Inspection on 10/05/06 for Whitstone House

This inspection was carried out on 10th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whitstone House 09/05/07

Whitstone House 31/01/06

Whitstone House 11/10/05

Whitstone House 03/03/05

Whitstone House 20/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Whitstone House 49 Norwich Road Dereham Norfolk NR20 3AS Lead Inspector Mr Roger Andrews Unannounced Inspection 10th May 2006 01:00 Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitstone House Address 49 Norwich Road Dereham Norfolk NR20 3AS 01362 698762 01362 699792 whitstone@nacha.org.uk 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) Norfolk Autistic Community Housing Association Limited Mrs Marie Ann Large Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to eleven (11) adults, of either sex with Learning Disability, not falling within any other category, may be accommodated. 31st January 2006 Date of last inspection Brief Description of the Service: Whitstone House provides a service for up to eleven people with learning disabilities and autistic spectrum disorders. The Home is managed by the Norfolk Autistic Community Housing Association. The Home is situated on the main road into the market town of Dereham. The Home is a large, double fronted detached building in keeping with other buildings in the area. The service users have single bedrooms and share the communal areas. There is parking to the front of the Home. The large garden at the rear of the Home is fenced to prevent access to the main road. The Home has an indoor swimming pool in the garden. Within the garden area there is also a smaller house, which is separately registered as a Home for three adults with a learning disability and is managed by the same organisation. Whitstone House provides a service for up to eleven people with learning disabilities and autistic spectrum disorders. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of Whitstone House was unannounced. It involved looking at some of the records, talking to staff and observing staff and residents together as well as joining residents for their tea time meal. Individual residents were not spoken to in private due to their particular conditions and the possibility of causing anxiety. A tour of the premises was made in the company of the manager. The Commission has not received any complaints about Whitstone House since the previous inspection took place and generally the service offers a good standard of care to the residents. However, some health and safety issues such as hot water must be monitored and dealt with promptly to ensure the safety of residents. What the service does well: What has improved since the last inspection? The Statement of Purpose has been updated to include all the information required by law. A new form has been devised to help gather information on new residents who are going to move into Whitstone House so that the staff have a better understanding of their needs. The staff are receiving training on adult protection issues. The window restrictors have been checked in line with comments made in the previous inspection report to help make sure residents are safe. A new complaints process has been set out, though it was suggested that other forms, such as an audio tape, could help residents to understand what to do if they had any worries. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 The Statement of Purpose has been revised and now contains the relevant information required by regulations. The overall quality judgement for these standards is Good EVIDENCE: A revised Statement of Purpose containing all the required information has been produced and a copy provided to the Commission in line with requirement in the previous inspection report. There have been no new admissions since the previous inspection took place. However, in line with a requirement in the previous inspection report a new inhouse assessment format has been developed. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Care plans are in place and contain a reasonable level of detail. Residents have opportunities to contribute their views or be informed of things going on. Risk assessments are in place. The overall quality judgement for these standards is Good EVIDENCE: Three care plans were chosen randomly and looked at. These contained a good level of detail and covered key areas such as personal care, health issues, nutritional issues such as allergies, communication issues and health and safety matters, an example being one resident who has “a poor knowledge of danger”. Care plans are reviewed monthly and indicate participation in their development by the resident. One care plan, for example, had been signed for by the resident. Another care plan noted that the resident concerned was not able to participate in developing the plan, but it had been read to him. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 10 In their questionnaire responses the residents indicated that they have house meetings and a member of staff reported that these take place on a Saturday morning. Some residents can contribute views, whilst others are able to listen to, for example, activities planned for the weekend. The manager reported that there has been some attempt to develop advocacy links on behalf of residents. However, it has proved difficult to recruit appropriate people for this role. Risk assessments were observed on residents’ files. Examples include self medicating, travelling in the minibus, using kitchen facilities, having a bedroom key and drinking alcohol. The risk assessments were clearly written and identify risks as low, medium or high. