Inspection on 17/05/05 for Whitehaven

This inspection was carried out on 17th May 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 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

Whitehaven 21/08/07

Whitehaven 15/12/06

Whitehaven 16/05/06

Whitehaven 05/11/05

Whitehaven 18/10/04

Whitehaven 27/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Whitehaven 43 Summerley Lane, Felpham Bognor Regis West Sussex PO22 7HY Lead Inspector Jo Hartley Announced 17 May 2005, 10:00 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. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Whitehaven Address 43 Summerley Lane, Felpham, Bognor Regis, West Sussex, PO22 7HY 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) 01243 587222 Allied Care (Mental Health) Ltd Care Home (CRH) 14 Category(ies) of Learning disability (LD), (14) registration, with number Learning disability over 65 years of age of places (LD(E)),(1) Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Learning Disability aged 18-65 years (LD) 2 One service user in the category Learning Disability LD (E), over 65 of age may be accommodated 3 Only service users aged 18-65 may be admitted Date of last inspection 18 October 2004 Brief Description of the Service: Whitehaven is registered to provide care for up to fourteen people who have a learning disability. The additional conditions of registration are that one named person in the service user category Mental Disorder (MD) under the age of sixty-five may be accommodated and one service user in the category Learning Disability (LD), over the age of sixty-five years may be accommodated. Only service users aged eighteen to sixty-five may be admitted. Whitehaven is a detached, two storey building in a residential road in the village of Felpham. There are thirteen rooms with hand-basins, one bathroom and one shower room. There are two adjoining communal rooms, one of which is used as a dining room. There is a separate room that is accessed via the patio area and is used for activities and staff training. Whitehaven is a non-smoking house. There is a car park at the front of the building and a garden for the use of service users at the back of the building. Allied Care (Mental Health) Ltd own Whitehaven. The responsible individual for the company is Mr Aslam Dahya. There is a manager designate who is responsible for the day-to-day running of the home. The manager designate will be submitting an application to become the registered manager. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was carried out over a period of six hours. The inspector read information held on the service file since the last inspection in October 2004, and read the previous two inspection reports. Comment cards were sent out but none were returned. During the inspection the inspector spoke to four service users, four members of staff and one visitor to the home. Two members of staff were interviewed formally. The inspector undertook a tour of the premises and looked at four care plans and four staff files. Various record books, policies and procedures were also examined. What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments need to be reviewed on a more regular basis, and the information recorded on service user files. Pre-admission assessments need to be kept on file. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 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 Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 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) 2, 3, 4 Prospective service users’ needs are assessed prior to admission, however this information needs to be kept on service users’ files. Service users have access to specialist services and staff have the skills and training required to meet the individual needs of service users. Prospective service users have the opportunity to visit the home on several occasions before they make a decision to move there. Whitehaven does not accept emergency admissions. EVIDENCE: There is evidence on service users files of pre placement assessments from the placing authority. The deputy manager reported that prospective service users’ are assessed by the home prior to admission; there was evidence of this on some service users’ files, but not on others. Pre admission assessments should be kept on file. All files contained an individual service user plan. Case records seen showed that residents have access to specialist services when they are required. Observation of staff working with residents, training records and discussion with staff showed that the staff employed at Whitehaven have the knowledge and skills required to meet the needs of service users. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 9 Whitehaven’s admissions policy and evidence from service users’ files showed that prospective service users are given the opportunity to visit the home on several occasions before they move in. This takes the form of an afternoon visit, an overnight stay, a weekend stay and a week long visit. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 10 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, 8, 9 Service users’ are involved as much as possible, considering their needs, in developing their individual plans and aspects of life in the home. There are suitable risk assessment and risk management strategies in place that enable service users to take responsible risks. Each service user has a named keyworker who can advocate on their behalf. Care plans are reviewed annually with social services. The home needs to ensure that internal reviews are recorded and dated. Risk assessment should also be monitored and reviewed regularly. EVIDENCE: Care plans looked at during the inspection showed that personal and social support and healthcare needs had been assessed using information gathered prior to admission. Photographs of service users were included in the files, as were individual personal histories. Personal goals and ways to achieve them were clearly set out. Any limitations to service users’ choice are recorded in care plans and risk assessments with reasons clearly stated. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 11 The files showed that yearly reviews are undertaken with social services. Staff spoken to said that the changing needs of service users are discussed at regular team meetings. This needs to be documented within the individual care plans and dated. Thorough risk assessments were seen for all service users. These are kept in a separate file from the individual care plans, consideration should be given to include them within the care plans. There was no evidence of risk assessments being regularly monitored and reviewed. Risk assessments should be dated, signed and updated regularly. The new manager is aware of these issues and said that she plans to introduce regular reviews of care plans and risk assessments. This will be aided by a new system for individual care planning called the “Cared For System”, which they are in the process of introducing. At present the home does not hold residents meetings. The new manager said she is going to introduce them to enable service users to have more input into the running of the home and to air their views. Staff said that service users talk to their keyworkers about things that concern them and the keyworkers pass these things on to the management if they are not able to address them themselves. During the inspection a service user was seen to discuss some problems he was having with the manager. Several bedrooms have recently been decorated and a service user reported that he was able to choose the colours himself. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 12 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, 14, 16 Service users are given opportunities for personal development and to take part in appropriate activities. They are encouraged to be part of the local community. Service users rights are respected by staff within the home. EVIDENCE: On the day of the inspection several service users were away from the home taking part in courses at a local college. Care plans and discussions with staff showed that nine out of the thirteen residents attend college throughout the week. Courses attended by residents include cookery, independent living skills and animal care. One service user is doing a City and Guilds course in bricklaying. The home also has an outreach activities co-ordinator who visits the home twice a week. He organises various activities including gardening, cooking and arts and crafts. Residents spoken to said they enjoy taking part in these activities and look forward to the days when they are on. The manager reported that service users have recently joined a local leisure centre and are taken there regularly to take part in various sports activities. Service users are supported in going to the local shops. A visitor to the home Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 13 said that her relative had been supported in attending church. The home has a mini bus and a car available to take residents out both in groups and individually. The home is currently making changes to the staff rota to enable more service users to be taken out during the evening. Staff said that service users were given the opportunity to vote in the recent election but none of them took the opportunity. Staff were seen interacting with service users, encouraging them and assisting them with activities and independent skills. It was seen that all bedrooms have locks on the doors and the doors are kept locked when service users are not in their rooms. Risk assessments and care plans state which service users have keys to their rooms, and give reasons if they don’t. A service user was seen using his own key to enter his room. There is a no smoking policy within the home. Service users who smoke are able to do so in a section of the garden. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 14 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, 19, 20 Service users are able to receive personal support in the way they prefer. Their physical and emotional needs are met by the staff in the home, and professionals outside the home. None of the service users administer their own medication. EVIDENCE: The care plans seen clearly stated service users preferences in the way they receive personal care. Individual health care needs were seen to be addressed in care plans, including access to outside professional services such as psychiatric support where required. Individual visits to healthcare professionals were seen to recorded in the case notes. The home runs a keyworker system, which helps to provide continuity of care for service users. Staff were seen providing personal care in private. The home runs a good, safe medication system. The certificate from the last pharmacy inspection, which was held on 15/02/05, was seen, the certificate had no recommendations. Staff training records showed that staff who administer medication have undertaken recognised training in the safe handling of medication. Medication was seen to be stored properly with up to Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 15 date MARS sheets and a photo of each resident to minimise the risk of medication being given to the wrong person. Controlled drugs are stored in a separate drugs cabinet, which meets relevant standards. Controlled drugs are recorded in a separate register, two members of staff sign when these are administered. The inspector was informed by the deputy manager that the home contacts NHS before giving homely medicines to service users to ensure that there are no contra-indications with prescribed medication. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 16 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) 23 The home has clear complaints and adult protection procedures and staff receive training in adult protection, which helps to protect service users from abuse, neglect ad self harm. EVIDENCE: Two members of staff spoken to said that they had received training on recognising abuse and adult protection. Certificates for attendance at these courses were seen on staff files. Staff were also aware of the home’s whistle blowing policy and said they would speak to the manager or deputy manger if they had any concerns about the safety of service users or the practice of their colleagues. A copy of the West Sussex policy for the Protection of Vulnerable Adults was seen in the office. Service users said they would speak to their keyworker or the manager if they had any complaints. During the inspection a service user was seen talking to the manager about concerns they had. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 17 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, 25, 30 Whitehaven provides a homely, comfortable, safe, clean and hygienic environment for service users to live in. Service users living space suits their needs and their bedrooms are personalised. EVIDENCE: On the day of the inspection Whitehaven was very clean and tidy. During the tour of the house it was seen that service users’ bedrooms were comfortable and personalised with their own belongings. Communal space includes a dining room, lounge and an activities room that is also used for staff training. The radiators were seen to have guards on them and the hot water system has a temperature control valve. The windows have restricted opening. Whitehaven had an Environmental Health Inspection on 24th March 2005. The inspection found that temperature records for the fridge/ freezer were incorrect, and that the kitchen was dirty at the time of the Environmental Health inspection. It was noted that the management have now set up a cleaning rota and have sent staff on a food and Hygiene course. On the day of this inspection the kitchen was found to be clean. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 18 A yearly maintenance plan for decorating and ongoing work was seen during the inspection. Other maintenance is done as it needs doing. The home has it’s own full time maintenance man who was able to show the yearly plan and the day-to-day maintenance book. Whitehaven has an enclosed back garden, which is neat and tidy. It was noted that a new higher fence has been erected between the property and a neighbour’s garden. There is also a vegetable patch that the residents have created as part of their outreach activities. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 19 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) 35 Whitehaven provide training for staff that enables them to meet the needs of the service users. EVIDENCE: Staff files that were seen showed that most staff have received induction training and have attended courses including Health and Safety, Food Hygiene, Adult Protection, First Aid, and Manual Handling. The deputy manager has an NVQ4 and Registered Managers Award. The manager is currently doing her NVQ4. Some staff have nursing qualifications from abroad. The manager said and staff confirmed that Whitehaven provide English language classes once a week for staff for whom English is not their first language. Staff records showed that staff are receiving supervision approximately every six weeks, and appraisals on a yearly basis. Staff informed the inspector that a counsellor visits the home once a week to give support to staff. The counsellor is also available at other times if needed. Staff spoken to said they find this very useful and appreciate the support it gives them. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 20 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) 42 Whitehaven provides an environment for service users that promotes the health, safety and welfare of service users. To protect the health and safety of service users risk assessments and care plans should be reviewed on a regular basis. EVIDENCE: The inspector saw training certificates for staff attendance on various health and safety courses including fire training, manual handling, First Aid, Food Hygiene and Adult Protection. Comprehensive policies were seen regarding health and safety and adult protection. Service user files show that individual risk assessments have been carried out. Some risk assessments seen had not been reviewed recently. The new manager said that she will be reviewing all care plans and risk assessments in the near future. It is suggested that all risk assessments have review dates on Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 21 them, and are reviewed regularly throughout the year. Staff said that the progress, concerns and health of service users are discussed at team meetings and at the handover over each morning. Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Whitehaven Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 23 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 6 Regulation 15 Requirement Care plans and risk assessments need to be reviewed on a regular basis, and the information recorded on service user files. Ensure pre admission assessments are carried out and kept in the service user file. See Schedule 3 of Care Homes For Adults (18-65) Regulations. Timescale for action 01/09/05 2. 2 14 01/09/05 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 Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 2nd Floor, Ridgeworth House, Liverpool Gardens Worthing Wst Sussex BN11 1RY 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 Whitehaven H60-H11 S48443 Whitehaven V220502 170505 Stage 4.doc Version 1.20 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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