Inspection on 28/06/06 for Whitfield Care Home

This inspection was carried out on 28th June 2006.

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

The inspector 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 22/04/08

Whitfield Care Home 24/04/07

Whitfield Care Home 08/11/06

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 Whitfield Care Home 107 Sandwich Road Whitfield Dover Kent CT16 3JP Lead Inspector Joseph Harris Unannounced Inspection 28th June 2006 10:00 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.V299989.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.V299989.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitfield Care Home Address Whitfield Care Home 107 Sandwich Road Whitfield Dover Kent CT16 3JP 01304 820236 01304 825861 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 Post Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Resident under the age of 65 yrs is restricted to one whose date of birth is 16/01/1943. Service users with DE are restricted to six (6) whose DOB`s are 15/12/1930; 16/08/1929; 20/11/1917; 06/01/1920; 28/07/1923; 14/11/1920. 6th February 2006 Date of last inspection Brief Description of the Service: The Whitfield Care Home is a large detached residence which is registered to provide care for 30 older people. 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 £303.25 to £390.00. Information on the Home 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.V299989.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was completed on 28th June 2006. The inspection commenced at approximately 10am and lasted for about 7.5 hours. During the course of the inspection individual and group discussions were held with service users and staff. Time was spent with the manager including lengthy discussions about the principles of care and management of the home. A range of records and documents were examined including those relating to service users, health and safety and the running of the home. A tour of the premises was also undertaken viewing all parts of the home including communal areas, bedrooms, bathrooms, the laundry and the kitchen areas. What the service does well: What has improved since the last inspection? Due to the fact that this is the first inspection by this inspector of Whitfield Care Home it is difficult to measure progress other than through compliance with previous requirements and recommendations. Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 6 It does appear that progress has been made regarding the training needs of staff both in terms of NVQ and the provision of courses such as dementia care and some mandatory training. The home has started to update service user plans and some work in this respect has been positive, however this process has not been continued at an expected pace and needs to be focussed on. What they could do better: 10 requirements and 7 recommendations have been made as a result of this inspection. The providers need to provide an action plan addressing environmental improvements to the premises. There is a need to ensure that a health and safety assessment is completed and many areas of the home would benefit from redecoration and the renewal of furniture and fittings. The garden area is also in need of attention to make it secure and accessible to all service users. The security of the home also needs to be addressed, although it was reported that this is in the process of being addressed. The home has begun to update service user plans, but this process needs to continue with all plans addressing the holistic needs of service users and being subject to regular monthly review or updates as the needs of individuals change. Staffing levels in the home are insufficient and fall below the minimum requirements as identified within department of health guidance, which has an impact on all aspects of care throughout the day and night. An emphasis needs to be placed on providing a range of organised activities for service users. The home does have a number of visiting entertainers, but there is little or no time for staff to provide social and recreational activities on a daily basis. This impacts on all service users and particularly those with dementia care needs and people receiving short-term respite care. A number of health and safety issues also need to be addressed including an assessment of the electrical wiring (NICEIC), arrangements for the storage of fresh foods and fire safety issues. The providers need to introduce a proactive quality assurance system including regular recorded monthly monitoring visits and an annual quality assurance report including the views of service users and stakeholders. The providers need to appoint a manager and put this individual forward for registration with the Commission. Systems of supervision also need to be improved for all staff, but with particular reference to supporting the manager in his or her duties. Amongst the recommendations issues include continuing to update mandatory and NVQ training for staff and developing a competency based induction programme in line with the Common Induction Standards. Ensuring service Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 7 users have regular access to a Chiropodist to provide appropriate foot care. A review of the complaints process to enable people to make their views and concerns heard ensuring that appropriate actions are taken as a result. Medication storage issues also need to be reviewed. 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. Whitfield Care Home DS0000063744.V299989.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.V299989.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. Adequate information is provided to prospective service users regarding the home. All service users are provided with a written contract on admission. Service user’s needs are assessed prior to admission. Prospective service users are given opportunities to ‘test drive’ the home. Arrangements for people admitted for intermediate care are satisfactory. