Inspection on 29/04/05 for Whittington House

This inspection was carried out on 29th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Whittington House 24/10/08

Whittington House 01/05/08

Whittington House 11/09/07

Whittington House 05/04/07

Whittington House 12/10/06

Whittington House 06/04/06

Whittington House 15/08/05

Whittington House 15/09/04

Whittington House 24/05/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 WHITTINGTON HOUSE 46 Dongola Road London N17 6EE Lead Inspector Susan Shamash Unannounced 29th April 2005 @ 12:30 pm The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WHITTINGTON HOUSE Version 1.10 Page 3 SERVICE INFORMATION Name of service Whittington House Address 46 Dongola Road, London, N17 6EE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8376 9219 020 8376 9219 Mr Francis Cleland Mr Francis Cleland Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia of places WHITTINGTON HOUSE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: NA Date of last inspection 15th September 2004 Brief Description of the Service: Whittington House is owned and managed by a private individual, Mr Francis Cleland who owns a number of other similar small homes in the North London area. The home is registered to provide a service to up to three people with mental health problems. The home is located in a densely populated area off Philip Lane, close to shops, pubs, the post office and other amenities. The home was opened in August 1999 and consists of a two-storey Victorian house with a newer, ground floor extension that is used as the kitchen. All the home’s three bedrooms are single although none have en-suite facilities. It is on an ordinary domestic scale and fits in well with the surrounding area, with a small garden. The home’s aims and objectives state that it provides support for service users to be part of the local community and to develop leisure and social activities. Special meals are available for those who have specific medical or cultural and religious preferences. WHITTINGTON HOUSE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted approximately six hours and was carried out as a routine unannounced visit to the home and in order to check compliance with the nineteen requirements made at the previous inspection. There were three residents living in the home and it was possible for the inspector to speak to all of them during the course of the inspection. The inspector was assisted for the majority of the inspection by the deputy manager of the home, and had the opportunity to speak to the provider (and acting manager) towards the end of the inspection. A tour of the premises took place and care records were inspected. It was of concern to the inspector that thirteen out of nineteen requirements have been restated in this report. The provider is aware that continued failure to comply with requirements made may result in enforcement action being taken against the home. What the service does well: What has improved since the last inspection? Since the last inspection there had been an improvement in the recording and review of risk assessments for individual residents. There were also improved records of food served at the home and monitoring of the storage of medicines, to ensure that residents needs are met safely and appropriately. Staff had undertaken a significant number of training courses including training in health and safety, lifting and handling, first aid, administration of medication and dealing with potentially violent situations. COSSH materials are now stored safely within a locked cabinet and the temperature of hot water provision at the home is monitored thus further protecting residents. WHITTINGTON HOUSE Version 1.10 Page 6 Arrangements to ensure that the finances of an identified resident are protected have also been undertaken as required. New carpets had been fitted in the communal areas of the home, and a new sofabed is provided for staff doing sleep-in shifts at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or WHITTINGTON HOUSE Version 1.10 Page 7 by contacting your local CSCI office. WHITTINGTON HOUSE Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection WHITTINGTON HOUSE Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 5. Insufficient information remains available for prospective service users to make an informed choice about the home. However an adequate system is in place to assess service users’ needs and goals effectively and ensure that these can be met. Service users’ rights are not sufficiently protected by contractual arrangements with the home and their local authorities, making them vulnerable to abuse/ exploitation. EVIDENCE: WHITTINGTON HOUSE Version 1.10 Page 10 No new service users had been admitted since the previous inspection. As noted at the previous inspection, the admission procedure for the home was found to be satisfactory. At the previous inspection it was required (for the third time) that the service users guide be updated to include service users’ views of the home and access to the most recent CSCI inspection report. The provider advised that he had hired a consultant to conduct a survey of service users’ views as part of a quality assurance audit for the home, however a report of the audit was not yet available. It was agreed that this must be completed by the end of May to avoid enforcement action being taken against the home. As noted at the previous inspection, service user plans included assessments with regard to the needs of each individual service user, and service users spoken to confirmed that they were consulted with regard to their needs. At the previous inspection it was required that