CARE HOMES FOR OLDER PEOPLE
Whitestones 129 Manchester Road Chapel-en-le-Frith Derbyshire SE23 9TW Lead Inspector
Denise Bate Key Unannounced Inspection 21st November 2006 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 Whitestones DS0000062727.V319181.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. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Whitestones Address 129 Manchester Road Chapel-en-le-Frith Derbyshire SE23 9TW 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) 01298 308166 01298 308130 www.derbyshire.gov.uk Derbyshire County Council Christine Mulryan Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd May 2006 Brief Description of the Service: Whitestones Care Home is a new purpose built home which has been built on the site of the old care home. It is registered to provide accommodation for 41 residents, comprising of 1 double room (for couples), 4 short term care beds and 37 long term care beds. All rooms have en suite bathrooms. Each room has its own private patio area or verandah. It is situated on the outskirts of Chapel en le Frith. Fees are £364 per week for permanent service users, but a range of prices for short term care service users. Extra charges are made for hairdressing, chiropody, magazines and newspapers. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven hours. During the inspection five residents, three relatives, and five staff members were spoken with. The deputy manager was present during the inspection and provided assistance and information. Written information was provided by the manager prior to the day of inspection. Nine surveys were received prior to the inspection providing feedback on the services provided. An assessment was made of the progress by the registered persons to address the requirements made at previous inspections. A number of records were examined, including care planning documentation, staff files, and medication records. Four residents were case tracked. A tour of the building took place. What the service does well: What has improved since the last inspection?
After the last inspection a detailed action plan was drawn up and monitored at regular intervals. This demonstrated the home’s systematic approach to continued improvement. All requirements made at the last inspection have been met. There are good systems in place for recording staff training. Staff files are up to date. An enormous amount of work has gone into updating care planning documentation which is very well organised and detailed. Medication storage
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 6 now includes a detailed description of each medication. A programme of activities, outings and entertainment has been developed. This is still being promoted by the home but sufficient evidence was given during the inspection to confirm that the home are making significant progress. Recommendations have been implemented. The Statement and Service User guide has been made available to all residents. As detailed above, wash hand basins have been replaced. There is a programme of staff supervision, although not all supervision is currently up to date staff said they felt supported by the management team. Copies of Regulation 26 visits were seen. The quality assurance programme has been carried out and identified that most residents felt the overall level of service at the home was good or excellent. The items highlighted for improvement are being worked on by staff and the management team. In addition a ‘sensory survey’ of the building has been carried out and an action plan developed. The home are in the process of ensuring that they comply with all advice in the Derbyshire County Council Pharmaceutical Guidance, which will include carrying out a risk assessment on residents who self medicate. 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. The summary of this inspection report can be made available in other formats on request.
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information is available to ensure residents can make an informed choice about where they live. EVIDENCE: A copy of the Statement of Purpose, Service User Guide, and other information was available in each bedroom. A monitoring document was made available to the Inspector indicating that Statement of Purpose and Service User Guide have been made available to each resident. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 9 Copies of assessments carried out by care managers were seen on care planning documentation of all case tracked residents. Potential residents have a visit to the home and an assessment completed after that visit. One current case was discussed on the day of inspection. The home does not provide intermediate care. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are suitably completed to demonstrate that residents health, personal and social care needs are being fully met. EVIDENCE: A great deal of work has gone in to care planning documentation since the last inspection. The four case tracked residents had excellent care plans covering all aspects of care planning documentation and risk assessments. Items in files included the link worker’s name, photo of the resident, front sheet with basic information, needs assessment, copies of reviews, personal service plans, risk assessments (moving and handling, falls prevention, tissue viability, nutrition), weight monitoring, health care professional visits, activities record, time spent one to one with key worker, monthly report, night check agreement, preferred
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 11 form of address and how individual rights and choices were to be promoted including individual routines, last wishes plan, personal property inventory, contract, and day to day logs. There is now a designated records room where staff can do their writing up and have handovers. Whitestones is a large and busy home which has taken residents from previous homes, as well as having new residents and four short term care beds. Good record keeping and care planning is essential to the well being of residents, and staff are to be congratulated for the progress they have made in this area since the last inspection. The feedback from residents and relatives indicates that they feel the home provide good quality care and liaison with health professionals is good. Comments included ‘ I am happy here and have settled well’, ‘staff really care about you’. Positive feedback regarding levels of care had been provided by the home’s own quality assurance study in summer 2006. There is a designated medication room. At the last inspection a medication requirement concerned the labelling of medication kept in the medication trollies, and this was complied with shortly after the last inspection. There are now two medication trolleys divided into two ‘lounge areas’ to assist staff who administer medication. There was a record of staff signatures. There was recording of the date of opening on eye drops. The controlled drug book was administered satisfactorily. One person who administers their own medication had signed the appropriate form but not had a risk assessment. The home are working through the new guidance from Derbyshire County Council to ensure they comply with current medication administration practice in every respect. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14, 15 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Activities are provided that generally suit the expressed preferences of residents. This assists in contributing to a pleasant atmosphere and the overall good level of satisfaction for service users. Dietary needs of residents are generally catered for with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: An action plan was produced after the last inspection indicating that a planned approach is taken to improve activities and make more contacts with the local community. Documentation seen included surveys of individual resident’s interests, activities advertised on notice boards, some photographs of previous activities and outings, and a record of activities undertaken is kept. However, some residents said they would like to do more, although staff report that it is
