Inspection on 16/05/07 for Whitehaven Lodge

This inspection was carried out on 16th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Whitehaven Lodge 15/05/09

Whitehaven Lodge 15/05/08

Whitehaven Lodge 20/11/06

Whitehaven Lodge 18/05/06

Whitehaven Lodge 16/02/06

Whitehaven Lodge 22/09/05

Whitehaven Lodge 03/02/05

Whitehaven Lodge 01/06/04

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

CARE HOMES FOR OLDER PEOPLE Whitehaven Lodge Buttermere Close Maybush Southampton Hampshire SO16 9JR Lead Inspector Tim Inkson Unannounced Inspection 16th May 2007 09:30 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 Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitehaven Lodge Address Buttermere Close Maybush Southampton Hampshire SO16 9JR 023 8078 4839 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) Southampton City Council Mrs Lorraine Tew Care Home 55 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (55) of places Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of eight service users in the category DE(E) may be accommodated at any one time. Three service users in the DE category may be accommodated between 60 and 64 years of age. 20th November 2006 Date of last inspection Brief Description of the Service: Whitehaven Lodge is a large purpose built residential home providing care and support to 55 elderly persons, some who are frail and have dementia relating to their old age. The home is located in Millbrook, the west of Southampton, approximately 2 ½ miles from the city centre and is managed by Southampton City Council. The building is laid out over two floors with a passenger lift access to the first floor. It was built in 1981. Recent renovations to the home now allow residents to be accommodated in single rooms. Bedrooms are arranged in 6 separate living units. On the ground floor there is one large dining room and four smaller lounges, one of these is a smoking lounge. There are 3 separate unit-living facilities available on the first floor, each with its own kitchen and dining facilities should residents wish to prepare drinks or snacks and retain or regain their independent living skills. The home has a pleasant garden, which incorporates a raised sensory flowerbed and a lawn. Garden furniture and a handrail enable residents to enjoy the garden to the full, particularly during the warmer months. The home also has its own shop, which is open twice a week, and on request from residents, however residents when staffing levels allow are supported to go out to the local shops if they wish. There is a library area, an arts and hobbies room and hairdressing facilities. People wishing to live in the home are given written information about the service that it provides and copies of reports of inspection made of the home by the Commission for Social care Inspection are readily accessible and on display in the building. At the time of a site visit to the home on 16th May 2007, the cost of living at Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 5 the home ranged from £382 - £447 a week. The cost of a short stay is £194 a week. The fees do not include the cost of chiropody, hairdressing, toiletries and newspapers. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 16th May 2007, starting at 08:55 and finishing at 17:50 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 38 people and of these 12 were male and 26 were female and their ages ranged from 72 to 101 years. One resident was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. People living in the home were canvassed using questionnaires before the site visit took place and their responses (26) were taken into consideration when producing this report. Other matters that influenced this report included: • An Annual Quality Assurance Assessment completed by the home’s registered manager before the site visit took place providing some detail about the way the home operates. • Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 30th October 2006, such as statutory notices received about incidents/accidents that had occurred. What the service does well: Records were in place that gave staff information that enabled them to provide the help that people in the home needed. Individuals felt safe and secure and happy that staff could look after them properly and treated them with respect. The home’s routines were flexible and it promoted among other things, equality and diversity and the right of people living in the home to make choices, exercise personal autonomy and influence through regular meetings day-to-day life in the home. Positive relationships had been established with health care professionals who had confidence in the ability of the staff and home to look after the people living there. People living in the home were positive about the food that the home provided and were pleased with the range of activities in which they could participate and the condition of the accommodation that they occupied. Management systems and procedures in the home worked well including, dealing with complaints, quality monitoring, and health and safety. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 7 Staff were recruited properly ensuring that the safety and welfare of people living in the home was given proper consideration. The home was equipped to promote safe working as well as encourage the independence of the people living there who may have disabilities. 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. The summary of this inspection report can be made available in other formats on request. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 8 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 Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The help that people needed was identified before they moved into the home to ensure that the level of support and care they required could be provided. EVIDENCE: The home had procedures in place for identifying the help that people who wished or who had to move into the home needed. These included visiting an individual wherever they were accommodated before they moved to the home. Also arranging for the person concerned to visit the home for a day to get some experience of life in the home and enable the home’s staff to ascertain the level and type of help that the person required. A sample of the records of 7 people living in the home was examined. For 6 of these the focus was on documentation concerned identifying the help and care that people needed. Everyone that moved into the home did so under care management arrangements. Consequently copies of care management assessments completed by staff employed by the local authority’s adults services department had been obtained by the home’s registered manager for the sample of records examined. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 10 It was apparent that the needs of everyone living in the home were identified before they moved in. There was documentary evidence that assessments of residents needs were reviewed regularly and usually revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of people living in the home was not always fully met because documents with information about the help individuals needed were not all up to date and some important information about things such as choices was not included in every care plan. Medication was not always managed safely and effectively on behalf of people living in the home because at weekends the number of staff giving it out was reduced and those responsible for doing so could as a consequence be distracted from their task. Staff working practice helped to ensure that residents’ privacy and dignity was promoted. EVIDENCE: Care plans were examined of the same sample of 7 residents as in the section above. At an inspection of the home on 21st November 2006 it was noted that care plans were being reviewed to ensure that they included more detail as well as specific and personalised instructions about how the help each individual required was to be provided. It was recognised at that time that more time Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 12 was needed to complete this work and it was apparent that on this occasion the work was still in progress. One of the home’s management team (a care co-ordinator) had the delegated responsibility for ensuring that the information in care plans were kept up to date and that they out clearly the actions staff had to take and what specialist equipment may be needed to provide the support and assistance each person required. The plans that were examined were generally person centred and based on the individual’s choices and preferences (e.g. getting up, bedtime drink, diet, name, gender of carer, etc). There was also evidence that the persons concerned and/or their representatives had been involved in developing and agreeing the contents of the plans. A number of potential risks to the welfare of the individuals concerned had been assessed and actions needed to control some of them had been included in care plans (see below). Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. mobility aid, food prepared in a certain way etc. Records indicated that care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled. Despite the progress that had been made with improving and updating care plans there were some weaknesses in the care plans examined. These matters were discussed with the home’s registered manager who indicated that they would be rectified without delay. They comprised the following: • One individual’s plan referred to the need for support and encouragement at mealtimes and maintaining a record of fluid and food that the person consumed. Care staff spoken to said that the records were not being kept because the person was “eating better”. It was however noted that the person left most of the first course of the main meal of the day and that recent daily notes concerning the person sometimes included a reference to how well they had eaten. Reviews of the care plan each month indicted there had been no change since the original plan was written and no formal record of the fluid and food eaten by the person was available. • A person’s access to cigarettes was restricted. This was explained: “ we feel they are at risk we look after their cigarettes”. There was a risk assessment concerned with the use of cigarettes in place but no control measures had been identified and included in the care plan and there was no evidence that this limitation or restriction on the individual’s right to access to their own property had been formally agreed. • A nationally recognised nutritional assessment tool had been used to indicate whether there was a potential risk of malnutrition to one individual in the records examined. The home referred to a nutritional Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 13 • assessment being used or every person but the document being used was for identifying people’s dietary preferences and likes and dislikes and was not a useful indicator of risk. It was suggested that a nationally recognised nutritional assessment tool be used routinely for all people living in the home. The preferred gender of the person providing care and assistance for an individual was not always noted in their care plan. All people living in the home that were spoken to during the site visit to the establishment on 16th May 