CARE HOME ADULTS 18-65
Whitewalls Bells Lane Hoghton Lancashire PR5 0JJ Lead Inspector
Mrs Jennifer M Turner Key Unannounced Inspection 13th December 2007 11:00 Whitewalls DS0000005929.V336373.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 Whitewalls DS0000005929.V336373.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. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Whitewalls Address Bells Lane Hoghton Lancashire PR5 0JJ 01254 852288 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) www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Mrs Catherine Margaret Horne Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD The maximum number of service users who can be accommodated is: 6. Date of last inspection 15th November 2006 Brief Description of the Service: Whitewalls is a large detached property situated in the village of Hoghton between Blackburn and Preston. The village provides access to local facilities and services and it has good transport links to nearby Preston and Blackburn. The home has strong links with Stanley Grange, which is also owned by CARE, some 2 miles away. The two-storey house stands in its own grounds and contains a lounge/dining area, a small conservatory, kitchen, two bathrooms, separate toilet, five single bedrooms and a staff room. There is also a self contained flat attached to the home which accommodates 1 resident. At the time of the inspection the fee was £625 per week. An additional fee of £12.75p per hour was charged for one to one support. There were also additional charges for meals out on special occasions; public transport costs; travel costs in company vehicle – less than 20 miles is £1; gifts for other people; clothes and haircuts; telephone calls; newspapers and magazines, music and videos. Information was available in a Statement of Purpose and Service Users Guide. At the time of the inspection there was full occupancy. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Whitewalls on 13th December 2007 over a six hour period. During the course of the inspection, the manager, a support worker and four residents were spoken with. Residents files and staff files were examined. Procedures and records were also examined and the premises were viewed. Feedback was offered to the manager at the end of the inspection. Information from a pre inspection questionnaire, two questionnaires received from members of staff and four questionnaires received from relatives, contributed towards the findings. Requirements and recommendations made following the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. A questionnaire relating to a document “Equality and Diversity – A Guide For Providers” which had been forwarded by the Commission was also completed. A review of the conditions of registration had been carried out by the Regional Registration Team when the manager had been registered. What the service does well:
Ongoing care and support was planned effectively to ensure the residents’ needs were met and there was a consistent approach taken by staff. The residents fully participated in the care planning process and were familiar with their essential lifestyle plans and person centred plans. This gave the residents the opportunity to communicate their views and influence the provision of support. One comment from a member of staff was, “The service provides friendly formats so service users understand the information regarding them”. The residents pursued a wide range of meaningful activities both inside and outside the home. This approach enabled residents to participate in the life of the home and gave them the opportunity to meet other people. One comment in a relative’s questionnaire was, “My daughter has been developed to her full potential. They ensure that she has a full a life as possible and she has achieved goals I never thought possible”. Another comment was, “My daughter has developed whilst at Whitewalls way beyond any expectation we had. She has a full and successful life thanks to the staffs support and efforts”.
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 6 The residents and staff shared good relationships and there was a friendly atmosphere in the home. One resident commented that, “I like it here” and “we go on holiday”. There were arrangements in place to ensure the residents were listened to and any concerns were acted upon. This was achieved by the means of residents meetings and established arrangements to investigate any complaints or concerns. Staff had access to a wide range of training opportunities, which gave them a good understanding of their role and the needs of the residents. The home had established systems to monitor the service provided for the residents and it was clearly evident that the home was managed in the best interests of the residents. One relative commented, “I receive a weekly phone call from a member of staff to check things are OK and I know I can ring or call in at any time without any prearrangement”. What has improved since the last inspection?
The Statement of Purpose and the Service Users Guide has been reviewed and given to residents. This ensures that they have “up to date” information about the home and services provided. A new way of writing care plans has been introduced. They are written with the assistance of the residents and are in a story form told by the resident. This makes them easier to read and for staff to fully understand the needs and preferences of the residents. The complaints procedure has been reviewed and a copy given to each resident. This will ensure that residents and their relatives know the procedure to follow if they have any concerns. The manager has been registered with the Commission. The medication procedure for residents spending time away from the home has been reviewed. This ensures that an audit trail can be carried out in respect of medication leaving and being returned to the home. The vulnerable adults procedure has been reviewed and includes all the necessary information. An overall training and development plan is available for the staff team. This ensures that the manager has information available relating to staff qualifications and training needs. .
