Inspection on 20/09/06 for Whitefarm Lodge

This inspection was carried out on 20th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 15/11/05

Whitefarm Lodge 20/06/05

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 Inspection 10:30 20 September 2006 th 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 Whitefarm Lodge DS0000061209.V311873.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. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 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 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) manager.burroughs@careuk.com Care UK Community Partnerships Limited Mr Shane Michael Cosgrove Care Home 60 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (37) of places Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Dementia Nursing Places To include no more than 23 service users requiring Dementia Nursing care at any one time. Dementia Places To include no more than 37 service users in the registration category of Older People with up to 25 requiring Dementia Care at any one time. 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 Manager of the Nursing Unit must be supernumerary for at least one day each week. The Home can admit one named service user under the age of 65 years. 15th November 2005 3. 4. Date of last inspection Brief Description of the Service: White Farm Lodge is a care home with nursing for up to sixty people. The home provides nursing care for up to twenty-three people 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 in Whitton, close to the high street, local shops, churches, pubs and other amenities. The home was newly built and registered in August 2004. 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 DS0000061209.V311873.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place over two days and was unannounced. Inspector. The Inspection Team consisted of two Regulation Inspectors and a Pharmacy The Pharmacy Inspector has written a separate report which is included within Section 2 of this report. The Inspectors met lots of the people who live at the home, the staff on duty and the Manager. Everybody made them welcome and helped by giving them information and sharing their experiences. The Lead Inspector ate lunch with some of the people who live at the home. The Inspectors saw that staff treated residents with respect and kindness throughout the visit. Before the inspection the CSCI wrote to the people who live at the home, their relatives, staff and other professionals asking them to complete questionnaires about the home. 17 residents completed questionnaires, some people were helped by an independent advocate. 26 members of staff, 30 visitors and 8 professionals also completed questionnaires. Such a large number of people responding is excellent and the information from these has helped form the evidence for the inspection report. their experiences of the home. The majority of people who live at the home said that had been able to make a choice about moving there, although some felt that others had made this choice for them. All those completing questionnaires said that they always or usually received the support they needed. Some of the people who live at the home talked about individual members of staff saying that they were very kind and supportive. One person said that the staff were not always available when they wanted to go to the toilet. One The CSCI thanks everyone who shared Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 6 person said, ‘the staff are always around, they are kind people, not bossy, just kind’. The majority of people said that they liked the organised activities. Some of the things people said were: ‘I am supplied with books to read’, ‘I enjoy the activities which I can join in like bird watching and exercises’ and ‘I like the exercises’. Most people said that they received the medical support they needed and some commented that the doctor visited the home regularly. Everybody who completed a questionnaire said that they always or usually liked the food, although one person said that breakfast was sometimes too late for their liking. Some of the things people said about the food were: ‘lovely can’t fault the food’, ‘the meals are beautiful, like home cooking’, ‘the food is very good’ and the food is ‘incredibly good’. Everybody liked the building and garden. Several of the people commented that ‘the home is spotless’. Some of the comments were, ‘the home smells clean and fresh’, ‘the home was beautiful’ and ‘I love my bedroom’. One of the people who lived at the home raised some concerns about staffing levels and the attitude of some staff. The person had discussed this with an independent advocate who advised them to speak to the Manager about these concerns. The relatives and visitors who completed questionnaires all made positive comments about the home. They said that they were made welcome and kept well informed. Some of their comments were: ‘the staff are very friendly’, ‘both the staff and Managers always welcome us day or night’, ‘we are always welcomed and offered drinks and biscuits’, ‘the staff always greet you when you visit’, ‘the staff are very welcoming and polite at all times and never make me feel that I am in the way when visiting my relative’, ‘the staff are most helpful’, ‘the staff are friendly courteous and cooperative at all times’, ‘the staff always make you welcome and know who you are, you are treated on a very Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 7 friendly and caring basis’, ‘when I visit the residents are always in good spirits’, ‘whatever time I visit the home there has been a caring atmosphere and staff seem happy and have found time to chat if I need to talk to them’, ‘very informative’, ‘very good at giving information’, ‘if there are any problems the staff always contact