and the content of service users’ statements of terms and conditions with the home be revised to ensure that all information as specified under Standard 5 of the National Minimum Standards is included, such as the room to be occupied, rights and responsibilities, arrangements for reviewing the service user plans, and any limitations to the freedom of each service user. Inspection of service user’s files indicated that this had not yet been carried out, and the provider advised that he had not yet addressed this requirement. It was also noted that a copy of each service user’s contract with the local authority was not available on their file, this is an additional area that must be addressed. This requirement is restated for the second time. WHITTINGTON HOUSE Version 1.10 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9. Service users’ needs and goals are assessed and responded to adequately, to ensure that these are met. There is however, room for improvement in the recording of risks, and actions taken to protect service users rights, so that service users receive consistent and effective support. EVIDENCE: Service users plans were available for all service users, and contained relevant information regarding particular areas of support identified as appropriate. The signatures of service users were also included indicating their involvement in the care planning process. Two service users spoken to confirmed that they were aware of the contents of their care plans. At the previous inspection it was required that all risk assessments be reviewed at least six-monthly and that a risk assessment regarding noncompliance with medication be recorded for one service user. As required records indicated that risk assessments for all service users were being reviewed at least six-monthly. However, no risk assessment had been recorded for the service user who refuses to take his medication on a regular basis. The deputy manager advised that the home had been in regular contact with the service user’s consultant and social worker regarding this issue, and WHITTINGTON HOUSE Version 1.10 Page 12 that this service user, following a review with his social worker, was being encouraged to improve his independence skills so that he might move on to a more independent living environment. The inspector saw a written note from the social worker, requesting that this service user should now be supported to self-medicate. Clearly a detailed risk assessment must be undertaken by the home prior to this service user starting to self-medicate, and this must take account of the service user’s history of refusing medication. At the previous inspection it was also required that the registered person continue to approach the family of the identified service user with regard to obtaining identity documents so that a bank account might be set up in his name, and that the assistance of his social worker be sought in this area. The provider advised that he had set up a client account for the service user in to which all payments were now being made. However he had still had no response from the family members, and the social worker for the service user had recently changed, so that no progress had been made in obtaining the service user’s identity documents. He advised that he was also still chasing up back payments of Disability Living Allowance for the service user. Although the use of a client account for the service user has partially resolved the situation, it remains required that the service user’s rights be protected by continuing to pursue his identity documents, and that all actions taken on his behalf must be recorded. This requirement is therefore restated. WHITTINGTON HOUSE Version 1.10 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17. The lifestyle needs of service users with higher dependency are not met, and there is a lack of provision of leisure activities for all service users in the home. Freedom is provided for service users to engage in personal relationships and maintain contact with family and friend. They are encouraged to take responsibility for the running of the home. Dietary needs of service users are catered for with a balanced and varied selection of food available that meets their nutritional needs. EVIDENCE: WHITTINGTON HOUSE Version 1.10 Page 14 The inspector spoke to the three service users and examined each service user plan, as well as discussing service users’ lifestyle choices with the deputy manager and provider. Minutes of house meetings and discussion with staff and service users indicated that service users were encouraged to be involved in house work within the home. Two service users attend day services on a part time basis according to their wishes, however one service user continues to require further support in finding meaningful daytime activities and therapeutic treatment. There was evidence at the previous inspection that the registered provider had requested an occupational therapy assessment for this service user, however this had not yet been undertaken. Although a recent review meeting had been undertaken for the service user, the provider confirmed that the service user who had attended the meeting did not maintain her own records of the meeting. It remains required (for the third time) that the minutes of the most recent review for the identified service user must be sent to the CSCI, and that staff from the home maintain their own minutes of meetings regarding service users welfare, so that action may be taken promptly. One service user has a network of friends and family, who meet with him both inside and outside of the home, and another service user is also very able to maintain