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Inspection on 05/09/05 for Whitehall Lodge Care Home

Also see our care home review for Whitehall Lodge Care Home for more information

This inspection was carried out on 5th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The registered person is also the registered manager and has constant involvement with the home. The home is well maintained and is fit for purpose. All three residents` living at the home have lived there for some time and have developed good relationships. The staff spoken to appeared to be keen and committed to providing a good standard of care to the residents`. One staff member stated " I enjoy working at the home". One resident spoken to commented " The staff are good". There was good communication and interaction observed between residents` and staff. Staff were heard giving residents` choices of food at breakfast time. Overall, records seen were of a good standard.

What has improved since the last inspection?

Information in respect of substances which may be hazardous to health has been obtained. The rear garden looks better tended.

What the care home could do better:

Fine tuning of care plans for one resident must be addressed. Information in respect of residents` last wishes must be determined and documented. Quality assurance and monitoring processes must be fully implemented.

CARE HOME ADULTS 18-65 Whitehall Lodge Care Home 109 Whitehall Road Greets Green West Bromwich West Midlands. B70 OHG Lead Inspector C athy Moore Unannounced 5 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Whitehall Lodge Care Home Address 109 Whitehall Road Greets Green West Bromwich West Midlands. B70 OHG 07773 327464 0121 353 6067 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) Mr P. K. Gunputh Mr. P. K. Gunputh Care Home 3 Category(ies) of MD Mental Disorder (3) registration, with number of places Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Nil Date of last inspection 29.11.05 Brief Description of the Service: Whitehall Lodge is located in a residential area of Greets Green, West Bromwich. The home is registered to provide care to a maximum of three residents at any one time who have a mental health diagnosis. The home is in a fortunate location, as it has a number of local amenities and facilities. There is a shop nearby and a park nearly opposite. The home itself is a traditional style semi-detached property. It has gardens at the rear and car parking at the front. The home is well maintained, comfortable and clean. Bedrooms are all single occupancy. There is an office and bathroom on the first floor, the lounge/dining area on the ground floor. The ground floor houses the homes kitchen and laundry. A toilet is located outside of the kitchen and a conservatory is available for residents which is located to the rear of the property. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector on one day between 07.30 and 11.40 hours. The inspection was the first of the home’s two routine statutory inspections for this inspection year. Three residents’ are accommodated at the home. Records pertaining to all three residents’ were randomly perused to include care plan and review and daily entry records. All three residents’ were spoken to, one in more depth than the others. The premises were partially assessed to include the kitchen, laundry, communal rooms and the bathroom. Complaints records and procedures were assessed. Records pertaining to health and safety and maintenance were perused. Two staff files were scrutinised. Two staff members were spoken to. What the service does well: The registered person is also the registered manager and has constant involvement with the home. The home is well maintained and is fit for purpose. All three residents’ living at the home have lived there for some time and have developed good relationships. The staff spoken to appeared to be keen and committed to providing a good standard of care to the residents’. One staff member stated “ I enjoy working at the home”. One resident spoken to commented “ The staff are good”. There was good communication and interaction observed between residents’ and staff. Staff were heard giving residents’ choices of food at breakfast time. Overall, records seen were of a good standard. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 6 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. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Nil No standards in this section were assessed as there have been no new admissions ,due to full occupancy, for a number of years. EVIDENCE: Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Fine tuning of one resident’s care plan must be addressed to give specific instruction on appropriate dietary advice. Otherwise, care plans are generally of a good standard. Residents’ are very much encouraged to make decisions about their lives. Residents’ are supported to take risks as part of an independent lifestyle. EVIDENCE: Care plans in general were seen to be of a fairly good quality in terms of content and presentation. There was evidence of resident participation in the care planning process. There were no specific instructions in respect of dietary requirements for one resident who is over weight and has a tendency to high cholesterol. There was ample evidence available to demonstrate that residents are encouraged to make decisions about there lives in respect of all areas examples being; recreation, social lives, education and stimulation. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 10 All residents’ are encouraged to be independent in all aspects. They at times attend doctors appointments, go out and shop independently , visit relatives and get themselves to and from different venues for example their day centres. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,15,17 Residents’ all have and take advantage of the opportunities offered for personal development. Residents’ choose and are in control of their activity provision. All residents’ access the local community on a regular basis, frequently on an independent basis. Residents’ are encouraged to maintain friendships and contact with their family. Residents are encouraged to eat healthily. They are however, fairly independent and make their own choices in respect of food consumption. EVIDENCE: Residents’ all have and take advantage of the opportunities offered for personal development. All of the residents’ attend day centre facilities at least three times per week. One resident has been undertaking a photography course she commented, “I really enjoy the course”. She is soon to enrol on a computer skills course. All residents’ choose their own recreational activities and engage in these regularly on an independent basis. All residents’ access local community facilities and amenities either as a group or on an independent basis, examples being shopping, eating out or going to the library. All residents’ have regular contact with their family. One said “ I go to Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 12 the pub with my daughter every Friday. I may be going to Ireland on holiday soon with my family”. Another resident regularly visits her son and daughterin-law and sometimes stays overnight at their house. Residents are encouraged to eat healthily. They are however, fairly independent and make their own choices in respect of food consumption. There was evidence to demonstrate that food consumed by each resident on a daily basis is recorded. Residents’ are involved in the menu planning at the beginning of each week, food shopping and sometimes food preparation. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,21 Residents’ receive personal support in the way they prefer and require. The wishes and choices of each resident in respect of death and dying requires attention. EVIDENCE: All residents’ living at the home can attend to their own personal hygiene and personal care needs with encouragement or prompting from staff. One resident was heard telling staff that she wanted a shower. This was attended to by staff giving minimal supervision. There was no evidence available to demonstrate that the last wishes of each resident have been explored and determined. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The home has a robust complaints procedure and documentation available to receive a complaint. EVIDENCE: The home’s complaints procedure has been revised. A copy was seen available in the lounge area. The print of the complaints procedure was seen to be slightly larger than average print. The complaints procedure is robust with accompanying documentation for logging any complaints. The home has not however, had any complaints for some considerable time. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 Residents’ live in a homely, comfortable and safe environment. The home is clean and hygienic. EVIDENCE: Areas of the home viewed, the lounge come ding area, conservatory and kitchen were seen to be well maintained . Theses areas were seen to be comfortable and homely. The conservatory area is used as a smoking area as all residents’ presently accommodated smoke cigarettes. The laundry contains a domestic washing machine and dryer. There is no need at the present time for sluice facilities. Residents’ clothes are all laundered separately. There is no sink in the laundry but one close by the laundry door. Liquid soap and paper towels were available in the bathroom, kitchen and toilet. There was evidence of cleaning schedules which are signed by the staff when completing cleaning tasks. Staff have not to date received infection control training. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Nil These standards were not assessed during this inspection. EVIDENCE: Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 Processes regarding quality assurance and quality monitoring at the present time are lacking. The home ensures the health, safety and welfare of the residents’. EVIDENCE: The home has purchased a quality assurance / monitoring system which to date has not been fully implemented. Maintenance records in respect of fire fighting and other records were assessed and were seen to be in order. Staff training in general was assessed as being up to date. Two new staff require certain training which has either been arranged or is being arranged. The homes fire risk assessment has been reviewed regularly. There was lack of evidence to demonstrate that staff are reading this document after each review. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 18 The kitchen was assessed as being clean and orderly. Records were available to demonstrate cleaning schedules are in place and are being adhered to. There was evidence of fridge , freezer temperature monitoring. Fly screens are not provided at the windows, this issue must be discussed with Sandwell Environmental Health Department. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Whitehall Lodge Care Home Score 3 x x 2 Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 20 Yes 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 YA6 Regulation 15(1) Requirement The registered person/ manager must expand information on A.T care plan in relation to food and dietary advice on weight reduction. The registered person/manager must determine in respect of each resident their last wishes (funeral arrangements etc). The registered person/manager must ensure that all staff receive infection control training. The registered person/manager must identify an appropriate quality assurance programme, preferrably one that is professionally recognised to implement within the home. Timescale of 12.2.05 not met. Timescale for action 20.09.05 2. YA21 12(4)(b) 01.11.05 3. 4. YA30 YA39 13(3) 24 01.12.05 1.11.05 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 YA42 Good Practice Recommendations The registered person/ manager should seek advice from E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 21 Whitehall Lodge Care Home 2. YA42 Sandwell Environmental Health Department to determine if the kitchen windows require the installation of fly screens. The registered person should ensure that staff re-read and sign the homes fire risk assessment each time it is revised. Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection West Point Mucklow Office Park Mucklow Hill Halesowen. B62 8DA 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 Whitehall Lodge Care Home E55 S30498 Whitehall Lodge V246995 050905 Stage 4.doc Version 1.40 Page 23 - 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!