Inspection on 20/06/05 for Whitefarm Lodge

This inspection was carried out on 20th June 2005.

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

Whitefarm Lodge 20/09/06

Whitefarm Lodge 15/11/05

Whitefarm Lodge 25/11/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Whitefarm Lodge Vicarage Road Whitton Twickenham Middlesex TW2 7BY Lead Inspector Sandy Patrick Unannounced 20 June 2005 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 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. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Whitefarm Lodge Address Vicarage Road Whitton Twickenham Middlesex TW2 7BY 020 8755 5740 01206 852 248 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care UK Community Partnerships Limited Mr Shane M Cosgrove Care Home 60 Category(ies) of Dementia - over 65 yrs of age (DE(E)) registration, with number Old age (OP) of places Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Dementia Nursing Places: To include no more than 23 service users requiring Dementia Nursing care at any one time. 2. Dementia Places; To include no more that 37 service users in the registration category of Older People with up to 25 requiring Dementia Care at any one time. 3. Dementia Care Nursing Unit 2nd floor: Two qualified 1st level Registered Mental Health Nurses must be available on the nursing unit during the morning shift at all times. These nurses must not have any management responsibilities for the home or within the nursing unit. The Unit Manager for the nursing unit must be supernumerary at all times. 4. The Home can admit one named service user under the age of 65 years. Date of last inspection 25th & 26th November 2004 Brief Description of the Service: White Farm Lodge is a care home with nursing, providing accommodation and personal care for up to sixty service users. The home provides nursing care for up to twenty-three service users who have dementia. The building is owned by the London Borough of Richmond and is leased to Care UK Partnership who manages and run the home. The home is located in Whitton, close to the high street, local shops, churches, pubs and other amenities. The home is newly built and was registered in August 2004. The majority of service users and staff have transferred from two other local Care UK homes, which have now closed. All bedrooms are for single occupancy and have en suite facilities. There is a passenger lift between floors. There are attractive, well-kept grounds. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 20th & 21st June 2005, and was unannounced. The Inspection Team consisted of two Regulation Inspectors and a Pharmacy Inspector. The findings of the Pharmacy Inspector are recorded under Section 2 of this report. The Inspection Team were made welcome by all at the home and met with service users, the Manager and other staff on duty. Interactions between service users and staff were positive and there was a relaxed and friendly atmosphere throughout the home. The Inspection Team were invited to join service users for lunch, which was a pleasant social occasion as well as an enjoyable meal. Fifty-nine service users were living at the home at the time of the inspection. A service user had been assessed for the vacancy at the home and was due to move to the home shortly after the inspection. The home was registered in August 2004 and the majority of service users moved in over the months following this. The Manager reported that service users were now very settled and were happy at the home. Many of the service users moved from other Care UK homes which have since closed. A new home is being built on the site of one of the old homes and service users will be offered the opportunity to move into the new home when it is registered later in 2005. The Manager reported that the placing authority would meet with all service users individually to discuss the choices available to them. The Manager stated that informal feedback indicated that the majority of service users would choose to stay at White farm Lodge. An independent advocacy service is available for all service users. Staff who previously worked at the other homes were also offered the opportunity to transfer to the new home. The Lead Inspector asked the Manager to distribute comment cards to service users, their visitors and health care professionals who worked with the home. Since the inspection twenty-three comment cards have been returned to the Commission for Social Care Inspection. Twenty-one from visitors and relatives of service users and two from health care professionals. All the visitors reported that they were made welcome at the home, that they could visit service users in private and that they were appropriately informed and consulted. Not all visitors were aware of the complaints procedure, however copies of this have been issued to all service users and are available throughout the home on communal notice boards and within the Service User Guide. All visitors stated that they were satisfied with the overall care at the home. Two visitors highlighted minor concerns regarding aspects of their relative’s care. These issues should be taken up directly with the home so that they can be addressed, and one visitor indicated that they would do this. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 6 Many relatives put notes of appreciation and thanks to the Manager and staff within their comments. Other written comments included: ‘We have always been very impressed by the professionalism and care given to our friend, and we are confident that they are in safe hands’. ‘You are always made to feel welcome whatever time of the day. A senior member of staff is always available to speak about any concerns. The activities are such fun and every occasion is celebrated, the most recent was Ladies’ Day at Ascot. We know our relative is in safe hands and is happy to be there.’ ‘More than satisfied with the support we receive from the Manager and team’. ‘I am so impressed and grateful for the loving care given to my relative by the Manager and staff.’ ‘My relative has been at the home for six months and I cannot fault the care.’ ‘I have always found the staff very friendly and helpful.’ ‘I am happy with my relative’s care. The staff are always pleasant and it is very clean.’ ‘My relative has recently moved to White Farm Lodge and I am very impressed with the care, support and professional way they look after her.’ ‘We have total confidence and admiration for the Manager and the staff. They are a credit to Care UK.’ ‘We are very satisfied. We are delighted that we chose White Farm Lodge.’ Both health care professionals reported that the home communicated clearly and worked in partnership with them. Both stated that senior staff were always available, that staff demonstrated a clear understanding of care needs, that specialist advice was incorporated into service user plans and that they were satisfied with the overall care. One comment card was from visiting nurses who attend the home twice weekly. The other card from a GP surgery used by the home stated that there was ‘very good communication between staff, service users and the doctor’, they also wrote that there was ‘excellent individual care provided by staff’. Service users who spoke with the Inspection Team spoke positively about their experiences at the home. Many complimented staff, saying that they were kind and supportive. Service users spoke about activities at the home and reported that they enjoyed these. A number of service users mentioned that they enjoyed ‘Nature Watch’, where a group of them spent time watching and discussing the birds and other wildlife in the garden. Service users said that they had been supported when they moved to the home and that they had Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 7 good support from individual keyworkers. The Inspection Team met with a small number of visitors. Those who spoke with the Inspectors reported that they were happy with care at the home. One visitor said, ‘the home exceeds expectations and the staff do a wonderful job’. Procedures at the home are organised and records are well maintained giving clear and consistent information for service users, their visitors and staff. There are appropriate procedures for consultation, including quality surveys and regular meetings with service users and their relatives. What the service does well: What has improved since the last inspection? The home has met the requirements and good practice recommendations made at the last inspection. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 8 At the last inspection, the Inspector was able to speak to service users about their experiences of moving to the home and how they had found this process. Since this time service users clearly feel more settled and those who spoke to the Inspectors indicated that they now felt at home and were very happy that they had made the move to White Farm Lodge. The systems and procedures have been developed with time and the service now presents as established and smooth running. Since the last inspection improvements to an already well run service have been noted. There are good systems for gaining the views of service users. Service users are able to meet with independent advocates on a regular basis. Surveys and individual meetings with service users have provided information which has been used to further develop services. In January 2005 service users identified particular needs which they felt were not being met. The Manager was able to evidence how changes had been implemented to meet these needs. Changes have been made to the menu to reflect service user’s wishes and four choices are now offered at each mealtime. A multi-faith room has been developed for service users, visitors and staff to use for prayer or personal reflection. The home received an award from the Environmental Health Officer for a high standard of hygiene in the kitchen and staff training. 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. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 9 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 Standards Statutory Requirements Identified During the Inspection Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5 There is a good range of information for service users and their representatives, which supports potential service users to make decisions about whether they wish to live at the home and existing service users information on their own care and key procedures. There are appropriate procedures for the assessment and admission of service users including trail stays. Service users and their representatives are issued with contracts of care which outline the terms and conditions of residency. The home does not provide intermediate care. EVIDENCE: The Registered Person has produced a Welcome Pack, which incorporates the Service User Guide and Statement of Purpose. This includes the required areas and gives a range of information, including the philosophy of care, aims and objectives, information on services and facilities and staffing. All service users are issued with a personalised welcome pack, which includes details of Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 11 their keyworker. Copies of these documents and the home’s complaints procedure are available in bedrooms and communal notice boards. Leaflets and information about the home, activities, advocacy groups and the Charter of Rights were also available throughout communal areas. There have been no changes to the Welcome Pack since the last inspection, apart from where information has been updated. All places at the home are contracted to the London Borough of Richmond. Twenty-three places are for service users with dementia and nursing needs. The nursing unit is appropriately staffed and procedures have been designed to meet the needs of the unit. Assessments of need are appropriately reflected within service user plans. Daily care notes are made and there is evidence of regular reviews. The home works closely with health care professionals who offer support, advice and training. Staff are offered a wide range of training appropriate to their roles. All service users are assigned a keyworker who is responsible for overseeing care provision and is a contact for the service user and families. The Inspectors saw