Inspection on 06/01/10 for Whittingham House

This inspection was carried out on 6th January 2010.

CQC found this care home to be providing an Poor 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 27/01/09

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 14/03/2010.

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:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 0 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.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 www.southendcare.com Strathmore Care care home 77 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 shower facility. The home has a large dining room, a variety of lounges and a garden area. Care Homes for Older People Page 4 of 33 2 7 0 1 2 0 0 9 77 0 Over 65 0 77 Brief description of the care home 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: zero star poor 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. At this visit we (CQC), 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. We spent seven hours at Whittingham House. As the home is large two inspectors undertook the site visit. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to Care Homes for Older People Page 6 of 33 complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for Whittingham House was completed by the manager. Although not well completed it gave us some information and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. The manager did not distribute these as requested. A further supply of surveys was left at the site visit. We received responses from one member of staff and one relative. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, care standards 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. Care Homes for Older People Page 7 of 33 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 on page 4. Care Homes for Older People Page 8 of 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. 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. People can feel confident that staff will try, through assessment processes, to ensure that the home will be suitable to meet their needs. Evidence: We saw that the home had a Statement of Purpose and Service Users Guide in place. The Service Users Guide had been reviewed in January 2010. It contained good information for people, including details of fees charged. Copies of a Residents Handbook were noted to be available in peoples bedrooms for them to refer to once they had moved in. Before admission people are given a brochure that provides generic information about the Company, and a sheet on each of the local homes. These sheets provided basic information about size location access and facilities. The brochure does not provide such full information as the service users guide. People should be given a copy of the service users guide as part of the assessment/admission process to ensure that they have good information to inform their decision making. Care Homes for Older People Page 11 of 33 Evidence: So that people interested in moving in, and management, know that the home will be suitable to meet peoples needs, the Company employs a placement co-coordinator. They carry out pre-admission assessments with people interested in moving into any one of the homes owned by the provider. Information is discussed with the manager and the admission arranged. The manager said that they were involved in some assessments and felt that they had a say over who moved into the home. We looked at the files of three people who had most recently moved into the home. We saw that good pre-admission assessments had been completed so that the home were aware of peoples needs when they moved in. Intermediate care is not provided at Whittingham House. However since the previous inspection the home are now providing a step down service. This is where people who have been in hospital move into the home for a short period of time to complete their recovery, wait for care packages or adaptation to their homes, or have some rehabilitation in a non clinical setting. People stay at the home for varying timescales up to a few weeks before returning home, or making the decision to move permanently into residential care. People using this service remain under the care of the health authority and receive services such as nurses and physiotherapists to aid their recovery during this period. 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 poor 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 they will receive good and consistent care that meets their individual needs in ways that they would wish. Evidence: During the day people living at the home and relatives told us that they were generally happy with the care they received at Whittingham House. One person said, I am very happy here, and another that Its alright I usually get the help I need. One relative said that although they were reasonably happy with the basic care provided that, no one has really taken the time to find out what my [relatives needs are. Is the home really interested in them as a person. Minutes of a recent residents meeting indicated that there is a feeling that standards in the home have dropped. One person said, The standard has dropped, there is a lack of communication. My relative needs to be checked more often. Other issues raised were people not being toileted regularly enough, people being forgotten on tea rounds, residents who wander not being adequately monitored, and issues about females being assisted by male carers when they are not comfortable with this. Care Homes for Older People Page 13 of 33 Evidence: On the day of the site visit people generally appeared well groomed and appropriately dressed. We did however notice that in spite of the time of year and snow being on the ground outside, most female residents were not wearing any leg coverings such as socks or stockings. This was not identified as personal choice in care plans viewed. When one person was asked about this and if they were warm enough they said, Well it will have to be alright wont it. We (CQC) appreciated that our visit coincided with a very busy day at the home with things being stretched due to an outbreak of illness. However our observations of care on the day of the site visit showed that people were not always offered appropriate care and support in a timely manner. People had to wait to go to the toilet or for other help. Some people in their rooms were left without access to their call bells so that they could not call for assistance if needed. Although in some cases the people would not be able to use a call bell, this was not always so. Some staff observed and spoken with did not always have a good knowledge of residents needs likes and dislikes. For example one person had been given a cup of tea with sugar which they did not take. The resident struggled to make the member of staff understand and change it. We saw that people living at at Whittingham House had individual care files in place containing various assessments, care plans and archived daily documentation. We looked at six care files to see how well care is planned for and arranged. We looked at a mixture of step down and permanent residents files. