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Care Home: The White House

  • 334 Horton Road Datchet Nr Slough Berkshire SL3 9HY
  • Tel: 01753541595
  • Fax:

Residents Needs:
Learning disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 15th December 2009. CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for The White House.

What the care home does well Care plans at this home contain detailed information about the support each person needs, and good guidance to staff about how to provide this support. The Company employs psychologists and assistant psychologists to work with residents, and in particular to help draw up behaviour management plans and risk assessments. Residents also have a health action plan, and the recent survey carried out by the Company showed that all the residents at this home thought their health care needs were being met. There are a good range of meaningful activities and social events for residents to enjoy. A full time activities worker ensures each person has their own activities plan which is regularly reviewed. There are facilities on site for arts and crafts, educational activities, and a small well equipped gym. There is also a summerhouse which allows private space for annual reviews and for residents to host visits from their families. This also contains IT facilities for resident`s use. Residents and their families were complimentary about the facilities, including one relative who noted: `We feel that CHOICE do everything possible for our relative to enjoy and have a quality of life that their situation enables. We are very happy and grateful to CHOICE for their commitment to their clients and the achievements that they make. Well done for CHOICE.` The home has a friendly and inclusive atmosphere and staff were seen to interact well with residents. Each person who lives at this home has a communication tool to ensure staff know each person`s preferred method of communication. Some documents seen during the inspection were in user friendly formats, for example details about the nurse coming to do a flu injection was seen in a pictorial format. The lunchtime experience is particularly sociable with all staff sitting down together with residents to enjoy a home cooked meal. Residents are encouraged to help in the home and garden and on the day of the inspection one resident had baked a pie for supper, and two others were out raking up the leaves in the back garden. Residents had their own area of the garden to tend in the summer, with one care manager reporting that their client had had their own flower pots. Residents have also started collecting their recyclable materials and are taking it to the local recycling point. On the day of the inspection the fire alarm went off and the staff and manager were congratulated for the way they evacuated the home, very quickly, with the minimum of fuss and without causing any panic. Residents were kept safe in the garden until they were able to return to the home. What has improved since the last inspection? No Requirements or Recommendations were made at the previous inspection but the home has continued to make improvements using their annual development plan and feedback from service users and other stakeholders. All residents have been reassessed by the Speech and Language Therapy Team and each person now has a communication book to enable staff to support residents with their communication needs. Residents are more involved in the running of the home and as well as helping to look after their own rooms, now help with the home and garden generally. This includes food preparation, cooking and clearing up, and helping in the garden. The staff no longer have the shopping delivered so that residents can help with the food shopping and have more opportunities to be out and about in the local community. The kitchen has been refurbished and is now more user friendly, with wheelchair height worktops so that residents who need to sit down to prepare vegetables and roll out pastry etc, can be involved. What the care home could do better: No Requirements were made during this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: The White House 334 Horton Road Datchet Nr Slough Berkshire SL3 9HY     The quality rating for this care home is:   three star excellent 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: Helen Dickens     Date: 1 5 1 2 2 0 0 9 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 Adults (18-65 years) Page 2 of 31 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The White House 334 Horton Road Datchet Nr Slough Berkshire SL3 9HY 01753541595 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: diane.grist@choiceltd.co.uk Choice Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: Learning Disabilities (LD) Date of last inspection Brief description of the care home The White House provides residential care for seven service users with learning and behavioural difficulties. There is a mix of younger men and women. The White House is a large two storey house with accommodation on both floors. There are extensive grounds and outbuildings, which are used for day services. The house is situated approximately 2 miles from Slough and Windsor Town centres near the village of Datchet. The home has two house vehicles and other means of transport are sought as necessary. There is limited parking on site for visitors. The basic fees are currently £1750 to £2200 per person per week, according to each persons assessed needs. 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector. The Registered Manager Mrs. Diane Grist, represented the establishment. A tour of the premises took place and a number of files and documents, including three residents care plans, staff training records, two staff recruitment files, and quality assurance information, were examined as part of the inspection process. Residents, staff and a visiting health professional were spoken with during the day. The results of surveys returned to the Commission prior to this inspection were also included in this report. The Annual Quality Assurance Assessment, completed by the manager and returned to CQC before the inspection, was used to plan the inspection, and in writing this report. The inspector would like to thank the residents, staff and the manager for their time, Care Homes for Adults (18-65 years) Page 5 of 31 assistance and hospitality. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? No Requirements or Recommendations were made at the previous inspection but the home has continued to make improvements using their annual development plan and feedback from service users and other stakeholders. All residents have been reassessed by the Speech and Language Therapy Team and each person now has a communication book to enable staff to support residents with Care Homes for Adults (18-65 years) Page 7 of 31 their communication needs. Residents are more involved in the running of the home and as well as helping to look after their own rooms, now help with the home and garden generally. This includes food preparation, cooking and clearing up, and helping in the garden. The staff no longer have the shopping delivered so that residents can help with the food shopping and have more opportunities to be out and about in the local community. The kitchen has been refurbished and is now more user friendly, with wheelchair height worktops so that residents who need to sit down to prepare vegetables and roll out pastry etc, can be involved. 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. 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 Adults (18-65 years) Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective service users individual aspirations and needs are assessed prior to them moving in to this home. Evidence: The Annual Quality Assurance Assessment (AQAA) stated that the home has a service user guide and statement of purpose and these are updated at least annually. It also states that all service users have a contract. One new service user has moved into The White House since the last inspection. The full admission process was carried out, with the involvement of other professionals. This residents file was seen and found to contain a number of pre-admission assessments. The homes own original assessment has now been archived as it is 18 months since the person moved in. The CHOICE admissions policy is that a Referrals Officer does the initial assessment and then prospective residents are encouraged to visit the home. This new client did visit the home, and staff went to visit them in their previous home during the transitional period prior to moving in. The new client completed a survey for CQC, with staff help, and ticked that they had been asked if Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: they wished to move in, and had received enough information prior to moving in. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Residents assessed and changing needs and personal goals are reflected in their individual plan of care and they are encouraged to make decisions in their day to day lives. They are supported to take risks as part of an independent lifestyle. Evidence: The AQAA stated that all service users have a care plan and essential lifestyle plan which the service user is involved in putting together with their key worker and management team who know them well. Three service users files were sampled, including that of the most recently admitted resident, and that of another resident who particularly asked to speak with the inspector. Social and health care needs were found to be reflected in care plans and there was good guidance for staff on important areas such as how to support residents special needs e.g. regarding epilepsy, eating and drinking, and dealing with aggressive behaviours. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: The residents benefit by psychological support and the Assistant Psychologist who works with residents was interviewed during the inspection. This is discussed in more detail under care planning later in this report. Care plans are reviewed 6 monthly and all those sampled had been reviewed recently. Staff read and sign risk management plans to say they have understood the contents. Clients goals are clearly documented and progress towards these goals is noted. Risk assessments were seen to be in a user friendly format, and the manager said two residents are able to go through their own risk assessments with staff. The annual survey carried out by CHOICE at this home showed that all residents said they thought their health care needs were met and some positive comments were noted from relatives including: We feel that CHOICE do everything possible for our relative to enjoy and have a quality of life that their situation enables. We are very happy and grateful to CHOICE for their commitment to their clients and the achievements that they make. Well done for CHOICE. Two service users completed CQC surveys, with staff help. They ticked that staff always or sometimes treated them well. The one who said sometimes went on to add White House is taking good care of me. Residents have opportunities to make decisions in their daily lives. Communication books have been set up to support residents communication needs, and to ensure their preferences can be ascertained. Residents were observed to be given choices about how they spent their time for example whether to be alone or in company. One survey from a service user said they only sometimes made decisions. The manager said there is a daytime activities plan and external activities, for example booked day care or horse riding, required residents to be ready for a certain time, so in that respect, choices may be limited if the resident wishes to take part in that activity. Staff interacted very well with residents and were seen to offer them choices throughout the day. Routines were flexible, to allow for residents choice and needs, for example one persons activities plan had been scaled down due to recent ill health and other more restful activities, such as one to one sessions were happening instead. Individual likes, dislikes and preferences were seen to be recorded on each residents file, and any restrictions were noted. Residents at The white House are encouraged to participate in the running of the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: home. The manager said that they are now supported