evidence of specialist needs being met. For example one service user has specialist dietary needs. Specialist communication pictorial books are used for a service user whose first language is not English. The Manager reported that staff had worked with this service user’s family to learn some basic phrases in the service user’s language. The Nursing Manager and Team Leaders are responsible for the assessment of potential service users. One Team Leader the Inspector that service users were invited to the home for a day to spend time with other service users, sharing a meal and activities. An assessment of need is conducted at this time. Information from the service user, their representatives and health care professionals is used to give a fuller picture of the care needs of each individual. The Inspectors examined six assessments. These documents were comprehensive and included information on different areas of need. Assessments made by the placing authority were also seen to be in place. The Nursing Manager reported that he visits service users in hospital or at their own home as part of the assessment process. Service users who spoke about moving to the home stated that they were provided with good information and that they felt that staff had taken time to get to know them and their needs. All service users and their representatives have been issued with tenancy agreements outlining the terms and conditions of residency. Signed copies of these agreements are held at the home. These contracts include information on fees, termination of contract, quality assurance, insurance, trail periods and facilities and services. The document is available in large print if required. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 12 All service users are admitted on a six week trail stay. At the end of this period a review meeting is held, where the service user, their representatives, the placing authority and representatives of the home make a decision about whether the service can continue to meet that person’s needs. Evidence of these six week review meetings was seen within service user files examined. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Individual service user plans are in place and incorporate specialist guidance from health care professionals. In the majority of cases risk assessments were in place, however, further risk assessments are required for some service users. Personal and health care needs are recorded within service user plans and are monitored. Service users are able to access external health care services and the staff work in partnership with health care professionals. The nursing unit offers specialist support to service users who have nursing needs and dementia. Specialist training and information for staff helps them to understand and meet these needs. The home has good arrangements for the ordering, storage, recording and auditing of medication and has access to a pharmacist for advice. Errors and omissions in recording and the incorrect administration of one medication along with one medication going missing might put service users at risk. Appropriate procedures are in place for care of the dying and death of a service user. Individual wishes are recorded within service user files, so that the staff have the knowledge and information to work with families and offer the most appropriate support. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 14 EVIDENCE: Individual service user plans are in place for all service users. The Inspection Team examined eight of these from the residential and nursing units. These were well designed and appropriately organised. Information was clear, consistent, accurate and up to date. There was a focus on maintaining independence and offering choice. Service user plans were signed by service users or their representative as a record of their agreement. There was evidence of monthly review and changes in need were appropriately recorded. Service user plans included information on emotional, social, physical and personal needs. The majority also include social histories provided by the service use or their family. Service user plans included a detailed night care plan. Daily care notes were made and accurately reflected information from service user plans. Assessment of risk were seen to be in place, were dated and signed by the service user or their representative. There was evidence of regular review. There was no general or nutritional risk assessment in place for a service user who had moved to the home shortly before the inspection. There was no risk assessment in place regarding the use of adjustable bed rails for one service user. The nursing unit was fully occupied at the time of the inspection. The Nursing Manager was on duty and one of the Inspectors spoke at length with him. He has a Registered Mental Health Nursing Qualification and said he is currently undertaking the Registered Managers Award. The Nursing Manager reported that since joining White Farm Lodge he has also completed training in Moving and Handling, Food Hygiene, Fire Safety and a Cannulation and Venepuncture course. He reported that he was undertaking a First Aid and Emergency Care four day course the week following the inspection. There has been a range of specialist training for staff within the nursing unit, including training in dementia and nursing interventions. All service users are registered with local GPs. One GP holds a weekly surgery at the home. The staff on duty reported that they work closely health care professionals. Service users told the Inspectors that a dentist, optician and chiropodist visited the home. Health care professionals who completed comment cards on the service stated that the staff worked in partnership with them and that their guidance was incorporated into individual service user plans. The Inspectors saw evidence of this and of appropriate consultation with health care professionals. Health care needs are recorded within service user plans and there are systems for monitoring these. Staff on duty demonstrated a good awareness Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 15 of individual needs and these were