their chosen representative were not included in the review. Residents spoken with were happy with the care they received. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, clinical nurse specialists, chiropodists, opticians and dentists. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. However there was no clear audit trail to identify how much medication was held by the home. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Comments received from residents and their relatives/visitors confirmed that staff treated them with respect and were supportive and kind. “The staff to a very good job.” “Staff are very kind and caring.” DS0000020446.V328515.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a wide range of activities and events for residents and satisfies their social, religious and recreational needs. Residents are also encouraged to maintain contact with family and friends and the wider community. Residents are able to exercise choice over their lifestyle, whilst living in the home ensuring that their individual preferences and routines are respected. Whitecliffe House serves a balanced and varied selection of food that meets residents’ tastes, choices and special dietary needs within pleasant surroundings. EVIDENCE: The home employs an activities organiser. Organised activities included: • Music therapy • Shopping • Minibus outings
DS0000020446.V328515.R01.S.doc Version 5.2 Page 13 • • • Outside entertainers Word Games Church meetings. It was clear through discussion with residents and from comments received that some of them preferred to arrange their own social activities, which they were free to do and they could spend their days as they wished. The home has introduced the role of “Social Carer”, which means that residents who are unable to attend the group activities have the opportunity of one-to-one time with a member of staff. Residents and staff confirmed this was working well and was much enjoyed by residents. Relatives confirmed that they were made very welcome at Whitecliffe House and residents said that they could receive their visitors in private. The menu provided choice and the chef was aware of residents’ likes and dislikes. Residents confirmed they could take their meals where they wished and some preferred to eat in their rooms and some preferred to go to the dining room. The Registered Manager had recently completed a food satisfaction survey with residents to highlight any shortfalls in the catering service. Generally most people were very satisfied but where alterations or adjustments were required action has been taken. DS0000020446.V328515.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 good. This judgement has been made using available evidence including a visit to this service. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: The home has a clear complaints procedure available to everyone. The registered manager has investigated three complaints in the last year, two were substantiated and one was partially substantiated. Residents spoken with during the inspection said that if they had any concerns they would feel confident about talking to the manager, knowing that she would listen to them. Whitecliffe House has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Staff had received training on abuse. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. DS0000020446.V328515.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 standard of the environment within Whitecliffe House is good providing residents with an attractive, homely and safe place to live. The home is kept clean and smells pleasant thereby making daily life for all in the home more pleasurable. EVIDENCE: The home has a programme of routine maintenance and the home provides an extremely comfortable environment in which to live. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation.
DS0000020446.V328515.R01.S.doc Version 5.2 Page 16 • • Lift. Hoists. A call bell system is available in every room. All areas of the home were clean and there were no unpleasant odours. The laundry was well managed and adequate supplies of clean linen were seen to be available. DS0000020446.V328515.R01.S.doc Version 5.2 Page 17 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to meet the care needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are generally well trained and experienced and residents could be confident they would be well looked after. However residents would benefit from more staff having NVQ level 2 in care award. EVIDENCE: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at all times. During the inspection call bells were answered promptly and residents commented that staff were on hand when they needed them. The home has an ongoing training programme, which includes NVQ level 2 in care. The registered manager confirmed that at the time of inspection less than 50 of care staff held this award. DS0000020446.V328515.R01.S.doc Version 5.2 Page 18 Three staff recruitment files were reviewed and they contained: • Completed application forms • Two written references • Enhanced CRB checks • Terms and conditions of employments • Documentary evidence of any relevant qualifications • Proof of identity, including a photograph • A record of the interview Training files demonstrated that healthcare assistants were receiving induction training and this was confirmed with staff spoken with during the inspection. They also said they enjoyed the training available and were encouraged by the management team to take up training opportunities. Recent training included: • Common induction training • Moving and handling • Fire safety • Health and safety • Use of syringe driver • Palliative care • Elder abuse awareness • Pain control. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk DS0000020446.V328515.R01.S.doc Version 5.2 Page 19 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents and relatives. Residents are assured of sound management of their financial interests. An appropriate supervision system is in place but not all staff receive regular sessions. Therefore individual’s training needs and practice may not be thoroughly assessed. DS0000020446.V328515.R01.S.doc Version 5.2 Page 20 The health and safety of the service users and staff are protected by the policies and procedures followed at Whitecliffe House. EVIDENCE: The registered manager is an experienced registered nurse and is in the process of completing the NVQ level 4 in management. Staff confirmed that there is a good level of communication within the home and everybody’s views are important. Staff meetings are held regularly and minutes are recorded. Colten Care has employed an external agency to carry out a thorough quality assurance audit within the home. This has included the views of those using the service. At the time of inspection an annual development plan for Whitecliffe House had not been produced but the registered manager confirmed that she and the senior management team for Colten Care were working towards this. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold ‘pocket money’ for some residents at their request. All monetary transactions were recorded and were seen to be up to date and accurate. The Registered Manager confirmed that management and clinical supervision takes place but not all staff have formal supervision six times a year as yet. Records showed that all staff had received recent training in fire safety and manual handling. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and appropriate action was taken as necessary. DS0000020446.V328515.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 DS0000020446.V328515.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP36 Regulation 18(2) Requirement The registered person must ensure that persons working at the care home are appropriately supervised. (This must be done at least six times a year and records must be kept.) This requirement was first made on 07/03/06. Timescale for action 01/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP28 OP33 Good Practice Recommendations Every care plan should give up to date information to the reader about how the needs of the resident should be met. There should be a clear audit trail for all medications coming into and leaving the home. The home should continue to work towards at least 50 of staff achieving a minimum of an NVQ 2 award. The home should provide a copy of the provider’s annual development plan to improve the home’s quality assurance procedure. DS0000020446.V328515.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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