Inspection on 17/05/07 for Whites

This inspection was carried out on 17th May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whites 10/04/06

Whites 28/11/05

Whites 04/05/05

Whites 19/06/04

Whites 13/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Whites Station Lane, Muller Road Horfield Bristol BS7 9NB Lead Inspector Nicky Grayburn Key Unannounced Inspection 15th May 2007 09:30 Whites DS0000026557.V339814.R01.S.doc Version 5.2 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 Whites DS0000026557.V339814.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 Adults 18-65. 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. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whites Address Station Lane, Muller Road Horfield Bristol BS7 9NB 0117 951 6407 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) Freeways Trust Ltd Mr. Gerald Padfield Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th April 2006 Brief Description of the Service: Whites House is operated by Freeways Trust Limited and is registered to provide accommodation and personal care for up to eleven people who have a learning difficulty. Primarily they accommodate people who have complex needs that can challenge the service provided. The home itself is situated in large grounds, which is set apart from a busy main road. This provides a secure area to which residents can have unlimited access. A cat also lives at the property. It is close to local amenities, including shops and public houses. It is also near to a main bus route. Whites benefit from having a van that is regularly used by residents to access community facilities. Freeways hold copies of all inspection reports, and Whites hold their individual reports. The home has an available Statement of Purpose and Service User Guide, which is user friendly. Freeways have a website which can be accessed to find out more information about the organisation as a whole. The day centre based at Leigh Court (head office of Freeways) also produces a newsletter for residents and their supporters. Freeways calculate their fees on a weekly basis. As of 3rd May 2006, the range of fees is from £656.11 to £1,182.58 per week. Additional charges apply to transport costs according to the resident’s mobility allowance. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Whites key inspection and was carried out over two days, including one evening. It was unannounced. The inspector met with many of the residents and staff, including the Manager. Since Whites last Key inspection, two random unannounced visits have also been carried out. There were some requirements to follow up from the previous visit. Prior to the inspection, previous records and reports held at the Commission for Social Care Inspection were read, such as the home’s monthly reports carried out mainly by Freeways’ Principal Care and Development Manager, who is also the Manager’s line Manager. The Manager also completed the Commission’s ‘Pre-Inspection Questionnaire’ giving basic information regarding the service. The inspector looked at key documents; talked with and observed residents, staff and the Manager on a one-to-one basis; and undertook a tour of the property. 5 relatives’ surveys; and 2 professional’s surveys were received and were analysed prior to the visit, and form part of this report. 5 residents’ surveys were returned after the visits, which were completed by 2 members of staff from Freeways Day Centre. The staff observed residents at different times of the day both at the Day Centre and at the resident’s home. Three residents were case tracked and the inspector spot-checked other residents’ records. Verbal and written feedback was given at the end of the inspection to the registered Manager. What the service does well: Residents at Whites have lived at the home for a number of years and appear settled and well. Residents have individualised lifestyles and staff are aware of their often complex needs. Residents have choices in their daily lives and express themselves freely. The home’s medication system is robust with clear emergency procedures for residents on high risk and changeable medication. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 6 Residents have personalised bedrooms, which suit their needs. A comment from a relative’s survey said “***is very well looked after and is happy at Whites. Her carers understand her needs and give her a good quality of life with opportunities to do the things *** enjoys most.” What has improved since the last inspection? What they could do better: There are a number of areas that still need work on to make the home better. Staff need to provide care in a dignified and private manner to ensure respectfulness towards residents. The home needs to eradicate institutional practices to promote a more person centred approach for the resident. The Manager needs to ensure that all health care appointments are undertaken and identified needs are acted upon to ensure that residents’ needs are met. Health Action Plans need to be complete for all residents. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 7 The cleanliness of the home needs to be improved to ensure that residents live in a hygienic home. A system needs to be in place to effectively record when a resident is unhappy and is making a complaint. In order to demonstrate that the home is committed in improving the quality of service, the quality assurance system needs to be fully developed and implemented based on seeking the views of the residents and their supporters. 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. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Current people using the service and prospective people using the service need a complete Statement of Purpose to that they can be aware of the entire service on offer at the home. Residents have full assessments ensuring that their needs will be met. Clear contracts are in place so residents and their supporters are aware of the terms and conditions of living at Whites. EVIDENCE: There are no new residents at Whites and many of the residents have lived at the home for a number of years. The home has a Statement of Purpose outlining the home’s objectives and care values. It has been updated since the new Manager started. However, there are a few omissions such as the complaints procedure; the fire and emergency procedures, and how the home respects the privacy and dignity of the residents. The Manager needs to ensure that the Statement complies with Schedule 1 of The Care Home Regulations 2001. Further, if a vacancy were to arise, the Statement would need to be more user-friendly because at the moment it is all text. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 10 The home’s admission procedure was not reviewed at the inspection as it was felt that this was not appropriate as there have not been any new admissions to the home, nor any future admissions. 4 out of 5 relatives’ surveys stated that the home ‘always’ meets the needs of their friend/relative. A requirement had been made at the last random visit concerning residents’ contracts with Freeways. The response to the requirement confirmed that all ‘individual contracts are up-to-date including signed financial contracts’. The inspector viewed two of these contracts and confirmed this. Parts of the contract has pictures to help the residents understand what the contract means. Efforts to involve family and advocates should be made. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ individual plans are reviewed regularly and reflect assessed needs in order to effectively meet the residents’ needs. Residents are supported to take risks within their lives and can choose what they want to do. EVIDENCE: Residents have individual plans regarding their needs and how to support them in areas of their life. Relevant professionals and family members are invited to reviews, and most attend to ensure that all areas of the resident’s life are assessed effectively. Information about how to support the residents is written clearly in their ‘lifestyle plan’. The inspector read two plans in depth and there was good detail on how the resident needs support. These are written with a person centred approach such as ‘How I communicate’; ‘If I am upset/angry, I would like you to…’ and ‘What you need to know/do to support me’. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 12 Residents have key workers who write monthly reports. These were up-to-date and give a good description of what has happened in the resident’s life in the past month, such as incidents; activitities, changes in medication and health appointments. The home has been trying to get advocates for the residents, as some of the residents do not have any family or friends outside of the organisation. The Manager told the inspector that the home as a whole is on the waiting list and that it is a slow process. However, 3 people have been identified from Freeway’s day centre who are acting as ‘long-arm’ advocates. They drop into the home on a casual basis for 3 particular residents. Further, an ex-employee who retired is going to become an advocate for the home as they already know the residents and the residents know them. The inspector observed how residents could make decisions for themselves, mainly through body language and personal ways of communicating. It was observed how staff give residents choice about what they want to do, eat and drink. Observations from the day centre staff also confirmed this: ‘observed client being offered choices and walking away or staying depending on the choice made.’ Residents are not generally able to do their own laundry. Coloured wool had been bought to sew into the residents clothing to identify whose was whose, and a chart in the laundry room corresponds to names and colours. However, it was observed that staff were still sewing name labels into the clothing. This discussed with the staff and they said that it was easier, for the staff, to sew in the labels than the wool. This is institutional practice and was discussed with the Manager. Risk assessments have improved. The majority of them have been reviewed, show levels of risk, signed and dated. Most assessments are kept in 1 folder, with more specific assessments in resident’s personal files. Some still require reviewing. The Manager is aware of this and is going through all of them. Residents also have reactive strategies in place for behaviour, which challenges staff, for example what to do when resident may self-harm or get angry. The inspector viewed these and they also correspond with incidents. Individual resident’s records are kept in the 2 offices, which are locked unless staff members are in there. Staff were sensitive whilst talking with the inspector about people in the shared spaces. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have individual lifestyles according to their needs. Residents are supported to maintain their relationships with relatives where appropriate. A balanced and varied diet is offered to residents and appear to enjoy their mealtimes. EVIDENCE: Residents have their own individual ‘programme’. Many of the residents access Freeways day centre at Leigh Court which enables them to participate in activities which they enjoy and choose to do. There is also a hydrotherapy pool at the centre which some residents enjoy using. Apart from the day centre, other day centres are accessed such as the Deaf Centre. Within the key worker reports, from talking with staff and observations during the visits, residents go out into the community regularly with the support from staff. Whites have their own van to transport the residents. For example, Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 14 residents go shopping; horse riding; to the pub; walking; to the zoo; the city farm, and visits to new places. Any incidents whilst people are out are recorded and the risk assessments are updated to reflect current potential behaviours. Residents also pursue interests within the home such as enjoying the garden; television; music; drawing, and playing with personal toys. One relative commented on their survey “The home lay on a wide range of trips and outings which so enriches life; even just evenings at the pub, skittles, football matches, walks etc.” It was observed that the television is nearly always turned on even when there are no residents watching it. This is institutional practice and was discussed with the Manager. Annual holidays for the residents were discussed with the Manager. Due to the support needs of the residents, it has proven problematic in the past. The Manager said that there is not enough funding for holidays due to the staff ratios which would be needed. Many resident would benefit from time away from the home. It is a noisy household and some residents prefer a more peaceful lifestyle. The Manager has discussed this with her line Manager and it may be possible for residents to go on long weekends. The Manager said that some residents would prefer to have day trips away and return to their home in the evening due to their routines. The Commission for Social Care Inspection would be pleased to learn about the progress of this matter. Not all the residents have contact with relatives, nor have friends outside of the home. Details of next of kin are recorded in residents’ care plans and the home’s diary reminds staff when to encourage residents to contact their family. Some relatives maintain regular contact and residents spoke of this to the inspector. The inspector spoke to some relatives before the previous key inspection and after this inspection. All spoke well of how staff support residents to maintain contact. 3 out of 5 relatives stated that the home ‘always’ helps their relative to keep in touch with them; 2 out of 5 said ‘usually’. Some residents spend weekends with their relatives and staff drive them to and from the location. Comments from the surveys included: “On visits, staff are always friendly and polite to my ****’s family and me”; “would like more information regarding home outings.” Some residents have keys to their rooms, and records for this have been seen on previous visits. It was observed how staff interact with residents and do not solely talk to each other. Staff have different approaches with residents and some staff have raised this with the Manager, is recorded in staff’s files, and is dealt with through training and supervisions. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 15 Two residents smoke the occasional cigarette. One resident always goes outside and the other sits in the dining area. The Manager must ensure that from 1st July all residents go outside to smoke. One member of staff compiles the menu on a 6-weekly basis. The care staff do all the cooking. There are 2 kitchens. The smaller kitchen is kept locked due to residents’ obsessions regarding tea and coffee, and continuous eating, however, it was observed how some residents can access the smaller kitchen as there are always staff around and drinks are made if requested. The Manager told the inspector that breakfast is like a buffet style and residents are supported by staff to help themselves. There was a good variety of fresh fruit and vegetables, which are delivered twice weekly. The menu on display showed a balanced and varied diet including sandwiches/packed lunch for lunch, and for dinner meals such as spaghetti bolognaise; vegetable pie; lamb stew and favourites such as fish and chips and burger and chips are offered. Residents can also have supper/ a snack before bedtime, such as fruit salad; crumpets; angel delight; or yoghurt. Two menus were also supplied with the Pre-Inspection Questionnaire. If a resident does not like the meal on offer, the manager wrote to confirm that alternatives are written on the menu placed under the main menu. Staff said that another meal would be cooked, but this is rare. Staff also told the inspector examples of which foods the residents don’t like and this is also recorded in resident’s care plans. During the second visit, it was a resident’s birthday and a big spread of ‘party foods’ was on offer, which all the residents appeared to be enjoying. The lounge was decorated with banners to celebrate the occasion. Residents eat around two dining tables and meal times observed in the past are relaxed and residents can eat at their own pace. Staff eat with the residents. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service are not always supported with their health needs. Dignity and privacy regarding support is not always upheld. Residents’ medication is administered well because there are good systems in place. EVIDENCE: Many of the residents require a lot of personal support regarding their healthcare and personal hygiene. Many of the residents have complex health needs, which are compounded by needs including autism, epilepsy and incontinence. Some residents now have a Health Action Plan. The Manager said that there are varying degrees of success with them. 2 of the 3 residents case tracked had these plans in place. These are, on the whole, well written and have good detail for staff to follow. Some residents also have pictorial formats to follow to carry out certain tasks themselves to increase their independence. Morning and evening routines are Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 17 important to the residents and are well detailed. Staff spoken with were aware of these. The health action plans also included the most recent health care appointments, such as optician; dentist; chiropodist, and General Practitioner. Key Worker reports also prompt when the next appointment is due. One of these appointments was over due and this was discussed with the Manager, who further confirmed in writing that the appointment was incorrectly recorded and was attended this year. A Care Plan Review identified that a referral for specialist input would be beneficial. This referral had not been done. Some residents need extra support with some health care appointments and strategies must be put in place to ensure that these are carried out. Recent emergency health needs were handled well and support was given, and continues to be, to the resident effectively. During observations, it was very disappointing that some staff do not provide care in a dignified or private manner. Prompts to carry out certain tasks were done in the middle of the lounge in front of other residents and staff. No one raised a concern deeming that that was normal practice. Details of this were discussed with Manager rather than in this report to ensure clarity and to not identify those residents observed. A requirement has been made for staff to provide care to the residents with dignity and respect. 4 out of 5 relatives stated on their surveys that the home ‘always’ keeps them up to date with important issues such as being admitted to hospital or had an accident. Both professional’s surveys stated that residents’ health care needs are met by the service and that staff have a clear understanding of the care needs of the residents. It was evident that residents could get up when they wanted and could dress how they wished. Staff told the inspector that a lot of residents go to bed quite early after their evening routines. There is a waking night member of staff so residents can be supported throughout the night if necessary. Medication was inspected with the Manager. Not all residents receive medication. No residents self-medicate due to assessed needs and the level of risk would be too high. The record sheets were completed fully and a spot check of medication was found to be correct. Homely remedies such as paracetamol and lactulose are used when necessary. It was evident that some residents use these medications frequently due to side effects from other medications. It was discussed with the Manager that advice must be sought if symptoms persist. Residents with specific high-risk medication needs have good systems and emergency procedures in place to ensure that residents remain safe. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 18 Staff receive full medication training at Freeway’s Head Office and then have in-house training including a questionnaire and 8-12 observations, ensuring that administration is carried out properly. Some residents sometimes refuse to take their medication. This can be an indication of their emotions that day. This is recorded and action is taken to ensure that the resident remains safe. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ complaints and concerns are not being recorded effectively but are dealt with as necessary. Residents are protected from abuse as staff are aware of the procedure and are trained in identifying what constitutes abuse. EVIDENCE: The inspector read the complaints procedure at the last inspection and was found to be clear and efficient. It must be included in the Statement of Purpose to ensure that all people who use the service can access the procedure. Staff are still trying to ascertain how to record complaints from residents who do not communicate verbally. Observations by the day centre staff confirmed that it could be evident from behaviour when residents are not happy. For example ‘if the client did not like/want something, they would reject it by pushing it away’; ‘the client will approach staff if not happy, seek support.’; ‘the client would demonstrate [his/her] mood through facial expression, body language and behaviour.’ Another survey confirmed that a resident had been shown the pictorial complaints procedure. This will be followed up at the next inspection. Some residents present behaviours which challenge staff and these incidents are recorded. The inspector went through some of the incident reports with the Manager and there was not enough information written down to give a full picture of the incident such as who else was involved in the situation; what environmental factors may have contributed, and the preceding events. Further, one incident report which adversely affected a resident should have Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 20 been reported to the Commission for Social Care Inspection despite it being dealt with appropriately. 3 out of 5 relatives’ surveys stated that they knew how to make a complaint, 1 stated ‘no’ and 1 wrote ‘can’t remember’. 