not only to look after their own rooms and bring their laundry down, where they are able, but to help keep communal areas clean and tidy, and help in the kitchen and garden. On arrival for the unannounced inspection two residents were outside with staff raking the leaves off the paths in the back garden. Another resident made a mince pie for all residents to enjoy that evening. Residents are encouraged to take risks as part of their everyday lives. As stated earlier, risk management plans have been drawn up with the Assistant Psychologist, and these cover a variety of potential risks to do with residents health conditions, and both indoor and outdoor activities that they might participate in. Actions are identified to minimise risks, and to ensure residents are able to participate in as wide a range of activities as possible, in the safest possible way. It was noted that there are fire risk assessments in place as all residents would need support and supervision to leave the building in the event of a fire. There was an unplanned fire evacuation on the day of the inspection as workmen in the building accidentally caused the alarms to go off. Staff took immediate and concerted action, already set out in their fire evacuation policy, to ensure residents were supported to evacuate the building within a few minutes. They were congratulated for the calm and professional way this exercise was carried out. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have excellent opportunities and the support they need to take part in worthwhile and fulfilling activities, and they are very much part of their local community. Routines are flexible, and residents are treated respectfully by staff. Mealtimes offer a very pleasant dining experience for residents at this home. Evidence: The AQAA states that families are still very much involved; and service users continue to access the community on a daily basis. There are structured day care timetables and service users are encouraged to self-occupy in their spare time. Activities are well established at The White House and residents have a range of worthwhile and enjoyable things to do. The home has an activities worker who draws up an activities plan for all residents and ensures staff are available to support them. The manager said this takes into account not only the favoured activities of each Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: resident, but who they prefer to be supported by and, in the case of joint activities, which residents prefer to be with each other. The White House has their own day care facilities in converted stable buildings in the grounds including an education room, an art and craft room, and a mini gym with a variety of exercise equipment. Their own swimming pool has now been decommissioned for health and safety reasons, so now residents go out to a local swimming pool. Some residents were out swimming on the day of the inspection. The activities plan includes educational and leisure activities, as well as helping in the home and garden. Residents were seen to be taking part in the activities scheduled for that day including swimming, cooking and gardening. The activities worker was interviewed during the inspection and she said activities plans were flexible to accommodate the changing needs of residents, and she was able to give examples of this. A care manager who was interviewed by telephone following the inspection said: My client is very happy and very settled. She now has a life of her own and is engaged and busy. She added that her client has plenty of support to follow her hobbies and interests. The CHOICE survey showed all residents said they liked the people they lived with, and all but one said they had a say about what happens in their home, and had enough opportunities to go out. Residents spoken with on the day of the inspection said they they enjoyed their activities, including one who spoke about their achievements in horse riding. The home ensures residents have plenty of opportunities to be part of the local community, and to have the staff support they need. Community activities include leisure pursuits such as swimming, and horse riding, and attending day services. One service user attends a faith based social club. Residents now also go out to do the twice weekly food shopping with staff, as well as their own personal shopping. Also some outings are arranged relating to individual residents interests for example one resident told the inspector they had been to a pop concert and to the Bollywood Cinema. The manager said residents had also started recycling, and were enthusiastic about it, helping to take the recycling to the local collection point. Residents family and friendship links are encouraged, and staff were found to be knowledgeable about each persons family connections. Opportunities are given to families to visit the home for special events, for example the Christmas party planned for the following Friday where residents would be dressing up as their favourite characters from the film Grease. Residents were noted to be given support with their Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: relationships, for example the assistant psychologist said she had recently being working with one person on sex education. CHOICE surveys are also sent to each residents next of kin and the last survey carried out in September 2009 received six responses. Comments were very positive with all six saying they felt the service met the individual needs of their relative, and that their relative enjoyed the day services provided. Asked if they felt they were invited to the home often enough three ticked Enough; two ticked Often; and a third ticked Too often. As noted earlier, routines at the home allowed flexibility where possible, for example in relation to activities. Residents independence is promoted by ensuring their preferences are recorded, and they are given the support they need. Staff were seen to interact very well with service users, and to anticipate their needs. There were no instances during the inspection of staff speaking exclusively with each other, and staff were seen to be respectful to residents at all times. They were seen to knock on