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how staff are helped to meet peoples needs in an individual way. Since the previous inspection there has been a change of manager at Whittingham House. Together with the recently appointed care standards manager they are working on care plans to try and make them more person centred and adequate to meet peoples needs. Whilst people are generally happy with the care they are receiving at Whittingham House, there are some concerning shortfalls in the level of care offered. Care is not well supported by robust care planning and record keeping. Some shortfalls found in care records were concerning. The homes Service Users Guide says, Following the pre-admission assessment and initial in-house assessment process the manager or senior member of staff draw up a comprehensive care plan, in consultation with the service user (if practical) or their family/Representative. At the moment however people are not proactivly involved in planning for their care. Although pre-admission assessment information is available, people admitted on a step down basis are not always having care plans formulated at all, or in a timely manner. For example for one person they were on a second stay in the home. Assessment information from the hospital indicated a number of physical and potential mental health issues. No care plans were in place. This means that staff may not be Care Homes for Older People Page 14 of 33 Evidence: fully aware of peoples needs, or react appropriately to any given situation. To try and address this, provide good information, and reduce the workload on staff of having to complete pages of detail for people who are only going to be in the home for a short while, a new format has been developed. This Care plan for step down residents will provide a more proactive and goal based approach to assist peoples progress. Care plans are divided up into ten different aspects of care for example personal care and skin care, and mobility, exercise and physical activity. These sections are then sub divided further to prompt staff to identify all aspects of needs. Care plans varied in quality. Some were good and described peoples preferences such as what time people liked to go to bed, covers and pillows required and so on. Most of those we sampled however provided quite basic information, and often did not address all of peoples assessed needs or provide any level of detail. For example one person was identified as having a hearing loss, and a specific medical condition. The impact of these conditions and associated care needs was not mentioned in care planning. Under the appropriate section the care plan just said does not wear a hearing aid. There was a lack of detail in care planning. For example statements such as needs assistance with shaving, requires one carer to assist with bathing will not assist staff in understanding peoples individual needs and help them to deliver care in a person centered way. Information in care plans could be very confusing and would not assist staff in offering care. For example in different plans and risk assessments in the care file one resident they were variously described as: chair and wheelchair bound, can weight bear with the assistance of two carers, is able to walk without a walking stick or zimmer frame, and mobilises with a zimmer frame, shaky when walking. This will not assist staff in providing care, and could put the resident at risk. Although daily notes and care records were reasonably well maintained, they are held in separate communal files from peoples care files. This means that staff may concentrate on maintaining these records and not access the information in care files to find out peoples needs. Many care plans did not contain a photograph of the resident to help staff to recognise them. This is particularly important, when due to providing step down care, there is a high turnover of residents. Where there is an element of risk associated with peoples care this needs to be assessed and strategies put in place to minimise the risk. This was not always the case. For example one person was identified as being at risk of falls. The moving and handling and falls prevention risk assessment had not been completed. The above findings on care plans were disappointing as care planning has been an ongoing issue at the home. The new care standards manager is committed to improving the situation, and is in the process of reviewing all care plans and documentation. Care Homes for Older People Page 15 of 33 Evidence: Training records showed us that some staff have undertaken training relating to peoples healthcare needs such as continence, pressure area care and nutrition. This should assist them in supporting residents. Records showed that people access appropriate health care to meet their needs such as district nursing, chiropody, opticians and general practitioners. We were however concerned that peoples health care may be compromised through assistance not being sought in a timely manner, and records of medical issues or interventions not being well maintained. One person told us that they were supposed to see the district nurse every day but had not seen one for a week. When we looked at their records we saw that they were admitted with a dressing on one leg and had been sent in with three days supply of dressings. From their records it was not possible to tell if any interventions or district nursing visits had occurred. The manager undertook to look into this. Another resident had a district nurse referral sheet in their file as they had developed a pressure sore. This was not mentioned on their body chart or on their personal care/skin care care plan. The day before the site visit one resident was identified in daily records as, noticed a pressure sore on bottom, complaining of a sore throat. No actions were noted as having been taken about this. The manager said that it was to be addressed today. During the site visit we requested a list of everyone in the home who currently had pressure sores, and whether these had been