CARE HOMES FOR OLDER PEOPLE
Whitemoss Resource Centre Benmore Road Blackley Manchester M9 6LD Lead Inspector
Ann Connolly Unannounced Inspection 8th March 2006 11:00 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.V285966.R01.S.doc Version 5.1 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.V285966.R01.S.doc Version 5.1 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 0161 720 6733 Manchester Children, Families and Social Care 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.V285966.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 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. 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. 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.V285966.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 8 March 2006. During the inspection, time was spent talking to staff, residents and visitors to find out about their views of the home. Time was also spent examining medication and care plan files, and a tour of the building took place. Since the last inspection a new manager has been appointed and he was on duty during this visit. The new manager has worked in the home in a senior position for a number of years and his appointment has been a smooth transition for residents and staff. One resident was consulted on her feelings about the new manager, her response was, ‘Oh he’s very good, but then again he’s always been very good’. During this inspection only a selection of the 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:
The staff team are very motivated and they were focused on improving services in the home. The home has prioritised staff training to ensure that staff are equipped with the skills required to meet the needs of residents in the home. All residents spoke highly of the services in the home. The six long stay residents appeared relaxed and comfortable in their environment and seemed to enjoy the company of the residents visiting the home on a respite basis. One resident said, ‘They don’t stay long, but it’s nice getting to know new people. Sometimes they keep in touch’. Residents on respite care expressed satisfaction about the care in the home and highlighted a number of positive experiences during their short stays. One resident said, ‘I love it here, staff are excellent. If you want anything you only have to ask’. Residents receiving respite care, also said that staff helped them to maintain contact with their community links in preparation for them returning home. One resident said, ‘If I have any worries about home, the staff will sort it out.’ All residents spoken to said that staff supported them in all aspects of their care and in keeping hospital appointments. One resident said, I have to keep
Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 6 hospital appointments, my family help if they can, if not a member of staff takes me.’ The staff are very good at getting you going and helping you to improve’. Another person said, ‘There’s a lot I like about being here, all the staff have their own special way of helping you’. 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. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement was made EVIDENCE: These standards were not assessed during this inspection. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 The home had identified and recorded residents personal and health care needs in an individual care plan. Some of the recording systems used by the home did not fully protect residents. EVIDENCE: Care plans were in place for each resident living in the home, however, these plans did not provided enough detail about residents needs. One file examined of a recent admission to the home contained an incomplete assessment carried out by staff in the home, missing out important information about the residents care needs. In addition, information in the care manager assessment had not been transferred into the current working care plan. Some recordings on the daily report form were inappropriate and did not cross reference to the care plan, merely stating, ‘had a good day’. One member of staff was involved in developing care plans using a care centred approach, in seeking the views of residents to ascertain their perception of their care needs and consultations with the resident on how he/she wanted care to be delivered. Discussion took place on how this could be
Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 10 cascaded to all staff in the home to ensure that there was a set standard for recording in the home. The manager must ensure that recordings in the care plan are appropriate and that staff are provided with sufficient information to assist them in their task of meeting residents needs. The manager said that recent supervision with staff had highlighted shortfalls in care plan recordings, and there was evidence that the home were taking steps to address these by using staff meetings and supervision as a forum to express ideas and concerns. As a result of the finding, a request had been made to the training department for all staff to receive training in care planning and recording methods. Since the last inspection the home had carried out a full audit on medication systems in the home, and this was reflected on the improvements found during this inspection. Whitemoss is a respite unit with frequent discharges and admissions to the home. On the last inspection stock levels and records for the respite residents did not balance, this has now been addressed. Receipt of medication is accurately recorded, and an ongoing audit of medication is maintained. The system is further enhanced by a detailed monthly audit carried out by the manager to ensure that excess medication is no longer stored in the home. All loose stock levels of medication examined balanced with the Medication Administration Records (MAR). Medication was seen to be administered appropriately and the medication trolley was stored safely in a secure place within the home. Two minor shortfalls were identified, but were fully addressed at the time of the inspection. These included contacting the supplying pharmacist to ensure that multiples of medication in the blister packs were accompanied by a description of each of the medication. Also where medication details had to be hand written on the MAR sheets, these were signed by two members of staff to indicate that accuracy of the details were correct. The medication policy was examined and did not include a policy on ‘homely remedies’. The home did not have a copy of the guidelines for medication in care homes published by Royal Pharmaceutical Society of Great Britain (RPSGGB) The manager must ensure that the medication policy is developed in accordance with the RPSGGB. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No Judgement was made. EVIDENCE: These standards were not assessed on this occasion. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 12 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): 18 Polices and procedures were in place to protect residents from neglect and abuse, however, some staff were not familiar with these procedures. EVIDENCE: The findings from the previous report are reiterated in this report. Staff members spoken to had a good understanding of issues surrounding adult abuse. However, some staff were unaware of the polices and procedures and had not received any updated training. The manager said that a request had been made to the training section for all staff to receive updated training. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 13 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): 19, 24 and 26 The home was comfortable and practices and systems were in place to ensure the home is kept clean and hygienic. Water temperatures systems in the home did not meet the required standards and could potentially place residents at risk. EVIDENCE: The home was well maintained in terms of 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. Some bedrooms were suitably furnished and personalised by residents. Furnishings and fittings in respite rooms were of a poor quality. One bedroom contained old furniture which was badly stained and scratched. The manager must audit all bedrooms to ensure that furnishings meet the required standard,
Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 14 damaged and faulty furnishings must be re-placed. Lockable storage units are available in some bedrooms, and must be provided in all bedrooms. In the past, this home has maintained satisfactory standards in terms of ongoing re-decoration, however, the rolling programme for re-decoration and refurbishment for the home appears to be at a standstill. There is no evidence of any schedule of work for the past three years and the manager said that Whitemoss has been excluded for the local authority budget for improvements in this financial year. In recent inspections, the inspector was informed that funding for a new laundry had been approved, however, the work has not been carried out. In June 2005 the Commission highlighted the need for the hot water outlets to be fully assessed and fitted with thermostatic mixing valves to ensure that water temperatures of 43 degrees centigrade was not exceeded to ensure the health and safety of residents in the home. The manager has completed a general risk assessment for water outlets , however, this is insufficient as the risk in individual bedrooms will be dependant on the resident occupying the room at the time, and may be greater at some times than others. The risk of scalding from water outlets in bedrooms and bathrooms is high and in order to ensure the safety of residents individual thermostatic valves must be fitted to high risk areas based on a comprehensive risk assessment of the building. Although the home benefits from large grounds, the are is not utilised to provide safe outdoor living space for residents. It was recommended that the outside space was developed ion order to provide safe accessible space for residents to access in the warmer months. A schedule of work to be carried out in the home must be submitted to the Commission to ensure that all parts of the home are maintained to a satisfactory standard and ensure that the health safety and welfare of residents and staff is maintained at all times. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 29 and 30 On the whole, residents are supported and protected by the home’s recruitment and training practices. EVIDENCE: The manager stated that all Criminal Record Bureau (CRB) for staff were held in the personnel department for Manchester City Council. The manager was advised to ensure that evidence from the personnel department verifying that CRB checks were in place must be held on individual staff files in the home. A sample of staff files were checked and contained two written references, however, all staff files required a detailed audit to ensure that they contained all the information required as detailed in schedule 2 of the Care Homes Regulations, Care Standard Act 2000. There was evidence that the home was proactive in developing the staff training programme. Two members of staff have taken the lead in coordinating staff training. The home has been issued with a training directory issued by Manchester City Council which details training courses available to staff in the home. There was recorded evidence of training, which was in the process of being transferred into a training portfolio enabling staff to monitor training in the home. Good progress was being made with NVQ qualifications in the home.
Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 16 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): 38 Some systems in the home did not ensure the health safety and welfare of residents and staff in the home. EVIDENCE: The home had policies and procedures in place specific to the home. Staff spoken to confirmed that they had regular updates on health and safety training including infection control, and moving and handling. Records were in place to evidence that staff were involved in fire training in the home. Water systems in the home did not ensure the health and safety of residents and staff in the home. Records maintained by the home indicated that water temperatures regularly exceeded the safe level of 43 degrees centigrade. A requirement has been made in standard 25 for individual thermostatic valves to be fitted to water outlets in high risk areas based on a comprehensive risk
Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 17 assessment of the building to ensure that water temperatures do not exceed 43 degrees centigrade. The rear stairwell banister appeared low, and the manager must check that the height of the rail complies with health and safety requirements. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 19 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 Timescale for action 20/03/06 2. OP9 13 3. OP18 13 4 OP25 13 Care plans must contain sufficient information to assist care staff in providing care and support to residents in the home. The medication policy must be 20/04/06 developed further to comply with the Royal Pharmaceutical Society of Great Britain publication, ‘The Administration and Control of Medication in Care Homes and Children’s Homes. All staff must be participate in 20/04/06 updated training on Adult Protection procedures. (Previous Timescale not met 20/09/05) Individual thermostatic valves 20/03/06 must be fitted to water outlets in high risk areas based on a comprehensive risk assessment of the building to ensure that water temperatures do not exceed 43 degrees centigrade. A comprehensive risk assessment must be submitted to the Commission together with an action plan scheduling the work. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 Page 20 5 OP24 23 6 OP24 23 7 OP29 18 8 OP38 13 The manager must audit all bedroom furnishings and replace damaged items and provide items as described in the standards including a lockable storage unit in each bedroom. A schedule of work to be carried out in the home must be submitted to the Commission, with details of dates for completion of any work carried out. Evidence must be retained on staff files to confirm that staff have a current CRB check. All staff files must be audited to ensure compliance with regulations and schedule 2 of the Care Homes Regulations. The manager must ensure that the height of the height of the banister rail in the rear stairwell complies with health and safety requirements. 20/05/06 20/03/06 20/03/06 20/03/06 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 19 Good Practice Recommendations To develop the outside space to provide safe, pleasant surrounding enabling residents to access outdoor space in the warmer months. Whitemoss Resource Centre DS0000032932.V285966.R01.S.doc Version 5.1 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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