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has developed adequate information for prospective service users and their representatives including a statement of purpose, which has been updated over the past year and a service user guide, which is on display in the home and is provided to all service users. Each service user admitted to the home is provided with a contract covering the key terms and conditions of residence. The needs of prospective service users are assessed prior to admission, although this is an area that could be strengthened further. The home requests Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 10 information from care managers and/or referrers prior to admission and the manager or senior staff endeavour to visit service users in their current accommodation to assess suitability and needs. Information is also received from relatives where appropriate. This information is documented, but it is recommended that the home develops a holistic assessment form covering all aspects of care and support, which can then provide a baseline for generating service user plans. Refer to recommendation 1. It was reported by the manager and staff that prospective service users are offered the opportunity to visit the home before deciding whether to move in. These visits can take the form of short introductions to the home, longer visits including a meal and overnight stays if appropriate. A number of service users have been referred through the Coleman Trust, which provides a two-week stay free of charge to enable the home and service user/representatives to determine whether the placement will be suitable. Emergency admissions are avoided wherever possible, but it was reported that key aspects of introduction to the home are covered in a timely fashion in such circumstances. The home does offer intermediate and short-term care for people requiring a respite placement. The home does not have separate facilities for this service, but plans of care are developed to promote independence and enable service users to return home. Whitfield Care Home DS0000063744.V299989.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. A plan of care is developed for each service user, but these need to be redeveloped and reviewed. The healthcare needs of service users are met, however processes for recording and monitoring information need to be improved. Medication systems are generally adequate. Service users are treated with respect and privacy is upheld. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A variety of service user plans were examined at random, which provided information in varying qualities. It was reported by the manager that the home is in the process of introducing a new system of care planning, which commenced in February 2006. However, a minority of the service user plans have been updated and there is little evidence of review on a consistent basis. It was evident that some staff have embraced good principles of care planning and one plan in particular was written in very clear language providing a good narrative of the care and support required. However, throughout all the plans viewed information was conflicting at times, had not been subject to regular Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 12 monthly review and did not address all aspects of care and support required. Staff reported that due to pressure of work there was little available time to focus on care planning and review. There also appeared to be no clear system in place enabling key workers to update and review plans of care. It was acknowledged by the inspector that due to management upheaval and low staffing levels there have been barriers in addressing these shortfalls, but as a key facet of the delivery of care it is essential that service user plans clearly and unambiguously state the holistic needs of service users, are regularly reviewed and provide staff with accurate guidance to enable individual needs to be met. Refer to requirement 1. The home has a system of risk management and assessment, however there is also poor evidence of review in this regard. The home does complete a number of risk assessment tools such as manual handling, pressure area care (Waterlow) and nutritional screening. Specific risk management plans should be developed in greater detail ensuring that actions to minimise risks are clearly identified. Refer to requirement 2. The home maintains reasonable records relating to the healthcare needs of service users and benefits from good support from community healthcare professionals such as district nurses. There was evidence that necessary actions had been implemented to minimise the risk of pressure sores and promote oral hygiene. Nutritional and dietary needs are also monitored. However, in line with the shortfalls apparent in the plans of care there is poor documented evidence of the changing needs of service users being addressed. Refer to requirement 1. Staff members spoken to were able to demonstrate a good understanding of individual service users needs in relation to healthcare and personal support. The home records the visits of healthcare professionals and any actions or outcomes highlighted. There was also evidence that residents are enabled to attend appointments or are visited in private. All service users have their own GP and other healthcare services are accessed such as audiologists, opticians and dentists. However, it was noted that amongst the records viewed that a Chiropodist visits the home on an infrequent basis. Service user records stated that toenails had been cut, but these entries were signed by staff members. Refer to recommendation 1. The home has adequate medication systems in place. Storage facilities are not ideal and would benefit from review. The medication trolley is secured to a wall, but is on open view and the home has recently purchased a controlled drugs cupboard, which has yet to be affixed to the wall. Refer to recommendation 2. Adequate policies and procedures are in place and medication administration records were clear and up to date. The home uses the Boots Monitored Dosage System and staff administering medication have received training in this regard. None of the current service users choose or are able to self-medicate. Staff are thoughtful and respectful in their approach to service users, which was evident through observation of staff interactions and confirmed by all residents spoken to. Comments such as “the girls are lovely” and “the staff are great, I can have no complaints” were consistently echoed. Additionally staff members demonstrated their commitment and dedication to the home and service users through group and individual discussions. The manager and Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 13 senior staff in the home provide good role models and lead by example promoting positive attitudes. The home provides a private telephone and service users reported that they receive the mail unopened and on time. There are three double rooms none of which currently have shared occupancy. Should these rooms be used for two people in the future it is advised that the home receives evidence that people have made a positive choice to share. Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. A wider variety and more proactive approach to providing recreational, therapeutic and social activities needs to be adopted. Families and friends are welcomed into the home. Service users can exercise choice and control over their lives. There is a healthy, balanced diet provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does provide some activities and has visiting entertainers on a regular basis including Mr Chirpy Tunes every Monday, armchair exercises every Tuesday and a visiting hairdresser on Wednesdays and Fridays alternately. However, this is the sum of all organised regular activities. There was a bingo session every Friday, but it was reported that this has not been a regular occurrence for some time due to low staffing levels. Through observation it was clear that, although the staff went about their work in an efficient and unflustered manner, there was little time available to engage in any social activities other than the routine aspects of the day. A number of the service users have dementia care needs and there was no evidence of any therapeutic interventions or activities to promote cognition or fine motor skills. The home does have an activities box, but some service users stated that they were unaware of this. The main lounge has three televisions Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 15 and the majority of the service users congregate in this area chatting, reading and watching television for the majority of the day. Some service users prefer to stay in their rooms and all bedrooms seen had available music, radios and/or televisions. It was reported that there are few opportunities to go out for a walk, on group outings or even use the garden and many individuals spend their time indoors. Some friends and relatives do make a point of going out with the person they are visiting. Although it is acknowledged that a balance needs to be struck between rest and relaxation and activities a wider social and recreational programme needs to be developed including simple, repetitive activities for people with dementia care needs, opportunities for fresh air and community inclusion and social and leisure events. Refer to requirement 3. Service users are able to maintain contact with families and friends. The home welcomes visitors at any reasonable times. Residents reported that their visitors are made to feel welcome and that they can meet in private should they wish to do so. The home provides information regarding advocacy services (CROP) which was on view within the home and in service user files. Residents are encouraged to bring in any personal possessions they wish into the home and this was evident in a number of bedrooms viewed. There is an access to records policy. No service users continue to manage their own finances, which is done through appointees independent of the home. A main mealtime was observed, which was unhurried and relaxed. There is a reasonably sized dining room and service users can choose to eat in their rooms should they wish. All residents commented that the food in the home is of good quality, that there is a choice at each mealtime and it is well presented. The home use local providers for fresh fruit, vegetables and meats. The cupboards were well stocked and adequate food was also available in the fridge and freezer. The manager reported that there is not a restrictive food budget. There is a cook employed for 5 days per week and a part-time weekend cook. It was reported that Intermediate food hygiene courses have been booked and paid for, but the home is awaiting a date for these courses to commence. Menu records were viewed, which showed a varied and balanced diet. The home completes nutritional screening and provides special diets where required. A recent complaint involved non-compliance by the home with a diabetic diet. The service acknowledged that there had been an aberration and mistake in one instance, but that this had not been repeated. There was no evidence to suggest that the home does not routinely comply with special diets and all staff demonstrated good competency in this regard. It was noted that the storage area for some fresh vegetables was inappropriate being stored in a shed that also contains potentially hazardous substances, which does need to be addressed. Refer to requirement 4. Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. There is a complaints process in place, which would benefit from review. Policies and procedures are in place regarding protection from abuse. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a written complaints process in place, which covers all key aspects and relevant points. However, 2 complaints have been received from relatives via statutory authorities since the last inspection. As part of the process of investigating one of these complaints through adult protection protocols it was stated that the issues raised by the relatives had been repeatedly brought to the attention of the home and not acted upon. The complaint was partly upheld, but issues were identified around the senior management of the service by the registered providers and communication. Refer to recommendation 2. The home has policies and procedures in place relating to the protection of vulnerable adults against forms of abuse. The vast majority of staff have also attended courses surrounding adult protection and POVA. There has been 1 adult protection alert (referred to above) since the last inspection that was partially upheld. There is a whistle blowing policy in place and adequate measures are taken to ensure service users finances are safe. Whitfield Care Home DS0000063744.V299989.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. The premises are in need of a thorough review to ensure that furniture, fittings, décor and maintenance issues are addressed. Communal spaces, toilets, bathrooms and individual rooms would all benefit from attention. There is adequate space throughout the home however. Further attention is required to ensure the home is safe. Areas of the home had an unpleasant odour and required deep cleaning. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whitfield Care Home is in need of much updating throughout. One person commented that the home, “is tired and feels unloved”. There is a good sized car park to the front of the home and externally the property appears in reasonably good repair. Some aspects of the premises appear reasonably well maintained such as the dining room and the lounge. Also on the tour of the premises many of the individual rooms are fairly well appointed. However on entering the house an unpleasant odour of stale urine was apparent. Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 18 Much of the service is in need of redecoration and would benefit from the renewal of furniture and fittings. The dining room furniture would benefit from being replaced as it is quite old and rather heavy, which was a complaint made by a number of service users. The tour of premises revealed that the kitchen is in need of deep cleaning and updating. The cooking facilities appear old and unhygienic. Cupboards, work surfaces and the flooring appeared dirty and in need of replacing. Storage facilities appeared poor. The laundry area is relatively small and disorganised. The washing facilities appeared insufficient for the needs of the home, but it was reported that a new sluice system washing machine and gas-fired tumble drier are on order. There is a good sized garden surrounding the home, but areas of which are not accessible to service users because of undulations and a lack of paving or steps. It was also reported that the garden cannot be made secure and needs new fencing and gates so that all service users can benefit from outside space. It was reported that new, more secure external doors have been ordered, following a spate of burglaries in the area. One of the double bedrooms on the ground floor had an unpleasant odour and the furniture and fittings were of poor quality and unsafe. The room, although not measured, appeared too small for use as a double room and should be reviewed within the schedule of accommodation and statement of purpose. A number of the bedrooms viewed possessed old and low quality furniture, many rooms would benefit from redecoration and refitting. There are sufficient numbers of toilets and bathrooms throughout the home, but these areas are also rather unpersonable and in need of redecoration. The process of installing radiator guards has commenced and needs to continue focussing on priority areas in the first instance. A full environmental assessment of the premises needs to be conducted assessing all aspects of the home including general repair, maintenance, furniture and fittings. Particular emphasis should be placed on the kitchen, outside access and safety, individual rooms for residents with dementia care needs, corridors, bathrooms and general security of the building. An action plan is to be developed providing details of work required and provisional, realistic timetables for completion. Refer to requirement 5. Whitfield Care Home DS0000063744.V299989.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. There are insufficient numbers of staff on duty to meet the needs of the service users. The home is working towards NVQ targets. The home’s recruitment practices are generally adequate, although some shortfalls were noted. The service is addressing training needs, but some shortfalls remain. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the staff rota and confirmed by the manager and staff members the home operates with 3 members of care staff from 7am until 9pm. At night there are 2 waking staff. A cook is employed from 9-3pm during the week and a weekend cook is also employed. The home has 2 domestic staff working from 8-1pm and a laundry assistant from 9-1pm. The home has operated without a manager for a period of around two months until 6th June 2006. At the time of the inspection there were 23 residents in the home at least 4 of which require 2 staff to assist with personal care. There are also 6 service users with dementia care needs. The layout of the home does not lend itself to easy observation being over two floors with bedrooms and communal areas spread out throughout the building. According to the care staffing tool used as part of department of health guidance to determine minimum staffing levels the home should provide a minimum of 653 total duty hours per week, but calculations based on the staffing rota demonstrated that only 434 duty hours are provided. Staff conceded that there is little flexibility within the working day to Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 20 provide social and recreational time or to complete required administrative duties. The registered providers need to ensure that sufficient numbers of staff are on duty at all times throughout the day and night to ensure that the needs of all service users can be met. Refer to requirement 6. 5 members of the staff team have achieved NVQ level 2 or above and 6 staff are currently working towards this qualification, therefore the home is working towards the 50 target of NVQ trained staff. Refer to recommendation 3. In discussion with staff members good levels of competency were demonstrated and staff had an understanding of individual and collective needs. There were positive attitudes towards the care and support of service users. Residents confirmed that they appreciate the input from staff and were positive about the relationships with all staff members. Refer to recommendation 4. A number of staff files were viewed, most of which were up to date and contained all relevant information. One staff file did not have evidence of CRB or a POVA check. The manager reported that these had been applied, but were being held at the head office. It was noted that the application form could be updated to ensure all past employment is included with reasons for leaving. Refer to recommendation 5. The home has made progress in terms of staff training, although some staff still have to update mandatory training including food hygiene and first aid. Dementia care training is planned for the near future as well as care planning training, although due to management upheaval some of this training has recently been postponed and reorganised. The home should continue to update all training to meet minimum standards. The home has an induction process in place, but it is not competency based, with broad topics signed by the new member of staff, but no information to validate understanding of the topics. Advice was given to introduce the Skills for Care Common Induction Standards to provide competency based training. Refer to recommendation 6. Whitfield Care Home DS0000063744.V299989.