acquired at the home or in hospital. This information was not provided and had to be chased up again following the inspection. Information eventually provided indicated that four people had developed pressure sores at the home, two of these people and a further resident, still in hospital, are the subject of current safeguarding referrals relating to this aspect of their care. Peoples nutritional needs are assessed, but again when these flagged up any potential risk factors, these were not always carried forward into the persons care plan. We saw that people are regularly weighed to highlight any potential concerns. Nutrition records are maintained to monitor peoples diet. During the day people were encouraged to drink plenty. As part of this inspection we looked at medication systems and records and found that they were generally well maintained. However, for people to feel fully confident that this aspect of their care is properly managed there are a number of issues that need to be addressed. When we looked at records we saw that there was a lack of consistency in how things are managed in relation to medicines. For example, sometimes there were protocols in place for medicines prescribed to be taken on an as required (PRN) basis, sometimes there were not. On most occasions handwritten entries on the medication administration record (MAR) sheets were countersigned to confirm quantities and instructions, and at other times this had not happened. Boxed and bottled medication had not always been dated on commencement to provide a Care Homes for Older People Page 16 of 33 Evidence: good audit trail. On one occasion medication had not been properly booked in and quantities received were not recorded. This also does not provide a good audit trail. Many records did not include a recent photograph of the resident as an aid to safe administration. Again this is particularly important for people staying at the home on step down as staff may not know them so well. There was one issue of concern relating to the management of controlled drugs. One person had their controlled drugs booked in, but these has not been booked out when they left. It therefore appears that these drugs are still in stock when they are not. We were concerned at the length of the morning medication round. Although two staff were undertaking this the round went on until about 11.00. One senior felt that this was unusual and that they would normally expect to finish by 09:30. Another senior however said that due to pressure of work, the increased workload engendered by having step down residents, and having to attend to other things, the round could sometimes go on until 11.30. This may not provide adequate spacing between doses of medication. Also during the medication round we saw that blister packed drugs were left unattended on a dining room table. This is because the current trollys do not provide adequate storage. Management at the home said that they are aware of these last two issues and are trying to address them. Staff spoken with and a training matrix seen indicated that they had completed medication training. The manager said that the training manager for the organisation does monitor staffs practice to ensure that good standards are maintained. Observations through the day showed that staff approached residents in a calm and kind manner. Staff treated residents with respect. Doors were kept shut when personal care was being carried out so that peoples privacy was maintained. However staff may sometimes need to think through their practice. for example in the dining room there was a list of diabetics on full display. This does not preserve peoples privacy and dignity. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have some opportunities to enjoy a fulfilling lifestyle. Evidence: The organisation employs an activities co-ordinator whose hours are shared between different homes in the group. At the last inspection we saw that they worked in the home for three days each week. This time they said that they worked there for two days each week. Whittingham house is a large and, particularly since undertaking step down, very busy home. It would benefit from having a dedicated full time activities coordinator. Staff do what they can to provide activity and stimulation when the activities co-ordinator is not available. There is an activities timetable in place to guide them. However as we saw during the site visit staff are often very busy and may not always have time to undertake activities. We saw that records of activity assessments, activity questionnaires and activity records are held separately to peoples care records. This may not help in providing a joined up approach to meeting peoples needs in a holistic way. Care plans sampled provided limited information or personal history that would assist staff in engaging residents on a personal level. Staff observed did not use everyday tasks as opportunities for engagement. Although most activities take place in one of the homes lounges, the home has a pleasant activity area that can be used. The activities folder included a record of the activities Care Homes for Older People Page 18 of 33 Evidence: undertaken by people living in the home. These included card decorating, arts and crafts and soft ball. Some people had enjoyed a recent trip out to see a pantomime. Seasonal events and parties take place on a regular basis throughout the year. The AQAA said that since the previous inspection more activities equipment had been provided. On the day of the inspection people participated in a music session in the morning and board games in the afternoon. A hairdresser was also visiting and people were enjoying having their hair done. The local group of homes have access to a minibus that can be used to take people out. At the moment no church groups visit the home to provide an opportunity for people to fulfil their spiritual needs. The manager said that this is arranged on a one to one basis if the need is identified. Visiting at Whittingham House is open and people can see their friends and family at any time. During the day people came and went. 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 such as getting up and going to bed. 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. People living at Whittingham House seemed mostly satisfied with the meals provided. Good food, I like the food and there is always choice, and Usually the meals are quite nice were some of the comments made. 