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Residents can participate in a variety of activities both at home and in the local and wider community. And they can maintain contact with relatives such as parents. The residents like the food. The menu appears reasonably varied. The overall quality judgement for these standards is Good EVIDENCE: There are a variety of activities available to residents. On the day of the inspection an evening list had been drawn up, (this is done each day), and the main choices on offer that evening were swimming and an evening walk. Residents may attend various day centres and usually relax and do what they want between arriving home and teatime. Regular activities include swimming, horse riding, walking, arts and craft, computer skills and the home also has a local allotment that the residents can help on. A member of staff who is designated as a day services activity worker described a particular resident who is progressing with computer, numeracy Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 12 and literacy skills at a local centre which she attends. Residents are able to go shopping with staff and use local pubs. Whitstone House is situated a short walk from the town centre. There are also three vehicles for use in transporting residents. Care plans reflected family contact. There were examples of residents going to stay with relatives on a regular basis. All of the relatives who completed the questionnaire as part of the inspection process indicated that they are kept informed about the care their relative receives and that they can visit and see them in private. One relative noted that she was still waiting for a response to a letter, though the manager reported that this matter has been followed up and produced correspondence on the matter. Relatives generally commented positively on Whitstone House. “We are very happy with the care….. it is both very caring and very professional” and “My son comes to visit me every 10 days….. I am very happy with the care and the staff”, are two examples of the comments received. One relative noted that “I am happy with the care… and the way they, (the staff), liaise with other care departments such as the day centre and social services”. Residents can also be involved in the domestic routine such as helping to lay the tables for mealtimes. One resident was observed making hot drinks for other residents which he does on a regular basis. A member of staff reported that one of the service users has been able to make purchases online such as music CD’s. The menu operates on a two weekly cycle. The menu looks varied and includes choices such as smoked haddock, chilli, sausages, chicken and pork slices. In their questionnaires five residents noted that they could choose what to eat ‘sometimes’. Four noted they could choose what to eat and one response noted no choice. The inspector joined the residents for the tea time meal which was gammon, pineapple, new potatoes and salad. This was followed by a rice pudding and fruit sauce dessert. The food tasted very nice and the residents appeared to enjoy it. Extra portions were available for those who wanted some. Staff sit with the residents for meals. The dining room is situated next to the kitchen. It is reasonably furnished and some of the residents’ own painting work is displayed in Perspex frames on the walls. Food preferences and examples such as favourite takeaway meals are recorded in care plans. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Personal care and health needs are promoted. Medication is properly stored and administered and staff receive training about safe management of medications. The overall quality judgement for these standards is Good EVIDENCE: There were some good written examples of residents being encouraged to promote personal care and social skills. One record noted that the resident “will open out his flannel on to his hand and apply soap”, but needed encouragement to perform his self care thoroughly. Several comments reminded staff not to make choices that ‘deskilled’ the resident. In discussion with staff there was a good appreciation of each resident’s specific skills. There were good examples of communication aids being used including one resident whose key worker has developed a picture board relating to various activities and preferences. This resident’s file contained a detailed communication plan. Health care needs are documented including contact with specialists such as Consultant Psychiatrist, community nurses and social worker. Residents are Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 14 registered with the local G.P. surgery. One of the residents has recently been in hospital. The manager notified the Commission at the time of admission as required by regulations. As a result of their particular conditions none of the residents look after their own medication. Medication is stored in locked metal cabinets in the office. The Boots MDS system is used for most medications. Other medications are stored in their original containers and stock is numbered so it is used in date order. Old medication is returned to the Pharmacist and a record is kept of returned medications, (the record is also signed by the Pharmacist). Staff have received training in the use of medications. The Boots care for medicines and Advanced Care for Medicines courses were attended in August 2005. Only level 3 staff and above are authorised to administer medication. Any staff administering medication must have attended a training course. MAR sheets were checked and were up to date. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Where residents cannot voice their concerns the staff are able to recognise changes in behaviour when residents are agitated for any reason. Staff are undertaking adult protection training and understand adult protection processes. The overall quality judgement for these standards is Good EVIDENCE: In their questionnaire responses residents indicated that they knew who to talk to if they are worried. In a number of cases this will rely on staff interpreting behaviour and one member of staff noted that one resident “approaches certain members of staff to make them aware of his needs”. Staff are aware of changes in a resident’s behaviour such as when they become agitated or distressed and are knowledgeable about how to de-escalate such situations. A number of staff have just undertaken adult protection training and others are booked on courses to be held in May and June of this year. From discussion during the inspection the staff are aware of the principles of adult protection. There have been no formal complaints or adult protection issues reported since the previous inspection took place. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 & 30 The environment including communal areas and residents’ bedrooms is reasonably personalised. Privacy when using toilet facilities needs to be protected. Hot water temperatures must be checked regularly and action taken when excessive temperatures are identified. Good fire precaution practice must be followed and fire doors must not be wedged open. The overall quality judgement for these standards is Poor EVIDENCE: A tour of the premises was undertaken with the manager. On the ground floor the residents have a choice of communal areas consisting of a lounge, a conservatory style room and the dining room. Examples of residents’ artwork are displayed in corridor and communal areas in addition to other pictures. The lounge has television and DVD equipment and the conservatory has recently seen the addition of some new furniture. One of the corridor fire doors was seen to be wedged open. See requirement. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 17 There is also a large garden with a sizeable lawn where some of the staff and residents were sitting out after tea due to the good weather on the day. There is an indoor swimming pool in the garden which should shortly be in use following some repair work. Bedrooms reflected good degrees of personalisation. One bedroom, for example, had a large collection of cuddly toys, certificates of achievement on the wall and a television. Another bedroom had posters on the wall and the resident had a large collection of CD’s. Toilets and bathrooms are on both ground and first floors. The single toilet on the first floor requires a net curtain over the window as people using the toilet can be seen from a corridor window opposite. See requirement. One of the bathrooms requires redecoration. In one first floor bathroom, (bath hot tap), and one downstairs bathroom, (sink hot tap), the temperatures are above the recommended levels. In two cases temperatures are in the region of 60°. These high temperatures have been recorded in the water temperature book, but no action appears to have been taken. The water temperatures are also meant to be checked weekly, but the last entry in the record is dated February 2006. See requirement. Cupboards containing cleaning materials and chemicals were locked. The building was clean and tidy and free from unpleasant odours. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 A sufficient number of staff were on duty. Staff have access to a range of training including NVQ. Appropriate checks are undertaken on new staff. Supervision is in place. The overall quality judgement for these standards is Good EVIDENCE: The staffing ratios appeared suitable to meet the needs of the residents currently accommodated at Whitstone House. Levels of supervision are geared towards one-to-one, for example, when on outings outside of the home. Rotas were supplied to the Commission as part of the inspection process as well as staffing levels being observed on the day of the inspection. The staff have opportunities to undertake a variety of training including autism specific courses. Examples of training over the past six months include first aid, team leader training, autism and diet theory & practice, best autism practice, fire prevention, management & leadership, food hygiene and an NVQ induction day. These examples are not exhaustive. A number of staff have Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 19 been undertaking NVQ training and are waiting for their final verification. A record of training undertaken by individual members of staff is maintained. Three staff files were examined at random. All three files contained applications forms, two written references, evidence of a Criminal Records Bureau check at enhanced level and evidence of identity. Staff reported that they received supervision which takes place in line with the frequency recommended in the National Minimum Standards. Supervision sessions are recorded. Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The manager is undertaking appropriate training. A quality assurance process needs to be developed. The servicing of fire equipment and records kept for the protection of residents, (e.g. financial records), are in place. The overall quality judgement for these standards is Adequate EVIDENCE: The manager is currently undertaking training at NVQ level 4. The manager has worked at Whitstone House for some years prior to being appointed as the registered manager. A formal quality assurance process needs to be developed looking at ways in which the service is meeting the needs of residents and consulting with them. The manager reported that she will be doing this in concert with the manager Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 21 of Lambert House, the ‘sister’ residential resource for people with autism. However, Whitstone House is accredited annually by an external assessor and receives an Autism Accreditation Report. This looks at selected core standards in relation to the care of people with autistic spectrum disorders. See requirement. The fire alarm system was serviced in January 2006. Extinguishers and other fire fighting equipment was serviced in April 2006. The record of weekly checks of fire points was up to date. The last fire drill took place on 8th April 2006. The accident record was examined and was in order. Two random samples of residents’ financial records were examined. These were up to date and recorded income and expenditure. A current liability insurance certificate is displayed in the main entrance hall. Whitstone House DS0000027409.V295811.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 23 Yes 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 2 Standard YA24 YA24 Regulation 23 23 Requirement Fire doors must not be wedged open. The window in the first floor toilet must have a net curtain or some over covering fitted to protect the privacy of residents using this facility. Hot water temperatures must be monitored and action taken when excessive temperatures are recorded. This currently applies to the two locations identified in the report. The registered manager must ensure that a review of the quality of care be undertaken as specified in regulation 24 of the Care Homes Regulations 2001. Repeated requirement for the third time. Timescale for action 10/05/06 16/06/06 3 YA24 13 16/06/06 4 YA39 24 31/10/06 Whitstone House DS0000027409.V295811.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 Whitstone House DS0000027409.V295811.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Whitstone House DS0000027409.V295811.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!