3 out of 5 said that they have ‘always’ received an appropriate response, 1 said ‘usually’, and for 1 it was not applicable. Some relatives wrote out who they would contact if they needed to, and a professional stated that the home has ‘always’ responded appropriately if they have raised concern about the care. Once the complaints procedure is included in the home’s Statement of Purpose, relatives will be aware of the process and know what to expect. Prior to starting work at the home, staff have a Criminal Records Bureau check and this is recorded in the staff’s personnel files. Some staff’s checks date from 2002. It is good practice to renew these checks every 3 years. Through the staff’s initial training, they receive ‘Safeguarding Adults’ training. This is to teach them about the various forms of abuse and what to do about it if they become aware of any abuse against residents. Staff then receive annual refresher courses by another of Freeways Managers or the Manager at Whites. The Manager has received training in ‘Safeguarding for Managers’. Referrals have been made to the Bristol Adult Community (Care Direct) in line with ‘No Secrets’ for the Protection of Vulnerable Adults and have been dealt with effectively. The Commission for Social Care Inspection have been informed at every stage. Risk assessments and reactive strategies have been updated to reflect current behaviours and situations between residents to make staff aware of what to do and when to be extra vigilant. The inspector asked staff what they would do if they saw any abuse and there were mixed responses, but all would tell the Manager. This was discussed with the Manager and she will be dealing with this during supervisions. From the Pre-Inspection Questionnaire, it stated that no residents maintain their own benefit book or handle their own financial affairs. The Executive Director handles all the finances in Whites and brings the new floats for the week. Residents’ ‘wallets’ were checked and there was one discrepancy which the Manager followed up on and will be reminding staff to record all expenditure when out. This was disappointing as this has been a recurring problem at the home. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home enables residents to live in a safe and comfortable environment. Residents have personalised bedrooms, which promotes their independence. The home was not clean or hygienic. EVIDENCE: The inspector undertook a tour of the property with the Manager. Some relatives had made comments such as “provides ‘homely’ comfort”; and “I feel it offers my *** a homely environment in which to live”. A requirement was made at the last visit regarding various maintenance issues within the home. It was pleasing to see that these are now being addressed. The home had become run down with areas such as the bathrooms and damp Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 22 needing attention. Since the last visit, a resident has had new flooring which is much more suitable and the action plan stated that they were very happy with it. New flooring has been put down in the dining room as well. The bathrooms are being worked on one-by-one. The ground floor bathroom is being turned into a shower/wet room due to the logistics of the plumbing. It was observed how staff were conscious that tools and equipment had to always be locked away to keep the residents safe. The Manager confirmed that the Executive Director has also approved funding for new furniture in the dining room and lounge. The lounge carpet is also being replaced, as there is spilt paint in the middle of it and looks poor. These changes will make the rooms a lot more homely and comfortable. The smaller dining room has been made into a second office for staff to access daily records with much more ease than the main office. It was observed how residents can still come and go from the room when staff are in there. Some relatives had concerns that this facility has been taken away from residents as it provided a quiet ‘closed off’ area for residents to take time out. This has been discussed with the Manager and residents can still access the room with supervision. The Commission for Social Care Inspection was involved in this decision and the shared space for the residents has not been compromised. The inspector went into a number of bedrooms and all were personally decorated with photos, certificates and pictures. Some residents benefit from living on the ground floor due to mobility problems. However, whilst talking with a resident, it was evident that the labels on drawers are unnecessary and appear institutional. This was discussed with the Manager and she confirmed that these will be taken off, therefore a requirement has not been made. Each resident has a ‘Life skills’ day where they are supported to clean and tidy their rooms and do their laundry. Evidence of this happening is not kept upto-date and staff were unsure of whose role it was to complete the record. Residents told the inspector who helps them to do these tasks. The kitchen is also going to be ‘re-vamped’ as it is looking tired and old. The flooring has needed to be replaced for a long time now, and the Manager confirmed that funding has been approved for this. The kitchen is a galley in style and access to the main door and office is through the kitchen. Due to the amount of cooking involved, the cooking hob needs to be made safe as at present there is no guard and the larger rings are positioned at the front. The garden has much improved and the inspector viewed how the residents can access it at any time. 2 of the porta cabins at the rear of the property are being removed, as the residents do not use them. One cabin is being kept for storage and the Manager has plans to make better use of the space. This will improve and increase the amount of space the residents can use. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 23 The home is fortunate to have a full time cleaner, and another of Freeways residents comes and carries out some cleaning tasks. Being a large house with 11 residents, this is needed. There have been issues in the past and these have continued. The home was not clean during either visits, for example, the hallway upstairs needed hovering; there was rubbish behind the washing facilities; rubbish round the sides of the building; the oven was dirty and smelly; a resident’s sheet was wet but the bed was made; and there was smelly spilt milk in the smaller kitchen’s fridge door. A relative had also raised a concern that the bathrooms were dirty. However, observations by the day centre staff stated that staff clean up after themselves and residents; some residents involve themselves in the cleaning, but common areas are sometimes not tidy. The Manager is fully aware of the continuous work needed within the home to bring it up to a good standard. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A more consolidated and fully trained staff team would better support residents. Consistent supervision would promote good practice ensuring that any staffing issues do not affect residents. EVIDENCE: The staff team at Whites is large and many staff work part time. There are a core number of staff who have worked in the home for a number of years and this is invaluable. The Manager has one deputy Manager; one team leader, and one new senior support worker. The organisation’s structure is clearly outlined in the home’s Statement of Purpose. The inspector spoke with various members of staff and the Manager throughout the visit. Comments from the relative’s surveys included: “at present there is a very established staff team which is reflected in the feeling of stability and relaxed atmosphere at Whites”; Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 25 “the carers I have met and know are patient, caring, accommodating, really good with my ****. It is a difficult job and I do feel that their skills and emotional input are such that they should be better rewarded in order to boost morale, self worth and keep them.” Observations from the day centre all stated that staff interact with the residents and are supportive and attentive to their needs. The inspector observed that the staff were always busy. After speaking to staff and the Manager, and observing the running of the home, it seemed evident that residents would benefit from having a more consolidated team to promote consistency and stability. Further, it is problematic for training to take place when staff are not able to attend due to such low hours worked. The Manager discussed how some kind of a teambuilding day would be beneficial for morale and relationships between the staff team. The Commission for Social Care Inspection received an example of the staff rota and the inspector viewed the current rota during the visits. Staff sickness has improved but remains often a daily issue. There are regular bank staff who come in to cover the shifts. Some residents have allocated 1:1 hours from the staff team, which was observed during the visit and from the staff rota. It was discussed with the Manager that due to the high needs of the residents, many more of the residents would benefit from specific staff time to increase interaction and social skills. It was observed how many residents are often left on their own throughout the day when they are at home without direct interaction or stimulation. This also contradicts some care plans stating that the residents need a lot of attention and need to go out. Another comment from a relative in relation to how the home could improve was “maintain and improve the funding so they can maintain what they do and even take on one or two more staff so as to do more.” The inspector viewed 3 staff files, 2 of whom started in the past 7 months. All contained a completed application form; 2 satisfactory references from previous employers; a form from head office confirming satisfactory enhanced criminal records bureau check; details of training and any qualifications; and supervision notes. The Pre-Inspection Questionnaire stated that 3 members of staff have their National Vocational Qualification in care. Staff who are new to care have to firstly undertake their Learning Disability Assessment Framework course which covers the fundamental basics of working with people with learning disabilities. It also covers the mandatory training courses such as Food Hygiene, Manual Handling, Fire Safety and First Aid. 1 staff record showed that no mandatory training had taken place, but has training booked. Some training is booked for Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 26 the near future and the inspector saw the record the Manager keeps to monitor training needs. Other training specific to the residents’ needs is undertaken by some staff such as ‘Studio III’ which is about dealing with behaviours which challenge staff and other residents, and ‘Epilepsy’. 