Inspection on 18/02/08 for Whiteoak Court Nursing Home

This inspection was carried out on 18th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Whiteoak Court Nursing Home 11/07/08

Whiteoak Court Nursing Home 09/01/07

Whiteoak Court Nursing Home 10/01/06

Whiteoak Court Nursing Home 21/06/05

Whiteoak Court Nursing Home 02/11/04

Whiteoak Court Nursing Home 26/04/04

Whiteoak Court Nursing Home 13/11/03

Whiteoak Court Nursing Home 08/05/03

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

CARE HOMES FOR OLDER PEOPLE Whiteoak Court Nursing Home 15 Selby Close Chislehurst Kent BR7 5RU Lead Inspector Rosemary Blenkinsopp Key Unannounced Inspection 18th February 2008 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 Whiteoak Court Nursing Home DS0000010146.V347784.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. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whiteoak Court Nursing Home Address 15 Selby Close Chislehurst Kent BR7 5RU 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) 020 8467 0954 020 8467 0954 sandraschluep@whiteoakcourt.co.uk Messrs I R & RP Tappin and Mrs S M Schluep Mrs Mary Lyons Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 27 9th January 2007 Date of last inspection Brief Description of the Service: Whiteoak Court is a two-storey nursing home in Chislehurst registered to provide nursing care for up to 27 elderly persons. This is a well-maintained building both internally and externally. Accommodation in the home includes bedrooms on the ground floor and the first floor accessed by a lift to the upper floor. All bedrooms are fitted with a wash hand basin. On the ground floor there is a large dining room and separate lounge area. There is car parking to the front of the building and a garden to the rear. The home is staffed throughout the 24-hour period with both qualified nurses and care staff. As this is a nursing home there is always qualified nursing staff on duty. The home has the regular support services of a GP, chiropody, optician and dentist. The home is well managed. The Proprietors are in the home frequently to provide support and assistance as well as monitoring the overall standards in the home. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection carried out by two inspectors over a one and a half day period. The Manager of the home, Mary Lyons, facilitated the inspection process on both site visits. The inspectors spent time with staff members met with residents and any visitors in the home. The home has provided the completed AQAA in August 2007. Comment cards were given out during inspection and left for relatives and health professionals. The inspectors observed the practices and routines during the morning period. The Registered Provider was present for part of the first site visit. The inspector’s case tracked resident’s files which included viewing of the assessment information, their care plans and supporting documentation. A tour of the home was undertaken and the environment was found to be clean fresh and well maintained. Staff files were sampled to establish recruitment checks and training provided. A selection of health and safety service records were inspected. At the end of the inspection feedback was given to the Manager, outlining the overall findings of the inspection, and any recommendations/requirements, which may be as a result of the site visits. Residents spoken with were positive about the care they were receiving. The residents that were unable to communicate appeared to be well cared and showed positive signs of well being. At the point of writing this report two comment cards had been received by the CSCI and both were complimentary of the service. It was evident that the outcomes for residents were good and that staff are well supported though training, day to day management and receive good working terms and conditions. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home needs to confirm in writing its ability to meet the needs identified through the assessment process. The care plans should reflect a holistic approach to care to include physical social and spiritual needs. The current medication recording system relies on the GP to sign the medication charts, this is onerous and sometimes delays occur in the signing of the records. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 7 It was noted that staff recruitment introduced an element of risk. This was evidenced as staff CRB and references had been received after the start date. This needs to be rectified. The training records were not representative of the training, which was provided, and that staff confirmed had taken place. This needs addressing. The home must ensure that all checks are made in respect of health and safety particularly in terms of fire precautions 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. Whiteoak Court Nursing Home DS0000010146.V347784.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 Whiteoak Court Nursing Home DS0000010146.V347784.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have information regarding the service. Assessments are undertaken by staff in the home and information received from other health professionals so that staff have the information they need to care and support people using the service. Evidence of trial visits and confirmation in writing of the homes ability to meet the resident’s needs was not available which offers residents little confidence that the home will manage all of their needs. EVIDENCE: At the time of the inspection the home had two vacancies. The residents living in the home included those who were Local Authority funded and those who were self funding. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 10 The home had developed the Statement of Purpose and Service Users Guide, which provided information to prospective residents. The information, with the exception of the small coloured leaflet, which shows photos of the home, is all in writing and in quite a small font for those who have visual impairment. Also with a break in the text it makes it difficult to read. A more appropriate format would benefit some of the residents. The document did provide some good information and is written in a very personalised way. Much of the information required by the Regulations and standards was included with the exception of a few areas. The home also needs to ensure that the information provided reflects what is happening in the home to ensure they “do themselves justice”. The Manager was also made aware of the need to ensure copies of the Resident’s Guide are provided to the residents. A number of homes do this by keeping copies in residents’ rooms. Contracts are provided to residents living in the home and, where the Local Authority is responsible for the placement, the placement agreement was available. This document was inspected in relation to one resident. The contracts are kept by the Provider and not in the home. The inspectors looked at the processes in respect of admissions to the home. The first file viewed it contained the Care Manager’s assessment and the assessment completed by senior staff in the home. There was no evidence of any confirmation in writing that upon assessment they are able to meet the person’s needs. In the other files selected for inspection the assessment information included the homes own assessment, which outlined the care required. Additional information had been received from Bromley Hospitals in the form of a discharge summary and assessment, a speech and language report and a further report from the stroke unit. Additional information including that relating to a pressure sore was also available. A second assessment was that of a resident who has initially been admitted for respite care January 07, becoming permanent November 07. The initial assessment information dated January 07 was on file. The assessment information included the home’s own assessment, a detailed care plan regarding pressure sores and a body map. In addition the manual handling assessment was completed two days after admission. Please see requirement 1. Please see recommendations 1 and 2. Whiteoak Court Nursing Home DS0000010146.V347784.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Healthcare is well provided for in this service. The staff team and supporting visiting health professionals meet all needs of residents. Care plans are in place although not fully reflective of residents needs particularly those relating to social needs. Medication records and some areas of practice introduce a margin for error, which may be a potential risk to residents. EVIDENCE: It was evident that turning charts were in place for those residents who needed them. Those charts seen were well completed. Fluid charts were also well completed and indicated that fluid intakes were sufficient. The GP for the home visits fortnightly. There was a record of the visit and a short summary of the treatment. The home has links with a private Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 12 physiotherapist should residents want to pay to improve their mobility. This would be on a one to one basis. The home has a visiting dentist and optician on a six monthly basis. Weights are recorded monthly and accidents are recorded in the accident book. There is a separate book for recording bath and bowel care. The care plans of those residents whose asessment information had been inspected, were viewed. The care plans covered activities of daily living although the focus was on phsical health issues. In one care plan there was a care plan for continence as well as a risk assessment for this. There was a specific information sheet regarding the feeding regime for this resident. The risk assesment covered skin integrity which indictated that the resident was very high risk. This was reviewed monthly the last entry dated 7/1/08. In the event that high risk is identified more frequent asesments may be necessary to prevent further skin damage. A manual handling asessment had been completed 17 /1/08. A bed rail asessment was in place for this resident. The daily events records focused on the physical health of the resident. The inspectors were advised that reviews with residents are conducted six monthly. One care plan was viewed and this contained some information about the care needs of the individual. It was written in a very sensitive way and provided staff with information on how to care for the person. There were gaps in this information that, would, if detailed, provide a more person centred care plan. The resident had diabetes and a care plan should have included details of how the home is monitoring vision, chiropody as well as the importance of leisure, social and financial management. Risk assessments had been developed for moving and handling, falls and pressure care although no risk assessment had been developed regarding nutrition and fluctuating BMs. Where the pressure sore risk assessment showed a medium risk of developing pressure sores there was no corresponding care plan detailing how the risk would be monitored and the interventions required. The omissions in the records were not borne out either by the residents or the observed practice on touring the home. It was clear from the tour that there was more than adequate equipment in place, which was used, and staff attended to resident’s needs in a caring respectful manner. As well as routine pressure relieving equipment the Providers have also purchased four profiling beds this year and six wheelchairs. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 13 There was some evidence of reviews taking place with staff signing to say this had been done although there was very little documentation regarding the involvement of others in this. Whilst the Manager stated that she had actively involved residents and relatives in the process, there was little written evidence about who was involved and what discussions had taken place. All information including any reviews that take place should be recorded. There was evidence of various NHS support including the diabetic nurse and eye examinations taking place. On the second day the Manager had developed a secondary sheet for recording multi-disciplinary visits to the home to make it easier to view such visits and corresponding treatment. Residents looked well groomed with attention to detail evident, ladies had make up and jewellery applied. Personal care was taking place behind closed doors and privacy was fully respected. One resident spoken to told the inspector that staff “are very kind” whilst another said of one carer who came into the room “she really looks after me” and of other staff she said, “I can’t criticise staff”. The following information was extracted from the completed AQAA, “We modify the care we provide to our service users, updating care plans when and where necessary, as conditions change. We listen to concerns of our service users families and try, in every instance, to accommodate them within the confines of our good practice standards. We have instituted a rolling medical assessment of service users with the General Practitioner inviting relatives to attend” The medications were inspected. At the time of the visit there were no Controlled Drugs in use. The medications were stored in a separate clinical room. The drugs fridge temperatures were recorded; the sharps disposal bin was dated on opening. The medication charts had the allergies recorded and the individual residents photograph was in place. The medication charts (MAR) were hand transcribed then signed by the GP. Some of the charts were with out the GP signature or any signature to confirm the written record. Charts, which are hand transcribed by nursing staff, should have two signatures in place to confirm the accuracy of the information recorded. Advice regarding this matter was Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 14 provided to the Manager. The inspectors sought advice from the inspecting pharmacist and the following information was received Two staff should sign the MAR if they have handwrite entries themselves or amending the dose/frequency on behalf of the GP, but we cant require the GP to sign the chart. If the GP writes a new drug on the MAR, suggesting one member of staff countersign his entry is fine. Medications received into the home were documented and signed by one staff member. The medications, which were to be disposed of, had no amount or signatures on the record. Records for all medications disposed of must be fully completed. Those medications with a shelf life once opened, such has calogen, should have be dated on opening. Although eye drops did have a date of opening. Please see requirements 2 and 3. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with opportunities to choose how they spend their day and what activities they want to engage with. Staff assistance is provided when needed; however independence is promoted. EVIDENCE: Residents were seen spending time in their own bedrooms or the communal areas. Bedrooms were equipped with TV’s and/or radios, newspapers are provided. Visitors were seen to come and go through out the day. Residents were well presented and displayed signs of well being interacting with one another and staff. Staff were observed to offer choices to residents and allow them time to be as independent as possible. One resident was seen in her bedroom she had a daily newspaper, which she was reading. There was a TV and radio in the bedroom. She related favourable comments about the service she received and the care staff provided. She did however request a telephone. On relaying this information, the Manager Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 16 explained that she had use of the home’s phone and mobile at any time and that she was unable to dial numbers herself. Another resident told the inspector that she had weekly visits from her niece who also took her out. She was well presented. She was adamant that she did not want to engage in the communal activities and preferred being in her own bedroom, which was always respected. The home employs an activities person three afternoons a week where various activities are provided for the residents. The activity co-ordinators’ hours have been increased as identified in one of the annual quality assurance questionnaires. She provides activities, interactions that individuals want such as reading newspapers, doing crosswords or puzzles and one to one chats. Newspapers are provided free of charge and people can obtain magazines for their own use. The home had purchased a karaoke machine, which the Manager stated was very popular. Religious services are offered to residents. The catholic priest visits four residents every Friday and every four weeks the Church of England vicar gives a service and Holy Communion. A rabbi visits the one Jewish resident. One resident spoken to felt