2007 indicated that they were satisfied that the staff working in the home were able to provide the help and support that they required. Responses received from the people living in the home that were canvassed for their views indicated that 92 believed that they received the care and support that they needed either always or usually and 8 sometimes. Comments from residents about the abilities of staff the care and support that they provided included: • “They help me with anything that I want … The staff are very nice. The carers and officers are all very nice. They saved my life when I first came here”. • “It is very nice. I am well looked after”. • “The staff are alright, most of them seem to know whet they are doing. It is better if it is the young man that helps me he is good”. • “They are very good, I only have to ring the buzzer if I need anything”. • “They help me with bathing. They know what they are doing they seem competent”. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for people living in the home when it was necessary. Individuals spoken to said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. Equipment or products necessary for the health care of individuals (e.g. pressure relieving aids; continence products) were obtained through the community nursing service, although the home had also purchased some pressure relieving equipment of its own. Two visiting health care professionals were spoken to during the site visit and their comments about the home included: • “I have been coming here for about 15 years and over recent years things have improved. The last couple of years they have got more procedural about the way they do things and more professional … I can rely on the home to alert me if they are concerned about one of my patients and they are not shy about doing that … I would say that they are thoughtful and caring and they seem to treat people her with dignity”. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 14 • “I do ulcer dressings, catheter care and so on. The staff here are well able to manager day-to-day catheter care. They contact us if they have concerns and it is always appropriate, they don’t call us unnecessarily. The staff are very good, they know the needs of the residents very well”. The home had implemented a new policy and procedures about the management of medication. It included the following statements: • • The highest standards of hygiene must be used when giving medication. Rotas and cover arrangements must be arranged to ensure that staff with designated responsibility for prescribed medication are able to conduct their duties fully and with minimum distraction. The home used a monitored dosage system. A local pharmacist provided most prescribed medication every 28 days in blister packs for each person concerned. Other medicines that could not be put into blister packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. The only staff in the home that dispensed and were responsible for the management and administration of medication on a day-to-day basis were members of the management team (care co-ordinators and all had attended a 2 day relevant training course. Good practice noted during the fieldwork visit included: • Recording the temperature of the refrigerator used for storing some medication • Dating of containers of eye drops when they were opened • Some sedative medication was treated as if it was a controlled drug Although the home strongly promoted the independence of people living in the home and encouraged self-medication at the time of the fieldwork/site visit no individual was looking after all their own medicines. At the last key inspection of the home on 21st November 2006 it was noted that where medication had been prescribed for an individuals on an “as required” (PRN) basis the care plan did not always included instructions about the circumstances in which it was to be given. The record sampled on this occasion for a person requiring medication when required to reduce agitation and distress did include such instructions. It was apparent from the following evidence that the home was not fully complying with all the statements set out in its policies and procedures concerned with the management off medication referred to above. • At the last inspection a member of staff administering medication was observed popping medicine from the blister pack into her hand to give to a person. On this occasion similar behaviour was observed that undermined the high standard of hygiene expected. The registered DS0000039153.V336003.R01.S.doc Version 5.2 Page 15 Whitehaven Lodge manager was made aware and she stated that the matter would be followed up in supervision with the individual concerned. • At the last key inspection of the home on 21st November 2006 the previous inspection of the home was referred to when it had been noted when there was only one senior member of staff on duty at weekends the giving out of medication could be difficult. It was stated that it took up to two hours to do this at weekends. Senior staff had said that if an incident arose needing their attention at the same time as they were giving out medication they had to stop what they are doing and deal with the situation. On this occasion as at the last two inspections of the home the same concerns were expressed and the level of staffing had not improved. It was noted during this site visit that 2 care co-ordinators gave out medication with one working on each of the 2 floors each with a trolley used to convey the medicines to people living in the separate living units within the home. At the lat inspection the home’s registered manager agreed that staff cover was inadequate at