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 7 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. Whitewalls DS0000005929.V336373.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 Whitewalls DS0000005929.V336373.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment procedure was carried out prior to people moving into the home. This meant that their diverse needs were known and met. EVIDENCE: Written information was available in the form of a Service Users Guide and a Statement of Purpose. Both documents had been reviewed since the last inspection. Staff said that the Service Users Guide was “more user friendly”. The Service Users Guide was written in pictorial form and in large print. Records showed that this had been discussed with each resident on an individual basis. Residents had signed documentation saying that it had been explained to them. Both documents were given to residents. The files of two people admitted into the home since the previous inspection were examined. One of these residents explained about coming to live at Whitewalls. Records showed that the residents’ needs had been fully assessed before admission by a social worker and by the staff in the home. An introductory booklet “Getting to Know You” was completed prior to admission From all this information, a comprehensive care plan was formulated. Photographs on the files showed the date they had been taken.
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of the residents were assessed and regularly reviewed. They were supported to take appropriate risks, which helped them to retain their independence. EVIDENCE: Records showed that the residents had an individual essential lifestyle plan, which reflected their personal, social support and welfare needs. The plans included detailed information about their preferred routines and personal aspirations along with instructions for staff to ensure all needs were met. The residents also had an individual person centred plan (PCP). This was very informative and was written “in the first person”. It was reviewed at least twice a year or in line with changing needs. Prior to the review, the residents prepared pictorial versions of the plans. They were also responsible, with the
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 11 assistance of staff, for preparing invitations for whom they wished to be involved with their review. Staff assisted them on the computer and then sent out the final invitations. The residents were supported with their financial affairs and detailed written records were maintained of all transactions. A random check of money deposited with the home for safe keeping corresponded accurately to the records. It was the practice of the home to support residents in all aspects of their daily life. Policies stated that the role of staff was “to facilitate independence wherever possible”. Detailed risk assessments and management strategies covered activities indoors, for example “home alone”, and in the wider community and were included on residents’ files. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Peoples diverse dietary, social, religious and cultural needs were identified and met. They were able to make choices and decisions about their life so that their lifestyle continued to meet their preferences. EVIDENCE: The residents were supported to pursue various vocational activities. At the time of the inspection residents were attending college courses, one person worked part time in a shop and another worked at a children’s day nursery. In addition, some residents worked in various workshops at Stanley Grange. The residents spoken to said they enjoyed their daytime activities. One person was pleased to show the inspector, gifts she had made for her family at her craft class and showed photographs of recent activities.
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 13 Residents engaged in activities in the local and extended community, which included going shopping, going out for meals to local restaurants, attending concerts and shows and visiting the local pub. Staff provided assistance with activities as necessary and had knowledge of events in the nearby area. People were supported to attend their own place of worship. Since the last inspection the residents had been away for a holiday in Whitby. Residents showed the inspector photographs of the holiday. Other holidays had been taken in Majorca and walking in Prague. All the residents spoken to said they “really enjoyed their holidays”. People were supported to maintain relationships with their families and where necessary the staff assisted with transport. There were no restrictions placed on visitors to the home and the residents said they could have visitors at anytime and could talk to their guests in the privacy of their own room. Information relating to visitors and community contact was available in the Statement of Purpose. The residents had unrestricted access to the home and grounds. They were able to use their room at any time should they wish to spend some time in private. It was observed that several of the residents spent time in their rooms, when they arrived home for the evening. The residents were provided with three meals a day and a range of drinks and snacks were available at all other times. A record of meals served was maintained on an individual basis, which detailed the actual food served to the residents. These records demonstrated that the residents were provided with a varied nutritious diet. The residents were seen being encouraged and supported to plan, purchase, prepare and serve the meals. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Peoples diverse healthcare needs were identified and met. Personal care was delivered in a way that promoted people’s privacy and dignity. EVIDENCE: The essential lifestyle plans set out the residents’ personal support preferences and provided details of how this support was to be delivered. Residents spoken to confirmed the staff fully respected their rights to privacy and dignity. One resident confirmed staff always knocked on her door and waited to enter. The routines were flexible and residents were encouraged to have a bath or shower as frequently as they wished. The residents also confirmed they were able to choose the time they went to bed and got up in the morning. Healthcare needs were appropriately assessed and were included in the essential lifestyle plan and the person centred plan. There was considerable evidence to indicate the residents had access to NHS services and the advice of