bedroom doors before entering, and heard to give residents choices throughout the day. Mealtimes offer a very pleasant dining experience at The White House with staff and residents sitting down together; one person who wishes to eat alone is also accommodated. On the day of the inspection even the maintenance man working in the home was invited to lunch, and the atmosphere was very sociable and relaxed. Staff share the cooking at this home, and menus are planned in advance. Laminated food pictures, together with residents communication books, enable people who live at this home to help choose the menus. Staff follow set recipes and there is at least one home cooked meal per day. A note is made when a resident has something which varies from the set menu. Cultural needs are taken into account and staff were knowledgeable about the special dietary requirements of residents. One who had a special diet due to their religious beliefs had this taken into account in the menu planning. Others had special diets following consultation with the Speech and Language Team in relation to swallowing. It was noted that the new fitted kitchen has a low surface worktop to enable residents in a wheelchair, or those who needed to sit down, to help prepare food and work in the kitchen. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are excellent arrangements in place to ensure residents receive personal support in the way they prefer and require, and that their health needs are being met. Arrangements for the administration of medication should protect service users. Evidence: The AQAA stated that all service users have a care plan and essential lifestyle plan which the service user is involved in putting together with their key worker and management team who know them well, and that all their needs are outlined on their care plan. As stated earlier in this report, three service users files were sampled and their social and health care needs were found to be reflected in their care plans and essential lifestyle plans. The home uses a person centred approach to care planning for residents, and there was good guidance for staff on important areas such as how to support residents special needs. Throughout the day staff members were noted to be very alert to changes in mood, behaviour and general well being of clients, and demonstrated that they knew how to respond. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Care plans are reviewed 6 monthly and those sampled had all been reviewed recently. There was evidence staff were familiar with the contents of care plans and risk management plans. Residents are working towards their individual goals which were clearly documented, and progress towards these goals was noted. Appropriate risk assessments were seen to be in place. The annual survey carried out by CHOICE at this home showed that all residents said they thought their health care needs were met and residents files showed that they had a health action plan in place. These plans covered goals in relation to their health, and ensured these covered health promotion, such as taking plenty of exercise. Appropriate risk assessments are in place in relation to potential health risks, such as choking, epilepsy, and moving and handling of residents with physical disabilities. Evidence was seen of medical and specialist advice for example from GPs, psychologists, and the Speech and Language Therapy team. The residents at this home benefit by psychological support and the Assistant Psychologist who works with residents was interviewed during the inspection. Her role involves drawing up behavioural risk management plans, and she said that staff sought further advice as necessary, and in a timely way. She said they were currently rolling out more staff training on applied behavioural analysis which focuses on the positive, as a means to reduce challenging behaviour. The home has a medication policy in place which should ensure the safe administration of medication to residents. Part of one medication administration session was observed and staff were noted to keep medicines secure, and to be sensitive in their approach to residents when they administered medication. The home uses a monitored dosage system, blister packs, from the local pharmacy. Two staff do medication together and both sign when each medication has been administered. Medication records were generally well kept though two unexplained gaps were highlighted to the manager for her attention. It appeared these residents had been given the medication at day care and the MAR sheets had not been updated. Some good practises seen including separate medication records for when medication is taken out of the home, during home visits or for day care. There were also good guidelines in place for staff from the assistant psychologist for one resident who sometimes refuses medication. And a pictorial description of the flu jab procedure was also seen on one residents file. The last visit by a community pharmacist was in 2007 and this report did not note that any remedial action was needed. The manager has chased up the community pharmacist to visit the home this year but this has still not happened. She was asked to follow this up again. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Complaints would be taken seriously at this home, and policies and procedures are in place which should protect service users from abuse. Evidence: The AQAA stated that residents are encouraged to discuss any concerns they have, and there is a complaints procedure in widget format for residents who would appreciate that particular format. Records at the home showed there have been no complaints in the last 12 months. Two service user surveys returned to CQC showed they had both ticked they would know who to speak to if they were unhappy, and they knew how to make a complaint. The CHOICE survey showed that residents said they knew who to complain to. A communication book for each resident sets out, especially for those who cannot voice their concerns, how each person might demonstrate that they were unhappy or had concerns. One that was sampled had laminated cards demonstrating different facial emotions which the resident could point to, to