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Inspection on 12/09/05 for Whitegates Private Nursing Home

Also see our care home review for Whitegates Private Nursing Home for more information

This inspection was carried out on 12th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff were friendly and were observed to be dealing with residents in a courteous manner. The home was clean and tidy. Residents stated that they liked their home and felt they were looked after properly.

What has improved since the last inspection?

The deputy manager has successfully completed level 4 NVQ management. The home was meeting most of their national minimum standards for older persons during this inspection but there were a few shortfalls since the last inspection as stated in the next section.

What the care home could do better:

These issues raised concerns during this inspection and requirements have been made as a result to rectify them: 1. The returns of unused medication procedure had not been amended, as the home should no longer return medication to the supplying chemist. Instead a contractor should have been contacted to provide the appropriate container in line with the changes in regulations that affected nursing homes.2. There were serious concerns regarding the employment of new staff and the regulations were not followed to ensure their fitness prior to starting work in the home. 3. It was apparent that staff who are involved in the recruitment of staff needed more guidance and training to ensure they knew the procedures and the legislations that governed employment of staff.

CARE HOMES FOR OLDER PEOPLE Whitegates Private Nursing Home Condor Road Laleham Staines Middlesex TW18 1UG Lead Inspector Kathy Martin Unannounced 12 September 2005 10:00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Whitegates Private Nursing Home Address Condor Road, Laleham, Staines, Middlesex, TW18 1UG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01784 441287 Whitegates Private Nursing Home Ltd Elizabeth Mendelssohn CRH N 38 Category(ies) of OP - Old Age - 38 registration, with number of places Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: In the case of this service residents may be admitted from the age of 60 years. Date of last inspection 16th June 2005 Brief Description of the Service: Whitegates is a privately owned nursing home which provides care for 38 residents with old age and situated in Laleham near Staines. It is well appointed to the major main routes by car. The river is within walking distance from the home. The home employs nursing and care staff and have internal catering. The home has ample car parking facilities and also have a garden which is accessible. The bedrooms are arranged over two floors which can be accessed by a lift. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection carried out by the CSCI this year. The inspection was unannounced meaning that nobody was aware that an inspection would take place that day. All the key national minimum standards for older people have now been assessed this year. The visit commenced at 10:00am when a lot of the residents were up and about in the various areas of the home. Several were having coffee and some were in their bedrooms receiving personal care. The inspector spoke to some residents and their feedback was that they felt well cared for and had their comfort in the home. The interactions between staff and residents were observed as being friendly and respectful. The home was running in an efficient manner during the inspection. The manager was on leave and the deputy was in charge and was present throughout the inspection. The inspector also had discussions with the Business manager who takes responsibility for the administration of the home working alongside the manager. The inspector looked at records, talked to the staff and residents and also toured the premises. The inspector wishes to thank the deputy, the staff and residents for their assistance on the day. What the service does well: What has improved since the last inspection? What they could do better: These issues raised concerns during this inspection and requirements have been made as a result to rectify them: 1. The returns of unused medication procedure had not been amended, as the home should no longer return medication to the supplying chemist. Instead a contractor should have been contacted to provide the appropriate container in line with the changes in regulations that affected nursing homes. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 6 2. There were serious concerns regarding the employment of new staff and the regulations were not followed to ensure their fitness prior to starting work in the home. 3. It was apparent that staff who are involved in the recruitment of staff needed more guidance and training to ensure they knew the procedures and the legislations that governed employment of staff. 