Care Home: Whitegates

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What the care home does well What has improved since the last inspection? Refurbishment and upgrading of the residents` accommodation has been completed. This means that accommodation in the original building now matches the high quality of accommodation in the new extension and so all residents benefit. There has been more work done to improve the written records of the residents care so that it is clear how each resident`s care is being planned and reviewed. The records are showing more evidence of consultation with residents and/or their relatives. Mrs. Brown is regularly auditing the medication records so she can pick up any shortfalls quickly. What the care home could do better: Mrs. Rogers and Mrs. Brown already have a clear view of the areas of the service they want to improve over the next few months e.g. the catering service, the external facilities. CARE HOMES FOR OLDER PEOPLE Whitegates 25 Hereford Road Bromyard Herefordshire HR7 4ES Lead Inspector Wendy Barrett Draft - Key Unannounced Inspection 3rd November 2007 10:30 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 Whitegates DS0000024748.V349896.R01.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. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitegates Address 25 Hereford Road Bromyard Herefordshire HR7 4ES 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) 01885 482437 F/P 01885 482437 karen.rogers@tiscali.co.uk Karen Anne Rogers Mrs Susan Winifred Brown Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Learning registration, with number disability over 65 years of age (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (37), Old age, not falling within any other category (37), Physical disability over 65 years of age (22) Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The category LD(E) relates to a named person The Home may accommodate one named service user under the age of 65 years who has a physical disability. 13th January 2007 Date of last inspection Brief Description of the Service: Whitegates is a large, older house situated in its own grounds on the outskirts of the small market town of Bromyard. In 2006, the accommodation was extended and the home now provides 37 places for older people who have care needs arising from the ageing process, mental health or dementia related conditions. 22 of the places may be used to accommodate older people who have care needs relating to a physical disability. One of the places is registered to accommodate a named older person with care needs relating to a learning disability and another has recently been registered to accommodate a named younger adult. In September 2006, the fees ranged from £400 to £550 per week. Additional charges are made for chiropody, hairdressing, newspapers and dry cleaning. Mrs. Rogers and Mrs. Brown have produced written information about the service. This is readily available at the home so that any enquirers can obtain a copy. Each bedroom at the home is supplied with a copy of the home’s Service User Guide. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information used in preparing this report has been gathered in a number of ways. The Care Manager, Mrs. Brown, completed a quality assurance report for the Commission. Survey forms were sent out to a sample number of residents, relatives, staff employed at the home and health care professionals who visit the home. Information held on the Commission’s service file about Whitegates was also considered. There was an inspection visit over two days. The first visit was an unannounced weekend visit. The second visit took place when Mrs. Brown was available at the home. An Expert by Experience (called the Expert in this report) also helped with this inspection. This is someone with previous knowledge of the type of service provided at Whitegates and who has been trained to go with inspectors on a visit to a service. Experts observe what happens in homes and talk to people who live there to obtain their views of the service. They then write a report of their findings and parts of this Expert’s findings are included in this report. What the service does well: This home affords the residents a safe, secure, friendly environment that values the individuality of each resident. This can be summed up by the comments of one of the residents – ‘things are good and always getting better’. The residents’ accommodation is high quality. It is designed to suit the particular needs of the residents but also retains a homely appearance. Mrs. Rogers and Mrs. Brown understand their responsibilities and are always looking for ways to improve the service. They encourage residents and their families to participate in decisions about the running of the home. The staff treat the residents well. They are respectful but cheerful in the way they go about their work. The Expert commented ‘staff work in a quiet unobtrusive way and exercise great courtesy when addressing residents’. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Whitegates DS0000024748.V349896.R01.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 Whitegates DS0000024748.V349896.R01.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): 1,2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to decide if the home will suit them and to know what they are paying for. Staff at the home recognise the importance of gathering as much information as possible about the potential resident so that they can assess if they will be able to meet individual needs and expectations. EVIDENCE: Mrs. Rogers and Mrs. Brown have produced written information about the service. This is readily available at the home so that any enquirers can obtain a copy. Each bedroom at the home is supplied with a copy of the home’s Service User Guide. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 9 Prospective residents are encouraged to visit the home so they can check the accommodation and meet the staff and other residents. One resident mentioned how she was able to select the bedroom of her choice from those that were available when she was admitted. Mrs. Brown always visits prospective residents if at all possible so that she can assess their care needs and expectations. The information is recorded so that the staff will have some essential details and guidance if the prospective resident is eventually admitted. Mrs Brown also considers information from other care professionals who know the individual e.g. one care record contained an assessment report written by a specialist social worker. All new residents are asked to sign a statement of Terms and Conditions when they are admitted. Self-funding residents enter into a contract with Mrs. Rogers regarding their fees. For those residents who are supported by local authority funding the contract is between Mrs. Rogers and the funding authority. Whitegates DS0000024748.V349896.R01.