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 13 sometimes difficult to engage residents in activities. It is anticipated that the home will continue to develop activities and provide encouragement and support in this area. Residents meetings are held regularly and the minutes were seen. An amenities committee is up and running and the minutes were seen. Various seasonal celebrations are being planned. A volunteer (who has been CRB checked) is coming to the home 3 days per week to socialise with residents. As indicated previously, the key worker system is working extremely well. All residents spoken to knew the name of their key worker and have a significant relationship with them. Relatives spoken to indicated that they were made welcome to the home and were confident that the home would communicate any changes in their relative’s circumstances. The home are continuing to rebuild relationships with the wider community. As previously mentioned, resident choice is recorded on care plans. The home’s philosophy is prominently displayed around the home. Staff aim to maximise residents independence and residents said they were treated with dignity and respect. Staff were observed interacting the residents in a thoughtful and caring manner while providing day to day care. Some residents who like to use their rooms as bed sits have been provided with alarm pendants as well as the call system for added convenience and security. Feedback from the surveys and residents spoken to had differing comments about the standard of catering ranging from ‘it is very good’, to ‘not very good’. However the home provided enough documentation to show they are trying to address these issues, e.g. lists of resident likes and dislikes, feedback book completed regularly, consultation at residents meetings. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 14 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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and accessible complaints and safeguarding adults procedures are in place to ensure residents can be confident that any issues raised would be acted on effectively and promptly. EVIDENCE: There is a corporate complaints procedure in place, although most relatives and residents prefer to raise issues on a more informal basis. There have been no formal complaints reported to the Commission. The complaints book was seen and contained details of day to day issues raised and how they were resolved. All relatives and residents spoken to said they would talk to the staff, key worker or a manager if they were not happy, but some residents may need encouragement to do so. Derbyshire County Council has clear procedures for dealing with the safety of residents and safeguarding them from harm. Staff spoken to showed an awareness of safeguarding adults issues and would pass any concerns on to their line manager. Training in safeguarding adults has been provided for staff.
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 15 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): 19, 20, 21, 23, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This new home is purpose built and provides residents with an attractive and spacious place to live. EVIDENCE: The home is newly built and offers spacious attractive accommodation with a choice of lounges, an attractive courtyard with ample garden furniture, an activities room, hairdressing room and kitchens that can be used by service users and their families. There is ample storage and office space, and a variety of aids and adaptations. All the furniture and decorations are of good quality. However, the design of the building can be a problem for residents, as the
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 16 corridors are very long and look the same, the kitchen is a long way from dining areas, and the lounges not near dining areas. The home have carried out a sensory awareness survey and are developing plans to help residents find their way about the building. All wash hand basins have been replaced and are situated at a convenient height, and have had taps replaced and overflows so that plugs can now be used. Staff report positive feedback from residents and all residents spoken to were pleased with their bedrooms, which are all ensuite, and have access to a private outside patio or balcony. There are two bathrooms with hoists, and other toilet facilities conveniently located. All areas of the home were clean and tidy on the day of inspection. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and competent workforce are in place which meet the dependency needs of residents currently accommodated within the home. EVIDENCE: The staff rotas were discussed and found to provide adequate staffing to meet residents’ needs at the current time, although staff were often very busy. New staff have been recruited as occupancy levels have risen. When a new member of care staff takes up their post in December the home will be fully staffed. There are currently five care staff on duty in the morning, four in the afternoon, and two waking care staff at night. However, with 41 residents it is possible that dependency needs could change quite quickly requiring more staff, and managers indicated that they will be doing work ensure that residents’ dependency needs are continually assessed. The home do have contingency hours that they can access. Staff spoken to felt that progress is being made on all aspects of the home’s organisation, including better teamwork.
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 18 The requirement to update staff files has been done and two staff files seen contained all relevant information. The requirement to update staff training records has been done and indicates that staff undertake a wide range of mandatory and other training to enhance their knowledge. Staff spoken to said that they were offered excellent induction training, and were encouraged to take advantage of the training opportunities offered. Staff meetings are held and the minutes seen, indicating that day to day issues relating to aspects of running the home are dealt with. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified and experienced and staff demonstrate an awareness of their roles and responsibilities, thus ensuring the home is run in the best interests of residents. EVIDENCE: The manager is suitably qualified and experienced to run the home. The management team is fully staffed and feel well supported by their service
Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 20 manager. Each deputy takes responsibility for some aspect of the home, e.g. hotel services, care planning, medication. The inspector was informed that the home is visited regularly by a representative of the registered person and copies of Regulation 26 visits were available, indicating that day to day matters are looked into, and action take where appropriate. There had been a quality assurance exercise which indicated that most residents and relatives feel the home provides an excellent/good overall service. The inspector was informed that at present residents’ personal finance records are kept manually which appears to work satisfactorily. Consideration may be given in future to a computerised system. Not all staff supervision is up to date but there is a system in place. Staff spoken to felt supported by managers and felt that they had worked very hard since the opening of the new home. Information on maintenance and health and safety records was provided by the manager in the pre-inspection questionnaire and indicates that matters relating to health and safety are satisfactory. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 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 3 3 4 4 x 4 x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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. 4. 5. Refer to Standard OP9 OP12 OP15 OP27 OP27 Good Practice Recommendations Risk assessments should be carried out for any residents who administer their own medication. The programme of developing activities should continue. The programme of consultation over the quality of food should continue. Resident dependencies should be monitored to ensure staffing levels continue to meet residents’ assessed needs. Consideration should be given to increasing night staffing levels. Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Whitestones DS0000062727.V319181.R01.S.doc Version 5.2 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
