CARE HOMES FOR OLDER PEOPLE
Whitemoss Resource Centre Benmore Road Blackley Manchester M9 6LD Lead Inspector
Ann Connolly Unannounced Inspection 10th June 2005 10:00 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 Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Whitemoss Resource Centre Address Benmore Road Blackley Manchester M9 6LD 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) 0161 740 7704 Manchester City Council Beverley Fox Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home provides accommodation for a maximum of 27 service users, 6 of whom are in receipt of long term care all of whom require care by reason of old age (OP). The Statement of Purpose must be maintained in line with the requirements of Schedule 1, of Regulation 4 (1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the home`s purpose must be agreed with the National Care Standards Commission prior to implementation. The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum, ` Care Staffing in Care Homes for Older People `. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older people`s homes by the Secretary of State for Health under Sections 22 and 23 (1) of the Care Standards Act 2000. The authority must at all employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. The matters detailed in the attached schedule of requirements must be completed within the stated timescales. 16th March 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Whitemoss is a purpose built Local Authority provision located in the North of the City which provides a range of services within the immediate area and from referrals City wide. The home provides accommodation and personal care for twenty residents within the category of old age (OP). Five of these places are long stay placements and the remaining twenty two are used for short term and respite care. The home is located within a residential area of Blackley and it is within easy reach of local shops, public transport and the local motorway network. Large gardens surround the property and there is car parking space for visitors.
Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 5 Accommodation is provided on two floors with access via a lift or stairway. There are a number of lounge areas which offer larger group living arrangements or small quiet lounge areas. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection, which took place over the course of five hours on Friday 10th June 2005. During the inspection, time was spent talking to residents living in the home, members of staff, the manager, and relatives who were visiting the home to find out their views of the service. Time was spent examining records, care plan files, medication and other documents. The inspection also included a tour of the building. During this inspection only a selection of the key National Minimum Standards were assessed. In order to gain a full picture of how the home meets the needs of residents, this report should be read together with the previous and any future reports. What the service does well: What has improved since the last inspection?
The home has made improvements to the Service User Guide and brochure which provides information to new and existing residents about the services offered in the home. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 7 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. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 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 Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Existing and prospective residents were provided with information about the home to help them to make an informed choice about their care needs. Prospective residents needs were assessed to ensure that the home was able to meet their care needs, and trial visits were arranged where appropriate. EVIDENCE: The home had recently updated the Service User Guide and brochure to include full details of the complaints procedure and information on how to contact the Commission for Social Care Inspection. The Service User Guide was in the form of a ‘user friendly’ brochure and was also available in a large print version. These documents were available to existing residents and it was noted that brochures were in a number of bedrooms and a selection of information about the home was also available in the entrance hall of the home. Information on trial visits was detailed in the Service User Guide. However, Whitemoss is a home that primarily provides respite accommodation for 22 residents and long stay accommodation for 5 residents. Most of the residents
Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 10 receiving respite care are regular users of the service and therefore are familiar with the home and the service offered. The files of three residents were examined. All three files contained a Care Management Assessment and pre-admission assessments carried out by the home. The information was detailed and sufficiently comprehensive to develop the resident’s care plan. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Overall the health care needs of residents were being met, however, failure to review all care plans and document changes in care needs and failure to keep them up to date did not provide staff with sufficient information to help them to provide appropriate care to residents. Although Policies and Procedures were in place for managing medication, staffs were failing to follow the procedures for receiving and storing medication and therefore posed a potential risk to residents. EVIDENCE: Care plans were in place for each resident living in the home. However, these care plans did not provide enough detail about residents needs and did not include up to date information about the changes in care needs. On examination of the care plans it was found that the filing system was fragmented making it difficult for the reader to gain insight into the current care needs of the resident. Not all care plans contained up to date risk assessments. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 12 On examination of the Medication Administration Records (MAR), one resident had not been taking her prescribed medication. This problem had not been addressed in the care plan and as a result the home had not sought any intervention or guidance from the General Practitioner. This posed a potential risk to the health of the resident. It was evident from talking to staff that they appeared to have a good understanding of residents care needs although this ‘known’ information about care needs had not been documented in the care plans. Residents spoken to during the inspection expressed satisfaction about the way in which the staff met their care needs. Respite residents are continually being admitted and discharged from the home. This respite service presents a challenge to the management in maintaining the safe handling of medication in the home. MAR sheets for the five long stay permanent residents were accurate and stock levels balanced with the record sheets. However, the medication and records of the respite residents was not as accurate. Excess medication was being stored and receipt of this medication was not recorded which meant that it was impossible to carry out an audit trail of medication in the home. There was the additional problem of storing medication, which may potentially be out of date. The manager was informed that a full audit of all medication received for residents on respite care must be carried out and a system must be put into place to ensure the safe handling, administration, receipt, storage and recording of medication must be in place. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents were encouraged to keep in touch with their friends and the local community. Residents received a wholesome, balanced diet and meals were well presented in a pleasant environment. EVIDENCE: Residents spoken to during the inspection confirmed that friends and relatives were welcome at any time of the day, and information about visiting was in the Service User Guide. Relatives and visitors were seen arriving at various times throughout the day and seemed relaxed and comfortable in the environment and in their discussions with staff on duty. There was a relaxed and friendly atmosphere. Links with the community was actively encouraged. The manager and staff in the home were creative in developing links with the community and in accessing community resources. There was photographic evidence of current involvement with the ‘Mayors games’ in the local community where organisations had met up socially for a ‘games’ event. Whitemoss had volunteered its resources to ‘host’ the final event. Residents spoke with
Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 14 enthusiasm about these events and said how much they had enjoyed participating in this community activity. Residents were encouraged to handle their own financial affairs as long as they were able and had the capacity to do so. Administrative support was available to support residents in managing their finances when this was required. All five permanent residents held their own personal bank account. The chef on duty at the time of the inspection demonstrated a good understanding and knowledge of the dietary requirements of residents in the home. The meals served on the day of inspection appeared appealing and nutritious. The chef presented home cooked meals that were seasonal and prepared using fresh meat and vegetables. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Complaints were appropriately dealt with and policies and procedures were in place to enable concerns to be raised and to protect residents from neglect and abuse. However, staff were not fully trained in adult protection policies and procedures. EVIDENCE: The home had a system in place to record complaints made to the home and to detail the action required taken by the home. A recent complaint made to the home had resulted in a comprehensive investigation and was followed up with a detailed letter of response to the complainant. Staff members were spoken to about their understanding of adult protection issues. The findings from the previous report are reiterated as it was found that although staff had a basic understanding and knowledge of adult protection they were unaware of the policies and procedures in place and had not received any updated training. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home was well maintained, comfortable and provided residents with a safe environment in which to live. EVIDENCE: The home was well maintained in terms of décor, cleanliness and was free from offensive odours. There was a high standard of cleanliness throughout the building. The communal areas were suitably furnished with furniture that was domestic in character providing a ‘homely’ environment. There was a small lounge facing the office, which provided a homely and intimate atmosphere. Bedrooms were suitably furnished and personalised by residents. Window restrictors were missing from room 10 and the ground floor bathroom and must be re-placed. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): On the whole residents in the home benefited from a staff team that were skilled and trained to offer care and support. EVIDENCE: At the time of this inspection the staffing levels met with the guidance of the previous registration authority. Staff confirmed that they had access to training opportunities, which promoted on going professional development. Residents who were spoken to during this inspection expressed confidence in the way care staff delivered care and the support they receive. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The management and administration procedures were effective in maintaining the best interests of residents and in promoting their welfare. EVIDENCE: The home had policies and procedures in place specific to the home. Staff were aware of the location of policies and procedures and that it was their responsibility to ensure that these were adhered to in their day to day practice in the home. Overall, records examined during the inspection were found to be up to date and securely held. Some records required updating and these are detailed in Standard 7. Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X 3 3 X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X X Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be updated to reflect the changes in care needs and must include current up to date risk assessments. A full audit must be undertaken of all medication systems and stored medication in the home. All staff must be participate in updated training on Adult Protection procedures. Window restrictors must be replaced or repaired as identified in the main body of the report. Timescale for action 20/09/05 2 3 4 OP9 OP18 OP19 13 13 23 20/09/05 20/09/05 20/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Whitemoss Resource Centre DS0000032932.V250362.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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