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 days menu was written up on a white board for people to see, and some residents were noticed to use this. We saw from nutrition records that there now seems to be more hot choices made available at tea time. At lunchtime we saw that many residents remained in their armchairs and had their meal from over bed style tables. This does not give them the opportunity to move about or have a change of scene. Seven residents in one small lounge had their meal like this. No staff were available to support or encourage them. One resident was not eating their meal. A number of residents at the home require support to eat. We saw that this was carried out in a sensitive manner. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not be fully protected through procedures and practice in the home. Evidence: The homes complaints procedure was last reviewed in April 2008 and it informed people about how to complain. People spoken with confirmed that they would know how to complain if they wished to do so. However one relative said, It takes so long to rectify a complaint. There had been two complaints since the last inspection and both had been dealt with appropriately. The records detailed the nature of the concern/complaint, who investigated it, what actions had been taken and the outcomes. No one has directly raised concerns with us (CQC) about the service. We viewed the homes safeguarding policy, which was last reviewed in April 2008. It included information on the signs of abuse and the actions that staff needed to take should they suspect a person is being abused. The home has obtained a copy of the Southend Essex and Thurrock guidelines, and the manager said that the homes policy works within them. One safeguarding issue has been raised since the last inspection and it was dealt with appropriately. Shortly after the site visit however we were advised that three further safeguarding referrals had been made in relation to care at the home. One of these related to a resident in hospital. We had not been informed of this through reporting procedures that the home is expected to maintain. The training matrix showed that twenty four staff have had safeguarding training in the past year. Staff spoken with showed an awareness of the homes safeguarding procedures. The Care Homes for Older People Page 20 of 33 Evidence: AQAA said We raise awareness of abuse and the symptoms that staff should look out for. Again however staff need to think through their practice and have their practice monitored, as issues such as leaving people without the means to summon assistance could be seen as abusive. One member of staff was heard to be quite abrupt with a resident when they asked for something. The staff member said, Yes, Yes I know in a hard tone. When we looked at staff recruitment records some required records were not available. We could not therefore see that there were consistent and robust processes in place to protect people. This is detailed further under the staffing section of this report. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant home, but may not be fully protected by infection control procedures. Evidence: In general Whittingham house provides a comfortable and pleasant home for people. The building appeared well maintained and a general hand is available to address any ongoing repairs. Records relating to this could be better. When issues are identified it is not always clear whether these have been addressed and rectified. Most bedrooms have an en suite facility. One relative felt that, The rooms could be more homelt. There is outdoor space for people to enjoy. The home has a number of communal areas, some of which is not utilised. Seating in the lounge areas was set out at the edges of each room leaving large gaps in the middle and giving the home an institutional feel. In one area of the older lounge chairs were placed close together. This meant that when people were served drinks, some did not have a nearby table to place their cups on, and had to hold on to them. This may present an element of risk if people spill their drinks. We raised this at the last inspection. The manager said that they have tried to address this but the furniture always ends up being put back where it was. Whittingham House provides seventy single and three double bedrooms, there were Care Homes for Older People Page 22 of 33 Evidence: sinks in all of the bedrooms and some had en-suite facilities. One person spoken with said I like my room, I am very happy here, have been here for six years. I was in a different room before but I like this one better. The home is registered to provide care for people who have dementia. Due to the different extensions added to the home it can be quite confusing. Although some signage is avaialble this would benefit from being developed to assist peoples orientation. On the day of the site visit, once morning odours had dispersed, the home appeared clean and was odour free. Morning odours may not be helped by staff practice. When staff assist people up, rooms are not left tidy with curtains open and some ventilation. The manager and care manager said that they were aware of this issue and are trying to address it with staff. Whittingham House has a laundry area on each floor of the building. Both were well equipped. In both areas although there were standard rubber gloves there were no disposable gloves and aprons available to protect staff and support good infection control. The manager said that the rubber gloves were only used by the laundry person. However during the site visit we saw a member of care staff use these. They told us they were the laundry gloves. As the home had an outbreak at the time of our visit the practice of different people using the same gloves in an area of high risk was poor. We raised the issue of lack of protective clothing and use of rubber gloves in the laundry at the previous inspection. According to the training matrix all staff have received training in infection control. Although the manager had not had this training. 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. It is therefore not clear if appropriate training had been undertaken or if it had, how useful it had been. Another member of staff confirmed that they had undertaken training but by their actions did not demonstrate good practice. 