weekends and she had said that she had raised this with senior management and a services manager has visited the home and observed the difficulties that staff faced. On this occasion she said that she believed that the organisation that owned the home i.e. Southampton City Council were addressing this staffing anomaly. The same level of staffing is necessary 7 days a week to ensure that medication can be managed safely and effectively at all times on behalf of the people living in the home. This is acknowledged in the home’s own policy and procedures referred to above. A requirement was made about this matter on 2 previous occasions and had not been met. It has been repeated as a result of this site visit and failure to comply may result in “the Commission” taking enforcement action. Most people living in the home were accommodated in singe rooms and they said they appreciated the privacy that these afforded and their ability to personalise them. • “If you want to make this place like home, you do what you want in you room and have who you want in your room”. • “My bedroom is comfortable and quiet and I am not disturbed when I am in it”. People living in the home that were spoken to during the site visit said that staff were friendly and polite and that they usually knocked before entering their rooms. This latter practice was observed during the fieldwork visit. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and generally according to the choices and preferences of those living in the home. EVIDENCE: Plans of care that were examined (see section above, “Health and Personal Care”) included details of the social and leisure interests and life style/personal preferences of the individuals concerned. The home organised a variety of social activities for people living in the home and there was a published programme of regular “events” that were organised on display in the home’s communal areas. These included bingo, cooking, sing along sessions, and church services. There was also evidence that individuals were supported to enjoy activities in the community including trips to local places of interest. On the evening of the day of the site visit a pyjama party with karaoke and bingo had been arranged and the day before a group of people had been out for a pub lunch. Several people spoken to said that they had recently enjoyed a riverboat trip. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 17 Responses from people living in the home who were canvassed for their views indicated that 70 thought that there was always activities arranged by the home that they could take part in, while 15 thought sometimes and 15 never. Individuals spoken to about the home’s routines indicated that they were flexible and that there were few restrictions with some minor exceptions. • “I have not heard that we have any rules here. I wake up and get dressed and come into the lounge here. If I don’t get up, one of the staff will come and ask me if I want to get up. I go to bed when I want and it is usually between 9 and 10 o’clock”. • “I go to the church services when they have them. We can do almost anything that we want, but I can’t go out on my own because I can’t walk”. The home held regular meetings for people living in the home in order to consult them about matters such as the food provided. Individuals spoken to indicated that they found it a useful and effective forum for effecting change and influencing life for them in the home. • “We have residents meetings and they are very helpful”. • “We have residents meetings and we talk about menus and activities and so on”. • “We have regular meetings and we can tell them what we think and what we want”. • “We have meetings every month when we can have a moan and if they can put it right they will. They are pretty good like that. A visiting relative was spoken to as well as several people in the home about arrangements for maintaining contact with families and friends. It was apparent that there were no restrictions and visitors to the home were made welcome at any time and the home communicated with individuals that were important to people living in the home. • “It seems fine. Mum seems very happy. She has not been well but they always phone us and let us know if there is a problem … There are no restrictions on visiting, I can come at any time”. There were pamphlets/leaflets in the entrance of the home with details about organisations that offered to provide advice, information and guidance that could be helpful to residents and their families. Residents were able to bring personal items into the home including furniture and several individuals had taken trouble to personalise their bedrooms (see also references to this in the section above “Heath and Personal Care”). Sensitive information that the home held about residents was kept secure and the home had written policies and procedures about maintaining confidentiality Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 18 and residents rights to access their personal files and case notes. One person spoken to said, “I know that I can see my records but I am not bothered”. Residents were generally complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. Discussion with people living in the home, menus and records of food provided indicated that the home’s food was nutritious and there was a range of meals provided with a selection of choices almost every day. Notified in advance of the choice of meals on most days people were able to choose from a choice of 2 alternatives. Individuals’ food preferences, dislikes and any food related allergies were recorded in their care plan documents and there was a copy kept in the kitchen. One