me’ and ‘they are first class’. The visitors and relatives were asked to give details of areas where they felt the home provided an excellent service. Some of their comments were: ‘they are very professional in all areas’, ‘the home provides a good all round service’, ‘my relative receives excellent care, is always well presented and enjoys the food’, ‘the home gives an all round excellent service’, ‘the staff are very attentive to my relative’s individual needs’, ‘all the staff are understanding and helpful’, the service is excellent in every way and I cannot speak too highly of the commitment they have to the residents’, ‘provides an excellent service in all areas’, ‘the residents always look clean and comfortable, their rooms and the premises in general are sweet smelling and fresh, the staff are well trained and highly efficient’, ‘there are no problems at all, I cannot see where the home could do any better’, ‘the care and well being of residents’, ‘I cannot fault the home in any way. I visit frequently and at no fixed time – the home is always the same’, ‘the home is clean and warm. The food looks excellent and my relative has put on weight since they have lived there and this is good’, ‘the home is always clean and welcoming. The residents are given a high standard of personal care’, ‘excellent services and amenities throughout’, ‘plenty of help and attention where it is needed’, ‘the two activities ladies work hard to ensure there is something going on to keep everyone happy’ and ‘the staff help my relative to socialise with others’. The things that relatives and visitors said that they would like to see improved at the home were more occupational therapy and physiotherapy support for residents, more staff and money, more day time activities, (one person wrote ‘some residents spend a lot of time watching the TV’). Some visitors have had a poor response to the entry phone at weekends and have said that they cannot enter or exit the home when they wanted to. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Some people wanted Version 5.2 Page 8 better contact with keyworkers. One person wrote that they would like there to be a coffee morning for relatives to meet, support each other and gain information from experts who could be invited to speak to them. Some of the other things that relatives and visitors wrote about the home were: ‘the home’s support takes away some of the stress’, ‘the care and support for my relative is the best she ever had’, ‘I think the people in charge and staff do a very good job under all circumstances, they all seem to be the right people for the job, a very well run place’, ‘I am personally so pleased that my relative will spends her time in such comfortable surroundings’, ‘the activities bring all the residents together’, ‘I am very impressed with the care and commitment to my relative and to any of my queries. I cannot speak highly enough of the care, the staff and the home itself – first class’, ‘my relative can be difficult at times but the staff have supported them sympathetically and competently’, ‘I could not be happier with the services and facilities at Whitefarm Lodge’, ‘I give all praise to the carers and management on my relative’s unit and to the Manager’, ‘of all the homes I visited prior to my relative’s move, this came tops in all departments’, ‘so far as I am concerned Whitefarm Lodge is a flagship home as the way people should be treated. The Manager and staff are a credit to care services’, ‘all the staff and conditions of Whitefarm Lodge are more than excellent. The friendliness and kindness of staff are second to none’, ‘the Manager and all the staff are always willing to discuss any topic’, ‘I have confidence that my relative is well cared for’ and ‘Whitefarm Lodge is more a true home than many others I have visited’. The staff who completed questionnaires said that they felt well supported and trained. Some of the things that they said were: ‘the management is very good. They really care about training for staff’, ‘the house runs smoothly and good care is provided to residents’, ‘there are very good training opportunities’, ‘there are good opportunities for professional development’, ‘there is a very open style of management’, the home has exceptionally high standards of care’, ‘I feel the home is excellent and very well managed’, ‘it would be good to Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 9 have more staff as sometimes I feel we rush things with residents’ and ‘this home has a very happy and relaxed atmosphere, which is enjoyed by residents, staff and visitors’. The professionals who completed questionnaires said that the staff worked in partnership with them and acted upon the advice they gave. speak in glowing terms about the home. Some of the things which they said about the home were: ‘At relatives’ meetings, relatives They have said that staff are responsive and efficient’, ‘this is one of the best homes I work with’, ‘a happy, caring atmosphere where we are always made welcome’ and ‘I think this is one of the best run homes. The standard is always aimed high and almost always met’. What the service does well: The people who live at the home are happy there. The staff treat people with respect and are kind and attentive. The relatives, friends and visitors feel welcome and listened to. The staff value the role of relatives. The service is well managed and the people who live and work at the home find the Manager approachable. The people who live at the home are consulted and are able to contribute their ideas and opinions. The records are well organised and information is accurate and up to date. The staff work closely with other professionals to meet individual needs. The people who live at the home like the food, activities and the environment. The staff are given good training and support. The professionals who visit the home believe that the service is run to a very high standard. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 10 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. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 11 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 Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 1, 2, 3 & 5 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. There is a wide range of information available for people who are thinking about moving to the home. There are procedures to make sure individual needs are assessed and potential residents are able to visit and stay at the home before deciding whether to move there permanently. EVIDENCE: People who are thinking about moving to the home and their families are given a welcome pack which includes a Statement of Purpose, Service User Guide and complaints procedure. Copies of the pack are available at the home and all current residents have been issued with one. The information is up to date and accurate. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 13 There are appropriate procedures for the assessment of potential residents, which include information from the person, their representatives, other professionals and observations by senior staff at the home. Anyone interested in moving to the home and their families are able to visit and spend time there before they make a decision to move in. Everybody is admitted on a six week trial stay. A review meeting is held at the end of this, involving the resident and relatives to decide whether they want to remain at the home. Records of the meetings are kept. One of the people who completed questionnaires about the home said, ‘the staff have gone out of their way to help my relative adjust and to support us. The Manager and staff were always patient and optimistic. relative now feels that Whitefarm Lodge is his home’. The majority of residents have their places funded or part funded by the local authority although some pay privately. Contracts are in place and have been signed by all parties. Some of the people who live at the home who completed questionnaires said that they could not remember receiving a contract. It would be useful for the Manager to make sure each resident is aware of their terms and conditions. I hope that my Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 7, 8, 9, 10 & 11 The overall quality in this outcome group is excellent. This judgement has been made using evidence including a visit to the service. Individual needs are recorded within care plans and risk assessments. Staff work with other professionals to make sure personal, health care and medication needs are met and they are striving to improve these areas further. EVIDENCE: The home uses a computer system for care planning. The staff have learnt how to use this system and have improved it since it was introduced a year ago. The staff were in the process of uploading photographs on to the computer care plans. Paper copies of care plans are kept. The care plans are appropriately detailed and focus on skills, needs and wishes. A senior member of staff said that staff needed to read all care plans and sign these in supervision before they can work with an individual. There are a range of risk assessments in place which look at how residents can be supported to make choices and be independent whilst reducing risks. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 15 There are a range of health and personal care monitoring charts and guidance from other professionals included within care plans. All documents are regularly updated and reviewed and this is recorded. The staff write daily records to show that care plans are being followed. All residents have a copy of their care plan in their bedroom. They have signed the care plans to show that they have read, understood and agreed with the contents. Residents and their relatives are told about any changes to the care plan. Some of the things that people who live at the home and their relatives said about the care were: ‘my relative has a care plan in her room which provides excellent guidance in relation to her needs’, ‘the staff have asked me about this area to make it easier to care for my relative’, ‘they care well for my relative who has a disability and health care conditions’, ‘Whitefarm Lodge has given my relative all the support they need to regain their mobility’ and ‘since moving to the home my relative’s health and quality of life has improved immensely’. The home is about to pilot a new project which aims to change the focus of care from providing physical care to promoting independence in whatever form it takes. The project recognises the importance of achieving meaningful tasks and retaining skills and independence. This is a new an innovative way of working and will help the staff have an even more person centred approach to care focusing on strengths. There will be training, information and support for all staff and residents. The aim is to use individual staff skills and experiences. This new way of working will have a direct impact on each person’s life and will help residents to have a better quality of life. There may need to be an increase in staffing and the organisation should meet this need to make sure that the outcomes for residents are as good as they can be. The residents are registered with local GPs and other health care professionals as required. One GP visits the home for a weekly surgery. The staff have a good relationship with visiting nurses and doctors. A visiting District Nurse who met with the Inspectors said that the staff worked hard to meet the health care needs of each resident. The written medication policies and procedures were found to be adequate on a previous inspection and were not reviewed on this