Inspection on 27/01/09 for Whittingham House

This inspection was carried out on 27th January 2009.

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

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whittingham House 06/01/10

Whittingham House 29/02/08

Whittingham House 03/09/07

Whittingham House 17/11/06

Whittingham House 18/01/06

Whittingham House 22/06/05

Whittingham House 03/12/04

Whittingham House 14/07/04

Whittingham House 10/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Whittingham House Whittingham Avenue Southend On Sea Essex SS2 4RH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Whittingham House Whittingham Avenue Southend On Sea Essex SS2 4RH 01702614999 01702436536 whittingham24@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Strathmore Care Name of registered manager (if applicable) Ms Marietta Masudo Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 77 The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Whittingham House provides care and accommodation for 77 older people. The home is also registered to provide care for people who have dementia. Whittingham House is situated in a residential area close to Southend on Sea. It is close to local amenities and bus routes. The home is purpose built on two floors with a passenger lift to enable access to both levels. There is a total of 71 single bedrooms and 3 double bedrooms. All rooms are en suite and for rooms in the new parts of the building this includes a Care Homes for Older People Page 4 of 33 care home 77 Over 65 0 77 77 0 Brief description of the care home shower facility. The home has a large dining room, a variety of lounges and a garden area. The Statement of Purpose and Service Users Guide and a copy of the last inspection report are available within entrance area of the home. A copy of the Service User Guide/Residents Handbook is also available bedrooms. The current scale of charges as quoted at the site visit ranged from £388.00 minimum to £538.00 maximum per week. Fees charged depend on level of needs and funding arrangements. There are additional charges for hairdressing, chiropody, toiletries, newspapers and other personal requirements. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. The previous site visit to the home took place on 29th February 2008. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. As Whittingham House is a large home two inspectors undertook the site visit, which took place over a period of nine hours. A partial tour of the premises was undertaken. Care records, staff records, medication records and other documentation was selected and various elements of these looked at to see how well these aspects of care and Care Homes for Older People Page 6 of 33 running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. We also spoke to several visitors during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us. The AQAA is a self assessment document that is required by law. It was received by the due date, was fully completed, and outlined how management feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from four people living at Whittingham House, five relatives, one visiting professional and four staff. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A robust assessment process ensures that people wanting to move into the home know that their needs would be met. Evidence: We saw that a Statement of Purpose dated May 2008, and a Residents Handbook and Service Users Guide, which was not dated, were available. The manager confirmed that when people are considering moving into Whittingham House they are not given a copy of the homes Service Users Guide, which would provide them with good information about the service. A copy of the Companys brochure is given to people, and the manager said that verbal information is given. This may not provide people with sufficient information in a form that they can view and consider at their leisure. However on four surveys received everyone felt that they had received sufficient information about the home. The family of one person who had just moved in said that they had visited the home and been given information. Care Homes for Older People Page 11 of 33 Evidence: Previous inspections have identified that peoples needs are assessed before they move in to ensure that the home will be suitable to meet their needs. At this visit we looked at the files of two people who had recently moved in. We saw either the placement co-ordinator for the Company and/or a senior member of staff from the home had carried out good pre-admission assessments that identified peoples needs. Information was also available from Social Services and in one case the discharging hospital. This good practice should ensure that staff at the home are aware of peoples needs, and are able to meet them from the beginning of their stay. After people have moved into Whittingham House their progress and satisfaction is followed up through a Post Admission Service Users Appraisal being carried out by the Companys marketing person or the admissions co-ordinator. Intermediate care is not provided at Whittingham House. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to receive adequate care, but this may not always be based on a clear recognition or documentation of their individual needs and choices. Evidence: Comments received about the care offered at Whittingham House were positive. On four service users surveys received all said that they always received the care and support that they needed. Some comments from relatives and residents were: They do well in all aspects of care, Both my [relative] and I are very pleased with their care, and I visit my [relative] every day and I think the staff are doing well in meeting the needs of the elderly in their care. To see how well peoples care is planned for and arranged so that staff are aware of peoples needs, and meet them in an individual way we looked at five care files in detail, and others more briefly to look for specific items. Where possible residents or their families had signed to say that they agreed with their care plan. Records and discussion with the care manager showed that families are invited to periodic reviews of care. Care plans were seen to Care Homes for Older People Page 13 of 33 Evidence: be reviewed monthly. Although care plans would assist staff in offering a reasonable level of basic