Care Home: The White House

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• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The White house is a small and friendly home. One person said, "The White House is a very friendly environment," another that, "The home makes you feel welcome and cared for." When people are considering moving into The White House they will be given good information about the service and encouraged to visit before making a final decision. People are able to welcome their visitors at any time so that they can maintain contact with their friends and family. People said that they were happy with the care they received and that, "The staff and management are always ready and willing to help." Staff seemed happy and motivated in their role. One said, "The home is very good at catering for residents individual needs and keeping the environment very homely and friendly," another that, "We treat each resident as an individual and support them with their daily needs." The service are keen to listen to people`s views. If people raise concerns or issues these are acted on promptly. The environment is homely and comfortable for people. Management at the home have a positive and proactive approach. They are keen to continually develop the service for the benefit of residents. What has improved since the last inspection? At the last inspection of The White House a number of requirements were made that needed to be addressed. Management have worked hard and been successful in addressing these. Medication storage and other issues have been resolved, so people can feel confident that this aspect of their care is now managed well. Staff are now well supervised and have undertaken a great deal of training in the past year. This should have increased their knowledge and skills in supporting people. The care that people receive is now better documented and based on good care planing with any risks properly assessed. A range of new activity and other equipment has been provided to give people more opportunities for stimulation and activity. An activities co-ordinator is about to start work to continue to develop this area. The environment has continued to be maintained with decoration and garden development having taken place over the last year. Quality assurance systems have been developed. People have regular opportunities to express their views. Systems and staff practice are monitored to ensure that good standards are maintained. What the care home could do better: Although staff have undertaken a high level of training in the previous year, management do need to ensure that areas such as dementia and conditions relating to old age are covered in the training programme. This will ensure that staff always have the required skills and knowledge to meet people`s needs. Although the providers are frequently in the home, they need to ensure that they fulfil their Regulatory responsibilities by undertaking regular visits to formally review the service. Key inspection report Care homes for older people Name: Address: The White House 11 Coggeshall Road Braintree Essex CM7 9DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The White House 11 Coggeshall Road Braintree Essex CM7 9DB 01376326847 01376345966 kathy.whitehouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avidcrave Limited care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of old age only. The total number of service users accommodated in the home must not exceed 16 persons. Three persons, over the age of 65 years, whose names are known to the Commission, who require care by reason of dementia Date of last inspection Brief description of the care home The White House is a care home registered to provide accommodation, personal care and support to sixteen people over the age of 65 years, not falling into any other category. The home is registered to meet the needs of people with dementia. The White House is a detached two-storey property, accommodation is provided on the ground and first floor in ten single rooms and three double rooms. Access to the first Care Homes for Older People Page 4 of 30 Over 65 0 16 3 0 2 2 0 1 2 0 0 9 Brief description of the care home floor is by the stairs or a passenger lift. However, due to the size of the rooms, corridors and passenger lift the home is not suitable for wheelchair users. The site is shared with a nursing home and both units share the gardens at the rear of the building, which comprises of a patio and grassed area with seating. There is a car parking area at the front of the building. Current weekly fees confirmed at this inspection, are from £465.00 to £500.00. There are additional costs for hairdressing, chiropody, toiletries and newspapers. A copy of the previous inspection report, the Service Users Guide and Statement of Purpose are available for people. Care Homes for Older People Page 5 of 30 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent six and a half hours at The White House. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the Care Homes for Older People Page 6 of 30 National Minimum Standards and how they can evidence this. The AQAA for The White House was fairly briefly completed by the manager. It gave us the information that we asked for, and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from four residents, two visiting professionals and nine staff. Some residents had been assisted to complete their surveys by their relatives. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, deputy manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? At the last inspection of The White House a number of requirements were made that needed to be addressed. Management have worked hard and been successful in addressing these. Medication storage and other issues have been resolved, so people can feel confident that this aspect of their care is now managed well. Staff are now well supervised and have undertaken a great deal of training in the past year. This should have increased their knowledge and skills in supporting people. The care that people receive is now better documented and based on good care planing with any risks properly assessed. A range of new activity and other equipment has been provided to give people more opportunities for stimulation and activity. An activities co-ordinator is about to start work to continue to develop this area. The environment has continued to be maintained with decoration and garden development