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 Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 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 standard(s) This section was assessed during the last inspection. The inspector was advised that the comments made in the report of June 16th remained current. EVIDENCE: Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 and 10 The medication management procedures needed updating to reflect the changes in the law. The returns of medication were not in accordance with these regulations and needed immediate rectifying. Residents were observed being treated with respect and there was evidence that the home promoted their rights. EVIDENCE: Standard 9: The inspector looked at the medication procedures and inspected the storage of medication. The returns of unused medication procedure had not been amended, as the home should no longer return medication to the supplying chemist. Instead a contractor should have been contacted to provide the appropriate container in line with the changes in regulations that affected nursing homes. The inspector acknowledged that the recent changes had not been notified to Whitegates at the same time of the other registered nursing homes a couple of months ago. Therefore the home was unable to take reasonable steps to ensure the medication returns were managed differently. The home was given an immediate requirement to take action to rectify this. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 10 The storage of medication in use was well managed and the room was clean and tidy. The controlled drugs were appropriately stored and monitored. The registered nurses were the only ones responsible for medication management. The medication administration charts were signed appropriately with no unexplained gaps. Staff received regular updates in medication management and also have to adhere to their own NMC (Nursing and Midwifery Council) code of conduct and guidance regarding medication. Standard 10: The home statement of purpose and service users’ guide both make reference to how residents’ privacy and rights were upheld. Staff received induction, which covered these. The deputy manager explained that she worked with all the new staff with the assistance of the registered nurses for at least 4 to 5 shifts to observe and monitor practice. Any practice issues observed are then rectified on the spot. All bedrooms are for single accommodation, which provides privacy. There is also practical assistance to promote privacy in the home. For example, there is a small lounge on the first floor, which can be used by residents receiving guests. Residents’ guests/ relatives can also book a room for holding private parties, meetings and birthday celebrations. Residents told the inspector that they felt cared for and were able to express themselves freely, were able to partake in the group activities or stay in their bedrooms without pressure to mix with others. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 and 15 The home was able to evidence that they promoted choice for residents in all possible ways and encouraged residents’ autonomy over their lives by its ethos. The arrangements for catering were regarded as excellent. EVIDENCE: Standard 14: Most of the residents in Whitegates were able to voice their opinion and make informed choices. Those who needed more help were offered assistance from relatives, visitors and staff. They were able to indicate when they liked to get up, go to bed, what to eat and when to go out, use the bathroom, wear their own clothing and have a key to their bedrooms. Several residents had a television or a radio in their bedrooms. They were able to bring in limited personal articles (plants, cushions, small pieces of furniture, own bedding and flowers) to personalise their bedrooms. The staff worked closely with the residents. The home has been able to maintain a reasonably stable staff group who are able to understand the residents better and there is continuity of care. Those who are able to go out do so. Visiting hours are flexible. Residents could order daily newspapers that were delivered to the home. The activities organiser worked very closely with the residents in establishing their likes and dislikes Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 12 when planning one to one and group activity and encouraged them to pursue their interests. Standard 15: The catering department consisted of a head chef, one part time chef and kitchen assistants. All the catering arrangements were in house. Menus were planned on a two weekly basis and orders/ preferences obtained one day in advance. The menu inspected suggested that the meals were varied and nutritious. The staff were able to seek advice from a dietician. Residents were weighed on admission and their nutrition monitored. There is a full breakfast (cooked breakfast and cereals/ toasts), which residents can eat in their bedrooms or in the dining areas. The main meals offered a choice of 3 dishes and desserts. The evening meals are usually a lighter option such as omelette, soup (every evening) and sandwiches. Snacks and beverages are available at any time during day and night. There are several tea/ coffee rounds during the day. The residents are also able to receive guests to share a meal. The kitchen provides a special cake for each birthday, which is personalised. This is a very good touch and residents did comment on this as something very enjoyable. The residents also stated that the food was “lovely” and “excellent”. Staff were observed helping residents in the dining areas on the day and preparing to assist the ones who needed help. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 This section was inspected at the last inspection and there had been no changes in the procedures. However the home’s recruitment procedures were breached and newly employed staff did not have clear CRB, applied from the home, prior to commencing work with vulnerable adults. EVIDENCE: The home was not dealing with any recent complaints and logged all complaints received appropriately. The staff also referred appropriately under the POVA (Protection of Vulnerable Adults) procedures. During this inspection, there were two staff members who had been recently recruited and had commenced work in the home before a clear CRB and POVA check were obtained. The home cannot accept CRBs obtained from previous employers. Their files did not contain references from their previous employers. The home did request these. The registered persons were reminded to ensure their recruitment procedures were tightened as a matter of urgency and to ensure their fitness checks were in line with regulations. Two requirements were made as a result. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This section was assessed during the inspection in June 2005. Please refer to this report for additional information. The inspector was advised that the comments made then remained current. EVIDENCE: Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The home employed sufficient staff who worked to cover a 24-hour roster. The recruitment practices were not good and left vital gaps in the documentation that should have been obtained ahead of new staff commencing work in the home. EVIDENCE: Standard 27: The rota inspected provided evidence that the home employed sufficient numbers of staff including registered nurses and ancillary staff. There has been little care staff movement, which ensured a stable core team of staff. However there have been changes in the registered nurses since the last inspection. 1.5 registered nurses have left and one was about to leave a month following the inspection. These were planned. The home recruited 2.5 registered nurses who had started work. Standard 28 and 29: The staff files were sampled during the inspection. There were serious concerns regarding the employment of new staff and the regulations were not followed to ensure their fitness prior to starting work in the home. Evidence of this included: the CRB (Criminal Records Bureau) checks and POVA checks had not been conducted beforehand. Additionally, references had not been obtained although these were requested by the home. The home was not able to evidence that they checked any gaps in the employment history on the application forms. There were no interview notes on file. The inspector was Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 16 advised that is was not the practice of those involved in recruiting staff to take interview notes. The home used the services of an employment agency for two recent staff employment. A requirement was made for the home to take reasonable steps to ensure that staff they employed were appropriately checked prior to them commencing work. It was apparent that staff currently involved in the recruitment of staff needed more guidance and training to ensure they knew the procedures and the legislation that governed employment of staff in regard to their fitness. A requirement was made for the home to provide this important training. The checklist for new staff was inspected and found to lack vital details that should otherwise provide information that robust checks were undertaken. It is imperative that the home revised its recruitment practices. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The home was running well for the exception of their recruitment practices that were not adequate. There are no changes in the health and safety procedures. EVIDENCE: Standard 33 There is practical help available to encourage residents to talk to staff and give feedback to the staff about their homes. The manager, deputy and the owner are in close contact with the residents and are able to receive direct feedback themselves regularly. Relatives are encouraged to talk to the staff and voice their opinions and suggestions. The home offers a homely atmosphere and staff were friendly. The feedback given to the inspector from residents themselves indicated that they felt secure and their needs were met. They felt that the management of the home was encouraging and they felt reassured that they were able to contribute to the way it was run. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 18 During the inspection there were serious concerns regarding the employment of new staff and the regulations were not followed to ensure their fitness prior to starting work in the home which then ensures that staff who worked there were appropriately checked before commencing work. Two requirements have been made under Standard 29 for the registered persons to rectify and ensure the protection of all concerned. Standard 38 There were no health and safety issues raised or observed during this inspection. Staff received appropriate training in this field and the home reported any untoward incidents via their regulation 37 notices to the CSCI. Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 4 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 2 x x x x 3 Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 (2) Requirement The home must change the procedure for returns of unused medication as per the new legislation The Registered persons must not employ staff unless s/he has obtained relevant information in relation to their fitness including a clear CRB For the registered manager/ or those involved in staff recruitment to obtain up to date training in staff recruitment in line with regulations Timescale for action 12/09/05 2. 18, 28, 29, 33 19 12/09/05 3. 18, 28, 29, 33 10 (1) (2) (3) and 18 (1) (c) 04/12/05 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 Good Practice Recommendations Whitegates Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Private Nursing Home h09-h58 s17651 Whitegates v241187 120905 stage 4.doc Version 1.40 Page 22 - 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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