Inspection on 21/09/05 for Whitegates

This inspection was carried out on 21st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 13/01/07

Whitegates 30/01/06

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 21st September 2005 13:40 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.V253182.R01.S.doc Version 5.0 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.V253182.R01.S.doc Version 5.0 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 01885 489206 Ms Karen Anne Rogers Care Home 22 Category(ies) of Dementia - over 65 years of age (6), 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 (6), Old age, not falling within any other category (22), Physical disability over 65 years of age (22) Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The category LD(E) relates to a named person Date of last inspection 4th February 2005 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. The home will provide transport to access the local shops, post office and pubs. The home is registered to accommodate 22 older people whose care needs arise primarily from old age or physical disability. Up to 6 places can be used for people who have dementia or mental health difficulties. One place is registered to accommodate a named individual who is over 65years of age and has a learning difficulty. There are 18 bedrooms. Four of these accommodate two residents. The communal rooms, which open onto each other, are on the ground floor. There is a quiet room/library on the second floor. The gardens are well maintained with partial access for people who have mobility problems. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 1.40pm and 6.20pm. The Provider arrived at the home shortly before the inspection finished. The Care Manager designate was on duty. There was a tour of the accommodation and two staff were interviewed. Residents were met in communal areas. Feedback questionnaires had been sent to the home by the Commission in June 2005 with a request that they be distributed to staff. It was disappointing to find that although the questionnaires had been received by the home they had not been distributed. A sample of records and documentation maintained at the home were inspected and there was reference to correspondence and other records held on the Commission’s service file. What the service does well: What has improved since the last inspection? A new Care Manager has been employed and she has applied for registration with the Commission. This appointment means that care staff can receive additional on the job support each day from an experienced senior. More staff are working to achieve a professional qualification. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 6 The owner and Care Manager designate are continuing to develop good systems at the home to make sure everything runs smoothly. 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. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 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.V253182.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Potential residents have the information they need to decide whether the home will suit them. There will need to be a check made to ensure that every resident has been issued with a signed copy of a contract of residence. The home gathers relevant information about potential residents needs in order to decide whether the service can meet these. In future, when potential residents are known to have significant personal care needs there should be increased consideration, before an admission is agreed, of the staff views that the workload is already heavy. EVIDENCE: There is a Statement of Purpose and Service User Guide that describe the service. They are printed in large type to help residents with failing eyesight. The Statement of Purpose is displayed at the home and a copy of the Service User Guide was seen in a resident’s bedroom. The Provider and the resident had appropriately signed one copy of a sampled Contract of Residence. A second copy had not been signed. It is important that signed copies are produced for every resident. This may mean that a Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 9 relative or other representative has to sign the contract on behalf of the more frail residents. There is a record of pre-admission assessment work that addresses all the required aspects. A Senior Care Assistant said she was usually provided with basic details of new residents prior to their arrival and was able to phone the G.P. if more details were required. Comments from staff indicate that they feel that the workload is getting heavier e.g. more reliance on a mechanical hoist lengthens the time taken to provide personal care to the resident. The capacity of the home should, therefore, be carefully considered before agreeing to admit more residents who have significant personal care needs. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 There are plans of care that are kept up to date and are detailed enough to be useful to staff in guiding them with the care they should provide to each resident. EVIDENCE: There is a care planning system for residents that addresses assessment, care planning and review. A sampled care record was well written with specific details. There was a record of the findings of regular evaluations of the plan. Various examples of risk assessment were seen e.g. manual handling, nutrition, and continence. A risk management plan had been written in response to a resident’s tendency to wander. The resident’s daughter had made a written contribution to this piece of work. A care assistant had read the care plans and found them very helpful, especially after a period away from work during which residents’ needs may have changed. A community psychiatric nurse supported staff with a behaviour assessment and there was a record of an activity assessment undertaken by an occupational therapist. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 11 A Senior Care Assistant was aware of the home’s medication policy and procedures. She had completed an accredited medication training course provided through a local college. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Residents are able to choose how they spend their days but there should be more thought to maintaining dedicated staff time for addressing social care programmes. EVIDENCE: A care assistant displayed awareness of the residents’ right to decide on their preferred form of address. The Provider supports staff in spending social time with residents. There had recently been bingo and quizzes at the home. The care assistant had been able to sit and chat with a resident group during the day of the inspection. One resident’s bath time had taken a little longer than usual because she appreciated the opportunity for one to one conversation with her carer. A diary of activities was seen in a care record. However, some staff were not completing the record at the end of their duty period so that there were gaps in the information available. It has not been possible to recruit a replacement activities organiser and the post has been vacant for some time. Perhaps existing staff could be offered some of these hours until the post is filled. At the last inspection residents felt that they are able to programme their days according to their wishes. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 13 A ‘record of food provided’ reflected thorough attention to residents’ needs and preferences e.g. attractive preparation of pureed food, alternative choices, and imaginative meals such as lasagne for the more adventurous residents. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a satisfactory complaints procedure and there is an example of appropriate action taken when a complaint is made. EVIDENCE: There is a complaints procedure available at the home. The Commission has received one anonymous complaint about the service since the last inspection. The Provider was asked by the Commission to investigate the issues. This was done and the additional information arising from the Provider’s investigation, which was shared with the Commission, confirmed the complaint had been fully addressed and was unsubstantiated. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 23 The premises are generally well maintained. Not all bedrooms are spacious enough to comfortably accommodate residents with mobility difficulties but there are proposals to extend and improve the facilities in the near future. Staff need to be more careful in the way they store work equipment so that residents are safe and their dignity maintained. EVIDENCE: There are proposals to extend the premises in the near future. The work will include a passenger lift. The Care Manager designate has taken on the work of preparing future decoration programmes for the premises. There were examples of investment to improve the facilities since the last inspection e.g. redecoration, new carpeting throughout communal areas, new dining room tables and chairs. The refurbished bedroom of a resident admitted on the day of inspection was seen. The family of the resident had viewed the bedroom prior to admission and were happy with it. It was rather space limited for an occupant who relies Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 16 on a zimmer frame and a recommendation is made for the situation to be carefully monitored during the initial period of residence. The hairdresser was using one bedroom. This is a long-standing arrangement originally introduced with the permission of the residents occupying the room. However, it is not ideal and the proposed extension should include an alternative arrangement. A push button hot tap had been fitted in response to the disability of a specific resident. An unlocked sluice room contained cleaning materials. Although residents apparently don’t use the toilet in this room the Care Manager agreed to either remove the cleaning materials to a locked area or lock the sluice room. Staff are supplied with disposable gloves and aprons. These should be stored more discreetly so that they are not on view to residents and visitors. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 There are enough staff for the current residents but capacity to respond to any increase in the existing dependency levels needs to be carefully monitored. The staff are developing their skills through training opportunities. EVIDENCE: A duty rota showed that there are 3 care staff on duty during the day. One care assistant is on active duty during the night with a senior who sleeps in on call. The home usually employs an activities organiser but has been unable to recruit since the post became vacant. Staff comments about the adequacy of staffing levels did not provide a clear picture. Although there was reference to an increasing workload there was also reference to time available for chatting to residents. Time is taken out each day to provide morning and afternoon activities. This work will eventually undertaken by an activities co-ordinator once this post is filled. A sampled care plan indicated careful staff attention to the needs of the individual with regular monitoring of the plan. Staff are doing relevant training e.g. NVQ and health and safety. Two staff are currently working towards an NVQ level 3 award, and two more are working towards an NVQ level 2 award. A care assistant confirmed she had participated in a fire drill within the last twelve months. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 18 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): 31,37 and 38 The home is being run with regard to legislative requirements and good practice guidance although there are a few health and safety areas requiring attention. Arrangements to access records need clarification with the Care Manager designate. EVIDENCE: The Care Manager designate has applied for registration with the Commission. She has previous relevant experience and has almost completed the required qualification for registered managers. This standard has not been scored as her registration application had not yet been fully processed. The Provider visits the home most days. She was observed chatting to residents in a communal lounge on the day of inspection. The home is using an induction programme for new staff that is in line with national specifications. A copy was seen at the home. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 19 Staff files and records of recent health and safety audits were locked in an upstairs office. The Care Manager believed she was unable to access them at the time of the inspection. The Provider feels that the Care Manager does have access. This should be clarified to avoid future misunderstandings. Accident records were being stored in compliance with Data Protection legislation. Other records seen during the inspection were well organised and properly completed. The Commission is receiving reports of notifiable events. There were examples of attention to overall health and safety of the service e.g. liquid soaps and paper towels, warning notices above hot water outlets at washbasins. A care record contained a risk management plan for a resident who wandered. There is a programme of health and safety training for staff although first aid training had recently been postponed due to staff shortages and manual handling refresher training was due to be arranged. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 20 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 2 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x 2 2 Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 21 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. 1 Standard OP2 Regulation 5 (b) and (c) 23 (2) f. Requirement The Commission must receive confirmation that every resident has a signed and dated contract/residential agreement. Records of pre-admission assessment must address the suitability of the bedroom if potential residents have restricted mobility. The practice of using a resident’s bedroom for hairdressing must be formalised, with evidence of the resident’s consent to this arrangement. The arrangements for storing statutory records must be reviewed to ensure they are available for inspection by the Commission. Cleaning materials must be kept in a locked area of the home. The Commission must be supplied with details of arrangements to provide manual handling refresher training and first aid instruction. To include dates, trainer details and names of staff involved. Timescale for action 31/10/05 2 OP23 31/10/05 3 OP24 23 (2) e. 31/10/05 4 OP37 17 (3) b 31/10/05 5 6 OP38 OP38 13 (4) a 13 (4) and (5) 20/10/05 31/10/05 Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 22 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 OP4 OP19 Good Practice Recommendations The Care Manager designate should consult all staff about current workloads, and their perceived capacity to respond to future residents’ needs. Disposable gloves and aprons should be stored discreetly out of sight in order to maintain the residents’ dignity and homely appearance of the accommodation. Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Whitegates DS0000024748.V253182.R01.S.doc Version 5.0 Page 24 - 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. 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