having taken place over the last year. Quality assurance systems have been developed. People have regular opportunities to express their views. Systems and staff practice are monitored to ensure that good standards are maintained. Care Homes for Older People Page 8 of 30 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 Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into The White House will be given every assistance to ensure that it is the right place for them, and will be suitable to meet their needs. Evidence: The AQAA completed by the manager said, We send out our Statement of Purpose and Service Users Guide to enquirers before they make their final decision in order that they have sufficient information to base their decision on. We offer trial visits to prospective residents. This information was confirmed at the site visit. The home had a Statement of Purpose and Service Users Guide in place. The manager confirmed that people would be given a copy of the Service Users Guide as part of the admissions process. On surveys people said that they had received enough information to help them to make a decision about moving in to the home. Two people spoken with confirmed that they had a good knowledge of the home before they moved in. Preadmission assessments included details of any pre-admission visits undertaken and recorded comments such as, Visited X at home and completed the assessment. X Care Homes for Older People Page 11 of 30 Evidence: visited the home and stayed for lunch prior to admission, and, Visited home with [relative] and social worker prior to admission, enjoyed having tea and biscuits and speaking with residents. This shows that people are encouraged to visit and gather as much information and experience as they can before taking the decision to move in. To improve things further the home are currently developing a website for people to access, and are putting together a Residents Handbook. To ensure that Peoples needs can be met by staff, an assessment of their needs should be undertaken before they move into the home. We looked at the files of two people who had been more recently admitted to The White House. Comprehensive pre-admission assessments had been undertaken by the manager. There was also good information available from the Authority overseeing the placement and funding the care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will receive good personal and health care to meet their individual needs. Evidence: During the day people living at the home told us that they were happy with the care they received at The White House. People were well groomed and appropriately dressed. On four surveys people living at the home said that they always received the care and support that they needed. People using the service said, I am very happy with everything, and, They look after my care very well. A relative said, The quality of care that my [relative] has received has been excellent. Our (CQCs) observations of care on the day of the site visit showed that people were offered appropriate care and support. Staff were attentive and quick to respond if someone needed assistance. Management and staff spoken with had a good understanding of individual residents needs and abilities. Training records showed us that since the previous inspection most staff have received training in care planning and risk assessments. We saw that everyone at The White House had a care file in place containing various risk assessments, care plans and Care Homes for Older People Page 13 of 30 Evidence: daily documentation. We looked at a three care files to see how well care is planned for and arranged. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how staff are helped to meet peoples needs in an individual way. Since the previous inspection staff at the home have worked hard to improve care planning. With one or two exceptions people can feel confident that their care is planned for well, and that staff will understand their needs. We saw that people or their families had generally signed care plans and assessments to show that they had been involved in saying how they want their care delivered. A member of the care team told us how they involve residents who they are a key worker for in their care planning and reviews. Information in the care plans and assessments reflected peoples needs that had been identified in the pre-admission assessments and information. They gave staff good information in how to care for people in a person centred way such as, X is to be offered a bath at least once a week. X likes to have theirs on a Monday evening.......X likes to have bubbles in their bath and uses dove soap. We saw that peoples independence was to be encouraged through identifying the tasks that they could manage themselves. Peoples care plans are kept under review. In this documentation we noticed that when reviews highlighted changes in needs, such as decreased mobility, this was not always then translated into the persons care plan. The manager is aware that this now needs to be addressed. Since the previous inspection work has been undertaken to ensure that any risks associated with peoples care are properly assessed, and a strategy for managing this put in place. Good daily records of care are maintained. On surveys people said that they always received the medical care that they needed. Records and discussion showed that people access appropriate health care to meet their needs such as district nursing, chiropody and general practitioners. Referrals are made to other agencies to meet changing needs. The home have a good local network of health professionals such the lead nurse for care homes and local mental health services where they can go for advice and support. These services also support the home through providing staff training. Training records and discussion showed us that some staff have completed training in epilepsy and hydration and nutrition to enhance their knowledge and skills in caring for people. Two visiting professionals returned surveys to us. Both answered all questions positively. One said, The home has good staff and arranges medical reviews and addresses any concerns promptly and appropriately. The other said that the home, Provide good care to service users. As part of this inspection we looked at medication systems and records and found that they were well maintained. Since the previous inspection management have addressed the requirements made