show how they were feeling. The home has a copy of the Berkshire area multi-agency safeguarding adults policy, and their own in-house CHOICE policy on this subject. All staff, except very new staff, have had training in safeguarding adults. New staff were booked on courses in the New Year. In the meantime they had read and signed the Berkshire safeguarding Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: policy as part of their induction to the home. The manager reviewed their safeguarding arrangements last year after an incident between two residents, and she took specialist advice about how to improve safety for all residents. The manager uses a flowchart to show staff, at a glance, what action to take should there be an allegation of abuse at the home. This is kept with the emergency contact numbers at the front of their telephone book. There have been no safeguarding adults referrals at this home in the last 12 months. The company has policies and procedures in place relating to assisting service users to manage their finances. Records are kept at the home and are available if individual clients families or care managers wish to check these. The company accounting procedures have been reviewed within the last twelve months to ensure that any staff refreshments, paid for by residents during outings etc, are clearly defined to protect service users. The manager at this home said residents rarely contribute to refreshments for the staff who accompany them outside the home as this is covered by the homes own activities fund. Care Homes for Adults (18-65 years) Page 21 of 31 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The White House offers a homely and pleasant environment for residents, which is clean and hygienic throughout. Evidence: The AQAA stated that residents continue to plan their bedrooms with key workers and purchase items as needed. A cleaning rota is in place. Accessible premises and a CAPEX (internal request process) is completed for yearly decorating. A tour of the premises took place including all communal areas, and one service users bedroom. The two gardens and day care facilities, with three areas one each for education, crafts, and a small gym, were also seen. The home has a summerhouse with IT facilities, which also offers a private area for residents to entertain their families and friends. The home was found to be clean, tidy, and well decorated. Bedrooms were personalised and communal areas seen to be homely and very comfortable for residents. The kitchen has been refurbished and now has accessible working areas to enable residents with mobility impairments to be more involved in food preparation. Residents had their own music and TVs in their rooms as they wished, and evidence of their own hobbies and interests could be seen. Windows had recently been triple Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: glazed by the airport authority to reduce aircraft noise for residents when in their bedrooms or communal areas. The Environmental Health Officer visited on 11/06/09 and their report noted that All legal requirements met at time of visit. A good visit. Well done. No new requirements or recommendations were made. There were no unpleasant smells in any part of the home. The laundry was visited and also seen to be clean and tidy. During the fire alarm there was no panic, and staff worked quickly with residents to evacuate the building and to ensure people remained safe outside until they could go back indoors. The assistant psychologist commented that one of the really positive things about the home was the use of the good use of the communal lounge/dining area which promoted good staff and service user interaction. She described it as A good functional area. It was noted during the day that residents and staff congregated in this area both for activities and meals, and there was a busy, friendly atmosphere and constant interaction between staff and residents. Care Homes for Adults (18-65 years) Page 23 of 31 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Residents are supported by competent staff, and protected by the arrangements in place at this home for recruiting new staff. Staff training is well developed and residents benefit from the arrangements for staff supervision and monitoring. Evidence: The AQAA noted that the home had not used agency staff for 12 months; new staff had an extensive induction; staff training is updated as soon as it expires; and staff are regularly supervised. Out of the 16 staff, 6 already have an NVQ Level 2 or 3, 6 others are currently on an NVQ course, and 4 others are due to start in January 2010. Staff were observed to communicate well with residents and to understand their fluctuating needs throughout the day. Those staff spoken with were motivated and enthusiastic, and there was a friendly yet professional atmosphere in the home. Communication books enable staff to work effectively with each resident, and there are behavioural guidelines in place for each resident, drawn up with the expertise of the assistant psychologist. Staff were seen to follow guidelines when working with residents. Recruitment arrangements are well developed and staff records well kept. Two new staff files were sampled and found to contain the necessary information including Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: completed application forms, a full employment history, and Criminal records Bureau checks. Both had had the homes own induction, and had already completed some training including first aid, moving and handling, health and safety, and food handling. New staff also do a learning disability framework induction, the LDQ. Staff training arrangements include a rolling programme of training, and a staff training matrix which allows the manager to see, at a glance, which training individual staff have attended, and when refresher training is due. This matrix was sampled and three courses were chosen at random; Anti-discriminatory Practice, First Aid and Food Handling. All staff had completed these courses except some of the new staff, who were booked on the training. A further course, moving and handling, was also checked and all staff had completed the training, though one