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 15 specialist services had been sought as necessary. A health action plan had also been completed with each resident, to supplement the information contained in the essential lifestyle plan and the person centred plan. One person wrote in her plan, “I would like staff to support me to be weighed monthly”. The residents’ health and welfare was reviewed at regular intervals and an overview of medical and health checks was seen on each of the residents’ files. There was a set of policies and procedures in respect of medication and appropriate records were maintained of receipt, administration and disposal of medicines. Pictorial information sheets about all aspects of the medication prescribed for the residents and homely remedies, were available for staff reference. All of the residents were self-administering in respect of their medication within a risk management framework. All staff designated to administer medication had completed appropriate training. The policy had been reviewed in respect of medication leaving the premises when people went to visit relatives. The Medical Device Alert relating to Lancing Devices was discussed. According to staff, District Nurses would carry out such practices or people would visit their own GP practice. Medication records were clear and accurate and medication was stored securely. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were protected from abuse and had access to the complaints procedure. EVIDENCE: A pictorial complaints procedure was displayed on the notice board. Records showed that it had been explained to each resident individually and there was evidence that people signed the procedure saying it had been explained to them. The complaints procedure was included in the Service Users Guide in a pictorial form, and contained the necessary information should a person wish to raise a concern. The complaints file was examined and no complaints had been recorded since the last inspection. A copy of the “No Secrets in Lancashire” procedure was readily available along with the homes “Whistle Blowing” policy. Staff were aware of their responsibilities toward residents and said that appropriate training was available. Records showed that “Protection Of Vulnerable Adult” training had been completed by three of the four staff. The manager understood the referral system for the Protection Of Vulnerable Adults register but had never had to refer anyone. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24;30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was warm, clean and comfortable with a good standard of hygiene being achieved and residents lived in a safe environment. EVIDENCE: Whitewalls is a detached property set in its own grounds. The home is located in the village of Hoghton between the towns of Blackburn and Preston. Accommodation is provided in five single bedrooms and one self contained flat. The shared space is provided in a lounge/dining room and conservatory. The furnishings and fittings were domestic in character and of a satisfactory standard throughout. Some bedrooms were inspected with the permission of the residents. The bedrooms had been decorated according to their personal preference. All bedroom doors were fitted with appropriate locks and the residents had been provided with keys.
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 18 The premises were comfortable, clean and free from offensive odours, in all areas seen. People were supported to use the domestic style washing machine to promote their independence skills. Cleaning materials were stored appropriately. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32;34;35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were recruited using current guidance and received appropriate training. This meant that the diverse needs of the residents were met. EVIDENCE: An overall staff training and development plan was accessed on the homes intranet. Staff spoken with confirmed they had access to good training opportunities and said they had attended many courses associated with the needs of the residents. At the time of the inspection all staff at Whitewalls had achieved NVQ level 3, which equated to 100 of the staff team. No staff had been recruited since the last inspection, but one member of staff had had an internal transfer within the organisation. All staff files were examined. Information available showed that a robust recruiting process was carried out. All the requirements of recruitment were met. Criminal Records Bureau checks had been completed. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 20 From staff files examined, it was evident that there was an established induction programme, which encompassed the Learning Disability Award Framework standards. Staff were issued with an Employee Information Pack, which contained copies of relevant policies and procedures and useful information about the person’s employment. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37;39;42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a new manager has been registered. She has completed the National Vocational Qualification at level 3 and has almost completed the Registered Managers Award. She has worked at the home for 8 years. The company holds the “Investors In People Award” and the home is on the Lancashire County Council Preferred Providers list. Residents meetings and staff meetings were used to collate information. The Service Development Plan was in place “to allow managers to compare and then challenge some of the issues that effect the way services are delivered”. Relatives were contacted on
Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 22 a monthly basis for feedback in relation to the service offered. Any concerns were discussed with the company’s managers and with staff at staff meetings. Feedback relating to residents progress in the workshops at Stanley Grange was obtained and acted upon. Feedback was also obtained from college staff. The manager said that visits by the registered provider did take place, but none were available in the home since 16/05/07. Staff received health and safety training, which included moving and handling, food hygiene, first aid and fire safety. The gas and electrical systems were serviced at regular intervals and the home had a valid electrical safety certificate. To minimise the risk of scalding, preset valves were fitted to all water outlets. No hazardous substances were kept on the premises. Cleaning materials were kept securely. Detailed safety checks were carried out on the premises on a monthly basis and risk assessments were completed on all safe working practice topics. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 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 Standard No Score 1 4 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 2 X 2 X X 3 X Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 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. 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 Refer to Standard YA37 YA39 Good Practice Recommendations The registered manager should continue to complete the National Vocational Qualification at level 4 in both care and management. Copies of reports following monthly visits by a representative of the organisation should be retained in the home. Whitewalls DS0000005929.V336373.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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