Care Home: White House Care Home, The

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What the care home does well The home provides an individualised level of service to each person and due to the size of the premises a comfortable homely environment. The small staff team are able to offer people a consistent approach to their care. The Registered Manager and staff team are able to meet the health, personal and social care needs of people who use the service. What has improved since the last inspection? Improvements have been made to the home since the last inspection. Refurbishment work has taken place for the benefit of people who use the service. The Registered Manager has sought feedback about the quality of the service from people who use the service and associated professionals. What the care home could do better: Records relating to the recruitment of staff and training need to be improved. The Registered Manager must be able to evidence that full recruitment checks have taken place, particularly with regard to Criminal Records Bureau Checks. A record must be made of in house training and staff induction training that included the elements of knowledge that have been covered in training. CARE HOMES FOR OLDER PEOPLE White House Care Home, The 30 Millbourne Road Hanworth Middlesex TW13 6NQ Lead Inspector Ms Susan Woolnough-Singh Key Unannounced Inspection 17th January 2008 10.40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White House Care Home, The Address 30 Millbourne Road Hanworth Middlesex TW13 6NQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8384 4746 mnow27@yahoo.co.uk Mr Bhiwsen Nowjee Mrs Laure Nowjee Mr Bhiwsen Nowjee Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on 15th March 2006, one named service user with a mental health condition can be accommodated within the home. This is approved for as long as there is no deterioration of the service user that affects the well being of any other person living at the home. The home must advise CSCI when the service user no longer resides at the home. As agreed on the 26th April 2006, one named service user (male) with a mental health condition can be accommodated within the home. 28th September 2006 2. Date of last inspection Brief Description of the Service: The White House is a privately run residential care home for three older people. It was originally registered in 1993. The Registered Providers are Mr. and Mrs. Nowjee. Mr. Nowjee is the Registered Manager. In addition to Mrs. Nowjee, there is one member of staff. There are two bedrooms upstairs, and one downstairs, occupied by service users. There is one bathroom with a toilet upstairs, which is used by the service users. There is an additional bathroom with a shower, and a separate toilet, available on the ground floor. Mr and Mrs Nowjee also live on the premises. The home is situated in a residential street in Haworth. Local shops are within walking distance from the home. The fee for the home is currently 481.21 per week. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection of Whitehouse Care Home. The inspection commenced at 10.40am and was completed at 4.30 The Inspector interviewed the Registered Manager. A tour of the building took place and records relating to people who use the service, staff and health and safety were examined. An Expert by Experience joined the Inspector between 2.15pm and 4.30pm. During this time she toured the building with the Inspector and spent time talking with people who use the service and the Registered Manager’s wife who lives and works in the home. A summary of the Expert by Experience report is contained in the body of this report. The Expert by Experience considered people to be well cared for and receive personal attention. What the service does well: What has improved since the last inspection? What they could do better: Records relating to the recruitment of staff and training need to be improved. The Registered Manager must be able to evidence that full recruitment checks have taken place, particularly with regard to Criminal Records Bureau Checks. A record must be made of in house training and staff induction training that included the elements of knowledge that have been covered in training. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided for people who are considering moving into the home had been updated since the last inspection. People who move into the home have had their care needs assessed and identified. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 9 EVIDENCE: Information contained in the Service Users Guide was amended and updated in September 2007. This was a requirement of the previous inspection. The guide contains information on the experience and qualifications of the new member of staff. The last person to move into the home did so in May 2006. The Local Authority funding this person had completed a full and comprehensive Needs Led Assessment. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Records seen indicate that service users daily health and personnel care needs are met; service users also confirmed this. There is a basic system for the administration of medication in the home mainly managed by the Registered Manager. EVIDENCE: Individual care plans are available for people who live at the Whitehouse, the Inspector examined the care plans of all three people who live at the home these contained information on the daily care and support needed. The care plan is brief but contains the relevant information on daily care, physical and social needs. There was a good record on the care plan of dates people had seen health care professionals such as the general practitioner and practice nurse. There was also evidence of regular hospital appointments and mental White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 11 health assessments as required. The Registered Manager has undertaken a short course in Chiropody and attends to basic foot care. The Registered Manager takes people to see an Optician and Dentist. People who live at the home although independent do require some support with personal care. The Expert by Experience in her report observed that people were clean and tidy in appearance and that their appearance was the best she had ever seen in a care home. In discussion the Registered Manager said that he felt the advantage of having a small home was that people could receive individual attention. The method for the administration of medication has not changed since the last key inspection. All three staff administer medication; the new member of staff had been trained in the administration of medication as part of the induction process. (Please refer to standard 30 for more information on staff training.) Medication is administered from a medicine cupboard on the wall in the lounge. Blister pack and monitored dosage systems are not in place; medication is administered from the original container. The medication administration record was seen medication had been signed for. The Registered Manager is responsible for collecting repeat prescriptions and returning any unused medication to the Pharmacy. A basic medication policy is in place for staff. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People spoken with appeared to be satisfied with the care offered in the home. People are given the opportunity to go out most days with the Registered Manager and are generally included in the daily routines of the home. People received a varied menu and reported liking the food in the home. EVIDENCE: The evidence for the above standards on lifestyle has been gained from the discussion the Expert by Experience had with people who use the service. The following is a summary of her report into life at the home, her observations and the feedback of people who use the service. All of the people living at the home at the time of the Inspection were male. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 13 The Expert By Experience spoke with each person individually. One person has been living in the home for a number of years. He enjoys listening to the radio and reading. He said that people are asked to get up at around at about 9am and usually retire for bed at 10pm. One person spoken with was able to give limited verbal feed back. He indicated that he liked living in the home and was happy. One person said he was happy with the food and that the Manager attends to his chiropody needs. People reported liking the food and enjoying trips to a local public house for lunch. Reading newspapers, watching television, outings and going out in the car were named as activities that people liked and experienced. One person said that the barbeques in the garden in the summer were enjoyable. There was not any fruit on display but one person said that he would not eat it any way. The care staff in the home cook meals and a record is made of meals taken by service users, these are mainly traditional British dishes. One person said he did not like curry and had not tried it. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is available, this has been updated and contains contact details should people whish to complain to an external organisation. A Whistle Blowing Procedure is available for the guidance of staff. EVIDENCE: A complaints procedure is available; this is contained in the Statement of Purpose. The information is clear and contact details for West London Commission for Social Care Inspection have been provided. The Registered Manager confirmed that no complaints had been made from people who use the service or relatives. The new member of staff had completed Protection of vulnerable adults training in 2005. The Registered Manager confirmed that the Hounslow Safeguarding Adults Procedure had been seen and read by the new member of staff. A Whistle Blowing Procedure is in place. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21,22,23,24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A well-maintained, comfortable and homey environment is offered. The Registered Manager had made improvements to the home since the last inspection for the benefit of people who use the service. EVIDENCE: White House is a small family care home with a comfortable homely atmosphere. People have their own bedroom, and a shared bathroom on the first floor. People use the main lounge and dining room during the day. Improvements have been made to the home since the last inspection. These comprise of all new laminate flooring to the ground floor. The bathroom has been vastly improved with tiling and new bathroom fittings. New curtains had White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 16 been purchased, these were seen, and were due to be hung. A new conservatory table and chairs set had been purchased. The Expert by Experience observed that armchairs were worn and one person slipped down. This she reported to the Registered Manager and a suggestion was made that perhaps more upright, upholstered armchairs would be better. The Expert by Experience was able to view people’s bedrooms and commented that these were personalised and that people confirmed to her that they liked their bedrooms. The home throughout was very clean and tidy. An environmental health inspection had recently taken place by the London Borough of Hounslow EHO and the outcome of this was very positive for the home. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A sufficient and experienced staff team looks after the service users. The numbers of staff on duty meets people’s needs. Recruitment practice in the home must be improved to protect people who use the service. Staff receive training to enable them to be competent in their jobs; this needs to be evidenced, especially new staff induction training. EVIDENCE: Three members of staff work in the home. The Registered Manager and his wife live and work in the home for the majority of time. A part time member of staff is employed to work shifts in the home mainly at weekends and occasionally during the week. The Inspector examined the Recruitment record of the new member of staff. An application form and identity verification was in place. The references were not seen. The Registered Manager confirmed that references had been sought White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 18 but these had been mislaid. The new member of staff had a CRB Disclosure dated in 2004 from a previous employer. A new employment CRB check had not been applied for neither had a POVA first check. This was discussed with the Registered Manager and he was asked to apply for this as a matter or urgency. The new member of staff has an NVQ in Care. She had undertaken an informal induction into the policies and procedure of the home. There was no record of the subjects covered on the Induction. The Registered Manager was advised that Induction Training must be evidenced and there must be a record of this. Material must also be available on the training staff receive in the safe administration of medication. The new member of staff had received training in moving and handling. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is also the Provider and is directly involved with the care of service users and the running in the home. This is done in a competent manner for the benefit of people who use the service. The home is aware of the need to have appropriate financial procedures in place to ensure people’s interest are safeguarded. A Quality Assurance System is in place; a Business Plan must be developed from this. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 20 EVIDENCE: The Registered Manager is a registered Psychiatric Nurse and has completed the Registered Manager Award training. He has been the Provider and Registered Manager of The Whitehouse since 1992. Quality Assurance Questionnaires had been sent out for completion and the Inspector was able to view the returned questionnaires. The General Practitioner, District Nurse, Pharmacist, and Chiropodist had responded; one relative and two people who use the service had also completed questionnaires. The outcome of these was positive, people commented that the home was clean, comfortable and friendly and people were happy. The results of the quality assurance exercise and monitoring need to be made available and included in an Annual Development Plan. Systems are in place for the management of people’s finances, these depend on individual arrangements. Two people do not manage their finances and family or the Local Authority do this. One person is able to manage with minimum support. A discussion on these arrangements took place. Records were not viewed. Fire Safety records were examined. Fire risk assessments had been completed for people who use the service. Fire extinguishers had been serviced in March 2007 and the fire alarm system in February 2007. The last fire drill had taken place on 16th January 2008. Risk assessments had been completed regarding the mobility of people who use the service although one person did not appear to have a moving and handling risk assessment on his file. Legionella Testing was carried out in 2003. The home had received a four star rating from the London Borough of Hounslow Environmental Health Officer. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X x 3 White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19. (1) (b) (i) Requirement The Registered Manager must ensure that all staff have a Criminal Records Bureau Disclosure prior to commencing employment. The Registered Manager must ensure that In-House Induction Training is evidenced and that there is a record of the skills and knowledge covered in this training. The Registered Manager must ensure that an Annual Development Plan is put in place as part of Quality Assurance. This must be forwarded to the Commission for Social Care Inspection. The Registered Manager must ensure that all the people who use the service have an up to date moving and handling risk assessment. Timescale for action 01/03/08 2. OP30 18 (1) (a) 01/04/08 3. OP33 24 (2) 01/06/08 4. OP38 13 (4) (b) and (c) 01/03/08 White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP24 Good Practice Recommendations The Registered Manager should review the seating in the lounge and see if this can be improved for the benefit of people who use the service. White House Care Home, The DS0000022904.V358930.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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