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 may find that there are not always sufficient staff available to meet their needs. Evidence: People spoken with said that the staff were nice. One person said Everyone is friendly and helpful. During the day staff were very busy, and call bells went for some time before being answered. On one occasion we assisted a resident to use the call bell as they needed to use the toilet. No one came. We approached a member of staff in the lounge to assist but they said that they had to stay where they were. Eventually a member of staff came. A member of staff said, We need more staff. Residents need staff to have time to interact with them. A relative said, More carers are needed, there never seems to be enough. We looked at the staff duty roster and it showed that ten care staff in the morning and eight care staff in the afternoon were scheduled to work each day. Rotas showed that these planned staffing levels at the home are not being maintained. This means that sufficient staff are not consistently available to meet peoples needs We carried out a random check of the staff duty roster. We checked three separate days and found that the on first day there were eight staff in the morning and eight staff in the afternoon. Five of the eight staff working a long day, therefore they worked the afternoon shift as well as the morning shift. This happens a lot at the home and is not best practice as staff may become tired and not work as effectively. The next day that we checked showed the correct amount of care Care Homes for Older People Page 24 of 33 Evidence: staff, which included the manager. The final day that we checked was the day of the inspection. The duty roster showed that there were seven care staff working in the morning and six care staff working in the afternoon plus the manager. Three of the care staff were shown as working a long day. Given the number of people being cared for in bed, and the addittional needs for increased care and hygiene due to the home experiencing an outbreak this was not acceptable. The manager said that the shortages were due to some staff being off sick. They had not wanted to call on staff from other homes in the group for fear of spreading the infection. The home were advised in this case to seek agency staff cover, ensuring that they were made fully aware of the current situation in the home. Ancillary staff are employed at the home to provide catering and housekeeping support. On the day of the site visit the rota indicated that laundry cover was being provided. In fact the worker was off sick but the rota had not been updated. An activity co-ordinator that works in the home two days each week. The care standards officer is currently based at Whittingham House and works in the home five days a week, and an administrative assistant has also just started work at the home. None of these people were included on the staff duty roster. The staff duty roster must be accurate and show who is and is not working in the home. To ensure that people receive care from a skilled workforce it is recommended that at least 50 of a homes staff achieve a National Vocational Qualification (NVQ) in health and social care. The AQAA for Whittingham House indicated that of twenty five care staff who work at the home eight staff have an NVQ at level 2 or above. The training matrix showed that nine staff have now obtained the qualification and a further nine staff are working towards an NVQ level 2. Five staff are working towards their NVQ level three. One of the staff files that we looked at contained a certificate for the staff members NVQ qualification. Although the home have not yet reached their 50 target they should achieve this soon. To see how well people are protected by the homes recruitment procedures we looked at five staff files, including that of the most recently employed member of staff. We saw that each person had completed a satisfactory application form, but that there was no evidence that their physical/mental fitness to do the job had been verified. Three of the staff files that we looked at contained two written references, one file contained only one written reference and the other file contained none although there was two letters requesting references on file. Four of the staff files that we looked at contained a satisfactory criminal records bureau (CRB) check. Where a staff member had started work before receipt of a Criminal Records Bureau Check (CRB), there was evidence that a POVA 1st check had been carried out prior to them starting work. This Care Homes for Older People Page 25 of 33 Evidence: information showed that recruitment procedures at the home need to be reviewed to ensure that high standards are maintained. On the day of our visit the hairdresser was visiting. They confirmed that they had never had a CRB check undertaken. The manager was advised that people working with residents in such ancillary capacities, should have appropriate checks carried out. To ensure that staff develop good skills from the start of their employment they should undergo a period of induction at the home. There was evidence of induction to the home having taken place on two of the staff files that we looked at. There was blank induction paperwork on two of the other staff files. Staff spoken with said that they had been given a full induction. We saw one completed Skills for Care Common Induction Standards workbook on one of the files that we looked at and we saw a blank workbook on another. On one survey received it was said that their induction mostly covered what they needed to know. The manager said that all staff have a 13 week probationary period. There were no forms or paperwork associated with this on the files viewed. This again shows a lack of consistency of approach to new staff and their induction. The Company has a training officer who is based at Whittingham House. We saw training certificates on two of the staff files viewed. Training undertaken included infection control, food safety, first aid, fire safety, control of substances hazardous to health (COSHH), nutritional care, dementia, diabetes and swallowing difficulties. A completed training matrix was sent to us following the inspection to give us a better view of training undertaken by staff. This showed us that a good level of basic training is offered. The home is registered to provide dementia care. We saw that a number of staff still have to complete training in this area to ensure that they have the right knowledge and skills. 