Inspection on 13/01/07 for Whitegates

This inspection was carried out on 13th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Whitegates 30/01/06

Whitegates 21/09/05

Whitegates 04/02/05

Whitegates 11/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Whitegates 25 Hereford Road Bromyard Herefordshire HR7 4ES Lead Inspector Wendy Barrett Unannounced Inspection 10:30 13th January 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitegates DS0000024748.V309590.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. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitegates Address 25 Hereford Road Bromyard Herefordshire HR7 4ES 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) 01885 482437 F/P 01885 482437 Ms Karen Anne Rogers Mrs Susan Winifred Brown Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Learning registration, with number disability over 65 years of age (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (37), Old age, not falling within any other category (37), Physical disability over 65 years of age (22) Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The category LD(E) relates to a named person Date of last inspection Brief Description of the Service: Whitegates is a large, older house situated in its own grounds on the outskirts of the small market town of Bromyard. In 2006, the accommodation was extended and the home now provides 37 places for older people who have care needs arising from the ageing process, mental health or dementia related conditions. 22 of the places may be used to accommodate older people who have care needs relating to a physical disability. One of the places is registered to accommodate a named older person with care needs relating to a learning disability and another has recently been registered to accommodate a named younger adult. A Statement of Purpose is normally displayed in the main hallway at the home. This was being revised at the time of this inspection. A revised Service User Guide was seen. Prospective residents receive a copy and there is one in each bedroom. Large print copies will be provided in the future. In September 2006, the fees ranged from £400 to £550 per week. Additional charges are made for chiropody, hairdressing, newspapers and dry cleaning. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence which was referenced in writing this report was gathered from correspondence and documentation held by the Commission, survey forms received from residents, relatives and involved professional workers, a preinspection questionnaire completed by the Care Manager and an unannounced visit to the service. What the service does well: What has improved since the last inspection? The accommodation has been extended and part of this work has resulted in improved facilities that will benefit all the residents e.g. upgraded laundry. Medication storage facilities has been improved. The way that the care given is recorded has been developed and there is work underway to continue this with more detail about each resident’s life history and individual leisure interests. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 6 Staffing levels are being increased in response to the increase in resident numbers. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to decide if the home will suit them. Staff at the home recognise the importance of gathering as much information as possible about the potential resident so that they can assess if they will be able to meet individual needs and expectations. EVIDENCE: A Statement of Purpose is normally displayed in the main hallway at the home. This was being revised at the time of this inspection. A revised Service User Guide was seen. Prospective residents receive a copy and there is one in each bedroom. Large print copies will be provided in the future. The Care Manager completes a thorough assessment of potential residents’ needs and expectations before agreeing to admit anyone. When other care Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 9 professionals can offer further information this is taken account of e.g. reports are obtained from placing social workers. The initial assessment work takes account of all the main areas of wellbeing and when there are any potential risk areas e.g. mobility difficulties, these are carefully considered by the use of recognised methods of measuring risks. New residents have an opportunity to experience the home before deciding if they want to stay on a long-term basis. A meeting had been arranged for one new resident so that everyone involved could sit down and discuss how things had gone in the first four weeks after admission. The resident, relative, social worker, Care Manager and any other relevant people would participate in this meeting. There is ongoing work to continue improving the pre-admission work so that residents have every opportunity to have a successful placement at the home e.g. there is more attention being given to obtaining social histories so that staff can understand a little of the resident’s background and life experiences. New recording documents are being introduced to improve the quality of information about health and personal care needs. A recently admitted resident was happy with the way she had been helped to settle into the home e.g. she had been given a large bedroom in an area of the home that would best suit her needs, and she was able to continue seeing her friends and family, and visiting her church. Two copies of contracts of residence were inspected. The Provider and either the resident or relative representative had signed these. The contracts described the service being offered and clarified the fees. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the care they need and they and their relatives are consulted as part of this work. Health and social care professionals express confidence in the care residents receive. The way that medication is managed and records are maintained should be checked more regularly so that any omissions can be checked promptly. EVIDENCE: Every resident has a written care plan. These are reviewed regularly by the staff to make sure the information is kept up to date. The resident and/or relatives are consulted e.g. annual review meetings are held. A relative commented ‘staff are always available for consultation if required’ and a reviewing social worker wrote ‘every effort is made by the home to meet families’ needs’. The way that the care is recorded is very thorough e.g. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 11 weekly checklists to confirm the personal care given to each individual. A relative commented ‘Mum is always well presented, clothes clean etc.’ The records would be improved if the action plans were more easily found among the other records e.g. some evaluation reports explained how care needed to change. This information should be incorporated in a new care plan. When residents are particularly vulnerable e.g. mobility difficulties, there is good use of recognised assessment tools to help the staff decide how to reduce risk. All comments from professional workers expressed confidence in the ability of staff to care well for the residents. A G.P. said ‘the seniors work with me on medical issues related to individuals and act on the advice given’. A Senior Care assistant confirmed she had received training to help her manage medication safely. Senior staff had supervised her until they were confident she could handle the medication appropriately. A new medication storage cupboard has been introduced since the last inspection. This was secure and contained a medication fridge. A sample of medication records was inspected. They were generally being properly completed but there were occasional omissions e.g. new containers had not been dated to show when the stock was brought into use, hand written entries did not always show two staff signatures to confirm checking of accuracy in transcription. There should be regular audits of stock and records so that any omissions can be addressed promptly. It may also be advisable to review the home’s policy and procedures to be sure they refer to current good practices, and to ask staff to refresh their awareness of this guidance. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to continue living in the way they prefer and they are supported by staff in getting out into the community and in enjoying group activities at the home. There is already work underway to improve awareness of individual interests so that staff can provide more one to one social support when this is required. EVIDENCE: Residents have opportunities to take part in leisure activities. Some of these are held at the home e.g. weekly quizzes organised by a relative, exercise sessions. Community trips are also offered e.g. a concert at a local school and monthly trips out for a lunch. The Provider has allocated 16 hours each week for staff to spend on social care, although only 3-4 hours each week were actually being used due to a staff vacancy. Some residents would benefit from additional one to one support in pursuing their leisure interests. This was being developed as part of the care planning work. Social histories were being requested from relatives so that staff would Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 13 understand about the resident’s previous lifestyle, achievements, interests etc. At the moment there is too little attention to social and emotional care within the care plans for each resident. However, there were examples to confirm that residents can continue with their preferred lifestyle e.g. a resident was met at the home. He had just returned from a trip up the road in his electric chair. Another younger resident was looking forward to having her children join her for lunch the following day. When residents are admitted to the home they are asked about their food preferences. The staff also assess nutritional needs and keep this under review. A resident mentioned his diabetes and said that he gets a suitable diet that he enjoys. Another resident’s appetite had improved following extra attention from staff. She was now enjoying extra portions of normal meals after a period when her appetite had been poor and she had been given food supplements to make sure she didn’t become malnourished. Resident feedback comments reflected high satisfaction with their meals although one comment was made that baked beans were served too often and the resident didn’t like baked beans. Copy menus did not support this view and there were examples of requests for alternative meals being responded to. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives know how to raise any concerns and they feel confident that the staff will listen to them and take any necessary action to put things right. The staff understand how to recognise any unacceptable treatment of residents and they have guidance to help them raise any concerns they may have. EVIDENCE: The Commission hasn’t received any complaints about the service at Whitegates during the past year. One complaint has been received by the home and was investigated by the home’s management staff. Residents and relatives feel that they know how to raise concerns. There is written guidance provided to help people in this. One relative’s feedback described concerns about the quality of the laundry service. The relative hoped that a planned improvement to laundry facilities would improve the situation. The laundry facilities had been upgraded at the time of this inspection and the Care Manager was confident that the service had now improved as a result of this work. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 15 Staff have been provided with training in adult protection awareness in March and October 2006 and they have written guidance to advise them on how to identify issues of concern and how to raise them. A recently recruited member of staff had been given copies of this written guidance and all staff have received a copy of the General Social Care Council’s Code of Conduct so that they know how they should behave appropriately as they go about their work with residents. When the Provider visits the home she checks the record of complaints so that she knows if any concerns have been raised. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from comfortable accommodation that is designed and maintained to keep them comfortable and ensure their safety. EVIDENCE: All areas of the home were clean, warm and bright when the inspection visit took place. The new extension offers high quality accommodation with attractive furnishings and fittings. There has also been ongoing attention to maintaining and improving the quality of accommodation in the existing part of the home e.g. new bedroom furnishings, new fittings, and decoration. There is still some Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 17 work to do where the new building adjoins to the existing. This was being addressed at the time of the inspection visit. A new medication storage facility was already in use and there are plans to have a new hairdressing facility when all the work is complete. When the Provider visits the home she reviews any maintenance work that may be required e.g. one report of her visits refers to the need for clearance of guttering. Residents said they were happy with their bedroom. One resident spent most of her time in her room and she had a comfortably large room to entertain her family and friends. A second resident had a much smaller bedroom but he was happy with it because he preferred to be out and about during the daytime. Both had been able to view their prospective room before deciding to be admitted. There were examples of attention to hygiene and safety factors around the building. Where building work was continuing, residents were protected from wandering into hazardous areas e.g. the door of one unoccupied bedroom was padlocked while the flooring was being replaced. The Care Manager referred to consultation with the Fire Officer in maintaining fire safety standards during the building work. The upgraded laundry facility had been designed with care e.g. automatic feed of cleaning fluids to machines, special disinfection system. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff and when the workload increases the number of staff is increased so that residents will continue to receive the care they need. New staff are carefully selected and they are supported as they get used to the work. Existing staff are receiving the training they need to work safely and respectfully with the residents. EVIDENCE: The number of residents is gradually increasing as the new extension becomes occupied. In view of this, the Care Manager had appointed new staff to increase the level of care staff on duty during each day. This was due to take effect shortly after the inspection visit. There were a satisfactory number of staff at work in the home when the unannounced visit took place although a staff member did feel that early mornings and meal times could be very busy. A Senior Care assistant, 3 care assistants, a cook, a kitchen assistant and a housekeeper were on duty. The introduction of an additional care assistant will ease the pressure at busy times of day. There was no indication that residents were not receiving the care they needed when the inspection visit took place Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 19 and relatives and a visiting G.P. were confident that residents were well cared for. There is little change in the staff group so residents can get to know individual workers well. A relative commented that the arrangement for each resident to have a special worker (key worker) was working well in her experience. Half the care staff have achieved a national vocational qualification (NVQ). This is good because it meets the national target. Records confirm that the staff are also receiving the health and safety training they need. They are also being offered other types of training that is particularly relevant to the residents e.g. the Care Manager and 7 staff were due to attend a course titled ‘Valuing the person with dementia’. All staff have recently been supplied with a pack of information that describes what is expected of them and how they should work appropriately with the residents e.g. a code of conduct, a Whitegates objectives statement. A recruitment file was inspected at the home. This confirmed a thorough selection to ensure that the prospective staff member would be suitable to work with vulnerable adults. When new staff start work at the home they are supervised by more experienced staff for a while and then they undertake a full induction programme that meets national specifications. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a service that is run by a competent Provider and Care Manager who know what is required to maintain and improve the health, safety and welfare of the residents. EVIDENCE: Both Provider and Care Manager have considerable experience and relevant qualifications to fulfil their responsibilities. An involved social care professional commented about the Care Manager’s performance –‘always very helpful and accommodating during phone calls and visits to the home’. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 21 A quality assurance policy was seen displayed at the home and the Care Manager had recently sent out questionnaires to relatives so they could comment on the service. The Provider was aware of future requirements relating to quality monitoring exercises and had arranged to familiarise the Care manager with this new development. There is a programme of auditing all aspects of the service. Reference to this work was seen in the Provider’s reports of visits to the home. The residents are benefiting from the Provider’s ongoing investment to improve the quality of the environment. There are examples of good attention to safety factors e.g. portable electric equipment is being tested regularly, work done to comply with Fire Officer recommendations. When staff hold residents’ money in safekeeping there are records kept to show how the money is handled. An example of this type of record showed that relatives were signing to confirm receipts, two staff were signing to confirm any expenditures and invoices were kept. A cash balance matched the balance shown in the record. The Commission is receiving notifications of accidents and events at the home although it may be advisable to notify less serious injuries when there is a pattern of regular minor incidents/falls. This allows the Commission to assess the response of staff in doing everything they can to protect the resident from further injury. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 22 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 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x 3 3 Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP37 Good Practice Recommendations The way that staff are managing medication should be audited more often so that omissions can be quickly identified and put right. It would advisable to notify the Commission when any resident is at additional risk due to a pattern of regular falls or incidents. Although these may not result in significant injury the frequency does increase risk factors. Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Whitegates DS0000024748.V309590.R01.S.doc Version 5.2 Page 25 - 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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