Inspection on 04/05/05 for Whites

This inspection was carried out on 4th May 2005.

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

The inspector 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

Whites 17/05/07

Whites 10/04/06

Whites 28/11/05

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 Sam Fox Unannounced 4 May 2005 09:30 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 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 Stationary 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 D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 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 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 PC Care home 11 Category(ies) of LD Learning disability (11) registration, with number of places Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19-June-2004 - Unannounced Brief Description of the Service: Whites House is operated by Freeways Trust Limited and is registered to provide accomodation and personal care for up to eleven people who have a learning difficulty. Primarily they accommodate people who have complex behaviour 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. 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. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the purpose of which was to ensure that the environment was clean and well maintained and to check on residents’ welfare. In addition to this several key records were spot checked, including care plans, staff recruitment files and health and safety records. Evidence was gathered through discussion with the manager and staff and examination of records. In addition to this a full inspection took place of the premises. A number of residents cannot directly verbally communicate and as such part of the inspection involved observation of interaction between the staff team and residents. What the service does well: What has improved since the last inspection? Whites have continued to successfully recruit new staff. This has led to increased stability and consistency for residents who are now receiving a better Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 6 service. They now benefit from receiving support from people they know and who have built up a relationship with them. Care plans continue to be improved and provide good guidelines about what residents need and how staff are going to support them. In addition to this staff are more regularly monitoring and reviewing plans to ensure they reflect actual work practice. The management team now have well-established systems in place for the maintenance of basic records and have been able to build on this to continue to improve standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 & 5 There is up to date information available so that prospective new residents can make an informed choice about their future care needs. Residents can be assured that formal assessments will establish whether the home has the resources and skills to meet their needs. EVIDENCE: The manager has recently reviewed the home’s Statement of Purpose. This describes the aims and objectives of the home, the services available and the complaints procedure. This meets with requirements of the legislation. Each resident also has a copy of the home’s brochure, which also serves as a contract. This is written by using pictures and symbols so that residents can more easily understand it. This is good practice. Whites have not admitted any new residents for over two years. Inspection of personal files, however, indicated that all residents had initial formal assessments from social workers before moving there. This enabled the home to establish whether they had the resources and skills to meet their needs. Each resident has an up to date contract. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 Care plans are well written, up to date and reflect individual needs. They enable staff to provide residents with the support they need and prefer. EVIDENCE: Each resident has a “lifestyle” plan which includes guidelines for staff about how they like to receive support. Opportunity was taken to spot check two of these and they were found to contain the following information: • • • • • Personality profiles Guidelines for morning and evening routines Essentials and likes and dislikes Care plans Care plan reviews The information was well written and evidenced that the home provides a service that takes in to account personal tastes and preferences. Care plans also included emotional and social support needed. The home operates a key working system - whereby there is a named member of staff who plays more of a central role in co-ordinating the services Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 10 they receive. This system is still working well and a spot check of monthly reports evidenced that key workers are regularly monitoring developments and reviewing goals. There were minutes of meetings which evidenced that professionals and relatives are invited to care plan meetings. Whites House have developed a number of risk assessments which are used to encourage residents to lead active lifestyles. These cover a wide range of subjects such as going out and using the kitchen. These were found to be reviewed regularly and contained clear guidelines to enable staff to reduce potential risks. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 & 16 Staff ensure that residents have access to community facilities. Day services are under resourced and need to be developed so that they are more meaningful. EVIDENCE: Records provided evidence that some residents have good links with their family and that they are supported to visit them at regular intervals. Whites provide day services and some residents receive additional one to one funding in the week for extra support from staff. Times for this are clearly identified on the weekly rota. Others attend Leigh Court which is a resource activity centre run by Freeways. The day services provided by the staff include regular trips into the community, art and crafts and walks to places of interest. It was apparent, however, that day services is an area for development in the home and that staff need further training, organisation and motivation to ensure that activities are meaningful and relevant. In addition to this the resources available are limited. There is a porta cabin in the grounds which is used for arts and crafts Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 