person was now overdue for a refresher. It was noted that this course is only offered to staff every three years, when current good practice shows most providers ensure this is done annually to keep staff up to date with any changes in this area. Staff training is linked to individual residents needs and additional training is made available on specialist topics. Staff supervision arrangements are also well developed at The White House. The deputy manager outlined how all senior staff carry out supervision sessions on a rolling programme; the two new staff members files that were sampled showed both had had several supervision sessions in addition to their induction. A number of positive comments were received on staff surveys returned to CQC. These included Its a nice place to work with a good environment. and Staff respect the people they support and give them choices. Some comments that were noted on these surveys were passed on to the manager for her attention. The home keeps a record of any compliments it receives and a number of these commented very positively on the staff at the home. For example, one care manager wrote to the manager: Please can you let the Team know how impressed I am with the service. You all do fantastic work in a difficult environment. Another compliment from a service users parent noted; Can I say how pleased we are with how our relative has come on in the period since her last review - this must be down to the good Staff Team we have at the White House. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well run home and their views, and those of their families, are taken into account in the running of the home and the development of the service. The health, safety and welfare of service users are promoted and protected. Evidence: The AQAA stated that annual surveys were sent to stakeholders; policies and procedures are up-dated as required; there is a strong senior management team; and regular maintenance checks and health and safety checks are carried out. The manager was new in post at the last inspection, and has now been the manager for over three years. She has completed the Registered Managers Award, and has an NVQ4 in care, and a City and Guilds Community Care qualification. She has been working in the field of care for over 20 years, and has been a care home manager for another company prior to moving to The White House. She manages the home well and was seen to communicate a clear sense of direction to staff. A care manager who was interviewed by telephone said that her client had benefited from the clear Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: boundaries set down by the manager, which had helped improve their clients challenging behaviour since moving to The White House. The home follows the CHOICE Ltd Quality Assurance policy, and there are a number of ways in which they receive feedback about the quality of the service including surveys, meetings, and client reviews. Regulation 26 visits are carried out on behalf of the provider, and various audits are carried out for example in relation to health and safety. Annual surveys take place and are given to a variety of stakeholders including residents, their families, staff and care managers. This is a company wide survey but a breakdown is done for each service and a copy of the most recent annual survey was given to the inspector. A development plan is in place for the home and this covers both the homes development, and service user development, e.g. the current plan is aiming to give more opportunities and choices to service users in relation to their activities. Health and safety arrangements are well developed at this home and this task is delegated to the deputy manager. She outlined the steps taken to maintain good health and safety including a system being in place for dealing with immediate maintenance and safety issues, and there is a weekly maintenance list and access to a Company maintenance worker to complete any outstanding work. Weekly fire equipment checks are in place and the home had to be evacuated during the inspection when the alarms were accidentally set off by someone working in the home. Staff quickly supported residents to leave the building within a matter of minutes and the manager was pleased with how the evacuation had taken place. Someone on each shift is responsible for ensuring the various aspects of fire evacuation are followed, including taking the emergency box with them, and timing how long it takes to evacuate the building. Staff were congratulated for the efficient way they followed procedures and kept residents safe. Health and safety audits are carried out by an external company who carry out 6 monthly visits and recommend any remedial action. The home also carries out risk assessments, and behavioural management strategies are in place where these are needed. Equipment deemed necessary for the safety of residents and staff is put in place for example rhino mats for personal protection, and emergency alarm pendants for staff use when taking some service users outside. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: There were good arrangements in place for the prevention of legionella including a regular programme of testing various water temperatures and cleaning of shower heads etc. However, the current risk assessment was completed in 2005 and it said it should be reviewed after 2 years. The manager and deputy manager said they would follow this up with the relevant people in CHOICE, and they confirmed that they had done this following the inspection. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 29 of 31 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 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 20 The community pharmacist should be contacted again regarding making a monitoring visit to the home as this has not been done since 2007. The risk assessment relating to the prevention of legionella is overdue for review. 2 42 Care Homes for Adults (18-65 years) Page 30 of 31 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. Care Homes for Adults (18-65 years) Page 31 of 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!

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