visit. All 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. A sample Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 16 of the current medication in stock was counted and compared to the current records and to the amount that should be in stock. Only trained staff assessed as being competent administer medication. All medication was stored securely and under the correct conditions. Residents are able to take control of their own medication following an assessment. Directions for administration were available for all items of medication and more specific directions were included for where creams were to be applied. Most medication is supplied in a monitored dosage container enabling staff to see if medication is given correctly. All medications not supplied in the monitored dosage system were dated when opened and the amount of medication carried over from one month to the next is recorded on the administration record. This enables a good audit trail for the use of all medication. A daily and a monthly audit are done on stocks of medication and records. Five residents did not have the quantity of medication recorded consistently for medication prescribed with a variable dose. All other records had been completed accurately and provided evidence that medication had been administered correctly and changes to medication clearly identified. The records clearly show any reason why medication has not been given to a resident at a particular time and this includes if a resident does not wish to have their medication. The new computerised system of care planning also provides a good, clear record of monitoring of residents condition and any necessary changes in medication following reviews by a multidisciplinary team. The home meets the individual needs of residents who have disabilities. This includes having care plans in place, providing special equipment and additional staff support as needed. The home works closely with other professionals to make sure needs are met. One of the professionals who contacted the CSCI said that they felt some staff needed more knowledge of mental health issues. Residents are able to request same gender carers. Care UK have introduced a falls management strategy which aims to help prevent falls through detailed risk assessments, work with other professionals and sharing information with residents and families. The Manager hopes to allocate a senior member of staff to take a lead in working with others to reduce falls and risk of falling. The home has produced a bereavement pack with guidance for relatives. The Manager contacted all relatives and has recorded individual wishes regarding dying and death. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 17 One of the people completing a questionnaire said that their relative had passed away recently. sensitive. They said that the staff were kind, supportive and One of the staff members said, ‘the residents are nursed at Whitefarm Lodge, they only go to hospital on rare occasions. The team work in caring for the sick and dying is something I am proud to be involved in’. The home works closely with other professionals to provide palliative care for people who need this. One of these professionals contacted the CSCI and said that they felt the staff at the home were dedicated in their care and approach. He said that they were willing to learn and worked closely with nurses and other visiting professionals. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 12, 13, 14 & 15 The overall quality in this outcome group is excellent. This judgement has been made using evidence including a visit to the service. There is a wide range of organised activities which have improved. There is still potential to improve ad hoc activities and support for residents who are not participating in the organised events. The home is excellent at consulting with residents and their relatives and enabling them to contribute to the running of the home. Food is varied and well prepared. EVIDENCE: There is a planned programme of activities held each week. These include popular activities, like exercise, musical bingo, countdown and bird watching. The events are well advertised on attractive notice boards throughout the home. Since the last inspection a French conversation group has started. The organiser of this said that the group was popular. There are two activity officers and they plan and facilitate the majority of activities. There are also regular visiting entertainers and a visiting library. The hairdresser visits the home each week and residents said that the service was good and reasonable. Residents told the Inspectors that they had newspapers delivered. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 19 The activities officer told the Inspectors that they were planning a range of different activities for winter. There is a store cupboard of games, craft materials, jigsaws and music which the staff can use to support residents with ad hoc activities. Some of the people completing questionnaires said that they felt there should be more variety in activities. The Manager has organised for boxes of games, puzzles, music and craft items to be placed in communal areas around the home for residents to help themselves and to encourage staff to use these with residents. The activity officers are trying to spend some time helping individual residents pursue certain interests. A new sensory room has been built at the home. This is attractively decorated and equipped. Residents are supported to spend time in the room with an activity officer. Staff at the home said that they could see the direct benefits for some of the residents. Some of the residents and staff wrote about the activities at the home in their questionnaires. One member of staff said that they felt the home made special events like