Care Home: White House Nursing Home, The

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What the care home does well `Smashing, could not be better`, `I can`t really fault it`, `very homely`, `I`m well looked after` and `they`ve been very good`. Another person said `the place is good, could not better it`. There is a stable staff team working at the service and they are supported effectively by a knowledgeable and experienced management team. Feedback about the staff was positive with comments including `very very good`, `very friendly and helpful` and `they pop in and we have a laugh`. People we spoke to said they appreciated the time the activities co-ordinator spent with them. Health needs are addressed promptly and medication is managed well. What has improved since the last inspection? The communal areas have been improved and re-decoration work is ongoing. Care plans have been improved. Care staff no longer wear uniforms and mealtimes are a more pleasant occasion for all involved. The home continues to have good links with other agencies and the administrator is now a member of the Local Authority Safeguarding Board. What the care home could do better: We were disappointed to find that some bathrooms and toilets did not have working locks when we first visited. This was addressed promptly by the service but this had been highlighted as an issue at the October 2007 inspection. The appointment of a dignity champion for the service may help to highlight this and similar issues in the future. Care plans could be even more detailed and address all areas of a persons life. The format in use needs to bring all the important information together in one place and be easy for staff to use. Key inspection report Care homes for older people Name: Address: White House Nursing Home, The 274 Malden Road New Malden Surrey KT3 6AR     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: Jon Fry     Date: 0 1 1 0 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 Older People Page 2 of 24 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 24 Information about the care home Name of care home: Address: White House Nursing Home, The 274 Malden Road New Malden Surrey KT3 6AR 02089490747 02089190759 thewhitehousenursinghome@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Badru Manji,Mrs Sater Manji care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home The White House Nursing Home provides residential and nursing care for up to twenty five older people. The home is situated on a main road close to public transport, shops and other amenities. Accommodation is provided in single bedrooms. A copy of the Statement of Purpose and Service User Guide for the service can be obtained on request. 0 Over 65 25 Care Homes for Older People Page 4 of 24 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: The inspection took place over two days. The inspector spoke with fourteen people who use the service, two visitors, two members of staff and the home administrator. We looked at records and documents including the care plans for two individuals. The service completed an Annual Quality Assurance Assessment (AQAA) when we asked for it. This gave us good information about the service being provided. Care Homes for Older People Page 5 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 6 of 24 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 7 of 24 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. Good information is available about the service. The home completes admission assessments to make sure they can meet peoples needs. Evidence: A guide is available about the home and this can be supplied in a large print version on request. This gives good information about the service provided but could be made more user friendly using photographs of key people and places. The home told us in their AQAA that the registered manager will carry out a preadmission assessment on prospective service users to identify if we can meet the needs of the service user. They also stated that we give the service users and family the opportunity to visit the nursing home and view the room before admission. The home offers a 4 week settling in period whereby notice cab be given by either party as part of the notice period. Care Homes for Older People Page 8 of 24 Evidence: We looked at an assessment for one person and saw that this covers areas such as breathing and circulation, nutrition, elimination, personal hygiene and mobility. Equality and Diversity is also addressed at this stage along with some information about social needs. We have recommended that the home look at how the assessment could capture more of the person. This could be capturing more detailed information about their life, their interests and preferences, what a good day looks like for them and the things they do not like. Care Homes for Older People Page 9 of 24 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. Individual health needs are addressed and medication is managed well by the service. Care plans give some good information about individual needs but could be improved further. Evidence: People look after me, very nice, Im well looked after and Im definitely well looked after were comments from people living at the White House. The AQAA said care plans are reviewed monthly or as and when changes arise and care staff have in depth daily reports where any changing needs/ concerns are identified and acted upon. We looked at the care plans for two people. These had been reviewed regularly and kept up to date. We saw that improvements have been made to make the plans more person centred and some good detail has been added about individual preferences and wishes. A separate set of files are kept containing my care plan for each person with some good information again about peoples background, family and how they Care Homes for