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): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the care they need and they and their relatives are consulted as part of this work. Health and social care professionals express confidence in the care residents receive. Residents can handle their own medication if they are safe to do so. Staff manage other residents’ medication competently. EVIDENCE: The staff take into account each resident’s special needs and preferences when they plan the care to be provided. As part of this work the resident, or their relatives, are consulted about the type of life they have lived and how they would like to spend their days. Relatives appreciate the results of this planning –‘I am very happy with the care my mother receives’. Health care Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 11 professionals also have confidence in the staff. A local G.P. refers to ‘respect and dignity’ for the residents. Practical care is based on assessments of each aspect of the resident’s wellbeing e.g. dietary needs, personal care needs. The Expert noted that all the residents, without exception, had obviously received the help they needed with their personal care-smart hairdos, freshly laundered, smart clothes. Residents can continue to manage their own medication if they want to and if the staff feel they will be safe doing this. The care plan of one resident who has chosen to do this included a record of the way the risk has been assessed and is being kept under review. Other medication is being managed safely by staff. Mrs. Brown checks the records regularly so that she can pick up any discrepancies quickly. A random check of records and stock was undertaken during the inspection visit. This reflected a satisfactory situation with very few minor discrepancies identified e.g. the medication record of a recently admitted resident did not yet have an ‘allergy’ box filled in. Whitegates DS0000024748.V349896.R01.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to continue living in the way they prefer and they are supported by staff in getting out into the community and in enjoying group activities at the home. The staff encourage relatives to participate in the life of the home. Most of the residents enjoy their meals although Mrs. Rogers intends to further improve the quality of the catering. EVIDENCE: Residents told the Expert that their social care needs are adequately catered for. Guy Fawkes night was celebrated in style with a large fireworks display and party. Some residents watched outside and others had a ringside seat indoors. Children and grandchildren were invited to this event. Arrangements are made to provide escorts for residents to church services and other external visits. There are plenty of newspapers and the Expert saw several residents happily reading. She also noticed that the lounges are well used with a lot of happy Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 13 banter and repartee between residents e.g. one 99year old lady and her companion of a year younger were cheerfully chatting and teasing each other. A resident said that when visitors come they are immediately asked if they want a cup of tea. A new activities organiser has recently been appointed. She has previous experience of providing activities for people who have a dementia so will be able to offer suitable things for most residents. The written records of care address social care e.g. one resident doesn’t remember things very well so the plan advises staff to make sure she is reminded about any activities and encouraged to attend. There is also reference to the importance of the resident’s family and the need for staff to help her maintain contact with her relatives. Staff are being offered the opportunity to complete a training course on Nutrition and Well being. A progress log, completed by a member of staff, showed this was a very comprehensive, relevant course. The residents told the Expert that the food was very good although one lady would like more alternative choices as she doesn’t eat red meat. The cook was aware of this lady’s preference and pointed out a number of alternative choices available from the kitchen e.g. fish, eggs. Teas and coffees were served in communal areas but residents may have their meals served in their bedroom if they wish. Survey responses about the meals varied-‘food is well balanced’, ‘meals swing between too much and too little’. Mrs. Rogers has recently appointed an experienced chef to raise the quality of the meals service at the home. She would like to move closer to hotel-type catering. Whitegates DS0000024748.V349896.R01.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. Residents and relatives know how to raise any concerns and they feel confident that the staff will listen to them and take any necessary action to put things right. The staff understand how to recognise any unacceptable treatment of residents and they have guidance to help them raise any concerns they may have. EVIDENCE: Every resident is given a copy of the home’s complaints procedure when they are admitted to the home. Relatives say they know how to make a complaint but there haven’t been any complaints received at the home or by the Commission during the past year. Mrs. Rogers intends to give staff more training in ‘customer care’ next year as part of her overall quality development. Mrs. Brown meets regularly with small groups of residents so that they can talk to her about any issues that are worrying them. The staff receive training to help them recognise and report any abusive practice. There are plans to provide this to all new staff as part of their initial induction training programme. Written guidance is provided in the home’s policies and procedures. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 15 Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from high quality accommodation that is designed and maintained to keep them comfortable and ensure their safety. EVIDENCE: The home has an impressive frontage and is set in beautiful Herefordshire countryside. An extension was opened last year and now the accommodation in the original building has been upgraded to match the quality of the new build. The lounge and conservatory have been re-designed to allow better access and a new call bell and fire alarm system have been installed. All furniture, carpets, curtains and bedding has been replaced in the past year and every bedroom has an en suite toilet and has been decorated. Three bedrooms have en-suite shower facilities. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 17 The entrance hallway is inviting and doesn’t in any way resemble an institution. It is both welcoming and exceedingly pleasant. The communal and dining areas are clean, bright and pleasant. Each resident has a room that is pleasantly decorated and an adequate size. These rooms are individually personalised and each resident has his/her personal belongings e.g. pieces of furniture and other objects that enable them to maintain a sense of ownership. This was evidenced in many cases by the individual door signs e.g. ‘Doug’s den’, ‘Mabel’s room’. The bathrooms are spotless, well lighted and large enough and secure enough to allow maximum privacy and safety. A new hairdressing facility is of ‘salon’ quality. A visiting professional worker commented on ‘a good and varied environment’. A resident felt that the outside facilities could be improved and landscaping of the grounds is already underway. All areas of the home were clean, warm and bright when the inspection visit took place. Eleven staff have received training in infection control and the Department of Health guide –‘Essential Steps’-is being used to assess infection control management at the home. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents needs although a few staff and residents feel there should be more. There isn’t any evidence to suggest that residents aren’t receiving the attention they need and Mrs Brown monitors the situation so she can increase the staffing if the workload increases. New staff are carefully selected and they are supported as they get used to the work. Existing staff are receiving the training they need to work safely and respectfully with the residents although one or two of them would like additional training opportunities. EVIDENCE: Several staff members told the Expert they were very busy during the day shifts but no resident suggested a shortage of personnel. Survey responses did include a few comments from residents and staff about staffing shortages but others confirmed a generally satisfactory situation. Mrs. Brown was already monitoring the staffing levels and resident dependencies so that she could be sure that each resident receives the care they need. There was no evidence to indicate that residents weren’t getting enough staff time although the cook did stay on after her shift finished so she could finish tidying the kitchen. There has been an increase in staff since the last inspection and Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 19 recruitment was taking place at the time of this inspection e.g. a new activities organiser had recently been appointed and a chef was also due to start work soon. Half the care staff have either obtained a national vocational qualification in care or are working towards it. Records confirm that the staff are also receiving the health and safety training they need. They are being offered other types of training that is particularly relevant to the residents e.g. epilepsy, dementia, diabetes, adult protection. One or two staff feel that they would benefit from more training although their survey forms didn’t provide any more detail about the type of training they wanted. Others feel happy with the training opportunities. The way that new staff are checked before being offered a job at the home was satisfactory when the home was last inspected. When new staff start work at the home they are supervised by more experienced staff for a while and then they undertake a full induction programme that meets national specifications. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 20 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 excellent. This judgement has been made using available evidence including a visit to this service. The residents benefit from a service that is run by competent managers who know what is required to maintain and improve the health, safety and welfare of the residents. There is a real commitment to consulting residents about the running of the home. EVIDENCE: Both Mrs. Rogers and Mrs. Brown have considerable experience and relevant qualifications to fulfil their responsibilities. They know what things make a care home a nice place to be. When they identify a need for improvement they put together clear plans for addressing the work e.g. the current project Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 21 on landscaping the gardens is at least in part a response to comments made by residents when they have been consulted about the running of the home. There are plans to involve residents in staff selection and to introduce a designated member of staff for room service. The written report submitted by Mrs. Brown prior to this inspection showed how she understands about the legal requirements and recognised standards for running a care service. All the home’s policies and procedures have been reviewed this year to make sure they are up to date. Mrs. Rogers and Mrs. Brown want to continue developing their quality assurance system by improving the way they record the findings of their auditing work and consultation exercises. Sometimes residents leave small amounts of money or valuables in the office for safekeeping. The arrangements for this, and the related records were satisfactory when the home was last inspected. Health and safety is addressed through a programme of regular auditing exercises. For example, the staff check the safety of each resident’s bedroom by assessing any potential risks from things such as water temperature, heated surfaces, window safety. A few bedroom doors have been fitted with a special device that allows the resident to have their door open without compromising the fire safety of the building. This has been done in response to assessed need for the particular individual resident. Most windows had restricted openings but one bedroom window didn’t have any restrictor fitted. This meant the window could be opened wide. This may pose a risk to residents and it was, therefore, reassuring to hear that Mrs. Brown had already noticed this shortfall and had arranged for a builder to fit a restrictor. Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 22 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 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road, Worcester WR3 7NW 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. Extracts may not be used or reproduced without the express permission of CSCI Whitegates DS0000024748.V349896.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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