3 out of 5 relatives stated that the cares staff ‘always’ have the right skills and experience to look after people properly. One relative commented that they are “not aware of staff skills and experience. It would be a good thing to have information of this sort on a formal basis.” Relatives may benefit from receiving the Statement of Purpose, which does contain all this information. Staff meetings take place monthly but due to staff’s hours, not all staff are able to attend. A system is in place for staff to read the minutes and to confirm this by signing the front. However, on average, only half of the staff team do this, evidencing that issues are not communicated effectively. This was discussed with the Manager. Handovers occur twice daily, and the shift times have recently been altered to ensure that these occur effectively. However, depending on residents’ daily activities and support needed for this, the handovers do not always happen as desired. This will be followed up at the next inspection. The inspector read some supervision notes, which are thorough, covering areas such as key responsibilities; staffing issues; training and development, and review of previous goals. It is evident that staff are comfortable with raising complaints with the Manager. The Manager said that when she joined, there were a lot of ‘niggles’ from the staff team to deal with. These issues were discussed with the Manager and are dealt with efficiently through supervision. Staff are also given the option of raising a formal complaint. Some staff are overdue their supervision session and these people are listed in the office and the Manager confirmed that they have been given dates for the next session. Due to the recent changes in management, it is important that issues do not affect the residents and supervisions are carried out. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home because the Manager is experienced and qualified. A developed quality assurance system will help the home improve, therefore, improve the resident’s lives. Residents are protected by safe working practices because checks and tests are done regularly. EVIDENCE: The Manager, Tess Robins, is the new Manager in the home. Ms Robins is qualified and experienced and moved from another of Freeway’s homes in January this year. MS Robins was present for the majority of the inspection and was open and transparent about the running of the home. Ms Robins has her Registered Manager’s Award and has been with the organisation for 11 years. Ms Robins has complied with the previously made requirements and Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 28 has made good positive changes according to the needs of the home and residents. Staff are comfortable with raising issues they have and are positive about the change of management. Ms Robins still needs to apply for registration with the Commission for Social Care Inspection. The home’s quality assurance system is yet to be fully implemented. Freeways have good strategies in place and the Manager needs to develop these. Monthly visits from senior management take place and the reports are of a high standard. Relatives spoke to the inspector about a questionnaire they had received and the feedback should improve the home further. The establishment of advocates and a system for recording resident’s views will help this process. This will be followed up at the next inspection. Health and Safety checks take place regarding the safety of residents. The pre-inspection questionnaire gave information about when the last checks were done, such as the electrics and the gas installation. The inspector saw evidence that fire drills take place but would benefit from knowing what action was taken to increase the safety of residents. The inspector also saw the report from the Environmental Health Officer who awarded the home with a 4Star Food Hygiene Award, with only a few recommendations. Records also showed that staff check the fire safety equipment to promote residents safety. Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 3 2 X 3 3 X Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 30 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 YA1 Regulation 4(1)(c) Schedule 1 Requirement The Statement of Purpose must be updated fully to reflect the home’s service and facilities. This will ensure that current people and prospective people know what to expect from Whites. Residents to receive care and support from staff with dignity and respect at all times. Residents must have regular health care appointments; receive appropriate support, and referrals have to be followed up to ensure that all residents’ health needs are met. Timescale for action 30/08/07 2. YA18 12 (4)(a) 30/06/07 3. YA19 13 (1)(b) 30/07/07 4. YA30 23 (2)(d) 5. YA37 The house must be kept clean to ensure that residents live in a hygienic and homely environment. CSA The Manager must apply for Section 11 registration for the Manager’s position in line with section 11 of The Care Standards Act 2000 through the Commission for Social Care Inspection to ensure that they are qualified and DS0000026557.V339814.R01.S.doc 30/06/07 30/07/07 Whites Version 5.2 Page 31 competent to run the home. 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 YA22 Good Practice Recommendations The manager to ensure that complaints are effectively recorded from residents to evidence the home’s practice of dealing with complaints and to also provide information for the home’s quality assurance system. It is good practice for staff to have Criminal Records Bureau checks every 3 years to ensure that residents remain safe. 2. YA34 Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Whites DS0000026557.V339814.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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