Older People Page 10 of 24 Evidence: communicate. Staff were adding notes to these documents but this appeared to have stopped in January 2009. A challenge for the home is how to develop the care plans to bring all important information about the person into one place and for these to be even more person centred. Information currently contained in activity records also needs to be part of the care plan and give clear guidance for staff about how the person likes to spend their time. A key strength of the White House is addressing individual health needs and we saw that good records are kept of health related assessments and appointments. We saw that medication is managed well and people are receiving their medication as prescribed with full records kept. Care Homes for Older People Page 11 of 24 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. A good range of activities are on offer. People generally enjoy the meals provided and are able to make choices about what they eat.. Evidence: I have visitors, I keep occupied, theres alot going on, we have things laid on but we need more to do and they keep you occupied were comments from people living at the home. The AQAA said the home employs a full time activities co-ordinator who on admission completes an individual profile for service users on their likes and dislikes ranging from food to activities and interests. The activities co-ordinator interacts with service users on a daily basis and organises activities. The activities co-ordinator is now part of a cluster group in the local area where she has regular meeting with other activities staff working in services close by. This has provided people living at the White House with opportunities to attend activities and social events organised by other homes. Two people were due to go on a trip to Worthing with another home soon after our visit. Care Homes for Older People Page 12 of 24 Evidence: A good range of activities is on offer and these include painting, card games, chair based exercises, baking and takeaway nights. A halloween party was being organised when we visited and a family day was also being arranged. We have recommended that the home looks at access to transport to further enable people to be part of the community and enable more regular excursions outside the home. The food is good, the food is very good, excellent, very nice and the new cook is about the best we have had were comments from people who live there about the meals provided to them. Other comments included a good amount of food, far too much and I could cook better. We saw that the dining room has been improved since we last visited. The AQAA told us that the home has recently reviewed the menu after suggestions from service users and also implemented a self serve style of dining where the service user is able to serve themselves thus empowering them to have more choice on a daily basis. We saw that people were indeed able to serve themselves and the atmosphere was relaxed with some staff chatting to people during their meal. We have recommended that the home look at the use of blue plastic aprons by staff as this detracts from a homely mealtime. More domestic style cloth aprons could be considered as an alternative. Care Homes for Older People Page 13 of 24 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 feel able to raise any concerns they have in the knowledge that these will be addressed. Safeguarding and recruitment procedures help protect individuals. Evidence: I have no problems, I have no complaints, the matron sorts things out and I can complain to the matron were comments from the people who live there. The service told us in the AQAA that the home has not received a written complaint since 2003 but, in the event that it does, keeps a log of the complaint and any action taken and staff are trained in POVA (Protection of Vulnerable Adults) and the home uses the Local Authority Safeguarding Adults Policy as a guide to dealing with suspected POVA issues. The complaints procedure is made available in large print and this document can be translated into other languages. We have recommended that photographs of key people be added to help people know who to speak to if they have a problem. The records we looked at showed that staff receive training around Safeguarding Adults and the administrator is active within the Local Authority as part of the Safeguarding Board. Care Homes for Older People Page 14 of 24 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 living at the White House are provided with a clean and comfortable place to live. Evidence: The AQAA told us that the home is a well maintained , nicely decorated, homely place for service users to live. The home is maintained in a manner that reduces the risk of infection and cross infection and staff are trained so they understand the importance of this. The people we spoke to were happy with their rooms and comments included it suits me, its a nice bedroom, fine and its very clean. We saw that improvements have been made to the home environment including a full re-decoration of the lounge and dining areas with new flooring laid. The dining area has been made more homely and the home told us that the reception area was next to be refurbished. We have recommended that the service look at providing more items and things for people to do in the lounge area. These should be accessible for use by the people living there and the staff at all times. Care Homes for Older People Page 15 of 24 Evidence: The new wet room is fully operational on the first floor and, as at the October 2007 inspection, the other bathrooms would benefit from updating to this standard. On the first day we visited, it was disappointing to see that two bathrooms had no lock fitted and the lock on the door of the new first floor wet room was also not working. This compromises