discussed at the staff handover of information between shifts. The Inspectors saw detailed care plans in place around the areas of continence and nutritional needs. Wound assessments and care plans in relations to these were seen to be in place. The written policies and procedures were found to be adequate on the last inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge of each unit was interviewed, the administration of medication on one unit observed, all medication not supplied in the monitored dosage system was counted and compared to the amount the should be in stock according to the records of receipt and administration and the audit records on all units reviewed. From these observations and discussions medication Two service users did not have the quantity of medication recorded for medication prescribed with a variable dose. The medication was supplied in the monitored dosage system indicating how many is given at each time. In one instance the medication could not be found and the nurse in charge stated that the medication had gone missing that morning. A new supply had been ordered. In another instance the amount in stock did not agree with the amount that should be in stock. This was because on at least one occasion the incorrect dose had been given. Two service users had not received their medication on two occasions. The record indicated that it had been out of stock. From discussion with staff the medication had been out of stock as a decision on continuation of therapy was being waited from the GP. All other records had been completed accurately and provided evidence that all other medication had been administered correctly, changes to medication clearly identified, medication was stored and administered safely by appropriately trained staff, regular audits had been performed and any necessary action taken. Service user plans include information on personal needs. Personal preferences and choices are recorded. Service users confirmed that staff treated them with respect and offered choices. Service users are offered same gender carers. All bedrooms have en suite facilities. Bathrooms at the home are large and appropriately equipped with specialist baths and showers. A hairdresser visits the home once a week. Service user plans indicate preferred times to rise and retire, and preferences for baths or showers. Staff were Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 16 observed to knock on doors before entering and used preferred forms of address. Throughout the day staff were seen treating service users with respect, dignity and kindness. Names of keyworkers are detailed within each service user’s room. The day of the inspection was a warm one. The Inspector was invited to observe the staff handover of information between shifts. The Team Leader responsible spoke to all staff about how best to protect service users during the hot weather and procedures were put in place for staff too offer encourage regular drinks and to monitor how service users were feeling in the heat. There are appropriate procedure in place regarding dying and death. The home has a bereavement pack offering information and advice for service users and their families. The Manager has asked all service users and their families to complete questionnaires on individual wishes and needs which atre then incorporated into the service user’s records. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Service users are able to choose from a range of organised activities and staff ensure that individual support is offered to meet social needs. Service users are able to receive visitors at any time and families are able to continue to be involved in their care if they wish. Service users are involved in the development and review of their own care plan. Service users are consulted about the running of the home and are able to make choices about how their care is delivered. Service users are listened to and their opinions are acted upon. There is a varied menu offering choice and nutritional balance. EVIDENCE: The home employs two Activities Officers who organise, coordinate and provide activities. There is a set programme of activities open to all service users and this is well advertised throughout the home. The Inspectors observed the Activities Officers giving service users information about planned activities on the day of the inspection. Service users who spoke with the Inspectors reported that they enjoyed planned activities, which included bingo, gentle exercise, singing, nature watching, films, visiting entertainers and quizzes. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 18 The Activities Officers have attended specialist training on providing activities to people who have dementia. Service users reported that they were supported to access local shops and with individual activities by all staff. Throughout the day, care staff were seen spending time talking with service users and supporting them with reading, listening to music, knitting and other individual and small group activities. Notice boards throughout the home displayed information on activities, service user meetings, the complaints procedure, hairdressing charges, information on local advocacy groups, the charter of rights and minutes from the most recent service user meeting. Activity participation is recorded by the Activities Officers and used to review and develop the programme of organised activities. One service user spoke fondly of special celebrations, including parties and a planned barbeque to commemorate VE Day. One service user stated that birthdays were celebrated one each unit. Two Christian denominations hold regular church services at the home and the Manager was liaising with another local church in the hope that they will also offer a service. There is a newly created multi-faith room at the home. This is equipped with religious guides and prayer mats and can be used by service users, their visitors and staff of any faith for prayer and personal reflection. The British Legion visit the home monthly. Some service users continue to attend local day centres and enjoy this opportunity for socialising outside the home. A