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The home does not have a registered manager. The responsible individual needs to introduce an accountable quality assurance process. Service user’s financial interests are safeguarded. The home needs to ensure that staff receive regular, recorded supervision sessions. The home needs to ensure that the health, safety and welfare of service users is protected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager had applied to be become the registered manager, but due to personal circumstances has decided to leave the service. She has agreed to stay in post until the providers have appointed a new manager. Following appointment the new manager needs to apply for registered status. Refer requirement 7. Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 22 There is little evidence to demonstrate any effective quality assurance processes. The last recorded monthly monitoring visit was in January 2006 since which time no visits have been recorded. It was reported that the responsible individual or representative do not visit the home on a regular basis, although some support was provided by the manager of one of the sister homes, whilst the manager was on leave. Regulation 26 monthly monitoring visits should provide an audit trail and review of service user and staff views, health and safety checks, administration and environmental issues amongst other things. In addition to this service users and stakeholders should be invited to feedback formally about the service on an annual basis, with the results co-ordinated and presented with an annual quality report. Refer to requirement 8. Service users financial interests are safeguarded through the homes policies and procedures. All appointees are independent of the service and the home only provides safekeeping for resident’s money and valuables if required. Clear records are retained relating to finances. A system of supervision is in place for care staff to receive formal 1:1 sessions, but due to the manager’s recent absence this process has lapsed, but was reported to be being re-instituted and recommenced. However, it was noted that the manager has not received any formal supervision to enable her to fulfil her duties. Similarly the acting manager received little or no formal support during the manager’s absence through a particularly difficult time including the adult protection process. Refer to requirement 9. A number of shortfalls with regard to health and safety were noted during the course of the inspection. Most notably was the fact that there was no evidence of an electrical wiring certificate (NICEIC) for the home. Refer to requirement 10. Electrical installation certificates were in place for fire systems only such as the emergency lighting. Some records with regard to fire safety logs were not maintained including visual fire extinguisher checks and fire instruction and drills for all staff. Refer to recommendation 6.The home is working towards completing and updating mandatory training for all staff. The home has environmental risk assessments in place, which would benefit from review in the near future. Whitfield Care Home DS0000063744.V299989.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 2 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 1 2 X 3 1 2 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 1 Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 24 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. Standard OP7 OP8 Regulation 15 Requirement To update and review all service user plans ensuring holistic needs are addressed and clear guidance is provided for staff to meet assessed needs. To introduce a system of review ensuring all plans are reviewed on a monthly basis. To ensure risk assessments are developed providing clear actions to minimise perceived risks. To ensure risk assessments are reviewed on a monthly basis or as needs change. To develop a positive programme of activities addressing assessed needs, interests and hobbies. To ensure food is stored appropriately. To complete a detailed environmental assessment of the premises and produce an action plan detailing work to be completed with realistic timescales. Action plan should address redecoration, renewal of furniture and fittings, kitchen DS0000063744.V299989.R01.S.doc Timescale for action 01/09/06 2. OP7 15, 13(4) 01/09/06 3. OP12 16(2) 01/09/06 4 5 OP15 OP19 OP20 OP21 OP24 OP25 OP26 16 16(2), 23(2), 24(4)(5) 01/08/06 01/09/06 Whitfield Care Home Version 5.2 Page 25 6 OP27 18(1) 7. 8. OP31 OP33 9 24, 26 9. 10. OP36 OP38 18(2) 13, 16 and laundry areas, external security and space, individual rooms with particular reference to those with dementia care needs and all issues affecting the health, safety and welfare of persons in the home. To ensure suitable numbers of staff are on duty at all times in accordance with department of health guidance. To appoint a manager and apply for registered status. To develop accountable and measurable quality assurance systems including regulation 26 monthly monitoring visits and an annual report containing stakeholder views of the service. To ensure the manager receives regular formal, recorded 1:1 supervision sessions. To ensure that all electrical wiring installations are assessed by a qualified professionals and recommendations implemented as required. 01/08/06 01/10/06 01/09/06 01/09/06 01/08/06 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. Refer to Standard OP8 OP9 OP16 OP28 Good Practice Recommendations To ensure service users receive necessary and preventative footcare from suitably qualified professionals on a monthly basis. To review arrangements for medication storage including location of the drugs trolley and controlled drug facilities. To review complaints processes to ensure that all issues and concerns are recorded and addressed in a satisfactory manner. To continue to work towards NVQ targets. DS0000063744.V299989.R01.S.doc Version 5.2 Page 26 Whitfield Care Home 5. 6. 7. OP29 OP30 OP38 To ensure evidence of CRB and POVA checks are retained on file with all other recruitment information. To continue to update all mandatory training and competency based induction training. To ensure fire safety logs are maintained and kept up to date. Whitfield Care Home DS0000063744.V299989.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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