of the home’s 2 cooks indicated that she had attended training in some specialist subjects concerning food preparation and diets e.g. diabetic and very aware of methods of increasing the nutritional and calorific content of meals. Comments from people living in the home about the food provided included the following: • “The food is very nice”. • “The food is good I suppose. You get a choice of things. We know beforehand what the meals are and there is plenty. You can have something in the evening if you ask for it, but I just have a biscuit”. • “The food is alright, I don’t eat a lot. There is normally a choice of 2 meals. They ask what we want the day before and on most days there is an alternative”. • “The food is pretty good. It is up to you if you don’t have enough, because if you don’t ask you don’t get”. • “They come and ask us what we want to eat the day before and sometimes we have a choice of 3 things” • “The food is pretty good. They come and ask us what we want for tea and also for lunch the next day”. Responses from people living in the home who were canvassed for their views indicated that 77 always liked the meals in the home and 12 usually, while 11 liked them sometimes. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of people living in the home and their relatives/representatives. Procedures that were in place to protect individuals from the risk of abuse need to be made more robust to ensure their rights are fully protected EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All people living in the home that were spoken to were confident about raising any concerns with the home’s manager and of 26 response received before the site visit took place 21 indicated that they knew how to make a complaint and 26 either always or usually knew who to speak to if they were not happy. The home kept records of complaints that detailed the matter and set out any agreed action to remedy it. There had been one complaint made to the home since the last inspection in November 2006 and it had been dealt with appropriately. The Commission for Social Care Inspection (CSCI) had received no complaints about the home during that time. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 20 Staff spoken to said that they received relevant training and this was confirmed when staff records were examined. Staff were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. The home’s registered manager had been proactive and reported a matter of concern to the local authority’s safeguarding adults co-ordinator. There was some discussion with her about ensuring that where the rights of individuals were constrained because of an identified risk this was formally recorded e.g. restricted access to cigarettes and lighter. This is to ensure that there is evidence that the decision making process was conducted professionally and rights of the person concerned are properly protected. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was safe and well maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was evidence from discussion with people living in the home and visitors that the premises was looked after and kept clean and some of the home’s furnishings had recently been replaced i.e. carpets in communal areas. • “My room is comfortable. They look after the building and furniture and so on it is OK”. • “They definitely keep it clean and tidy. They are cleaning all the time”. • “They bought a lot of new carpet not long ago and they are always doing things to the building”. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 22 • “I have notices that they have had new carpets put down in bedrooms and the hallway. The toilets are always clean” (visitor). At the time of the site visit contractors were in the home working on improving the home’s hot water system and this had included replacing the boilers. A new emergency generator was also due to be installed and there was evidence of that work having started. The registered manager said that she agreed an annual budget with the organisation that owned the home i.e. Southampton City Council for matters such as the replacement of furniture and fittings; bed linen; and crockery. She pointed out that any minor repairs or maintenance issues were dealt with rapidly through the Council’s property services department and any major work was planned and agreed through her line manager with the relevant department in the authority. There were a range of adaptations and equipment installed or available in the home to promote the independence of people with disabilities included: • A system in the communal lounges to assist individuals who had a hearing impairment. • Railings in all corridors and grab rails and raised toilets in WCs. • Assisted baths showers/wet rooms • Passenger lift to providing access to the first floor of the building It was suggested that signage could be improved to help people who had problems with short-term memory easily orientate themselves independently. The home had comprehensive procedures in place concerned with infection control. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home was clean and odour free at the time of the fieldwork visit and residents and visitors spoken to were positive about these aspects (see above). The home’s laundry was appropriately sited and equipped. Effective procedures were in place for the management of soiled laundry items. Responses from people living in the home whose views were canvassed before the site visit indicated that 92 believed the home was always or usually fresh and clean and 8 sometimes. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had clear staff recruitment, training and development procedures and there was an appropriate and satisfactory mix of staff. The level of staff deployed to provide personal care needs to be the same 7 days a week to ensure the needs of people living in the home can be met at all times. EVIDENCE: The home’s care staff team comprised 19 care assistants and 9 care coordinators and of these 20 (71 ) had at least a National Vocational Qualification (NVQ) at level 2. All the remaining care staff were or would be working towards a relevant qualification. At the last inspection of the home on 21st November 2006 it was noted that additional staff were needed at weekends to assist with giving out medication. Only one care co-ordinator was on duty throughout the day at weekend but it was stressed that the needs of people living in the home do not change at weekends and therefore keeping the same staffing level was vital at weekends as at any other time. On this occasion the care staff rota setting out the minimum number and skill mix deployed in the home for weekdays and weekend was as follows: Monday to Friday 07:30 to 14:30 14:30 to 21:30 21:30 to 07:30 Care co2 1 2 ordinators Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 24 Care workers Total Saturday and Sunday Care coordinators Care workers Total 4/5 6/7 4/5 6/7 2 3 07:30 to 14:30 1 4/5 5/6 14:30 to 21:30 1 4/5 5/6 21:30 to 07:30 1 4/5 3 The registered manager said that she believed that the organisation that owned the home was taking action to rectify the staffing arrangements at weekends. It had however been an outstanding requirement arising from 2 previous inspections of the home and timescales of 31st July 2006 and 31st December 2006 had not been met (see also section about “Health and Personal Care, above). The requirement has been repeated in this report and failure to comply with it may result in “the Commission” taking enforcement action. Comments about the sufficiency of staff on duty were mixed and included: • “I think that there are more than enough sometimes and at other times not enough. Today I have not felt at all stretched. Sometimes we have extra staff at lunchtimes. It is difficult sometimes when we are organising activities and still do care when somebody need help or buzzers are going”. • “We have 2 staff up and 2 down, unless there is a lot of illness then we have 5 carers on duty. I think that that is enough”. • “I think they could do with more staff sometimes” • “I suppose that there are enough staff, it has always been the same”. At the last inspection of the home the records of two members of staff appointed since the previous inspection were examined and documentation was incomplete for one of them. The home’s registered manager was not able to demonstrate that the person had been satisfactorily checked against the Protection of Vulnerable Adults list or that a Criminal Records Bureau check had been completed for that person. On this occasion the records were examined of 2 staff that had been employed since the last inspection of the home in November 2006. It was apparent that all necessary all pre-employment checks had been obtained and conducted before they had started work in the home. There was evidence form discussion with staff and records examined that all new staff received comprehensive induction and completed a programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 25 Individual’s training needs were identified through appraisals and individual supervision sessions. Discussion with staff and records examined indicated that there was a commitment to professional development and personnel attended training in subjects that were relevant to the specific needs of people living in the home e.g. dementia care Comments from staff about training included: • “I hope to start an NVQ in September. My induction training included a college course over a month. I did first aid, manual handling, bereavement, abuse awareness, understanding mental health and fire training … The course has been helpful … We have regular fire training”. • ” I got NVQ in November last year … We are doing fire safety next week and we do it twice a year … I have supervision about once a month. I find it very helpful because it is one to one about things that matter around the home and what I think about the job and so on”. • “I have had an NVQ for 11 years but I have also done adult protection, first aid, medication, dementia … We have yearly mandatory training such as manual handling”. Staff other than those in the care staff team also had opportunities to pursue relevant qualifications such as NVQs in “hospitality” for individuals’ involved housekeeping. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home was not wholly effective as the needs of people living and working in the home were not fully met. There were systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s registered manager had been responsible for the day-to- day operation of the establishment for some approximately 8 years. She had formal and relevant qualifications (.e. NVQ level 4 and the registered managers award) demonstrating her ability to fulfil her role. From discussion with people living and working in the home and visitors, including health care professionals, it was apparent that she was well respected Observation during the site visit indicated that she was sensitive and empathetic. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 27 Comments about her abilities and personal qualities included: • “Lorraine is very nice. She is always there if we want her”. • “She is very nice, she sometimes comes and asks how I am”. • “From what I have seen of her she is very good”. • “I can’t fault Lorraine. She is a lovely lady”. • “Lorraine is a very nice woman, she certainly knows what she is doing”. • “Lorraine is brilliant. When there is a problem she will sort it out straight away if she can” (member of staff). • “She is lovely, she knows how to manage the staff. I feel free to discuss any problems with her” (member of staff). • “I have been coming here for about 15 years and over recent years things have improved. The last couple of years they have got more procedural about the way they do things and more professional … I would say that Lorraine is a hard taskmaster” (Health care professional). • “The management team are all very helpful” (relative). The general satisfaction and contentment with the service the home provided also reflects the management of the home as described by one individual living in the home and also group of 4 that were using the home’s smoking room when they were spoken to. • “I have been her 11 years and it is a thumbs up from me. It is spot on. I cannot fault anything. I am well looked after, the food is good and there is plenty of it, it is perfect”. • “It’s not at all bad, we generally get on alright and have a good time, they look after us all very well … We feel safe ” The overall quality rating for this group of standards is however influenced by other factors that include; the omission of information in care plans and the fact that they were not all up to date; and the reduced level of care staff including care co-ordinators at weekends that exposes individuals responsible for giving out medication to the risk of distraction while carrying out that duty consequently putting people in the home at risk because of possible delay in receiving essential medication or arising from a mistake. (See also below the reference to previous requirements). There were systems and procedures in place in the home for monitoring the quality of the service that it provided and these included the following: • Monthly “residents meetings” with the agenda set by the people living in the home. Copies of the minutes of thse meeting were displayed prominentlty to inform all interested parties of the content of the discussions and any decisions that were made. • Questionnaires were used every 6 months to obtain the views of people living in the home about the service that they received. • In accordance with the care Homes regulations 2001, the responsible individual representing the organisation that owned the home (i.e. Southampron City Council) visited the home at least once a month. This was in order to inspect the home, its records of events and complaints, Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 28 interview people living and working there and subsequently form an opinion of standard of care provided by the home . The home’s registered manager said that she and the home’s staff made every effort to encourage people to speak out and create an open culture so they would feel comfortable abut expressing their views. She also indicate that changes that the home had made as a result of consulting residents included. This was confirmed in discussion with people living in the home and minutes of a recent “residents meeting” indicated that the home had acted on suggestions that had been made such introducing items to the menu that were requested e.g kippers The home had a range of policies and procedures that were readily available for staff to refer to and informed their working practice. They included the some specifically about promoting diversity and equality e.g. sexuality and relationships. Staff spoken to said that these were helpful and informed their working practice. Two requirmments from the last inspection of the home had been fully met. However an outstanding requirment from two previous inspections of the home about increasing the number of care co-ordinators to be on duty at all times during the waking day in the home had not been met. The home did not look after any sums of money for anyone living in the home. The organisation that owned the home i.e. Southampton City Council/local Authority, managed money on behalf of individuals in individual interest bearing accounts. The home’s manager received a statement of the balances held in the accounts every month. If a person required some cash, a sum was taken out of the home’s petty cash for them and their account was then invoiced accordingly. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. Staff said that they attended regular and compulsory fire and other health and safety training and records examined confirmed this. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. Guards covered all radiators in the home and all windows above the ground had restricted access and opening. There were hoists, and other equipment in the home to promote safe working practices. Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 3 X 3 Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement All care plans must be accurate and up to date at all times to ensure that the needs of persons concerned will be fully met. The number of staff on duty employed to provide personal care during the waking day to people living in the home must be the same 7 days a week. This is to ensure that medication can be given out safely and without distractions and the full needs of people living in the home can be met at all times. (Previous timescales of 31/07/06 and 31/12/06 not met). Timescale for action 31/08/07 2. OP27 OP9 13 (2) and 18(1)(a) 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000039153.V336003.R01.S.doc Version 5.2 Page 31 Whitehaven Lodge Standard Whitehaven Lodge DS0000039153.V336003.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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