Christmas and birthdays really nice. One resident wrote about their birthday and said that the staff had made them feel very special. One profession wrote that they had seen staff dressing in costumes and making a real effort to celebrate special events. A charity event was being organised shortly after the inspection for residents to be involved and help raise money for a national charity. A pantomime was being organised for Christmas. The residents told the Inspectors that they had enjoyed a summer barbeque. All the visitors and relatives who completed questionnaires about the home and those who met with the Inspectors said that they were made welcome and were able to visit their relatives whenever they wanted. Some of the comments they made were, ‘I can always speak to the Manager’, ‘from the Manager, to the care staff, domestic and kitchen staff you always get a warm greeting’, ‘they always seem pleased to see us’, ‘the home has a warm atmosphere and you are always made welcome’, ‘Whitefarm Lodge always has a very warm and welcoming approach as soon as you walk into the lobby, flowers, lovely lighting and friendly staff’, ‘they phone me immediately if there is a problem’, ‘they always send us details of resident meetings and phone us with any information about our relative’ and ‘I am phoned promptly if there are any changes to my relative’s health’. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 20 There is a trolley telephone which can be used in residents’ bedrooms and there are a number of small lounges where residents can entertain guests in private. The Nursing Manager told the Inspector that he plans to organise for regular coffee mornings so that relatives can meet and socialise with each other. He hopes that this group will be supportive and help some of the relatives. He also hopes to invite expert speakers to give information about dementia and the impact this can have on everybody’s life. One of the relatives also raised this as a thing they would like to see at the home. The Manager said that he wants to build up a strong support group amongst relatives. Regular resident and relatives meetings are organised. These are chaired by an independent advocate. The advocate helped some of the residents complete questionnaires about the home and completed one herself. She said that she felt the home was really good at consulting with residents and helping them have a say about their lives. She wrote that, ‘the enthusiasm generated by residents at their meetings is an indication for the respect they have for staff’. Minutes from the most recent meetings showed that residents and relatives were well informed about changes and were able to contribute their ideas and opinions. Minutes of the meetings were displayed on notice boards around the home. The Inspectors observed staff treating residents with respect and being kind and attentive. The staff knew about the people they cared for and what their individual needs were. Residents who spoke with the Inspectors said that staff were always kind and supportive. An independent advocate was running a training session for staff shortly after the inspection. The training focused on relationships and emotional care and included information on relationships that are important to residents, how staff can support and strengthen these, what kind of relationships staff should form with residents and can staff help build relationships between residents. Whitefarm Lodge and other local Care UK homes have made arrangements to set up a ‘focus group’ of one resident, one relative and a non management member of staff from each home. These representatives were due to meet with an independent advocate and the local authority shortly after the inspection. The aim of the group is to discuss care services and consider how these can be improved. The Inspectors met the resident and relative representatives from Whitefarm Lodge. They said that they were looking forward to the event and had consulted with people to have a clear understanding of their views before the attended the group. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 21 There is a residents committee which meets about 3 times a year. The committee members speak to other residents to bring questions and suggestions to the management team. Languages spoken by staff are recorded and used to help converse with residents whose first language is not English. There is a multifaith room available for residents, staff or visitors to use for private worship or contemplation. Special communication books have been created for two residents who do not speak English with the help of their families. This are designed to help staff communicate with them. The majority of residents who completed questionnaires about the home said that they liked the food. Many of the visitors and relatives said that they thought food looked nice and that residents had put on weight and become healthier since they moved to the home. One person wrote, ‘the food is excellent, there is a varied diet which takes into consideration changes in weather’. The home caters for specialist diets. The Chef has attended residents meetings and asked them for their views on the menu and quality of food. The Chef is undertaking a pastry and cake making course. Residents are able to have snacks and drinks from kitchenettes on each floor at any time of the day or night. The Lead Inspector joined some of the residents for their midday meal. This was nicely prepared and tasty. Residents make their choices from a menu in advance. On the day of the inspection residents did not have a choice of vegetables. The Chef should consider providing a choice of vegetables with meals. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 22 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 the following standard(s): 16, 17 & 18 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. There are appropriate procedures regarding complaints and protection. EVIDENCE: There is an appropriate complaints procedure, detailing time scales and how to contact the Commission for Social Care Inspection. Copies of this are given to residents and are available throughout the home. The Manager keeps a detailed record of all complaints, investigations and any action taken. One of the people who completed a questionnaire about the home said that a recent complaint was investigated thoroughly and that action had been taken to prevent reoccurrence of the event. The Manager keeps a record of compliments and thank you cards from residents and relatives. Age Concern provide an advocacy service for individuals and also facilitate resident meetings. The local authority protection of vulnerable adults procedure is used by the home. Care UK has its own procedures on abuse and whistle blowing. All staff are trained in this area. The home works closely with other agencies to make sure residents are safe. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 23 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The quality in this outcome group is good. evidence including a visit to the service. This judgement is made using The residents live in a nice building which is well maintained and very clean. EVIDENCE: The home was purpose built in 2004. There are three floors, one floor is a dedicated nursing unit. Each resident has their own bedroom with en suite WC and wash basin. There is room to equip these en suites with shower facilities and the organisation should consider this. Bedrooms are equipped with call alarm systems, television aerial points and thermostats. There are comfortable lounges and spacious well equipped bathrooms on each floor. The dining areas on some of the floors are small and make it difficult for residents to move around. Other rooms throughout the home are spacious. There are a number of different communal lounges where residents can entertain visitors. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 24 Since the last inspection one of the lounges has been made into a sensory room. This is really nicely decorated and full of sensory and music equipment. The staff who created this should be proud of their work and the positive impact it is having on some of the residents’ lives. There is a passenger lift and hand rails throughout corridors and bathrooms. All residents 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 residents. Examples of these were seen in all the care plans examined. There is no air conditioning at the home and this caused some problems during the summer because some rooms became really hot. The Manager purchased portable air conditioning units and these were risk assessed. The staff said that these helped to cool the home down. The Manager should consider how best to label residents’ rooms on the nursing unit to help them identify these and orientate themselves. Residents said that they like the building, their rooms and the garden. The home is nicely decorated and maintained. The domestic staff keep the home very clean, tidy and odour free. Lots of the people who contacted the CSCI commented on how clean the home was and one person said: ‘The home is always clean and tidy, the residents appear comfortable and content and the focus of care is upon the individual in their own home’. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The staff are appropriately recruited, well trained and supported. EVIDENCE: Lots of the staff who completed questionnaires about the home said that they felt there should be more staff to help give residents more individual care. One person said that they felt there needed to be more male staff to give support to male residents. The home is planning to introduce a new way of working to help focus on residents developing and maintaining skills and independence. In order to fully meet the needs of residents there may need to be more staff employed. The Registered Persons should make sure there is enough staff. One of the NVQ Assessors who visits the home on a regular basis completed a questionnaire on the service and said, ‘whilst many of the staff are still learning their role within health/social care, they are well supported by other more experienced members of staff. This ensures a high level of service and quality of care is maintained and monitored. All the staff work well as a team.’ Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 26 All the staff completing questionnaires and those who spoke to the Inspectors said that training was very good and that they had lots of training opportunities. Some commented that this was an area they considered the home did exceptionally well. The training plan for the home includes a wide range of training, such as supervision and appraisal, moving and handling, health and safety, induction courses, food hygiene, introduction to dementia, protection of vulnerable adults, palliative care, fire, bereavement and specialist nursing interventions. The staff and their line managers decide which courses they need to go on. They record all training. The training events are well advertised. The organisation supports staff to undertake NVQ qualifications. Many of the staff are undertaking NVQs and the Manager and Nursing Manager have recently completed their Registered Managers Award. The NVQ coordinator gives feedback on the progress of each member of staff to the Manager and they work together to make sure the staff learn and develop. In general the staff said that they felt well supported and worked well as a team. A small number of the staff who completed questionnaires raised concerns about specific staff members or other staff issues. These people also commented that they found the Registered Manager supportive. They should raise their concerns directly with the Manager so that problems can be addressed appropriately. Regular individual supervision meetings and team meetings for all staff are held and recorded. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 The overall quality in this outcome group is excellent. This judgement has been made using evidence including a visit to the service. The home is well managed and the management style is open. There are excellent systems for consultation and monitoring quality and health and safety. EVIDENCE: The Manager has managed the service since it was registered and before this he managed another Care UK home which lots of the residents and staff also came from. He has the Registered Managers Award and has a wide range of experience. He has an excellent knowledge of the home and the needs of individual residents and staff. He has demonstrated a genuine commitment to continuous improvement and uses information from the CSCI and other professionals to develop the service. He manages the home well and is Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 28 popular with residents, visitors, staff and other professionals. undertaking training to develop his skills further. The Manager is The Manager has a clear plan for the future and told the Lead Inspector that his main aims for the coming year were to develop the falls management strategy and look at new ways of involving residents in the running of the home. Some of the things that people wrote about the Manager in questionnaires they sent to the CSCI were: ‘The Manager is always willing to listen and is proactive in solving any issues that arise’, ‘the Manager’s ethos and personal values play an important part in the success of the home’, ‘I have always found the staff and management very helpful and supportive’, ‘we have a really good homes manager. He is supportive and respectful. He is a good listener and really cares for staff as well as the residents and their families’, ‘we couldn’t wish for a better Manager’, ‘the Manager always has time to listen to residents and staff’ and ‘the Manager is very supportive to his staff and treats everybody with respect. He gives equal treatment and appreciates the work the staff do. His criticisms are constructive and residents are his priority. themselves’ Everybody who spoke to the Inspectors said that they found him approachable and felt able to raise concerns and queries with him. The Manager is dedicated to consultation and involving residents, their representatives and staff. The Manager and staff said that they feel supported by senior managers and the organisation. There are good systems for monitoring the quality of the service and ways of improving this. The local authority who commission most of the places at the home conduct quarterly monitoring visits based on key performance indicators. The report of the most recent visit in September 2006 showed that the local authority were happy that standards were high. The staff and Manager do their own quality monitoring of services and health and safety at the home and regular fire drills. Records of these are kept. He helps staff develop Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 29 Care UK conduct an annual quality monitoring inspection and monthly audits which look at different areas of care. Reports from these visits include actions for improvement. The CSCI receive copies of these reports. The most recent annual audit report was undertaken in May 2006. The audit is thorough and looks at 16 standards including privacy, dignity, independence, choice, rights, human resources and the environment. The report finds that the home provided a good service in all areas and states, ‘the residents are clearly central to the ethos of this home and services are focused on meeting their choices, needs and requirements’. Twice a year the residents are asked to complete surveys for the home on staffing, quality of care, information, equipment, leisure pursuits and improvements. The results of these surveys are recorded within a ‘service user involvement report’, which is made available to residents, staff, visitors and other professional organisations. The most recent report in June 2006 showed that residents all residents were either very satisfied or satisfied with all aspects of the service. Recommendations and comments were included in the report and the Manager was able to evidence where action had been taken to address these concerns. Small amounts of cash are held on behalf of any resident who wants this. These are stored securely and accurate records are kept. There are excellent systems for record keeping. Records are accurate and well organised. Policies and procedures and key documents are available on each floor for residents, staff and visitors. Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 30 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 4 3 Whitefarm Lodge DS0000061209.V311873.R01.S.doc Version 5.2 Page 31 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. Standard OP9 Regulation 13(2) Requirement Timescale for action The registered person must 19/10/06 ensure that all the quantity of medication given is recorded accurately. 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 The Chef should consider offering a wider range of vegetables at meal times. The Registered Person should consider installing showers within en suite facilities for service users. 2. OP23 3. OP22 The Manager should look at ways to help residents to identify their rooms through pictures, signs and labels. DS0000061209.V311873.R01.S.doc Version 5.2 Page 32 Whitefarm Lodge Commission for Social Care Inspection SW London Area Office 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 DS0000061209.V311873.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!