social contacts. The third service user needs far more support in this area, and does not appear to have opportunities of meeting people of his own age or with shared interests. It remains required that the registered person must consult with social services over possible day activities. Although the provider advised that plans were in place to take service users on a day trip to Brighton and on at least one more day trip over the summer (this was confirmed in the minutes of the most recent house meeting), no other activities had been arranged since the previous inspection although a requirement was made accordingly. It remains required that regular trips out of the home e.g. to the cinema, cafes, pubs, bowling etc. must be arranged for all service users. Due to the differing needs of service users in the home, staffing implications in addressing this need must be reviewed. As required at the previous inspection, a record of food served to service users was being maintained, and service users spoken to were satisfied with the food available to them. One service user expressed a wish for more Caribbean food to be available, and this was passed on to the provider. WHITTINGTON HOUSE Version 1.10 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20. Service users receive appropriate physical and emotional support and are supported to take their prescribed medicines appropriately to ensure medication needs are met. EVIDENCE: Service user plans, and feedback from service users indicated that they were treated with respect and that their privacy and dignity was maintained. There was also evidence that service users attended regular health care appointments as appropriate. The storage and recording of the administration of medication appeared to be satisfactory, and as required at the previous inspection the storage temperature of medicines was also being recorded daily and was found to be within the specified range. A requirement is made under Standard 9 regarding the service user who frequently refuses medication and is now self-medicating at the request of his social worker. WHITTINGTON HOUSE Version 1.10 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The home’s complaints procedure is not followed adequately to ensure that the concerns of service users are acted upon effectively. Procedures and training are in place to ensure that service users are protected from abuse. EVIDENCE: The home has a complaints procedure in place, an adult protection procedure and guidance for staff regarding whistle blowing. A copy of the Haringey Adult Protection Policy and Procedure is also available within the home. The provider advised that the majority of staff employed at the home were due to undertake training in the protection of vulnerable adults on 3rd May 2005. At the previous inspection a requirement was made regarding the recording of all complaints within the home’s record, with particular regard to a previous complaint raised and addressed with regard to the home’s stock of food. A record of this complaint and the way in which it was dealt was still not recorded in the home’s complaints record at the time of the current inspection. This requirement is therefore restated. The provider advised that no further complaints had been made since the previous inspection. WHITTINGTON HOUSE Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 28 and 30. Service users live in an environment that is homely and comfortable, with adequate private and communal space. However service users would benefit from the home being more responsive to their choices with regard to their accommodation. EVIDENCE: The location and layout of the home are suitable for the service user group, there is sufficient communal space for three service users and the cleanliness in the home was of an acceptable standard. A requirement made regarding the replacement of the curtains in one service user’s room with curtains of a darker colour, in line with his wishes, had not yet been met and this requirement is restated. The provider advised that new curtains had been bought and were due to be fitted at the weekend following the inspection. WHITTINGTON HOUSE Version 1.10 Page 18 Since the previous inspection new carpet had been fitted in the lounge and on the staircase, and a new sofabed had been provided in the office for staff sleeping-in. During the inspection, the inspector noted that no hot water was available. However discussion with service users and staff indicated that hot water was generally available at all times. One service user had had a bath just before the inspection and he advised that there had been plenty of hot water at this time. As requested the deputy manager telephoned the inspector on 4th May 2005 to confirm that a plumber had attended the home on the evening of the inspection, and advised that the problem had been due to the timer for the home’s hot water system, and had been rectified. WHITTINGTON HOUSE Version 1.10 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36 and 37. Staff are adequately trained to meet the needs of service users safely and effectively with the exception of training in protection from abuse. Insufficient records are available at the home to evidence that an adequate recruitment procedure is in place for as-and-when staff, which adequately protects service users. Inadequate staff supervision also places service users at an increased risk. EVIDENCE: Satisfactory enhanced CRB disclosures were available for all staff as required, and staff files had been updated to include the required information. A requirement was restated for the third time at the previous inspection, regarding a number of core training