Inspection on 11/10/05 for Whitstone House

This inspection was carried out on 11th October 2005.

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 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 9 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 10/05/06

Whitstone House 31/01/06

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 Clive Lucas Announced Inspection 11th October 2005 09:30 Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 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.V249074.R01.S.doc Version 5.0 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.V249074.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Whitstone House Address 49 Norwich Road Dereham Norfolk NR20 3AS 01362 698762 01362 699792 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.V249074.R01.S.doc Version 5.0 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. 3rd March 2005 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.V249074.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced. Its main purpose was to follow up issues from previous inspections. Consequently not all areas of all the standards were inspected. The deputy manager and two team leaders were spoken with, records were examined and comments were sought from service users and relatives. What the service does well: What has improved since the last inspection? What they could do better: Some records were not available for inspection, or for staff to use, as they had been locked away and the key was not available. Clarity is needed over how service users and relatives can access the complaints procedure. Supervision and support has not been taking place for some staff. While a good range of training is provided, some staff were not getting the training that they need in order to do their job. The process for checking that staff are suitable to work with vulnerable people has not been working properly. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 6 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.V249074.R01.S.doc Version 5.0 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.V249074.R01.S.doc Version 5.0 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 and 2 It was not possible to form a comprehensive judgement, as key records were unavailable. The Statement of Purpose requires a little more work and the service user guide is good. EVIDENCE: The Statement of Purpose has been regularly revised, the last time being April 2005. However, while it contains much of the information required by the Care Homes Regulations 2001, it does not contain all of it. The registered manager must ensure that the Statement of Purpose be revised to ensure that it contains al of the information required; a copy of the revised Statement of Purpose should be sent to the Commission for Social Care Inspection. There is a service user guide, which is also produced using Widget symbols. It was a requirement of previous inspections that the registered person ensure that full assessments be obtained or undertaken. There has only been one new service user since the previous inspection. The assessment for this person was not available as a senior member of staff had kept it in their personal locker and gone off sick. Attempts had been made to obtain the key for the locker, but these had been unsuccessful. It is not appropriate that service user records are kept in staff’s personal lockers. The registered manager must ensure that these records are retrieved as a matter of urgency Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 9 and that all staff are aware that they must not keep records in their personal lockers. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 Individual needs are assessed and recorded. Service users are involved in decision-making about this, and other areas of their life, as far as their abilities allow. EVIDENCE: A selection of care plans was read. It is the role of key workers to draw up the plan, which is then checked by the manager. Records are kept of the service user’s involvement in the planning and any reason why this was limited. Plans and risk assessments were comprehensive. One parent, in the comment card returned for the inspection, stated that staff had supported her daughter in her decision to remain sharing a bedroom with a friend, when the placing social worker thought she should have a single room. The parent was clear that sharing was her daughter’s decision. Details of service user’s choices relating to diet are recorded in the care plans. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 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, 14 and 15 Service users are supported in developing individual lifestyles and interests as far as their abilities allow. EVIDENCE: Day care programmes are implemented for all service users. In addition to this they are supported in pursuing leisure interests. Examples were given of service users going to football matches of their chosen team, going out for meals to restaurants that provide the food of their choice, trips on a steam railway and supported trips out with family. Group trips out are also organised. Care plans record the details of service users’ contact with families. Contact with families is supported by staff. An example was given of a service user who goes out with a relative, with a member of staff remaining in the area, but not with them. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 12 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): 20 There is now clear guidance for staff on the use of PRN medication. EVIDENCE: It was a requirement of previous inspections that there should be clear written guidance available to advise staff about when to give PRN medication. A folder is now available with individual simple and informative sheets for each type of PNR medication for each service user. These sheets detail the medication, the effect of the medication and the criteria for its use. Authority to use PRN medication must be sought from the manager, deputy manager or a team leader. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 13 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 There is a complaints procedure. A summary of this procedure is available in the service user’s guide, but the availability of the procedure may limit complaints. EVIDENCE: There is a written complaints procedure and the service user guide contains a summary of the procedure using Widget symbols. Staff stated that any relatives who asked, would receive a copy of the complaints procedure. They were not clear about whether parents were given the details of the procedure as a matter of course, or if they were made aware they could ask for it. Six out of ten relatives who returned comment cards indicated that they were not aware of the home’s complaints procedure, although one felt that they would be able to get this information if they needed it. In order to ensure that service users and their relatives or representatives are able to raise any complaints it is recommended that a complaints leaflet be developed, which would be more user friendly than the whole complaints procedure. This leaflet could also be available in Widget format. The leaflets could be readily available to service users and their families as well as provided on request. The record of complaints was not available as the manager keeps it in a locked cabinet. The deputy manager does not have access to this cabinet, which would cause problems if a complaint were made when the manager was not available (she was on leave at the time of the inspection). This would especially be the case if a complaint were made about a matter that had Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 14 previously been complained about. See comments for Conduct and Management of the Home. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 15 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 The building is appropriate for its use. The change to external day care has been a positive development. EVIDENCE: The home was previously used for day care for people other than those who lived there. This has now ceased and all day care is provided out of the home. The organisation is to be commended for this move, which will enhance the privacy of service users who view the building as their home. A brief tour of accommodation was made in order for the inspector to familiarise himself with the service. Not all bedrooms were looked at, but those that were had been personalised to a greater or lesser degree depending upon the wishes of the service users. While not of an unacceptable standard, some parts of the building are looking worn and will require attention in the near future (for example the landing wall and the downstairs bathroom). It is recommended that the manager continuously monitors the standard of accommodation to ensure that it remains at an acceptable standard. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 16 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): 33, 35 and 36 Staff recruitment procedures are not protecting people who live at the home. There is a thorough induction and good range of training, but not all staff receive the training they need to do their jobs. Staff are not being supervised as they should. EVIDENCE: Previous inspection reports have required that the registered person undertake a review of the situation whereby staff work two 14-hour days every other weekend. Staff had identified this as being difficult. This matter, which was first identified in May 2004, has not yet been addressed. The deputy manager has devised a draft rota to reduce the length of these shifts, but it has not yet been implemented. The registered manager must ensure that this matter be addressed. The home’s recruitment procedures are not safeguarding service users. Regulation 19 and schedule 2 of the Care Homes Regulations 2001 require that staff are not allowed to work in a care home unless specified information has been obtained. Staff have been employed without this information, in some cases without Criminal Records Bureau checks. This is a major failing and places service users at risk. Immediate requirements were left on the day of this inspection that: Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 17 • • • Staff currently in post must be rostered to work under supervision of named and appropriately checked members of staff. An audit of personnel files must be carried out for all staff. ‘Missing’ statutory staffing records to be obtained. The responsible person must ensure that these matters are addressed. The deputy manager was unaware of the process for ensuring that agency staff have had appropriate checks as the manager deals with this. See comments for Conduct and Management of the Home. Staff are introduced and inducted to the home by their team leaders using a format based upon the TOPSS specifications; records of these are not placed on individual worker’s files. It is recommended that evidence of staff induction and training be placed on their files. Examination of the central folder of staff training showed that while there is a good range of training on offer to staff, some staff are not undertaking training (and where appropriate refresher training) essential to their role; for example COSHH and health and safety training for domestic staff, and first aid and fire training for care staff. The registered manager must ensure that staff training needs are regularly reviewed and that each member of staff has an individual training and development profile. Care staff are supervised by their team leaders, who are in turn supervised by the deputy manager. The manager supervises the deputy manager. Due to the sickness of one team leader, a number of staff have gone eleven months without supervision. The manager must ensure that staff have regular, recorded supervision meetings at least six times a year. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 18 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): 37 and 39 The running of the home may be disrupted by the absence of the manager, due to the limited role and responsibilities of the deputy manager. EVIDENCE: The deputy manager is unable to fully deputise for the manager in her absence, as he is not allowed access to documents such as complaints records. While it is the registered manager who has legal responsibility for the running of the home, the running of the home should not be jeopardized by her foreseen or unforeseen absences. It is strongly recommended that the role of the deputy manager be reviewed to ensure that the running of the home is not disrupted by any absences of the manager. Senior staff spoken with during the inspection were unaware of any review of the quality of care that may have been undertaken by the manager. The Commission for Social care Inspection have not received a report of any review of the quality of care. This matter was initially raised in the inspection report of November 2003. The registered manager must ensure that a review of the Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 19 quality of care be undertaken as specified in regulation 24 of the Care Homes Regulations 2001. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x x x Standard No 22 23 Score 2 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x x x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x x 1 x 2 1 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Whitstone House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 x x x x DS0000027409.V249074.R01.S.doc Version 5.0 Page 21 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 Standard YA1 Regulation 4&6 Requirement The registered manager must ensure that the Statement of Purpose be revised to ensure that it contains all of the information required; a copy of the revised Statement of Purpose should be sent to the Commission for Social Care Inspection. (Previous timescale of 31 July 2004 not met) The registered manager must ensure that the records of the assessment of the new service user are retrieved as a matter of urgency and that all staff are aware that they must not keep records in their personal lockers. The registered manager must ensure that the situation whereby staff work two 14-hour days every other weekend be addressed. (Previous timescale of 31 May 2005 not met) The responsible person must ensure that staff currently in post must be rostered to work under supervision of named and appropriately CRB checked members of staff. Immediate requirement left at the time of DS0000027409.V249074.R01.S.doc Timescale for action 31/12/05 2 YA2 14 14/11/05 3 YA33 18 31/12/05 4 YA34 19 15/10/05 Whitstone House Version 5.0 Page 22 the inspection. 5 YA34 19 The responsible person must ensure that an audit of personnel files be carried out for all staff. Immediate requirement left at the time of the inspection. The responsible person must ensure that missing statutory staffing records be obtained. Immediate requirement left at the time of the inspection. The registered manager must ensure that staff training needs are regularly reviewed and that each member of staff has an individual training and development profile. The manager must ensure that staff have regular, recorded supervision meetings at least six times a year. (Previous timescale of February 2004 not met) 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. (Previous timescale of April 2004 not met) 13/10/05 6 YA34 19 08/11/05 7 YA35 18 31/12/05 8 YA36 18 14/11/05 9 YA39 24 31/12/05 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 Refer to Standard YA22 Good Practice Recommendations It is recommended that a complaints leaflet be developed, which would be more user friendly than the whole complaints procedure. This leaflet could also be available in Widget format. The leaflets could be readily available to service users and their families as well as provided on request. It is recommended that the manager continuously DS0000027409.V249074.R01.S.doc Version 5.0 Page 23 2 YA24 Whitstone House monitors the standard of accommodation to ensure that it remains at an acceptable standard. 3 4 YA35 YA37 It is recommended that evidence of staff induction and training be placed on their files. It is strongly recommended that the role of the deputy manager be reviewed to ensure that the running of the home is not disrupted by any absences of the manager. Whitstone House DS0000027409.V249074.R01.S.doc Version 5.0 Page 24 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. 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