trolley telephone is available on each floor and can be moved to individual rooms for service users to make and receive calls. The Manager reported that there has been problems installing land lines within individual bedrooms but that most service users were happy with the current system of the trolley telephone. He reported that many service users also had their own mobile telephones. Service user meetings are held every six week and are facilitated by a local advocacy group who are independent from the home. Minutes of the meeting indicated that service users were well informed and that they were able to ask questions and voice their opinions. There is a newly formed service user committee who have worked with advocates to conduct quality monitoring. There is a flexible visitors procedure and visitors are welcome at any time. Families are able to continue to be involved in care provision for service users if they wish. The Inspector observed staff and visitors communicating well and Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 19 all visitors who completed comment cards stated that they were made welcome at the home. One member of staff reported that they had worked closely with the family of on service user to support them with the religious and communication needs. There is an appropriate menu, offering a choice of wholesome, freshly prepared food. Trained catering staff are employed throughout the day and prepare all main meals. Food is delivered to the units in heated trolleys. Smaller kitchenettes on each floor are well stocked with snacks, drinks and fresh fruit. Service users reported that they were able to eat their meals in their room or at different times if they wished. They also told Inspectors that they were able to have snacks and drinks whenever they wanted them. The Inspection Team was invited to join service users for their midday meal on the first day of the inspection. The meal was a pleasant social occasion and food was well prepared and tasty. Staff offered choices at the time of serving and also offered second helpings to service users. Some meals were brought to the tables with gravy already poured over the meal and desserts were brought with custard on them. In addition vegetables were also served before the food was brought to the table. This was discussed with the Manager. The Manager reported that many service users did not want to serve themselves vegetables although he acknowledged that sauces, gravy and custard should be served at the table so that service users could make choices about the amount and placement of these items. The Manager reported that specialist diets are catered for service users with health or religious needs. The service users were asked to participate in a quality survey in January 2004 which included asking for their views on food choice, presentation and quality. Suggestions arising from this have been implemented and changes to the menu were made. There are now four choices at each mealtime. The Chef attends service user meetings on a regular basis. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 There is an appropriate complaints procedure, which is accessible to service users. Service users rights are protected and service users have access to independent advocacy services. Procedures are in place to protect service users from abuse. EVIDENCE: There is an appropriate complaints procedure which is available to service users within the Service User Guide and on display throughout the home. There have been no complaints since the last inspection. The Manager reported that all service users are registered to vote. All service users have representatives external to the home. A local independent advocacy service facilitates six weekly service user meetings, works with the service user committee and offers a service to individuals. Information on advocacy services is displayed throughout the home. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults procedure. Care UK has its own procedures on abuse and whistle blowing. All staff have attended training in recognising and reporting abuse or have applied to attend this. The Inspector saw evidence of this in the staff training files which were examined. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 21 Care UK has sound recruitment and selection procedures and pre employment checks, including criminal record checks, are made on all staff prior to employment. The Inspectors spoke with a number of staff about the whistle blowing procedure and they were all able to confirm that they knew and understood about this. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 The environment is safe, well maintained and comfortable. Service users have unrestricted access to communal areas and report that they are happy with the environment. EVIDENCE: The home was purpose built and registered in August 2004. Accommodation is provided on three floors. All bedrooms are for single occupancy and have en suite facilities. There are nine additional WCs, six bathrooms and two shower rooms, all with WCs. Bathrooms and shower rooms are equipped with specialist equipment. Rooms are large and appropriately designed. The The building is building is well lit, ventilated and heated throughout. attractively decorated and furnished throughout. Additional staff facilities include shower rooms, changing facilities and a rest room. There is an attractive garden. There are a small number of parking spaces available. Areas of snagging have been identified and monitored and appropriate action taken to address concerns. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 23 There are lounges, quiet rooms and dining areas on each floor. There is These are attractively additionally a garden room on the ground floor. decorated and furnished. The hairdresser has an allocated room. Kitchenettes are available on each floor. All bedrooms are appropriately equipped and furnished. Service users are able to personalise their rooms. Bedrooms are equipped with call alarm systems, television aerial points and thermostats. There is a call alarm system available in all rooms. The home is equipped with a passenger lift and hand rails in corridors. All service users are individually assessed for equipment needs and referrals to health care professionals are made as necessary. There are a number of hoists available at the home. Specialist nursing beds are available. All staff receive training in manual handling. Moving and handling risk assessments are in place for all service users. Examples of these were seen in all the service user plans examined. The day of the inspection was a very hot one. Electric fans were being used throughout the home. Consideration should be given to whether it is possible and appropriate to install ceiling fans to provide improved ventilation. The home was clean and odour free throughout. There are appropriate procedures for infection control, disposal of clinical waste and Control of Substances Hazardous to Health. There are appropriate laundry facilities. One member of care staff complimented the cleaners for the ‘marvellous’ job they did and reported that they were always available if needed. Hand towels and liquid soap were available in all bathrooms and WCs. Service users stated that they were very happy with the facilities at the home and enjoyed the garden and lounges. One service user said that the dining room on their unit was rather small and difficult to negotiate when using a walking frame. Staff echoed this sentiment and reported that getting all service users seated and leaving the dining area could be difficult. Other than this, the Inspection Team heard nothing but praise for the home and the way it was maintained. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 24 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30 Staff are employed in sufficient numbers to meet the needs of service users. The staff team is well organised and there are appropriate procedures for supervision and support. Staff are offered a range of training and feel that this is well organised and gives them the knowledge and skills to meet the needs of service users. EVIDENCE: There is a good range of information for staff on their roles and responsibilities. All staff have comprehensive job descriptions and additional guidance and information were seen to be available. The home was well staffed at the time of the inspection and the Manager reported that agency staff have not been used at the home for over ten months. Recruitment for part and full time staff is ongoing. There is a clearly defined staffing structure. The Nursing Manager and Team Leaders manage teams of nursing and care staff. A Team Leader is on duty at all times and sleeps at the home over night. One of the Team Leaders and the Inspectors about their roles. The Leaders. They all demonstrated needs, staff issues and procedures Whitefarm Lodge Nursing Manager spoke at length with the Inspectors also met with two other Team an in-depth knowledge of service users’ at the home. Senior staff reported that all Version 1.30 Page 25 G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc the staff had settled well at the home and had shown dedication and commitment. Staff on duty reported that there was good procedures for supervision and that individual supervision meetings took place every two months. There are systems in place for senior staff to monitor work performance. One of the Team Leaders reported that there was a high number of experienced staff who willing took on delegated duties. The Team Leader reported that the team were flexible and hard working. There is an appropriate procedure for induction of new staff. All new staff shadow experienced staff and are supernumerary for two weeks. Approved induction workbooks are completed by staff and are externally verified. There is support for staff to undertake NVQs and all Team Leaders have embarked or have completed NVQ Level 3. The Nursing Manager is undertaking the Registered Managers Award and twenty care staff are training to NVQ Level 2. There are good procedures for the handover of information between shifts. The Lead Inspector was invited to observe the staff handover on the day of the inspection. This was an informative session where staff demonstrated a good understanding of individual needs and how they planned to meet these throughout the afternoon. There is a comprehensive training programme and the Manager demonstrated a commitment to staff development and training. A Training Coordinator is employed to support staff at this and two other local Care UK homes. The Manager has undertaken an audit of all staff training and individual staff training records are up to date. Recent staff training included dementia care, supervision, manual handling, nursing interventions, communication, health and safety and infection control. Planned training for the near future included care planning and bereavement and loss. All staff have received training in manual handling, fire safety, food hygiene and basic first aid and this is renewed as required. Three nurses have just completed a comprehensive course on dementia. Staff complete training evaluation forms following all training. These are held on file and indicated that staff were happy with the training provided and found this useful. Staff who spoke with the Inspectors reported that training was good. One staff member said that the training at the home was the best they had experienced in their work. Regular team and senior staff meetings are held and minutes indicated that staff are able to contribute their ideas and opinions. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 26 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 37 & 38 The Manager is appropriately experienced and qualified and has demonstrated a commitment to the development of the service. The management style is open, positive and inclusive. There are comprehensive systems for quality monitoring and service user consultation. Procedures are in place to promote good health and safety. Records are appropriately maintained and information is accessible, organised and up to date. EVIDENCE: The Manager is experienced and previously managed another of Care UK’s homes. He is currently undertaking an NVQ Level 4. The Manager demonstrated an in-depth knowledge of the service and the needs of service Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 27 users. He talked about his plans for the development of the service and how he intended to implement these. The Manager and Nursing Manager were due to attend an external course in Professional Development shortly after the inspection. There is an organised staffing structure and clear lines of accountability. Service users , staff and visitors spoke positively about the Manager and reported that they were appropriately consulted and involved in decision making. There are excellent systems for service user consultations through meetings, individual discussions, quality monitoring, use of advocates and surveys. The Manager and senior staff also presented as open and welcoming and throughout the day were seen to welcome comments from service users and their relatives. Staff who spoke with Inspectors unanimously reported that there was good communication at the home. Care UK has an appropriate quality assurance procedure, whereby the home is inspected annually by a representative of the organisation against a set of standards. Standards cover sixteen areas, including ‘preparation for home life’, ‘participation in home life’, ‘upholding rights’, ‘residents care’, ‘record keeping’, ‘policies and procedures’, ‘health and safety’, ‘human resources’ and ‘hotel services’. The home received such an inspection in November 2004 and had a good report. Recommendations made from this visits had been actioned. The Operations Manager visits the home once a month to conduct unannounced visits. Reports from these inspections are forwarded to the Commission for Social Care Inspection. These indicate that the Operations Manager speaks with service users and staff and examined records. The London Borough of Richmond conducts quarterly inspections of the home and assesses the service against a series of performance indicators. Quality monitoring using surveys and individual discussions with service users has taken place in January and again at around the time of the inspection. The results of these meetings, which are facilitated by an indent advocate and the surveys lead to the development of a report which is available to all. There is evidence that service development has reflected the comments received during the last monitoring process. Regular service user and relative meetings are held. Minutes of these indicate that people are able to contribute their ideas and opinions and that they are listened to. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 28 The Manager and organisation’s Area Manager set and monitor the budget for the home. The Manager reported he was developing the home’s budget for October 2005 at the time of the inspection. The Manager reported that he has allocated funds for further staff development and sees this as a priority for the service. Records required by Regulation were seen to be in place and were highly organised, up to date and accurate. Information is easily accessible. Copies of policies and procedures, service user consultation and minutes of meetings are available for service users, their visitors and staff. The Manager reported that a new computerised system for record keeping was due to be installed at the home and all staff were to receive training in this. There are good procedures for ensuing health and safety at the home. Checks on general health and safety, fire equipment, environmental and water temperatures, gas and electrical safety were seen to be in place and were kept up to date. Care UK organised for a full health and safety check of the home and this is to be repeated annually by a Health and Safety consultant. The report of their findings was comprehensive and included an action plan. There was evidence that requirements on the action plan had been met. Individual and building risk assessments are in place and are subject to regular review. The Environmental Health Officer visited the home in May 2005 and issued an award for high standards of cleanliness, hygiene and staff training. Accidents and incidents are appropriately recorded and monitored. The home has an Emergency Plan which is subject to regular review. Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 29 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 4 3 3 4 STAFFING Standard No Score 27 3 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 4 3 x x 4 3 Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 30 NO Are there any outstanding requirements from the last inspection? 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. OP7 13(4) & (6) 15 The Registered Person must ensure that: 1. General risk assessments are in place for all service users. 2. Risk assessments are in place where adjustable bed rails are in place. 2. OP9 13(2) The Registered Person must: 1. Ensure that the quantity of medication administered is recorded for all items of medication prescribed with a variable dose. 2. Ensure that all medication is given as the prescriber directed. 3. Ensure that an incident form is completed for the missing mediation and the incorrect administration of one medication. 18/07/05 31/07/05 Standard Regulation Requirement Timescale for action Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 31 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. OP9 It is recommended that where medication has been recorded as being out of stock for a specific reason the reason be recorded. It is recommended that condiments, sauces and gravy are served at the table so that service users can make individual choices about amounts and placement. Service users who wish to should be offered the opportunity to serve their own vegetables. Consideration should be given to whether it is possible and appropriate to install ceiling fans to provide improved ventilation. Refer to Standard Good Practice Recommendations 2. OP15 3. OP19 Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 32 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Whitefarm Lodge G54-G04 S61209 Whiteform Ldg V227904 200605 Stage 4.doc Version 1.30 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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