in relation to medication storage and management. People can now feel confident that this aspect of their care will be managed well. We did however offer some best practice advice such as the need to ensure that boxed Care Homes for Older People Page 14 of 30 Evidence: and bottled medication is dated on commencement to provide a good audit trail. The home did not have a copy of the Royal Pharmaceutical Guidelines on the management of medicines in care homes. This would provide staff with good information and advice relating to medication management. The morning medication is given from 07:00. The manager was advised to check if this means that people might be taking medicines before they have eaten anything, and if this could have any contraindications that could effect their wellbeing. Training records and staff files showed us that staff have received training in administering medicines and that their practice is monitored. Management undertake regular medication audits. The system is also periodically audited by the supplying pharmacist to ensure good practice and compliance. Observations through the day showed that staff approached residents in a calm and kind manner. Staff treated residents with respect. Doors were kept shut when personal care was being carried out so that peoples privacy was maintained. Although we did not inspect this standard fully we saw that people are encouraged to state their wishes in relation to end of life care. There was space to note if any advance directives were in place, to identify what peoples wishes were and to highlight any spiritual or cultural needs. The format included space to discuss with families issues such as when relatives wished to be contacted in the event of illness, accident or injury. We saw from training records that a number of staff have completed training in end of life care. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to enjoy a fulfilling lifestyle through activity and maintaining family and other contacts. Evidence: The AQAA said that, We could improve activities and socialisation planning and recording. However, on surveys three out of four people felt that they home always provided activities that they could take part in. One resident told us that they enjoyed doing courses and getting certificates. Since the previous inspection the home have used grants to provide a lot of new activities equipment and materials. Large scale traditional games, a games console, sensory equipment, a computer with large print keyboard and craft materials are all now available to provide activity opportunities. People were enjoying the new opportunities. One person told us that they had enjoyed playing on the Wii. At a residents meeting one person reported, being really pleased with the computer, especially the big keyboard and publisher software as they can now make their own cards. The home is a member of an organisation that promotes and provides information, training and advice about providing activities in care homes. This showed that the management team are aware of the importance of this aspect of peoples care. During Care Homes for Older People Page 16 of 30 Evidence: the inspection people told us that they were happy with the activities provided. Staff were attentive and offered occupation on an individual and group basis. Exercises and games took place. People living in the home have opportunities to socialise and visit residents living in the attached sister home to The White House. Regular coffee mornings are held. The home is situated close to the town centre and shops so people can access the local community. The manager hopes that this aspect will shortly be improved through increased staffing. An activity co-ordinator is about to start work at the home. They will work for two hours each weekday afternoon. This will improve opportunities for activities and getting out and about. Management are keen to ensure that they are meeting everyones needs. Although it was said that only two people at the home have dementia, the manager has arranged for a professional to visit and carry out a dementia care mapping exercise at the home. This will help staff to understand the experience of people with dementia living at the home, and help to identify any changes that might enhance their care and wellbeing. People have the opportunity to fulfil their spiritual needs through regular services taking place in the home. Entertainers visit regularly as does a mobile library. The home produces a regular newsletter to keep people informed of events and changes. The home can access transport locally to provide the occasional trip out. For example a tip to a local pantomime was planned. Visiting at the home is open and people are able to welcome their visitors at any time. Information about visiting was on display saying that people were welcome, and able to have a meal with their relative if wished. During the day people followed their own routines and spent time where they wished. Rooms were homely and people had clearly brought in their own possessions and memorabilia to help them feel at home. Information on advocacy services and resident/relatives associations were avaialble so that people would know where to go for independent support and advice if they wished. On surveys people said that they always or usually liked the meals at the home. At the inspection the feeling was similar. One person felt that the food was, Always very good, whilst others were more non committal. People said that it was good home cooking. We saw that plenty of fresh fruit was available for residents. The cook said that food is homemade with plenty of fresh vegetables. A four week menu plan is followed. This was on display for people with the menu for that particular day written up on a whiteboard. The lunchtime menus do not offer a choice. One resident said, They usually tell us what we are going to have. We discussed this with the manager. They said that the menus were planned in consultation with the residents, and that where particular dislikes were known then an alternative was offered. They felt that Care Homes for Older People Page 17 of 30 Evidence: with the home being so small it was not practical to routinely offer a choice at each meal. Lunch on the day looked appetising and was plentiful. The home has a small dining room which cannot accommodate all the residents at the same time. The manager said that should everyone wished to use the dining room, they would have two sittings. People needing prompting or support to eat were offered appropriate assistance. At the meal some residents were asking for more gravy and apple sauce. It was discussed with management that many people living at the home are quite able, and would be able to serve their own gravy and condiments to their taste. The manager undertook to assess this. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for safely through procedures and practice in the home. Evidence: The home has a complaints procedure in place that is on display for people. A suggestions/comments box was available in the lobby area. People said that they knew who to to talk to if they had any concerns or wished to make a complaint. One person said, I would talk to [the manager] they will always listen. When we looked at complaints records we saw that the home are good at recording all peoples concerns or complaints no matter how seemingly insignificant. This is good practice and will help to give people confidence that their concerns will always be listened to and acted on. Actions taken in response to peoples complaints or comments were detailed. Since the previous inspection no concerns about the service have been raised with us. We saw that the home had an appropriate procedure in place to provide staff with knowledge and guide their practice in relation to safeguarding residents. Training records viewed showed that all staff had undertaken training in this area. Staff spoken with had an understanding of safeguarding. The manager showed us the booklet that each staff member was given about safeguarding and their responsibilities. Although there was information and training materials available, the home did not have a copy of the Southend, Essex and Thrurrock Guidelines in relation to safeguarding that would provide an ongoing resource. The manager undertook to obtain a copy of this, Care Homes for Older People Page 19 of 30 Evidence: and said that currently they use the internet to get up to date contact details. Since the previous inspection one safeguarding alert has been raised in relation to the White House. This was not substantiated. Currently only one person living at the home can behave in a manner that is challenging for staff, and potentially other residents. Staff are good at keeping a record of their behaviour and appropriate referrals have been made. There is however a need to ensure that care planning reflects their behavioural needs so that staff manage this in a consistent manner. We saw that some staff have competed training in understanding and managing challenging behaviour. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant home. Evidence: As part of this inspection we undertook a partial tour of the premises to see if it was a pleasant and safe place for people to live. Generally The White House provides a pleasant and homely environment for people. We did however notice that in the new area of the building the beds provided in three rooms were old style hospital beds, one of which was in a poor condition. Also in this area one bedroom door was extremely hard to open and a resident would find it hard to do so. The manager undertook to get this looked at. The AQAA told us what improvements have been made in the home during the last year. These have included, some bedrooms being decorated, a small patio area with a ramp and handrail to improve garden access has been built, and the kitchen area has been refurbished. Equipment such as a new large TV have been provided. Other equipment such as recliner armchairs are on order. A fish tank has been installed to enhance the environment for residents. A full time handy person is employed to provide ongoing maintenance and carry out regular safety checks on equipment. Peoples rooms were homely and personalised. People spoken with said that they were happy with the accommodation provided. Care Homes for Older People Page 21 of 30 Evidence: On the day of the inspection the home appeared clean and was odour free. The laundry area of the home is very small and accessed externally. However the home do limited laundry. Laundry is taken to and returned from the attached sister home on a daily basis. Training records viewed and staff spoken with showed us that staff have undertaken training in infection control. Plenty of protective clothing was noted to be available and was used appropriately by staff during the day. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring and trained staff. Evidence: During the day we saw that residents and staff had a good rapport with one another. People told us that they liked the staff and got on well with them. They said, The staff and management here are all very good, and, The staff care for me and I am very happy. The AQAA indicated that staff turnover at The White House had been quite high for the size of the home with five staff having left in the previous year. The manager explained that many staff had worked at the home for a number of years and that the turnover had mostly been due to retirement and ill health. There is still a stable group of core staff and management that provide stability and consistency for residents. Although some agency staff are used at the home this is not excessive. On the day of inspection 15 people were being accommodated at The White House. Rotas showed us that staffing levels are maintained at three staff during the day and two awake staff at night. The managers hours are supernumerary to this. There is always a senior care assistant on duty. A cook works each day and housekeeping hours are provided during the week. On surveys people said that there were always staff available when they needed them. Observations on the day of the site visit showed that people were well supported and that staff had time to interact with residents. On staff surveys most (seven out nine) felt that there were usually enough staff to meet the individual needs of residents. Care Homes for Older People Page 23 of 30 Evidence: So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided on the AQAA and confirmed at the site visit indicated that out of 18 staff ten have an NVQ at level two or above. The home have therefore reached the 50 basic target. We looked at the files of two members of staff who had most recently started work at The White House to ensure that recruitment procedures protect people living in the home. Nine staff returned surveys to us. All said that all appropriate