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 cannot feel confident that they are living in a well managed home. Evidence: Since the previous inspection the registered manager at Whittingham House has left. The home has been managed by the current manager since February 2009. The manager has many years experience in the care of the elderly and holds both an NVQ 4 in care and the registered managers award. The manager regularly updates their practice. Recent training includes medication, health and safety, moving and handling, fire awareness, safeguarding, first aid, food hygiene, pressure area care, dementia and challenging behaviour. The home has recently appointed a clerk to assist the manager with managing telephone calls and the step down documentation. This inspection has raised concerns about the management of the home. Some areas such as the management of medication, care planning and staff recruitment seem to have deteriorated since the previous inspection. Although the site visit coincided with a very busy day at the home, we found it difficult to get the information needed to complete the inspection. Information often had to be asked for several times, or Care Homes for Older People Page 27 of 33 Evidence: incorrect/incomplete information was given. A Care Standards Manager has recently been appointed and is working with the manager to address issues and shortfalls. They have started to review and renew care plans, and have developed more robust documentation for people placed at the home on a step down basis. The manager requested an extension to the deadline for returning the annual quality assurance assessment (AQAA). When received we saw that the AQAA was a copy of one submitted by another home in the group with amendments made as appropriate. Because of this we were not always sure if the information presented was accurate or actually related to Whittingham House. Some areas could have given us better information. For example the health and personal care section did not give us accurate information about the current situation in the home, and there was no mention of medication management. The provider ensures that the regular monthly visits to review the service are carried out. This is required by Regulation and prepares a report of the visits findings is produced. We viewed the reports that were made as a result of the last two visits. Both reports showed that the views of the people living in the home are sought on a regular basis, and that the provider also regularly talked to their families and friends to obtain their views. The reports showed that the provider monitors the homes plans for improvement and looks at further improvements that are identified as a result of the visit. The manager said that the organisation carries out annual surveys to establish the view of people using the service and other interested parties such as relatives, visiting professionals and staff. However, they were not able to locate a copy of the most recent report. When, as part of this inspection process, we sent surveys to the home to be distributed, these were not given out. We left more surveys for people to complete when we carried out the site visit. People can generally feel confident that if they wish the home to support them in looking after their money, that this will be done in a way that protects their interests. We checked a random sample of the cash and cash transaction records belonging to people living in the home. We found them to be accurate and up to date. Care is needed however to ensure that the system is well organised and all receipts readily available. We looked at five staff files and we found supervision notes on two of them. The other three staff files did not contain supervision notes as the staff had started work at the home within the past eight weeks. The supervision notes that we looked at covered areas of staff practice and and training requirements. Staff spoken with said that they felt well supported and that they had regular supervision. Care Homes for Older People Page 28 of 33 Evidence: No major health and safety issues were noted during the day. However there were some issues. As at the previous inspection we noticed that a number of zimmer frames had ferrules that were worn through to the metal. This could increase the risk of falls. In the morning we noticed that a number of self closing doors were propped open by different items such as chairs. This could potentially provide an increased risk in the event of a fire. In a home registered to provide dementia care potentially hazardous areas such as laundry rooms and sluices were not secured. Areas labelled as keep locked were open. We checked a random sample of safety certificates and they were all up to date. We looked at the homes fire risk assessment which was reviewed on 14/1/09. The last fire officer visit to the home took place on 7/4/09. This showed that the homes fire arrangements were to a satisfactory standard. We looked at the fire records and these showed that regular fire drills have taken place so that people would know what to do in the event of an emergency. The record of weekly fire tests of equipment showed that test had not been carried out since 1/12/09. The training matrix indicated that staff are kept up to date in core areas such as moving and handling, health and safety and fire awareness. 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 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. 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 9 13 Medication systems must be more robustly monitored to ensure that good standards are maintained. To ensure that peoples medication is managed in a safe and robust way. 14/02/2010 2 29 19 Recruitment procedures must be robust and consistently carried out. References must be obtained and peoples fitness to work explored. So that people are protected and have suitable people employed to support them. 14/02/2010 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 improving their service. No Refer to Standard Good Practice Recommendations 1 1 People should be given a copy of the homes Service Users Guide so that they have good information about the home Care Homes for Older People Page 31 of 33 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 improving their service. No Refer to Standard Good Practice Recommendations to inform their decision making process. 2 15 Mealtime routines should be reviewed to ensure that everyone has the opportunity to sit at a proper table if they wish, and to ensure that people have proper support at mealtimes. Staff knowledge of and practice in relation to infection control needs to be monitored to ensure that people are care for safely. Staffing rosters should include all staff working at the home, must be accurate and up to date. So that people receive support from a well trained workforce 50 of the homes care staff team should complete and NVQ in health and social care at level 2 or above. 3 26 4 5 27 28 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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