care, much of the information lacked the sort of person centred information that would allow staff to tailor care to individual needs and preferences. The training manager for the Company said that some staff have completed training in person centred care planning. One care plan was good in the level of detail included, but others made frequent comments of needs assistance, or needs encouragement, without telling staff exactly what was needed. Both inspectors found that the information available could be confusing and contradictory. For example, a risk assessment for one person said that they were doubly incontinent, the care plan said that they were able to use a toilet with support and that frequent assistance would be required. A member of care staff said that they were able to use the toilet independently, which they were also observed to do. The profile for one person said that they liked to go to bed between 22.00 and 23.00, the night care plan said, unable to mention about preference time to go to bed. In speaking to the resident, they were quite able to state their needs. Good risk assessments were in place for appropriate aspects of care, but these were not followed through. For example one person was identified to be at high risk of falls, this was not mentioned in the mobility care plan. The risk assessment said, ensure frame is in good condition at all times. When viewed the rubber ferrules on the persons frame were worn through to the metal, thus increasing the risk of falls. Another person was using bed rails. This was not mentioned in the appropriate section of the residents profile although it was mentioned in the night care plan. The risk assessment did not identify the process gone through to establish that bed rails were the most appropriate method of keeping the person safe. The issue of consent had not been addressed. Both the risk assessment and the care plan said that bumpers must be used at all times to prevent entrapment. These were not in use. The manager undertook to look into this, but these issues have the potential to place people at risk. Daily records of peoples care are maintained. Both inspectors found that these were often difficult to read. It was also difficult to follow through incidents because sheets were not numbered or stored in consecutive order. Often parts of pages were left blank, and a new sheet had been started. On one occasion it was identified that a wound swab was to be taken. The rest of the sheet was blank, and we could not find a record that this had been followed up. On another occasion someone had a fall which resulted in paramedics being called. They were subsequently unwell, but there was no further mention or follow through about the fall, for example if it was connected to being unwell, if they were alright or if there was any bruising or pain. Records of professional and specialist visits were maintained and showed that people access suitable services such as opticians, doctors, district nurses and chiropodists. A number of people were seen to have some of their own teeth. The manager said that routine dental care is not offered, but sought if there appeared to be a problem. Again Care Homes for Older People Page 14 of 33 Evidence: care planning and records were not adequate in identifying and supporting peoples healthcare needs. One person suffers from leg ulcers requiring regular district nursing input, and recent attendance at hospital. This was not mentioned at all in the Personal/Skin Care care plan where it said Skin type are healthy, and went on to mention about another issue relating to skin care. For another person in a similar situation, the care plan mentioned a leg ulcer, but not what was happening about this such as district nursing input. Good assessments are undertaken relating to nutrition and pressure area care, but again this is not always followed through. For example one person was identified on the Waterlow assessment as being at high risk of pressure sores. This was not identified in the appropriate care plan where under pressure sore prevention it said non. The person was noted to be using a pressure relieving cushion on their chair. This confused approach has the potential to compromise peoples care. The manager confirmed that no one at Whittingham House administers their own medication. We looked at medication systems and records to see how this aspect of peoples care is managed. We saw that good records are maintained, and there were no omissions or errors on the medication record sheets or medication sampled. However we did find another example of where staff need to develop a more joined up approach to planning and care. Two peoples records sampled showed that they were on a medication that requires them to avoid a certain foodstuff. This was not identified on their care plan and could therefore place them at risk. Staff said that they had undertaken medication training. This was confirmed on training records. The manager said that the system was regularly audited. During the day staff treated people kindly and respectfully. Doors were kept shut when personal care was taking place. Sometimes though staff need to have a greater awareness of, and sensitivity to peoples needs. For example in a shared room one person had recently died. The bed had been stripped and their belongings packed up and left, some in black plastic bags, on and beside the bed in full view of the other person. This was not sensitive. Another person with dementia had just lost their spouse. Staff said that it depended on how they were as to what they were told about this. Sometimes they were told that their partner was ill in bed. No care plan was in place relating to their bereavement that would enable staff to adopt a consistent and sensitive approach. Language used by staff also needs to be monitored. On one occasion we heard a member of staff say to a resident, We need to dry your bum now. We also noticed that in spite of it being January most female residents were not wearing any stocking/tights/socks. There was nothing in any care plan that indicated that this would be peoples preference. A relative told us that their relative preferred to wear shoes, and that the previous day in a meeting it had been agreed that this would happen. They pointed out that in spite Care Homes for Older People Page 15 of 33 Evidence: of this their relative was currently wearing someone elses slippers that were too big for them. This does not support individual choice and could cause a hazard. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will find that there are some opportunities for them to enjoy a fulfilling lifestyle, but opportunities may not suit their personal needs and preferences. Evidence: The organisation employs an activities co-ordinator whose hours are shared between different homes in the group. The homes staffing roster did not show the activities coordinator as working in the home over the past three weeks, however the homes weekly recreational rota showed her as working in Whittingham House for three days each week. This rota showed that activities were offered both morning and afternoon seven days a week. It showed that care staff assisted the activities co-ordinator on the days that she worked, and carried out the activities on the days that she did not. The activities folder included a record of the activities undertaken by people living in the home; there had been no entries made in this since 14th January 2009. The activities co-ordinator said that due to time restrictions these had not been completed but that the activities set out on the rota had taken place. People spoken with said that they had played soft ball and in house hockey and that there were often sing-a-longs to old time music. This was the case during the day of inspection, when the same music of old time songs was played throughout most of the day. The recreational rota showed Care Homes for Older People Page 17 of 33 Evidence: that a range of activities takes place including, dominoes, floor netball, seated exercises, colouring, catch ball, board games, quizzes and I spy. The activity folder included evidence that some people had visited Southend town centre for shopping and had been to see a pantomime over the Christmas period. It also showed that people had participated in paper chain making. Staff were observed participating with people living in the home in board games, dominoes and a sing-a-long. People were alert and interacting fully with the staff, they appeared relaxed in the staffs company. Some people were observed that were not fully involved in the activities. One person said when spoken with, I sometimes do ball games but I like horse racing and dog racing and we dont do that. On checking this persons care file it had been identified that the person had these interests but there was no evidence that this had been pursued as an activity for them. The manager said in the AQAA, There is a more varied choice of activities to meet individual needs - more focused on those with dementia. While care plans do contain a sheet relating to Routines of Daily Living. Likes, Dislikes, Social Activities and Hobbies, those viewed did not always contain good information. For one person cared for in bed it said for leisure Unable to participate in any complex tasks. For another person it said, Being a Christian as his place of worship is church. these comments will not help staff to identify and meet peoples needs. People on surveys said, We went out several times with groups and I participate in house on most things. There are two large lounge areas where activities take place and both have their own television set and music players. At the time of the inspection one of the television sets was left on throughout the activity session. One visitor spoken with said, I visit twice a week and the television and the music is often on at the same time, which can be quite annoying to people and the different sounds can get quite confusing. This issue was raised at the previous inspection. The lounge seating was set out at the edges of each room leaving large gaps in the middle and giving the home an institutional feel. With chairs placed close together in the older lounge area this also meant that when people were served drinks, some did not have a nearby table to place these on, and had to hold on to them. This could increase the risk of accidents. Records showed that people living in the home had regular visits from their friends and family, people spoken with confirmed this. There were several people visiting their relatives throughout the inspection. When spoken with one said, I visit every day another said, I visit twice a week. Relatives said in their surveys, My relative is very happy at Whittingham House and you can go and visit at any time. The staff are always friendly and helpful. We saw notes kept of the meetings that were held for people living in the home. It was clear from these that people were consulted on issues such as the menu and activities. Some people living at Whittingham House are limited in their capacity to participate in Care Homes for Older People Page 18 of 33 Evidence: the meetings, but the notes clearly showed who was able to express their views. During the day people were noted to spend time in their rooms or communal areas according to their choice. Care plans identified to a degree peoples choices in relation to daily routines. We saw that information on advocacy services was available, so that people will know where to go for independent support and advice if they wish. The home offers a four week rolling menu that includes a choice of two main meals daily. Any changes made to the planned menus are recorded. The cook that was on duty said that he was a relief cook who works in other Strathmore Care homes when required, and that the regular cook was on holiday. The cook said, All of the food prepared here is home cooked, and I cook equal amounts of the two choices that are offered on the menu. People living in the home are shown the alternatives to allow them to choose what they want. At the mealtime staff were observed asking people if they wanted chicken or sausage. The meals offered on the menu board were shown as chicken and stuffing or toad-in-the-hole. Staff did not make this clear to people. People spoken with said, The food is good and you get enough and, I like the meals, jolly nice cooking. People said in their surveys, The food is always nice and, Food is always very good and staff are helpful. A visiting relative said, I visit daily and I feed my relative so see the food all of the time. It is good home cooked food, and there is always enough of it, sometimes too much. The supper menu was shown as a choice of pilchards on toast, jacket potato, assorted sandwiches and bread and butter. Neither of the hot choices were available at supper time, and people were given sandwiches, sausage rolls and home made cake. When asked why no hot food was available as described in the menu staff said, This is what the cook has written on the menu and he left earlier so we just serve it up. We also noted that supper was being served to people as they sat in lounges at 16.30, which makes it a long time to breakfast for people who may choose to go to bed early. During the morning the lunchtime menu was written up on a whiteboard for people to read. The supper time menu was not written up to provide information for people. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected through suitable procedures and practice being in place. Evidence: We saw that there was a clear complaints process in place that was on display for people to refer to. On surveys all residents and relatives said that they knew who to speak to and knew how to make a complaint. People said I have been informed by the staff many times, but so far I have not needed to, and, They have always responded to what was asked of them. Staff said that they knew what to do if people raised concerns with them, they said they would report the matter to the manager. When we looked at complaints records we saw that two issues had been recorded since the previous inspection. One of these related to an issue that we (CSCI) were aware of that is being investigated under safeguarding procedures. The other had been well recorded and managed. Training records and discussion with staff showed that training in safeguarding people had taken place. Local guidelines relating to safeguarding practice were available, with a flow chart of actions to be taken on display on the office notice board. However some work may be needed to ensure that staff fully understand their responsibilities, and always react appropriately to situations that are potentially safeguarding issues. One member of staff said that if a member of staff was unkind or reacted badly to a resident, that they would talk to them about this, explaining that the resident could Care Homes for Older People Page 20 of 33 Evidence: not help their behaviour. Some records viewed indicated that a few people living at the home could display behaviour that challenged staff. The manager confirmed that staff have not received any specific training in relation to managing challenging behaviour. We saw that one person had been identified as, At times very aggressive. There was no information describing what the behaviour was, or any guidance for staff as to how this was to be managed. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now moving into Whittingham House can expect to live in good personal accommodation, and have access to homely communal areas. Evidence: Whittingham House is a large home set in a residential area. Extensions have been added to different parts of the building which have provided more bedrooms and communal accommodation. Accommodation in new areas of the building is pleasant for people, and all rooms have an en suite shower facility. A new activities area has also been provided. In some new rooms furnishings had been rearranged. This had meant that the person would no longer be able to access the emergency call system from their bed. This particularly so as most call points were not equipped with cords. Also in new areas, although some people had bedside lighting available, not all did. The provider is aware that the original parts of the building now need to be brought up to a similar standard as the new extensions. A tour of the premises showed that furnishings were often mismatched and beds in a very poor condition in the older parts of the building. The extremly poor condition of many of the beds was raised at the previous inspection of the home. Although Whittingham House is registered to provide 77 beds, on the day of the site visit only 44 were occupied. This is to allow for the refurbishment to take place. A number of bedrooms had notices on them to advise that the room was closed for refurbishment. One resident confirmed that they had Care Homes for Older People Page 22 of 33 Evidence: been offered a room in a new part of the building but had preferred to remain where they were. They said that they had a very nice room with all their things around them. The home has some grounds to the front of the building with a fish pond. Other outdoor space is provided by concreted terrace areas. We saw that seating was available, and that a start has been made, following the extension work, to soften these areas with plants. The home is registered to provide dementia care. Although there is some pictorial signage on bathrooms and toilets, this is an area that could be developed. Bedroom doors in particular have small numbers and name plates that would not assist people in finding their rooms in long corridors where all the doors are the same. A number of bathrooms in the home are not operational. In some there were no plugs, in another the bath seat did not work, in others there was only luke warm water. The manager said that these things would be rectified as part of the refurbishment, and that with a reduced number of residents they were able to cope. Similarly with hoists. The manager said that up to three people required the use of a hoist, but only one operational hoist was available in the home. On the day of the site visit, once morning odours had dispersed, the home appeared clean and was odour free. On surveys everyone said that the home was always fresh and clean. A visitor said that one of the things they liked was that the home was, Always clean with no bad smells. Another person said The standard of care in relation to hygiene is good. Whittingham House has a laundry area on each floor of the building. Both were well equipped. In both areas although there were rubber gloves labelled laundry there were no disposable gloves and aprons available to protect staff and support good infection control. The AQAA said that one of the things it could do better was to encourage staff to take more responsibility for infection control procedures. We tried to ask one member of the cleaning staff about their training and understanding of infection control, but their lack of ability to understand and speak English prevented this. Training records viewed showed that staff have undertaken training to support their practice in infection control. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot feel confident that there will always be sufficient staff to meet their needs. Evidence: As previously indicated, occupation levels at the home are currently low to allow for the planned refurbishment of the original building. The AQAA stated that, Staffing levels are worked out by management to meet the needs of residents. Forty four people were being accommodated at the time of the site visit. The manager said that staffing levels were maintained at eight staff in the morning, seven in the afternoon/evening and four at night. These numbers include one person being in charge. Rotas viewed confirmed that these numbers were being maintained. Rotas also showed us that ancillary staff such as domestic and catering staff are employed. The home has no on site administrative support, and the managers hours are only supernumerary on some days, and mostly they are working as part of the shift. According to the AQAA staff turnover at the home is high with 18 staff having left in the past year. This was confirmed by a visitor who said There has been a high staff turnover in the past twelve months. The home is very reliant on agency staff to cover the rota. On the day of the inspection six shifts were covered by agency staff, with two agency carers working long days, which is not best practice. When we received the AQAA it said that in the previous three months 56 care shifts had been covered by Care Homes for Older People Page 24 of 33 Evidence: agency staff. This will not help to provide residents with continuity and consistency of care. The rotas also showed that some of the homes permanent staff work long hours, with some staff working a mixture of night and day shifts in the same week. If staff become tired they may not be as competent or safe in their practice. On the day of the site visit there appeared sufficient staff on duty to meet peoples needs. A visitor however said, I visit regularly and there definitely seems to be more staff around today. Feedback on staff was often positive, such as: Care staff have the right skills and experience and they all seem very capable in what they are doing, I cannot complain about the care and experience because I know that a senior person is always on duty, and, The staff are all very nice. However a number of people commented about staffing levels: More staff are needed day and night - the present staff are always under pressure looking after the patients, I think the Company needs more permanent staff, and, I think they could do with more staff. Staff who completed surveys also felt that more staff were needed and said, Too much job to do, Short of staff always, and, Need sufficient staff and need to have teamwork. Staffing levels provided are based on an assessment of peoples needs. The assessment tool currently used to calculate someones level of need may not provide an accurate picture of peoples dependency. For example, when we looked at records, we saw that a person who is cared for in bed, is doubly incontinent, requires assistance of two staff for all daily living activities, needs assistance with eating and has some behavioural issues, only just falls in the medium dependency category. Using this tool management risk people not being supported in the way that they need by having the correct number of staff always on duty. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. The manager provided us with a training matrix, this showed that seven staff currently working at the home have either completed or are working towards their NVQ level 2 in Care or above. We looked at the files of two members of staff who had been most recently recruited to ensure that recruitment procedures protect people living in the home. Records were in place to show that appropriate checks such as taking up references, checking identification and employment history and carrying out Criminal Records Bureau (CRB) checks had taken place. A further four staff files were requested, but one of these could not be located. The manager said that the file would be in one of the organisations other homes, where the staff member had been recently working. The manager confirmed that they had worked at Whittingham House since just after Christmas. As the file was not available, the manager was not aware of any details of this member of staff, the reasons they had transferred, their skills or training and supervision needs. This is not good practice. The remaining three staff files contained Care Homes for Older People Page 25 of 33 Evidence: relevant recruitment documents. However two of them contained written references from friends and family only. The manager said due to circumstances of the two individuals, they were unable to obtain either employment or educational references for these staff members. There was evidence on all of the staff files examined that a basic induction to the home takes place, however it does not meet the Skills for Care standards. This would give staff a good grounding, and provide them with the skills needed from the start of their employment. The training matrix provided showed that the organisation offers staff training in dementia, nutrition, continence, pressure area care, care planning, medication, moving and handling, fire awareness, food hygiene, safeguarding, infection control and first aid. The matrix highlights when an update of training is due and when staff are booked to attend. There were certificates on staff files to confirm that this training had taken place. Staff spoken with said that they are offered a good range of training, although on a survey one person said that what the home could do better was to, Give proper training. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to have their views heard, and to live in a safe home. Evidence: The manager at Whittingham House has worked there for a number of years and has relevant experience and qualifications. The management team has been strengthened by the appointment of a Care Manager in the home. This inspection has highlighted weaknesses in some areas of management. Particularly in the arrangements for providing well planned, consistent and person centred care to residents. Systems for hearing what people have to say and quality assurance are in place. There are opportunities for people to express their views about the home. We saw that residents meetings are held fairly regularly, and that relatives are also involved in these meetings. The minutes we looked at showed that topics such as food, activities and care are discussed and that there is a general level of satisfaction in these areas. Staff meetings are also held so that they have an opportunity to comment on things Care Homes for Older People Page 27 of 33 Evidence: happening in the home. Surveys are completed following admissions to the home to ensure people are happy with everything. The last external audit undertaken by the Company took place in May 2007. The manager said that they had just received the questionnaires for the next audit. This is being undertaken by an independent company. Regular monthly visits are undertaken by a person appointed by the organisation to ensure that standards are being maintained. These visits include talking to people who use the service. The AQAA was completed by the manager in May last year. It was adequately completed and gave us all the information that we had asked for. We looked at records of peoples monies that are held by the home. We saw that when people need help in looking after their personal monies that this is done well and safely to protect their interests. Good records were maintained with receipts for all transactions. Monies checked balanced with record sheets. The system is periodically audited. No major health and safety issues were noted at this inspection, but some issues were highlighted to the manager. We noticed that some doors were propped open with chairs or wedges which does not support fire safety. The manager said during the day this was not an issue as there were plenty of people around, and that if people wanted to have their doors open at night that they would have to pay for a door guard to be fitted. It is the managements responsibility to meet peoples needs and keep them safe. Some doors that were labelled keep locked were open. As the home is registered to care for people with dementia this needs to be monitored. Fire records maintained at the home were good. They showed that regular drills are undertaken, a fire risk assessment is in place and that all equipment is regularly tested and checked. The fire service visited the home in October 2008 and found everything to be satisfactory. The last environmental health officer (EHO) visit on 25/01/08 rated the home as 3* Good for the maintenance of food hygiene standards. However this site visit revealed some areas of concern. The cook is responsible for maintaining the cleanliness of the kitchen and store rooms and uses a range of documents to record this. These include the environmental healths Making Food safely and Strathmore Cares own cleaning schedule book. Both of these documents showed gaps in the recording of essential cleaning tasks. According to the 2008 cleaning schedule record, the kitchen floor had not been washed since 13/07/08, and the freezer had not been cleaned/defrosted since 5/05/08. We saw that there was a significant amount of built up ice in the freezer. In the refrigerator there was prepared and sliced cheese on a tray covered in cling film that had no date on it, so it was not possible to tell when it had been prepared. The cook said it had been sliced earlier in the day. Some of the opened foods in the fridge were labelled with the date of opening but others were not. This Care Homes for Older People Page 28 of 33 Evidence: issue had also been highlighted by the EHO at their visit. Dried goods were stored in a large cupboard off the kitchen, and most of the containers had date of opening labels on them. Some however did not, and one was found with the lid off exposing the contents. A container of icing sugar had no lid and the plastic bag was split open, exposing the contents. These issues have the potential to compromise food safety. It was also surprising to note that, for what is now such a large home, there was no dishwasher to provide for good sterilisation of crockery and utensils. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16(m) and (n) The activities provided in the 31/05/2008 home must be appropriate and specific to the needs of people living there. Particular regard must be given to people with dementia. Previous timescale of 14/10/07 not fully met. Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 People must be confident 01/03/2009 that their personal and healthcare needs are properly identified and managed through a robust and joined up care planning system. People should expect that staff are aware of their needs and meet them in a professional and consistent way. 2 38 16 Satisfactory standards of hygiene and food storage must be maintained in the kitchen to minimise the risk of contamination. To ensure that people are cared for safely by satisfactory procedures being in place. 01/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 31 of 33 improving their service. No. Refer to Standard Good Practice Recommendations 1 1 People should be a copy of the Service Users Guide to provide them with good information about the home, and information about fees. Whatever peoples abilities they should feel confident that staff will be sensitive to their needs and feelings at all times. Management need to monitor staff practice, and provide guidance in how to manage situations such as death and bereavement in the home. So that people of all abilities have opportunities for activity and stimulation that meets their assessed needs and preferences, management need to continue to develop this aspect of care. So that people receive skilled care and staff are consistent in their practice, staff should be offered opportunities to receive training in managing challenging behaviour. So that staffing levels are sufficient to meet peoples needs at all times, the tool used to assess peoples dependency levels should be reviewed. To ensure that people always receive care from a skilled workforce 50 of care staff should achieve an NVQ at level 2 or above. So that staff develop good knowledge and practice skills from the start of their employment, the homes induction process should be in line with Skills for Care standards. 2 10 3 12 4 18 5 27 6 28 7 30 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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