checks were carried out before they started work. Files viewed were satisfactory and showed that proper checks such as POVA first, references taken up, proof of identification sought and health declaration had been undertaken before people started work. The manager explained that before starting work staff attend a three day induction programme provided by an external trainer. This covers all core training such as moving and handling and health and safety. On nine staff surveys everyone said that their induction had covered what they needed to know to do the job very well. We saw evidence of these training certificates on peoples files. Staff continue to work through the induction process and complete a workbook which is in line with the Skills for Care Common Induction Standards. These were not available to view as they are held by the person until completed. There was nothing on files to show that people had received an induction into the home in terms of fire procedures, routines, practice expectations and so on. Although this happens it was advised that a format for recording this be developed. Training information viewed showed that staff attend a range of different courses. Staff spoken with during the site visit and on surveys were positive about the level of training offered and felt that it equipped them well to carry out their role. Although the number of people living at the home who have dementia is currently very low, the home is registered to provide care for people with dementia. At the moment not all staff have received training in dementia care, and the training that has been undertaken has been at a basic level. This could be improved. Also training could be improved relating to conditions of old age. For example one resident was identified as having Parkinsons disease, but no staff appear to have had training relating to this to increase their knowledge and understanding. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well managed home where their views are sought and listened to. Evidence: The White House benefits from having an experienced and well qualified management team in place. The manger has appropriate qualifications and is registered with us (CQC.) People liked the manager and felt that they were, Supportive and easy to talk to. A member of staff said, Management operate an open door policy. The White House had a friendly open atmosphere and people seemed comfortable and at ease with staff. People have opportunities to express their views at regular residents/relatives meetings. A recent newsletter reminded people, Dont forget all residents, family and friends are invited to residents meetings. This enables our residents to have a voice. It would be nice to see more family and friends come as you may be able to put some suggestions forward. Watch the notice board for details. Residents meetings were recorded and showed that peoples views are listened to and Care Homes for Older People Page 25 of 30 Evidence: acted on. For example people had asked for more fresh fruit to be available in lounges and this now happened. As well as meetings a suggestions box is also available for people to use. Quality assurance processes are in place. Surveys were undertaken and analysed in October last year. Information viewed showed that responses and comments about the service had been positive. Management undertake internal audits such as premises and medication to ensure that standards are being maintained. Monthly visits to review the service by the registered person or nominated individual are required by Regulation. The manager said that the providers are in the home most days and spend a lot of time at The White House. However regular visits to formally review the service and have discussions with people are not being undertaken on a regular basis. Only five were recorded for last year. One said May 09 to 13/10/09 [providers] worked in both The White House and nursing home Monday to Friday. The AQAA was completed by the manager. It was briefly completed and some areas could have given us more information. For example in spite of the home having three requirements in relation to medication at the last inspection there was no mention of medication, or the improvements made under the Health and Personal Care section. It did however give us a reasonable idea about how the home was functioning, and recognised areas where the home needs to continue with improvements. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. When we sampled two peoples monies they balanced. Good records were maintained and receipts were in place for all transactions. The AQAA identified that systems and services are monitored and maintained. A partial tour of the premises showed that the home seemed well organised, and no particular health and safety issues were identified. The manager was reminded however that should the home admit more people who have dementia then issues such as the storage of disposable gloves and other equipment will need to be reviewed. A fire risk assessment was seen to be in place. Fire records were well maintained. Systems are tested weekly, and regular fire drills are carried out to ensure that staff know what to do in an emergency. The last fire service visit identified standards to be very satisfactory. The environmental health officers visit last year found standards of food hygiene to be satisfactory. A five star Excellent rating was awarded. Good accident records are maintained and these are audited to identify any concerns or issues. Care Homes for Older People Page 26 of 30 Evidence: A training matrix and discussion with staff showed that training in core areas such as moving and handling, fire awareness, health and safety and basic first aid is kept up to date. Care Homes for Older People Page 27 of 30 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 Older People Page 28 of 30 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 2 15 30 The home should consider ways of offering people a greater choice at mealtimes. Management should continue to ensure that staff have good knowledge and skills in areas such as dementia and conditions relating to old age. Visits undertaken to review the service and comply with Regulation 26 should be undertaken properly and recorded with the required frequency. 3 33 Care Homes for Older People Page 29 of 30 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. 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