12 and relaxation. This is in need of updating and the environment is not homely. It is recommended that the home focus on developing day services in the forthcoming months. Members of staff confirmed that residents will benefit from an annual holiday. The deputy explained that the home endeavour to ensure that residents are able to go out frequently and that they have a good community presence. Residents were observed being supported to go out at the time of this visit. There were risk assessments available in relation to residents accessing community facilities and public transport. It was noted that there had been a potentially challenging incident with one resident recently when they were out shopping and lengthy discussion took place about whether the appropriate actions were taken by staff and whether the risk assessment was followed. The home was asked to further investigate this, send a copy of the updated risk assessment to the CSCI and ensure that all staff are consistently following guidelines (this has since been achieved). It should be noted that the home make strenuous efforts to ensure that residents are given opportunities to go out despite some of the complex, and sometimes challenging behaviours that they have the potential to display. The kitchen area was found to be cleaned to a satisfactory standard. The kitchen cupboards and fridge are kept locked. Whilst this may be considered institutional practice it was evident that a number of residents require supervision when eating and drinking, particularly in relation to the excessive amounts that they would consume. It was observed, however, that residents had access to tea and coffee making facilities throughout the day and they were sensitively deterred from drinking excessive amounts. A member of staff explained that each resident has a life kills day when they stay at home and do their household chores, such as cleaning their room and doing their laundry. Some residents require more support than others with this. Residents were observed, however, taking responsibility for their environment in a manner which was appropriate to their level of understanding. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 & 20 Residents can be assured that they will receive personal care support in a sensitive and respectful manner which takes into account their individual personalities. Staff are skilled at supporting residents with their complex health care needs. EVIDENCE: Each resident has a lifestyle plan which includes guidelines of morning and evening routines. These were written to excellent detail and provided information about individual needs and preferences. This is particularly important for a number residents who have ritualistic behaviours and who need a routine to help them feel secure. Residents were observed being sensitively and discreetly assisted with personal care. They had their own styles of dress which reflected their personalities. Records provided evidence that residents are supported to see the relevant health professionals, including specialists. Some residents have complex medical health needs and the home has adapted its procedures to ensure they can meet these needs. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 14 Each key worker monitors follow up appointments through monthly reports. These showed that residents are supported to have regular check ups at the dentists and opticians. In addition to this some residents are taken for regular blood tests. Members of staff explained that a resident had been in hospital recently and that the team provided support for her whilst she was in there, including taking in food that she liked to eat. This is good practice. Whites operate a monitored dosage system for the administration of medication that is supplied at regular intervals by the local pharmacist. Records held in relation to the administration and disposal of these were found to be well maintained and met with the requirements of the legislation. There were up dated medication profiles for each resident which described the tablets they were prescribed, what they were for and side effects. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Staff have the skills to communicate effectively with residents and they can be assured that their preferences will be respected. EVIDENCE: Freeways Trust Limited have a formal complaints procedure which includes timescales for investigation and the contact number of the CSCI to whom concerns can also be raised. This has been translated into a more user friendly format, using photographs, which are located in residents bedrooms. One formal complaint regarding safety in the community is currently under investigation. Personal files included methods of communication and behaviours that may indicate that a resident is upset or unhappy. This is good practice and particularly important at Whites were a number of residents cannot directly verbally communicate their needs. Staff were observed sensitively supporting residents in situations which could have escalated into challenging situations. A number of residents have complex needs which can result in them displaying challenging behaviour in the form of shouting and possibly hitting. Personal records include “reactive strategies” which detail specific triggers which may lead to such behaviour and distractions which may reduce the likelihood of them occurring. Those seen at the time of this visit were up to date and contained useful information. There was evidence to indicate that staff have received protection of vulnerable adult training last July. Freeways have policies in place regarding this which have been used to good effect in the past. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 16 All residents accommodated require support to manage their money and the home holds some of this for safekeeping. A spot check of records revealed that there was some money missing. (This has since been resolved and was the result of human error). The home must ensure that accurate records are maintained of financial records at all times and this will remain a requirement so that it can continue to be spot checked at the next visit. It was noted that a number of residents have excessive amounts of change and this made it difficult to count and keep track of monies available. It was recommended that the home reduce the amount of change retained for residents. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 30 Residents benefit from living in a clean, homely and generally well maintained environment. EVIDENCE: Whites House is located in large grounds set back from a busy main road. It is close to local shops and a main bus route. It has a gated entrance which is there for the protection of a number of residents who need support to go out. The premises benefit from large grounds which continue to be well maintained and residents were observed using this area to relax in. The house requires a lot of maintenance and sustains regular damage due to the behaviours of some residents. There is now a more established programme of maintenance and there were no major issues arising from inspection of the premises. It was noted, however, that the two sofas in the main lounge were badly stained and torn. These need replacing. In addition to this the carpet on the back stairs was badly stained, worn and requires upgrading. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 18 Generally all areas of the home were found to be cleaned to a good standard and there were no unpleasant smells. There are sufficient bathing and toilet facilities for those residents currently accommodated. Some of these rooms appear bare – this, however, is due to the needs of some residents who may damage property. In addition to this one resident has a tendency to ingest toiletries so these have to be locked up at all times. All bedrooms seen were personalised and reflected individual tastes, some were locked to ensure resident’s privacy. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 There is an effective recruitment system which is in place to protect vulnerable adults. Staff benefit from a thorough induction, which gives them the skills and confidence to support residents. EVIDENCE: On the day of the inspection there were five staff on duty, one member of staff had rang in sick and one member of staff was on annual leave. There were three staff on duty in the evening, reducing to one staff who sleeps in and one who says awake. In addition to this the home employs a housekeeper. These staffing levels are adequate to meet with the needs of those residents currently accommodated. In the recent past Whites have had difficulties recruiting staff and this had led to a high use of bank and agency staff. This situation continues to improve and the home have successfully recruited more people since the last inspection. The deputy explained this has led to more stability and new staff are showing enthusiasm and a willingness to try new things. This is a positive development and there was a calm and relaxed atmosphere in the home at the time of this visit. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 20 Opportunity was taken to view the personnel file of one of the newest members of staff who had been employed for three weeks. This was found to contain an enhanced police check, completed application form and two references. This provided evidence that the home continues to follow a robust recruitment procedure. The file also included a completed in- house induction. In addition to this Freeways also provide a formal four day induction during which time new recruits receive their statutory training of first aid, manual handling and food hygiene. There were certificates to show that these had been achieved promptly. The organisation provides a good foundation for new employees to learn. The deputy manager explained that as part of the initial induction new staff are enrolled on a specific training course in place to increase their knowledge of learning difficulties (LDAFF). They are expected to complete this within six months. It was noted that one member of staff began it in 2002 and is yet to complete. It was recommended that further emphasis be placed on having this timescale as a realistic target. There were minutes of staff meetings that take place at regular intervals and it was apparent from these that all aspects of residents’ welfare are discussed as well as organisational policies. In addition to this the home has a well-established formal supervision policy and minutes of these indicated that they take place at approximately six weekly intervals. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Residents benefit from living in a safe environment. EVIDENCE: The fire log book evidenced that the home makes tests and checks of the system at the appropriate intervals. Whites have a fire procedure and at the time of this visit the fire alarms sounded. The staff team evacuated the house calmly and quickly. It was also apparent that the majority of residents knew to exit the building and did so promptly. This is good practice. Whites has a workplace fire risk assessment. There were other heath and safety risk assessments available, including in relation to bathing. The home had a visit from the environmental health officer in January from which there were a few minor recommendations. The deputy manager said these had been acted upon. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 22 Freeways appoint a senior manager to oversee the day-to-day running of the home. He visits on a monthly basis and writes a report of his findings, copies of which are sent to the CSCI. These are detailed and indicate that all aspect of the running of the home are monitored. The deputy manager said they feel supported by the manager. A spot check of staff training evidenced that they receive statutory training of first aid, food hygiene and manual handling and that these are updated when necessary. The home now has a good system in place for monitoring this. Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Whites Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 24 no 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. 2. 3. Standard 23 28 28 Regulation Schedule 4 (8) 16(2 )(c ) 16(2) (c ) Requirement Keep acurate records of all financial transactions Replace the sofas Replace or clean carpet to an adequate standard Timescale for action 4 May 2005 4 July 2005 4 July 2005 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. 2. 3. Refer to Standard 13 23 Good Practice Recommendations Continue to develop day services Reduce ammount of change held on premises Whites D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 D56_26557_Whites_223853_040505_Stage4.doc Version 1.30 Page 26 - 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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