courses that must be undertaken by staff, and regarding the reviewing of staffing numbers within the home. The provider advised that training had been undertaken in health and safety, moving and handling, first aid, administration of medication, drug and alcohol awareness and dealing with potentially violent situations. Staff files confirmed that these courses had been attended. The provider WHITTINGTON HOUSE Version 1.10 Page 20 advised that a course on the protection of vulnerable adults would be undertaken on 3rd May 2005 and in physical restraint on 4th May 2005. Staff files were not available for staff who work on occasions at the home. This was of particular concern to the inspector, as requirements have been made regarding this issue at previous inspections. A requirement is made accordingly. At the previous inspection it was recommended that an abbreviated induction format be available for agency/bank staff members working in the home for the first time. This had not been undertaken, and a requirement is made accordingly in this report. The provider is also required to review the number of staff working within the home to ensure that all service users can be supported to undertake activities within the community on a regular basis (as noted under Standard 14). Inspection of staff files and discussion with staff confirmed that whilst individual staff supervision sessions and staff meetings are occurring, these are not occurring at sufficient frequency to meet the National Minimum Standard of at least six times annually. A requirement is made accordingly. WHITTINGTON HOUSE Version 1.10 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 In the absence of a record of the acting managers hours it is unclear as to whether the home is adequately managed with the needs of service users in mind. The absence of adequate quality assurance procedures, staff supervision and some safety checks also places service users at an increased risk. EVIDENCE: Concerns remain regarding the ability of the registered provider to balance the demands of the other homes and services that he owns and still manage this home on a full time basis. At the previous inspection the registered person was required to appoint an appropriate full time manager for the home or record the hours that he works within the home on a daily basis. The provider (and acting manager) advised that he was now spending the majority of his time at the home. However he had not recorded the hours that he was working within the home. This requirement is restated. WHITTINGTON HOUSE Version 1.10 Page 22 At the previous inspection it was required that a quality assurance audit be conducted for the home. The provider advised that he was working with an independent consultant to complete this task and had already circulated questionnaires to service users. He was reminded that he also needed to request feedback from health care professionals and other visitors to the home in addition to an internal audit of how the home is functioning. It was agreed that a report of the findings of this audit would be sent to the local CSCI area office by the end of May. COSHH materials were stored in locked facilities as appropriate, however the provider advised that he had not yet collated hazard analysis sheets for all COSHH materials used within the home. The provider advised that he had not yet carried out risk assessments with regard to the building. This requirement is restated. It was also required that testing be undertaken for Legionella and that the temperature of hot water in the home be monitored. Evidence was available that the water tanks in the home had been serviced and the temperature of hot water was consistently within the required range. Although there was a problem with the hot water during the inspection, the deputy manager advised that this was rectified later that evening. Current gas and electricity installation certificates were available for the home and records indicated that appropriate fire safety checks were generally being undertaken. However it is required that fire alarm checks must be undertaken at least weekly (rather than fortnightly) and a portable appliances testing certificate must be obtained for the home. SCORING OF OUTCOMES WHITTINGTON HOUSE Version 1.10 Page 23 This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 2 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 x 3 N/A 3 Standard No 11 12 13 14 15 16 17 x 3 3 1 3 1 3 Standard No 31 32 33 34 35 36 Score x x 2 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x 2 x WHITTINGTON HOUSE Version 1.10 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5(1) and 5(2) Requirement The registered person must ensure that the service users guide is updated to include service users’ views of the home and access to the most recent CSCI inspection report. A copy of the completed document must be sent to the local CSCI area office. (Timescale of 05/11/04 not met.) This requirement is restated for the fourth time. Failure to provide a copy of this document within the stated timescale may result in enforcement action being taken against the home. 2. 