she very much benefited from such visits and enabled her to keep her faith despite feeling not able to leave the home. The lunchtime meal was observed; it was a pleasant affair and unhurried. Comments regarding the food indicated that overall residents felt it was to a good standard. Tables were nicely presented with condiments serviettes and juice was served. Staff were seated to assist residents with their meals, four staff were present during lunch. Fresh fruit was available and home baked cakes offered. One resident spoken to has special dietary needs which staff were aware of. The resident’s benefit from two hairdressers, one male and one female to ensure specific needs are addressed. Throughout the day and half of the inspection the inspectors noticed a number of residents having visits from relatives. They appeared to be warmly welcomed by staff and known to staff. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on how to raise a complaint was available including external avenues. The home operates an open ethos, which encourages open, frank discussion including areas, which are not to the expected standard. The visual presence of the Manager and the Proprietors provides residents with opportunities to raise concerns immediately and directly. The lack of CRB or POVA checks on the commencement of employment of staff introduces a margin of risk to residents. EVIDENCE: The CSCI has received no complaints regarding this service. Currently there is one on going adult protection investigation. The AQAA showed that the home has received no complaints in the last twelve months The information on how to raise a complaint was on display and included in the Statement of Purpose. The complaints information contained most of that required by the Commission and informed people what to do if they wished to complain. The procedure needs some amending to ensure it provides people with details of the CSCI rather than the NCSC, as we were formerly known. Within the complaints book the last entry was dated 8/8/05 and nil since. The Manager prides herself on her involvement on a day to day basis with Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 18 residents; staff and family members to ensure any issues are dealt with before they get out of hand. People spoken to felt the Manager and staff to be approachable and felt that they could raise concerns if they felt it necessary. Staff with whom the inspectors met were asked about what action they would take in the event of suspected abuse. Staff stated that they had received training on this topic as part of NVQ or dementia training. The staff members were aware of what constitutes abuse and that it must be reported. In the records viewed, due to the standard of the training records, it was difficult to determine how much training or guidance staff had received specifically in abuse. This is an area identified for improvement in the next twelve months. The home had available the Bromley Safeguarding leaflet. There were polices available on restraint and the use of wheelchair lap straps and risk assessments in place for the use of bedrails. Please refer to the staffing section in respect of protection of residents through staff recruitment procedures. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides clean, comfortable domestic style accommodation for residents. All areas were well maintained which ensure residents live in a safe environment. EVIDENCE: The inspectors toured communal areas as well as individual bedrooms. All areas were found to be well maintained clean and fresh. Resident’s bedrooms were personalised with photographs, ornments and pieces of furniture. The inspectors were advised that a programme of maintenance including replacing carpets and redecoratating each room as it becomes available, was in place. A programme to replace all central lighting in bedrooms is in place. Lamps have been removed from bedrooms and dimmer switches have been installed. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 20 All communal areas have been decorated.The inspectors noted that the door to the sluice and the laundry were without locks. This was pointed out to the Manager who stated that there wer no residents who wandered an that it had never been an isssue. She added that should a lock be put on the sluice door this would hamper staff working. In all circumstanses the home must ensure resident’s safety and a risk assessments should be undertaken to determine what if any risk is present. The home is wanting to expand so that there would be no sharing of bedrooms, however planning permision is proving a difficult and lenghty process. Currently there are five bedrooms that have en-suite facilities whilst the remainder have wash hand basins. In shared bedrooms appropriate screening is available. The inspectors felt that the standard of equipment around the home was very good with pressure relieving equipment, including mattresses and cushions. Bathrooms and WCs also had aids to help those who needed this and the inspectors were particularly impressed with the backrest cushions for toilet seat lids meaning people were seated comfortably. Wheelchairs were stored in a specific place to ensure safety and accessibility. New garden furniture was purchased for use by residents and their families in the warmer weather. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to address the needs of residents. Staff confirmed that training is provided on mandatory topics as well as updates on statutory topics although the records were not maintained. The lack of CRB clearance prior to employment introduces a margin of risk to residents. EVIDENCE: The staffing numbers that the home operates with are as follows: two qualified and four care staff in the morning, and one qualified with four care staff in the afternoon. The Manager is supernumerary to these numbers. A number of ancillary staff are employed in the home. Staff on duty met with the inspector. The first staff member stated that she had been in post for five years. She confirmed that she had received two weeks induction on commencement of employment. She had since starting completed NVQ 2 training and had done Dementia course. This had taken place over a year period and was self directed leaning and some lectures. In addition she confirmed that she had received recent fire, first aid and wound care training. On questioning her about infection control principals she demonstrated a good knowledge. The staff member stated that supervision Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 22 was conducted every three to four months and that a copy of the discussion during the supervision was provided. A qualified nurse met with the inspector. She had been in post since 2000. She confirmed that training was provided including updates in the mandatory topics as well as those topics relating to residents care. She had also completed a dementia course. Staff in the home are valued, birthdays and Christmas are celebrated with separate staff celebrations. Staff related positive working conditions in their contact with the inspectors. The work force seemed genuinely happy. There is a warm and relaxed atmosphere when you wander around the home with staff welcoming, polite and professional. Positive interactions with individual residents was noted. Currently all care staff except for 2 have NVQ certificates. Cooks and ancillary staff are also enabled to attend NVQ courses. There were many reference books available for staff to refer to for clinical as well as general issues. Training in the home is either provided through the Bromley training consortium or external trainers. The inspectors viewed the training records; these were of a mixed standard. The training matrix and individual records were viewed, these were not up to date and therefore it appeared as if there were a number of gaps in the training as well as some of the new staff not appearing on the training matrix. Recruitment records were viewed in respect of four individuals who had been employed since the last inspection. There was good information relating to proof of identity and all had Criminal Records Bureau (CRB) checks in place. However, in all four the CRB had not been in place until after the start date of the individual. If there had been a POVA first check completed, with evidence of the supervision arrangements in place, and an induction record, this would have lessened the risk to people. However these checks were not in place. The Manager was made aware of her responsibility in these areas. Each file contained an application form and CV although the quality of information provided was variable. Not all included a ten year employment history and there were no written explanations as to gaps in employment. Applicants had also completed a health declaration. Two references were in place for 2 staff and one reference for the other two. Some of the references had a company stamp to ensure reasonable steps had Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 23 been taken to ensure legitimacy. It was difficult to establish from some references and information provided (or not provided), on the application form, as to whether the address the reference was sent to was the actual employer. The Manager was also made aware of the need to obtain verification of the applicants’ previous employment in care, in particular the reasons why they left their employment. This includes any employment, be it several years previous and including the last employment, where a reference would be obtained. The Manager told us that she did check the references verbally but did not make a record of this. Nurses employed by the home had the required checks made on NMC registration including their PIN numbers and statement of entry detailed on their files. All new staff employed are provided with a handbook and GSCC codes of conduct. Induction practices are yet to be implemented in line with the Common Induction Standards. The Manager of this home, and others, have formed a group to develop formal induction to meet their needs. This has been developed but not been implemented. The Manager must also remember to ensure the home’s induction for new staff is also recorded as there was little evidence of this in the training or personal files. On the second day one staff personnel file was inspected. There was a CV as well as the application form and health questionnaire, which were completed. One reference, which had an official stamp, was available. Evidence of checks on identity and address were available. Although the staff file contained the offer letter, which was, dated 2/5/07 and the CRB was dated 1/6/07. There was no evidence of POVA first. Please see requirements 4 and 5. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in an open and transparent manner by an experienced individual supported by the providers. Health and safety aspects of the home are maintained with regular servicing of equipment and on going maintenance Quality assurance measures are in place providing opportunities for staff, residents and relatives to input in to the service. EVIDENCE: Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 25 A qualified nurse of many years experience manages the home. Ms Lyons has worked in the care home sector for many years and has a wealth of knowledge not only relating to the sector but also knowledge of the local area. An annual quality assurance questionnaire was sent out for completion by residents and relatives. Any comments received are acted upon by who ever is the most approprite person. A staff questioniarre was conducted October 07, the Provider collated the results and produced a summary of the findings. The outcome of that survey was very positive indeed. A residents survey had also taken place with a report on the findings. This also showed a good standard of care to be provided. Audits had beeen conducted on care plans medication administration sheets and risk assessements. These were audited on a regular basis. Other audits included cleanliness of the home and staff sickness. Regulation 26 visits are conducted and a report on the findings made. The environmental health officer visited February 07 and the home was rated as a five star service in respect of its kitchen facilities. The employers liability insurance was current. A comprehensive fire risk assessment was in place adated October 06. The London Fire Brigade Safety Officer recently visited. The fire extuinguishers were serviced May 07. Fire drills were conducted regularly throughout 2007 although there were no staff signatures in place to confirm attendence. Weekly fire alarm tests are carried out . There were gaps between 18/12/07 and 8/01/08. These must be completed weekly and if the person responsible is not able to do so then the responsibility must be delegated to another individual. The emergency lights had been serviced September 07 and no further testing since. Emergency lights are subject to regular testing which must be recorded. An information leaflet was provided on the requirements regarding fire records and frequency of tests. The fire alarm was serviced 05/07 as well as the fire equipment and lighting. The portable electrical applince testing had bee conducted January 08. The five year fixed electrical wiring took place January 07. No urgent requirements were made although some minor recommendations and observations where made. The passenger lift requires six monthly servicing as required under the LOLER regulations. Hoists had been serviced recently and had evidence of up to date servicing. The gas inspection is due April 2008, as the equipment is new in the last year. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 26 The home is operating outside of the Smoking legislation, which came in to force 2007. The home need’s to ensure smoking law is enforced in home, guidance was provided on this. Health and safety training records were not up to date and it was difficult to determine what training staff had received. There was little evidence of infection control training or medication training. There was some evidence of staff receiving fire training as well as moving and handling instruction. The records relating to first aid were mixed and the Manager must risk assess the needs for first aid training for nursing staff. The financial records were inspected. In this home the Manager does not have responsibility for individuals’ finances. Their role is to purchase goods or services on each person’s behalf and then invoice the person responsible for paying the bill. Receipts are provided and sent to Head Office for individuals to be invoiced. The records relating to supervision were inspected. All RGN’s are responsible for the supervision of staff. The Manager stated that they have received training to enable them to do this there was little evidence that this was the case. Supervision forms have been developed which itemises the agenda for both parties and action to be taken. These are to be signed by both parties. Please see requirement 6. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 27 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 2 X X 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 Requirement The Registered Manager must confirm in writing to the resident, that following the assessment, the home can meet their needs. This is a repeated requirement and is now outstanding. Previous date for action 8/2/07. The Registered Manager must ensure that care plans reflect a holistic approach to care to include physical social and spiritual needs. The Registered Manager must ensure that medication administration is safe. And have supporting records in place for all medication procedures. The Registered Manager must ensure that all staff are subject to robust recruitment procedures including receipt of the CRB prior to employment or POVA first with the correct supervision in place. The Registered Manager must ensure that training records DS0000010146.V347784.R01.S.doc Timescale for action 28/04/08 2 OP7 15 30/07/08 3 OP9 13 28/03/08 4 OP29 18 28/03/08 5 OP30 Whiteoak Court Nursing Home 18 28/03/08 Version 5.2 Page 29 6 OP38 13 accurately reflect the training received and are updated. The Registered Manager must ensure that all health and safety aspects are addressed in the home including those pertaining to fire precautions 28/03/08 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. OP1 2 OP5 Refer to Standard Good Practice Recommendations The Registered Manager should review the Statement of Purpose into a more user friendly format. The Registered Manager should ensure records are retained of trial visits and all information provided prior to admission. Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Whiteoak Court Nursing Home DS0000010146.V347784.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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