CARE HOMES FOR OLDER PEOPLE
Whitgift Foundation The Whitgift House 76 Brighton Road South Croydon Surrey CR2 6AB Lead Inspector
Alison Ford Key Unannounced Inspection 15th September 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitgift Foundation The DS0000019047.V311901.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. Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Whitgift Foundation The Address Whitgift House 76 Brighton Road South Croydon Surrey CR2 6AB 020 8760 0472 020 8681 1269 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) The Whitgift Foundation Mrs Philomena Kavanagh Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Whitgift house is a care home that is also registered to provide nursing care for a limited number of residents. This home is owned and managed by the Whitgift Foundation, which is a long established charitable trust. The philosophy of the Trusts founder was that both younger and older people should mix and be together. To this end the home shares its grounds with a secondary school and sheltered accommodation, which are both run by the same organisation. Many of the residents who come to live at the home have lived in the Trusts own sheltered accommodation. Accommodation is provided in large single rooms over two floors. To maintain a sense of privacy and independence, all residents’ rooms have a doorbell and some have a letterbox and a small kitchenette and en-suite toilet facilities. The home is exceptionally well maintained and attractive and the extensive grounds are well kept, with trees, lawns and a cricket pitch. There is ample off street parking, in the grounds and local public transport links are near. Fees currently range from £524 - £695 with some extra charges payable, which would be discussed prior to admission. Further information can be obtained from the home and a copy of the latest inspection report can also be obtained from The Commission for Social Care Inspection via the internet. Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was an unannounced visit lasting four hours however, as the Registered Manager was not on duty that day; a further visit was needed on the 20th September to check some records that had not previously been available. During this time a tour of the premises was undertaken, the majority of the residents were spoken with and also nine members of staff on duty at the time. A sample of care plans were assessed, as were medication records and storage. On the second day of the inspection various records that are maintained to ensure the protection, health and safety of staff and residents were seen. Prior to the inspection The Registered Manager submitted a completed preinspection questionnaire along with various other records to allow an assessment of the service to be made. No complaints have been received about the service since the last inspection. What the service does well:
This organisation aims to provide care for elderly people from the time that they are admitted into sheltered accommodation and for the rest of their life. They could be transferred into the nursing home if the level of support that they required increased. Privacy and dignity within the home are given a high priority with residents having a key to their rooms and staff being expected to ring the doorbell prior to entering. Residents are encouraged to exercise choices within their daily living and domestic routines are made as flexible as possible. On the day of the inspection they all looked happy and very well cared for. Initial assessments made prior to admission are used to form the basis of care plans, which are regularly reviewed, and residents are able to access other healthcare professionals as required. The home is staffed 24 hours a day by a mixture of trained nurses and care staff and residents spoken with were unanimous in their praise of the staff with one commenting that “she wouldn’t swap them for anything! “ Training is given a high priority and the majority of care staff have completed or are undertaking an NVQ qualification. Qualified nurses also agreed that they Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 6 are able to access training appropriate to their work and professional journals are delivered to the home. The home is exceptionally well maintained and resident’s rooms are large and well furnished. They have been encouraged to bring in personal possessions and rooms reflect their occupant’s individuality. Several residents commented on how happy they were in the home and many of them have been there for some years. Activities are provided which suit their needs however it is entirely their choice if they wish to participate. Residents agreed that the food served in the home is of a very high standard. There is always a choice and deserts and afternoon cakes are homemade. A hot snack supper is available in the evening. A lunch club also operates in the home and is attended by residents from the sheltered accommodation and friends and relatives. What has improved since the last inspection? What they could do better:
Very few concerns were raised at this inspection and these can be easily rectified before the next visit. Assessment of care plans revealed that not all pre- admission assessments, which are designed to ensure that the home will be able meet the needs of the resident, were signed by the nurse who had carried them out and dated. This information must be included in future as it contributes to the residents records. There was also no evidence to show that residents or their representatives had been involved in the process of care planning. Many of the residents would be able to contribute to these and they must be given the opportunity to influence the care and support that they receive and express their views and wishes. Some staff that were spoken with displayed a good understanding of residents physical needs however, seemed unaware of their past lives. The Activities Organiser undertakes life history work with residents and a way must be found to disseminate this information to care staff so that they can gain a better understanding of the people that they are looking after. In addition care plans must be readily available to care staff so that they can refer to them, note any changes in the support required by residents and document the care that they are giving. They are currently locked away in a cupboard and while recognising