the privacy and dignity of people living at the White House and was an issue at a previous inspection in October 2007. This was addressed by the home after our visit but the owners and managers must make sure that all bathrooms and toilets have working locks fitted at all times. We saw some unmarked toiletries and cream left in the bathrooms. The staff need to make sure that each persons toiletries are marked and stored in their room wherever possible. The home was clean and hygienic at the time of our visits. Care Homes for Older People Page 16 of 24 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. Staff have training to help them do their jobs well. The people living there are protected by the recruitment procedures in place. Evidence: Theyre very good, very nice, very friendly and helpful, they are all pretty good, the staff are exceptionally good and they treat me very well were all comments from the people who live there. The AQAA told us that there is a low staff turnover rate at The White House and staff sickness levels are very, very low. Continuity of care is very important to the management team therefore staff are employed on a permanent basis and agency staff are not used unless in severe circumstances. Staff have good access to training and courses include Fire Safety, Health and Safety, Moving and Handling, Safeguarding and the Eden Alternative. Induction for new staff is to Skills for Care specification and over 50 of care staff have an NVQ qualification. We have recommended that the home keep developing the training programme in place and consider further training around dementia care, person centred care and activities. We saw that care staff do not wear uniforms and this does add to the homely nature Care Homes for Older People Page 17 of 24 Evidence: of the service. The nurse on each shift is still in uniform and we were told that the people who live there preferred this. We suggest that this be kept under review. The appointment of a staff dignity champion should be considered and they should be given support and training to highlight dignity issues within the service. One staff file was looked at and this contained all the important checks required to make sure that people are protected. Care Homes for Older People Page 18 of 24 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. The home is well run. Health and Safety checks take place to keep the home safe for those living there. Evidence: The AQAA told us the management structure has remained the same for the last 7 years with the Registered Manager and the home administrator working closely together with wonderful support from the proprietor who is on-site 6 days a week. As stated above, the service benefits from having a stable management team who are knowledgeable and experienced. They have strong links with the Local Authority and this benefits the people who live there in terms of staff training and support. The administrator has recently been involved in delivering good practice presentations to other providers working in the borough around emergency planning. Comments from the people who live there included its run well and the manager is very approachable. Staff members we spoke to said they felt well supported in their Care Homes for Older People Page 19 of 24 Evidence: work and were able to voice any concerns to the home management. We saw that the home has recently completed surveying the people who live there, their relatives and staff members about the quality of care provided. The administrator was in the process of collating the results and producing an action plan. We have recommended that the home looks at having more regular meetings with the people who live there as there have only been two meetings held so far in 2009. We saw that Health and Safety checks take place to help keep people safe. Records for checking the fire alarm and hot water temperatures were seen during our inspection and the home gave us information about other improtant checks in their AQAA. Care Homes for Older People Page 20 of 24 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 21 of 24 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 3 1 3 7 The guide to the home could be made more user friendly with photographs of key people and places. The assessments in use could be developed to capture more individual information. Care plans should continue to be developed to capture more of the person and how they like to lead their life. Guidance for staff could be even more detailed and address al areas of the persons life. The use of blue plastic aprons by staff during mealtimes should be reviewed. The home should look at facilitating more regular trips outside the home for individuals. Improved access to transport may help to achieve this. The complaints procedure should include photographs of key people in this process. The bathrooms could be updated to provide a more pleasant environment for the people who live there. Toiletries and creams need to be marked as required and 4 5 12 13 6 7 16 21 Care Homes for Older People Page 22 of 24 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 kept in peoples rooms wherever possible. 8 9 10 27 30 30 The practice of having a nurse in uniform should be kept under review. The appointment of a dignity champion for the service should be considered. The training programme should continue to be developed and further courses looked at around being person centred, dementia care and activity provision. The home should look at having more regular meetings with the people who live there. These could be infomal get togethers such as a coffee morning or similiar type events. 11 33 Care Homes for Older People Page 23 of 24 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 Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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