Inspection on 22/04/08 for Whitfield Care Home

This inspection was carried out on 22nd April 2008.

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

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

Other inspections for this house

Whitfield Care Home 24/04/07

Whitfield Care Home 08/11/06

Whitfield Care Home 28/06/06

Whitfield Care Home 06/02/06

Whitfield Care Home 11/08/05

Whitfield Care Home 08/03/05

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

CARE HOMES FOR OLDER PEOPLE Whitfield Care Home 107 Sandwich Road Whitfield Dover Kent CT16 3JP Lead Inspector Julie Sumner Unannounced Inspection 22nd April 2008 09:45 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 Whitfield Care Home DS0000063744.V361228.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. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitfield Care Home Address 107 Sandwich Road Whitfield Dover Kent CT16 3JP 01304 820236 01304 825861 whitfield@1stchoicecarehomes.com 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) Mr Kanagaratnam Rajaseelan Mr Kanagaratnam Rajamenon vacant post Care Home 30 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 30. Date of last inspection 24th April 2007 Brief Description of the Service: The Whitfield Care Home is a large detached residence, which is registered to provide care for 30 older people with dementia. It is located in the village of Whitfield and is set back from the main road that runs through the village. At the front of the home there are parking facilities for several cars, and at the rear there is a small lawned area for residents use. Local shops and a post office are nearby, and there are also several public houses and take-away food premises. There is a regular bus service to the village. The town and port of Dover is within easy driving distance, with Deal, Sandwich, Canterbury, and Ramsgate just a little further afield. The current fees for the service at the time of the visit range from £320.00 to £550.00 per week. Information on the Home’s services and the CSCI reports for prospective service users, will be detailed in the Statement of Purpose and Service User Guide. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report is based on information we (Commission for Social Care Inspection) received about Whitfield Rest Home including an annual quality assurance assessment (AQAA) completed by the manager and an unannounced site visit to the home lasting around 8 ½ hours. Information was gathered for this inspection in a variety of ways both prior to and during the visit to the home. We sent out surveys to residents, relatives, staff and visiting professionals. Those returned have been taken into account in this report. We also carried out a SOFI (Short Observational Framework for Inspection) observation to find out what life was like, for residents, in the home. This type of observation is used where people have communication difficulties. This meant that we sat in the lounge and the dining room for 2 hours observing and recording what was going on. The visit also included talking with residents, the manager, staff and having lunch with some of the residents. We also made general observations during the day of how people are supported. We toured around the building and inspected various records. The people living in Whitfield Rest Home were able to participate in the inspection by having conversations about their lifestyle and completing the surveys prior to the visit. What the service does well: Clear assessments are carried out to make sure that people moving into the home can have their needs met. All the residents spoke positively about life in the home. Residents said that they are well looked after and that staff are kind and know their likes and dislikes. Staff interacted with the residents and each other in a calm and cheerful manner. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 6 Meals are provided to a good standard with attention paid to a balanced healthy diet including fresh fruit and vegetables. The manager has a good awareness of equality and diversity and has begun to promote this in the home. The manager is aware of where the home needs to improve and advocates well for the people living in the home. What has improved since the last inspection? What they could do better: The manager states in the AQAA that a full review of care plan documentation and record keeping is planned. As part of this review, the manager also needs to look at the design of the care plans and consider ways to make them easier for residents to read and understand. The people living in the home need to have greater choices and chances to have individual activities and be able to go out sometimes. The manager is in the process of recruiting an activities co-ordinator. The home have joined the National Association for Providers of Activities for Older People (NAPA) to assist with designing a more interesting activities programme. The recommendation to increase the available activities has been carried on from the last inspection report. One of the bathrooms was showing visible wear and tear and needs to be repaired and refurbished to make sure the bath chair is comfortable and the flooring is washable. It would be useful to have a copy of the maintenance plan so that the manager and staff can see when work on the home is scheduled. The manager needs to continue to consider ways to make the downstairs areas fresher smelling. A recommendation has been made for this. Please contact the provider for advice of actions taken in response to this Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 7 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. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home and their advocates are provided with good information to make an informed choice about moving into the home and their needs are suitably assessed prior to moving in. EVIDENCE: The statement of purpose is up to date. It was last edited March 2008. A copy was given at the visit. The design and contents of the contracts have been reviewed and contain all relevant information. The manager explained that the most recent contracts drafted had gone out to individuals’ advocates to be agreed and signed. An assessment called ‘Behavioural Assessment Scale of Later Life’ (BASOLL) has been completed for all people who have dementia. This assessment is designed to highlight areas of support needed for people who become confused Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 10 and develop symptoms of dementia. Staff are in the process of completing these for all other residents so that appropriate support can be offered if people start to develop confusion. Two of these completed assessments were viewed and discussed with the manager. They form the basis of the plan of care for each individual. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team meets the health and personal care needs of the service users and their privacy and dignity are respected. EVIDENCE: A sample of 2 care plans were viewed and discussed with the manager. There was information to assist care staff to meet the assessed needs of the person. The layout of the pages with the guidelines was not helpful and some of the information was confusing. The folders were sectioned out so that different areas of information were accessible. The plans did consider the individual diverse needs and preferences. Plans had been completed with information relevant to each individual with specific information and guidelines. For example, one person needs specific support with nutrition and there were ideas for food preferences, places to eat and a chart to monitor weight. Additional advice and intervention is sought from other health professionals. There were sections in the plans for information relevant to different Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 12 professionals and entries related to the overall care. A random sample of 5 care plans were also viewed briefly to look at the daily records to check the staff support given. The home uses a monitored dosage system. Medication storage was viewed including medication that is not dispensed into the blister packs. At present none of the residents self- medicate but are assisted to take their medication. A sample of medication administration charts was viewed and had been neatly and accurately completed. The administration procedure and storage of controlled medication was viewed and discussed with a member of staff and the deputy manager. The monitoring of administration has been increased following a reported medication error. The team leaders carry out a weekly audit and the manager carries out a monthly medication audit. No further errors have been reported. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are given the opportunity to take part in some activities arranged in the home but would benefit from a wider variety, more one-to-one activities and opportunities to go out. EVIDENCE: We carried out a SOFI observation to find out what life was like for residents in the home. This meant that we sat in the lounge and the dining room for 2 hours observing and recording what was going on. We were looking for and recording 5 residents’ state of being, for example, positive, passive, negative, withdrawn or asleep. We looked to see how engaged they were, for example, with staff, other residents, in a task, with an object or not at all. We were also looking to observe the quality of staff interaction to see if it was it good, neutral or poor. We used agreed criteria within these broad descriptions. We fed back our observations to the manager. Staff were observed to respond positively and sensitively to the people living in the home. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 14 We saw that staff were assisting people with what they wanted to do. Staff asked each person if they would like to join in with the music and movement activity that was being held in the other lounge. At other times staff offered drinks, responded to requests and sat and talked to individuals. We felt the quality of interactions between people was, on the whole, very positive. There was good eye contact and some conversation between staff and each person. Some people living in the home said that they were quite happy doing what they want without needing other entertainment. Both lounges had a TV which was on and some of the residents were watching it. The TV did not dominate the sound in the room and was placed so that you could choose not to watch it. There are some planned activities but the manager is aware that what is currently on offer is limited. The home have joined the National Association for Providers of Activities for Older People (NAPA) to assist with designing a more interesting activities programme. The manager has advertised for an activities co-ordinator and there has been some positive response. The recommendation to continue to develop a structured programme of activities and consider the appointment and role of an activity co-ordinator has been carried on until someone is actually employed and the programme is in place. There were visitors coming and going and looked like they could all visit freely. One relative spoken to confirmed that the home was very welcoming and friendly. Staff encourage residents to have their meals in the dining room and the majority of the residents do. The inspector had lunch with some of the residents who were happy to chat about their lifestyle. Menu sheets give choices for people to indicate what they want. There were good stocks of food including fruit and vegetables. There was a choice of drinks on a trolley in the lounges and in bedrooms for those who prefer to spend time in their rooms. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents say they are happy with the service provision. The people living in the home are protected by the policies and procedures and the home is clear when an incident needs to be referred to the local authority. EVIDENCE: Three adult protection alerts have been raised since the last inspection visit: One with regard to medication and the others with regard to individual behaviour of the people living in the home affecting others living in the home. The home manager was involved in reporting these to the adult protection team and also reported these incidents to CSCI under regulation 37. Social services have investigated each alert and an action plan was formulated for improvements to be made. The home has responded to the need for improvement and carried out the action plan. The alerts have now been closed. The complaints procedure was discussed with the manager. The complaints log was checked. The manager has clearly responded to the concerns raised. The people living in the home who spoke during the inspection visit said they liked it here, the staff were nice and they had no complaints. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 16 The staff team have received training in safeguarding adults. Staff on duty were able to demonstrate their understanding. Staff were observed to be respectful to the people living in the home. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The people living in the home would benefit from a fresher smelling environment. EVIDENCE: A tour of the home was carried out with one of the staff. The AQAA states routine maintenance is carried out regularly. This was evident during the tour of the home and the maintenance man was on site at the time of the visit. Several areas of the home have been decorated. New carpet has been laid in the hallway and it has been decorated. The lounge has also been decorated. One of the vacant bedrooms had been decorated and another one was being prepared for redecoration. A new Parker bath has been installed. One of the bathrooms is out of use. Another bathroom was showing signs of wear and tear and needs refurbishment. The bath chair was warn at the edges and Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 18 there was a cut out part of the flooring where a piece of equipment has been removed. There is, clearly, a refurbishment plan for the home but the bathroom was not included on planned improvements stated in the AQAA. This needs to be given priority as the floor cannot be properly cleaned and the chair may be abrasive. The communal spaces have been rearranged so that there are two lounges with adjoining dining rooms. Residents spoken to liked this arrangement. People were observed to have sufficient space. The toilet doors have all been painted yellow and dark wood toilet seats have been installed in all the toilets to assist people with dementia. Specialist equipment has been purchased to assist individuals and one person said how much the quality of their life had improved because of this. The back garden has been landscaped and made secure. It provides a nice area for people to sit in and some of the residents went out in the garden during the inspection visit as the weather was fine. There was a mild smell of urine in the main parts of the home. This is despite the lounge carpet being replaced last year. The area manager visited the home during the inspection visit and said that the lounge chairs are being replaced a few at a time. This may partially be the cause. A recommendation has been made to continue to improve the environment to make it fresher. The staff were attentive to individuals and the home has the support of the continence advisor. There is a programme of infection control training and 8 staff have attended so far. The laundry was viewed and provides an adequate facility to the home. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using services are generally satisfied with the care they receive to meet their needs. The manager is aware that there are some gaps in the staff knowledge of how to put training into practice since the change of registration and has plans in place to deal with this. EVIDENCE: Staff were observed to be friendly and attentive to residents. The staff team has increased since the last inspection visit. There are now 4 care staff in the morning and afternoon. The manager has organised the rota so that there are more staff available at peak times of activity during the day. A sample of 2 staff files were viewed and records checked. The home had made sure all the checks such as CRB/POVA and references had been carried out before they had started work. The home has a well established NVQ training programme. Over half of the care staff in the team have achieved the NVQ level 2 or above. Staff training was discussed with the manager. A copy of the recent training matrix was given. A sample of training certificates were seen in the 2 staff files viewed. Staff spoke about their training in conversation. Over two thirds Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 20 of the staff team have an NVQ qualification at level 2 or above, with one of the care staff having level 4. All staff have attended mandatory training and all are up to date, with the occasional gap that is planned for. The company employs an advisor who specialises in dementia and provides training and support. All staff have attended dementia awareness training. The manager and deputy manager have attended an additional accredited course for understanding dementia which they can share with the rest of the staff team. Staff were observed to interact with people with and without dementia with sensitivity and care. The manager monitors competency and support required following training given, through supervision and one-to-one meetings. Staff meetings are held to discuss the day-to-day running of the home. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has good people skills and a clear understanding of the key principles and focus of the service. The manager has highlighted areas where they need to make improvements and has a development plan for undertaking the work. EVIDENCE: The manager has been registered manager in another home owned by 1st Choice Care Homes and is in the process of transferring her registration to Whitfield Care Home. She has recently attended additional dementia care training and has another day to attend to complete the course. Comments received from staff, a relative and people living in the home were all complimentary about the manager. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 22 The home has a quality assurance system in place. The manager said that completing the AQAA would also be part of this process from now on. Plans for improvement were included in the AQAA. The area manager visits the home regularly and produces a monthly quality assurance report. Quality survey forms are given out by the home to enable residents, visiting professionals and relatives to make comments and provide feedback. The home does not take on appointee roles for residents, but does provide a safe keeping service and records are kept. Relatives are invoiced monthly for payments for hairdressing, chiropody and newspapers. It is evident from observations in the home and the AQAA that safety checks in respect of equipment, gas, electricity and hot water supplies are undertaken at appropriate intervals. The CSCI is advised of reportable events without delay. Whitfield Care Home DS0000063744.V361228.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 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP12 OP26 Good Practice Recommendations To continue to develop a structured programme of activities and reconsider the appointment and role of an activity co-ordinator. To continue to improve the environment to make it fresher smelling. Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Whitfield Care Home DS0000063744.V361228.R01.S.doc Version 5.2 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. 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!