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 7 the need to keep sensitive information secure, care staff must be able to access them freely. During the inspection it was noted that many of the residents stayed in their own rooms. Although they agreed that this was their choice there seemed to be a lack of communal space that would be conducive to them interacting with each other. Planning permission has now been granted to allow the home to extend and provision of “a cosy sitting room” forms a part of the intended building. 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. Whitgift Foundation The DS0000019047.V311901.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 Whitgift Foundation The DS0000019047.V311901.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): 3,4,6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. An assessment, undertaken prior to residents moving into the home, ensures that they can be confident that their healthcare needs will be met and that the home is suitable for them. EVIDENCE: Pre-admission assessments are undertaken to ensure that residents needs will be met by the home. Many of the residents transfer from the sheltered accommodation attached to the nursing home so will be known and will be familiar with the home. It was noted that pre-admission assessments are not always signed by the nurse undertaking them or dated. Care must be taken to ensure that this always occurs in the future. During the inspection it was observed that one resident has developed dementia since admission. A variation to the registration category of the home
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 10 must be applied for to allow them to remain there if that is their wish and the home is confident that it can meet there changed healthcare needs. This home does not offer intermediate care therefore this standard does not apply. Whitgift Foundation The DS0000019047.V311901.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Residents all have an individual care plan, documenting the help and support that they require, so that all members of staff are aware of how they prefer to be cared for and that their assessed health care needs remain met even though they may change. Residents can be confident that they will be treated with respect and dignity and medication policies and procedures are in place to ensure their safety. EVIDENCE: All residents have an individual care plan and five of these were examined at this inspection. They all contained assessments of physical and mental health, including dietary needs and risk assessments. There was evidence available to show that other healthcare professionals are consulted as required. Risk factors, which could lead to the development of pressure sores, are monitored regularly and appropriate interventions and equipment are used. A key worker system is in operation however, although care staff spoken with knew about
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 12 residents current needs they only had a limited knowledge of their past lives. Life history work is undertaken by the activities organiser and each resident has an individual file. A way must be found to ensure that care staff are made familiar with the contents of them. Limited evidence was available to show that residents or their relatives had contributed to the care planning process. Plans must show that they have been given this opportunity and that they agree with the interventions and support that is being given. There was not always any indication of the date that the resident had been admitted into the home and this must be documented somewhere. It was noted that care plans were locked away apparently in response to data protection requirements. While appreciating that sensitive information must be safeguarded care plans must be seen as “working tools” which ensure that all staff are aware of how residents wish to be cared for and the support that they need. The Registered Manager will need to ensure that all staff have access to these documents as needed. Medication storage and administration was seen to be in order and policies and procedures are in place to ensure that resident’s safety is maintained. Staff were observed treating residents with kindness and respect and supporting their remaining capabilities for self care. To maintain a sense of privacy staff were observed to be ringing on doorbells prior to entering residents rooms. All personal care is given in their own rooms apart from bathing which is undertaken in especially adapted bathrooms. Whitgift Foundation The DS0000019047.V311901.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Activities offered to residents suit their preferences and expectations and provide interest in their daily lives and they are encouraged to exercise their choice over their daily lives as much as they are able. Their relatives and friends are encouraged to visit and maintain their relationships with them. Residents enjoy the food served in the home and meals, which suit their preferences and capabilities are prepared for them. EVIDENCE: The routines of daily living and activities are made as flexible as possible, for example there is no set bed time or getting up time. The home is run in a manner that promotes choice and independence and this was confirmed through residents’ comments, policies, and observation. The activities programme is recorded on a board. Some sessions are undertaken by care staff and some by a dedicated activities organiser.