5 5(1)(c) The registered person must ensure that service user’s statements of terms and conditions with the home are updated to include all the information as specified under this Standard, including the room to be occupied, rights and responsibilities, arrangements for reviewing the service user plan and any limitations to the freedom of each service user. Copies of local authority Version 1.10 Timescale for action 10th June 2005 24th June 2005 WHITTINGTON HOUSE Page 25 contracts with each service user must also be available. (Timescale of 05/11/04 not met). This requirement is restated and amended. The registered person must continue to approach the family of the identified service user with regard to obtaining identity documents so that the service user can set up his own bank account. The assistance of the service user’s social worker must also be sought to ensure that the service user’s rights are respected. Copies of all correspondence must be maintained on file. (Timescale of 05/11/04 partially met). The registered person must ensure that a risk assessment is undertaken and recorded regarding the service user who has been refusing to take his medication for approximately two months. This should be included within a risk assessment regarding this service user self medicating. A copy of this assessment must be sent to the local CSCI area office. (Timescale of 08/10/04 not met). This requirement is restated for the second time (slightly amended). The registered person must ensure that regular supervised trips are arranged outside of the home to places of interest to service users such as trips to the cinema, pub and local cafes/restaurants, and day trips to more distant destinations, and that these must be recorded in Version 1.10 3. 7 20 1st July 2005 4. 9 12 13(4)(b) 3rd June 2005 5. 14 16(2)(m) (n) 1st July 2005 WHITTINGTON HOUSE Page 26 service user files. The possibility of a short holiday away from the home for all service users must also be investigated. (Timescale of 22/10/04 not met). 6. 16 13 (7) 14 This requirement is restated. The registered person must ensure that a review is held for the specified service user with regard to his needs, both in the daytime and at night, and how and whether they can be better met in this placement. A copy of the minutes of the most recent review meeting must be sent to the local CSCI area office. (Timescale of 22/10/04 not met). This requirement is restated for the second time. The registered person must ensure that the representative from the home maintains his/her own minutes of any review meetings attended with regard to service users in the home. (Timescale of 08/10/04 not met). This requirement is restated for the second time. The registered person must ensure that all complaints addressed to the home are recorded within the complaint’s register for the home. (Timescale of 01/10/04 not met). This requirement is restated. The registered person must ensure that the identified service user is given the opportunity to choose, and be provided with Version 1.10 15th July 2005 7. 16 15, 17(1)(a) Sched 3 (4) 20th May 2005 8. 22 17(2) Sched 4(11), 22 20th May 2005 9. 26 23(2)(d) 27th May 2005 WHITTINGTON HOUSE Page 27 new (darker) curtains and nets for his bedroom. (Timescale of 22/10/04 not met). 10. 33 18(1)(a) This requirement is restated. The provider is also required to review the number of staff working within the home to ensure that all service users can be supported to undertake activities within the community on a regular basis. This requirement is restated. The registered person must ensure that staff files for all staff including occasional workers are available for inspection. These files must include the items specified in Schedule 4 (6) of the Care Homes Regulations 2001. A schedule for the induction of occasional staff when working in the home for the first time, must also be developed and utilised. The registered person must ensure that all staff who have not yet received training in adult protection, receive this training. (Timescale of 22/10/04 partially met). This requirement is restated and amended for the fourth time. The registered person must ensure that staff receive individual supervision sessions and staff meetings are arranged at least six times each year. The registered person must ensure that proper arrangements are in place to effectively manage the home. He must propose a candidate to be registered as manager of the home and make application to the for registration. Version 1.10 1st July 2005 11. 34 17(2) Sched 4 (6) 27th May 2005 12. 35 13(6) 18(1)(c) (i) 10th June 2005 3rd June 2005 13. 36 18(2) 15th July 2005 14. 37 10 22nd July 2005 20th May Page 28 WHITTINGTON HOUSE In the interim period the provider/manager must record the hours that he works within the home on a daily basis. (Timescale of 01/10/04 not met). This requirement is restated for the second time and amended. The registered person must undertake a quality assurance audit of the home, and this must be repeated at least annually, obtaining feedback from each service user (with assistance from an advocate where appropriate), care managers, health care professionals and regular visitors to the home. A copy of the findings of this audit must be sent to the local CSCI area office. (Timescale of 05/11/04 not met). This requirement is restated for the second time. The registered person must ensure that individual risk assessments are recorded with regard to the building including individual data hazard analysis sheets for COSHH materials used in the home. Copies of these assessments must be sent to the local CSCI area office. (Timescale of 05/11/04 not met). This requirement is restated for the second time. The registered person must ensure that the homes fire alarm is tested weekly, and portable appliances testing is undertaken for the home. 2005 15. 39 24 10th June 2005 16. 42 13(4) 10th June 2005 17. 42 13(4)(a) 23(4)(c) (v) 27th May 2005 10th June 2005 WHITTINGTON HOUSE Version 1.10 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations WHITTINGTON HOUSE Version 1.10 Page 30 Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI WHITTINGTON HOUSE Version 1.10 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!