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 14 Group activities include reminiscence, exercise, crafts and musical entertainment. Croquet is also played on the lawn by both residents and staff. The home has its own minibus and arranges local and day trips. There is also a large community room with a piano, television, video, music centre and board games. There is an open visiting policy and visitors are told they can visit at any time, which suits the resident. Religious representatives visit and some residents attend churches in the community. The home does not take responsibility for the control or administration of any residents’ finances. Where an individual may not be able to exercise control in this area the home will liaise with relatives or independent advocates, for example solicitors. Meals can be taken in the dining room, which has room for all residents to be seated or separately if wanted. Menus are based on the likes and dislikes of residents and additional drinks and snacks are available at any time. The menus seen were varied and choices were offered including vegetarian options. A hot cooked supper is available and deserts and afternoon cakes are homemade. The home also offers a lunch club for residents from the sheltered housing section of the organisation and other older people from the local community. All of those spoken with agreed that the food served in the home was of a high standard. Whitgift Foundation The DS0000019047.V311901.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents can be confident that any complaints that they might have would be dealt with promptly and appropriately and that measures are in place to ensure that they are protected from abuse. EVIDENCE: The complaints procedure is contained in the service user guide, which is given to all residents on admission. Those spoken with were confident that should they have any concerns they would be dealt with appropriately by the home. No complaints have been received by the home or by The Commission since the last inspection. In order to protect residents, staff in the home are not employed before relevant checks have been completed and all staff have received training in adult abuse awareness. Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. This home provides a comfortable, clean and safe environment for residents to live in, which suits their needs, and they have been encouraged to bring in their own possessions to enable them to personalise their rooms and feel at home. EVIDENCE: The home is exceptionally well maintained and attractively presented. It is set in extensive grounds and resident’s rooms overlook either these or the garden. A tour of the premises was undertaken; individual rooms are large and well furnished and residents have personalised them with their own possessions. There is a large dining room and an activity room although other sitting areas are limited. There are plans to extend the home and this will include the provision of a sitting room to allow residents to sit and chat if they wish to. It was noted however that the majority of resident were sitting in their own rooms and this was their choice.
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 17 The home was extremely clean on the day of the inspection apart from some staining on the carpet in the communal room on the first floor. The deputy manager agreed to get this cleaned as soon as possible. Laundry facilities are very good and clinical waste is stored well away from the building. Hand washing facilities and protective clothing are available where required and used. Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents can be sure that sufficient numbers of appropriately trained staff will be on duty in the home in the home to meet their needs and that recruitment policies and procedures are in place to protect them. EVIDENCE: The home is always well staffed by a mixture of trained nurses and carers. A range of ancillary staff supports them. On the day of the inspection there were two trained nurses on duty with 5 care staff. This was in addition to the nurse in charge. In order to ensure that the needs of residents in the home are always met training is given a high priority and the training schedule was seen. All staff have received training appropriate to their work during the last year and future requirements are highlighted. The majority of the care staff have undertaken NVQ training at level 2 and some are progressing to level 3. Trained nurses are also able to access training in order to remain updated in their clinical practice. A member of the care staff was able to describe the induction programme that is undertaken by new staff
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 19 Two files of employees recruited since the last inspection were seen. These were all complete and contained evidence that all of the checks necessary to protect residents are carried out prior to the start of employment. Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents can be sure that the home is managed by a person who is fit to be in charge and that it is run in their best interests. Policies and procedures are in place to show that health and safety of staff and residents is protected EVIDENCE: The Registered Manager has been in post for some time and displays an understanding of the needs of this client group. She is supported by two deputy matrons. Staff meetings are held regularly to make sure that they are aware of any developments in the home and able to contribute their views.
Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 21 Residents meetings are also held every month in order to gain their views of the home and the care that they are receiving. In addition a questionnaire is sent to them every year and visits are made by a senior member of the organisation on a regular basis. Records of these visits are kept in the home. The home does not manage the finances of any of the residents. All have relatives or representatives who do this on their behalf. In order to monitor performance and identify future training needs, supervision is undertaken for both carers and trained nurses on a regular basis and the records of theses sessions were seen. Yearly appraisals also occur for all staff. According to the pre-inspection questionnaire maintenance and safety checks undertaken to ensure the health and safety of staff and residents have all been completed although there was no evidence of a valid certificate to show that bacterial water analysis had been carried out within the last year. A copy of this certificate must be forwarded to the Commission for Social Care Inspection office. Hot water temperatures are tested and recorded regularly however it was suggested that to further ensure that protection of residents this should be undertaken weekly. Fire drills and alarm checks are carried out regularly and several staff are trained in first aid. Kitchen records were seen and were in order and an award was gained earlier in the year to reflect a standard of excellence in food hygiene. Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 22 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 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 3 X 3 Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP3 Regulation Schedule 3 14 Requirement The Registered Manager must ensure that all pre-admission assessments are dated and signed. The Registered Manager must ensure that a variation to registration is applied for in respect of one resident currently out of category. The Registered Manager must ensure that care staff are made aware of the contents of the life story files of residents. The Registered Manager must ensure that there is evidence that residents or their representatives have been involved in the compilation of their care plans. The Registered Manager must ensure that care staff are able to access residents care plans. Timescale for action 20/09/06 2 OP4 30/12/06 3 OP8 15 30/12/06 4 OP8 15 30/12/06 5 OP8 14(2)(b) 30/12/06 Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Whitgift Foundation The DS0000019047.V311901.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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