Care Home: Whitestones

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What the care home does well The managers and staff are knowledgeable and experienced. There is a clear emphasis on maintaining people`s independence whilst respecting their dignity and privacy. A relative wrote in our survey, "Staff have the skills and experience to look after people properly". People living at the home were full of praise for staff. Comments included, "staff are very kind" and, "I am very happy here, everyone is very friendly". One relative said that, "I cannot fault the care given". The quality of food provided is very good. One person said that, "I enjoy all the dinners" and another person praised the homemade soup. The building is two years old and was built to a high standard with ensuite facilities in every bedroom including a shower. Good quality furnishings have been used and people living at the home appreciated the high standard provided by the surroundings. The outside area is secure and very attractive. The intention was to compete in the `Best kept garden` competition that is run by Derbyshire County Council. They are working towards further improvements for people coming to the home for short-term care with the use of ` Telecare`, which is a system to promote people`s independence around medication and safety. What has improved since the last inspection? Changes have included the manager returning from sickness absence and now working on a job share basis with a second manager. The two managers are working hard to ensure that they work in a consistent way. In response to comments from people living at the home, staff and managers are trying to think of ways to make the large lounge areas more homely. They have purchased scatter cushions and have started to provide bowls of fruit in these areas. Risk assessments are now completed concerning people`s ability to administer their own medication. Medication is now administered to people in their home bedrooms before breakfast to improve privacy. The managers are looking at ways to administer medication at lunchtime without having to give medication around other people. The falls prevention team have been involved with people living at the home and provided staff with a tool to asses people at risk in order to help minimise falls. CARE HOMES FOR OLDER PEOPLE Whitestones 139 Manchester Road Chapel-en-le-Frith Derbyshire SK23 9TW Lead Inspector Jill Wells Unannounced Inspection 24th June 2008 09:30 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 Whitestones DS0000062727.V366869.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. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitestones Address 139 Manchester Road Chapel-en-le-Frith Derbyshire SK23 9TW 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) 01298 300620 01298 308130 www.derbyshire.gov.uk Derbyshire County Council Christine Mulryan Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: Whitestones Care Home is a new purpose built home which has been built on the site of the old care home. It is registered to provide accommodation for 41 residents, comprising of 1 double room (for couples), 4 short-term care beds and 37 long-term care beds. All rooms have en suite facilities including a shower. Each room has its own private patio area or veranda. It is situated on the outskirts of Chapel en le Frith. Fees are £392.18 per week for permanent service users, but a range of prices for short term care service users. Extra charges are made for hairdressing, chiropody, magazines and newspapers. Whitestones DS0000062727.V366869.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 the service is two star. This means the people who use the service experience good quality outcomes. The inspection visit was unannounced and took place over 8.5 hours. There were 41 people living at the home on the day of the inspection, although 3 were in hospital. 8 residents, 4 staff, 3 visitors, and the managers were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 21.11.06. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. • The previous key inspection report Completed surveys from people living at the home, staff, relatives and professionals that visit. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. What the service does well: The managers and staff are knowledgeable and experienced. There is a clear emphasis on maintaining peoples independence whilst respecting their dignity and privacy. A relative wrote in our survey, Staff have the skills and experience to look after people properly. People living at the home were full of praise for staff. Comments included, staff are very kind and, I am very happy here, everyone is very friendly. One relative said that, I cannot fault the care given. The quality of food provided is very good. One person said that, I enjoy all the dinners and another person praised the homemade soup. The building is two years old and was built to a high standard with ensuite facilities in every bedroom including a shower. Good quality furnishings have been used and people living at the home appreciated the high standard Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 6 provided by the surroundings. The outside area is secure and very attractive. The intention was to compete in the Best kept garden competition that is run by Derbyshire County Council. They are working towards further improvements for people coming to the home for short-term care with the use of ‘ Telecare’, which is a system to promote peoples independence around medication and safety. What has improved since the last inspection? What they could do better: There are a high number of shifts where, due to sickness and holidays care staff numbers are reduced. This is having an impact on the quality of care that can be provided at these times. One person living at the home wrote in our survey that staff didnt have much time to listen and always seemed in a rush. Recording tools are not always completed for new people, including people staying for respite care including risk assessments and inventories. Although daily records and monthly reviews of peoples care are person centred and focussed on each person as an individual, personal service plans are not person centred, and are not updated to ensure that care staff provide individualised care. However care staff spoken with were able to give examples of how they did provide care in an individualised way. A choice could be provided at lunchtime rather than only offering an alternative if the main meal was not liked. Care staff should ensure that when they are asking people about potentially personal information, this is done in a private area. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 7 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. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 8 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 Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 9 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): 1,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. EVIDENCE: The statement of purpose and service user guide were available for prospective people wishing to live at the home. These documents provided all the information that was necessary however the new contact details of the Commission for Social Care Inspection (CSCI) needed to be amended. The notice boards in corridors and in the entrance hall gave additional information about the daily running of the home. The notice boards had a magnifying glass attached for people who are unable to see clearly. This idea should be commended. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 10 Out of the 9 people living at the home that returned surveys, 8 people told us that they had received enough information to help them make a decision about staying at the home. We were told that prospective service users are always invited for a day’s visit or overnight stay if necessary before they take up placement. A person recently admitted to the home for respite care was spoken with and said that, it is not like home, but I have settled here, everyone has been helpful . Copies of assessments carried out were seen on peoples records. These were detailed and included information concerning each persons health, well being, personal care needs, and family involvement. This ensured that the service could assess whether they could meet each individual’s needs. We were told by the service that each person has a written and signed contract and receive a letter prior to admission confirming that the service could meet their assessed needs. The home does not provide formal intermediate care and therefore standard 6 was not assessed. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 11 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. Although records were not always up-to-date or person centred, peoples health and personal care needs were met and the principles of respect, dignity and privacy are put into practice. EVIDENCE: The care records of three people living at the home were seen. The daily records and monthly reviews completed by care staff were written in a person centred way for example ‘likes to sleep with curtains slightly open and bathroom light on’. However the personal service plans were not always person centred or detailed. For example one stated, requires one carer for personal care when bathing. There was not an indication of when or how they like their bath. Another personal service plan that was seen said that the person was, Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 12 ‘aggressive-managed by staff and medication’. It did not explain what triggered the aggression and how staff needed to manage this. Some but not all files included individuals past history and preferences. Some records also included moving and handling plans, falls risk assessment, nutritional assessment and tissue viability risk trigger tools. One file that was seen had a blank tissue viability tool and risk of falls tool in place, however the resident had signed these blank documents. One tissue viability risks trigger tool was last completed September 2007, however the score indicated that this person should have been assessed monthly. The manager did confirm that the district nurse was monitoring this person regularly. The date of the persons admission to the home was not recorded in the file. It was explained that this information was in the manager’s office. Although there was up-to-date information on the monthly reviews and daily records, these had not been used to update the personal service plans, which indicated that they were not being used as a ‘working tool’ to inform staff of assistance each person needed. A care worker was spoken with and said that they were given time to write monthly reviews and daily records. These records indicated that people living at the home had been involved in the completion of them. Records, staff and people living at the home were all able to confirm that GPs and other health professionals were contacted and visited when required. The service had started a trial of the local district nurse visiting on a fortnightly basis and speaking with any person that had any concerns. This gave people at the home the opportunity to raise any health questions that they may have. Medication in the home was stored securely. Medication was administered by one of the managers. All had received medication training. The medication administration records were seen and were correctly completed apart from the hand written records. The person writing some of the records had not signed them. Two records that were checked against the medication labels had inaccurate information. One had the wrong strength recorded and another did not state that one medication should be dissolved in water. These records had not been countersigned to indicate that they had been checked by a second person. There was however no indication that they had been administered incorrectly. Controlled drugs were securely stored and the controlled drugs register was checked and found to be accurate. There was a locked fridge for medication that required refrigeration. Care records showed that individuals had been assessed or asked if they were able to self medicate. The manager told us that they were looking at moving away from administering medication when people are together in groups i.e. at meals times in order to increase privacy. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 13 Medication was now given in bedrooms before breakfast. The managers are also looking at ‘telecare system’ to promote independence with medication for people staying at the home for respite care. People spoken with said that were treated with respect by staff. One person said that, staff are very courteous. The management placed a high emphasis on ensuring that people are treated with respect and their independence is promoted. One person living at the home said that, I think that staff like you to do as much as you can for yourself so that you do not lose your independence, which I think is good. One carer was observed going through a questionnaire in a communal area with a person visiting for the day. The managers were told about this and said that it was not the way that they expected staff to treat people. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 14 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 adequate This judgement has been made using available evidence including a visit to this service. The range of activities and standard of meals offered was good; although more frequent activities and a choice at all meal times would further improve the service provided. EVIDENCE: There was a wide range of activities that people could be involved with. This included quizzes, bingo, craftwork, manicures, as well as mystery trips out fortnightly. Some people were in the process of making a large tile mosaic that was to be put up at the home. However on the day of the inspection visit there were no activities planned for the day. Details of forthcoming activities were not displayed and a staff member explained that the activities for the afternoon were usually decided at hand over, rather than in a more planned way. Records were kept of activities offered and included the names of people that had been involved or declined to take part. A member of staff said that, when we are short staffed sometimes we will not have time for activities . A person living at the home in our survey said that, it would be nice if there Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 15 was a little more going on . The manager told us that a deputy manager had recently taken responsibility for activities with the intention of having more structure and advertising so that people living at the home were aware in advance of activities that are planned. There was no activities coordinator at the home, therefore care staff supported all activities. Key workers for each person were expected to complete ‘promotion of choice’ and what I like to do’ document, although some were not in place. Residents meetings were held on a regular basis. Minutes of these meetings showed that people were well consulted. Issues discussed included daily running of the home, activities, how to make the home more homely e.g. fruit in lounge areas and scatter cushions. There were also reminders about inviting families for a meal, and use of the kitchenettes. This showed that residents’ views and opinions were sought and listened to. The manager told us that peoples religious needs were met with a fortnightly service. Managers told us that residents could go to bed and get up when they wish to do so, although one staff member said that there was not much flexibility with getting people up, as we have to rush to get everyone up for breakfast at 8:30 a.m.. A person living at the home said that staff wake her up every morning at 8 a.m. with a cup of tea. She thought that this was too early and had at times asked them if she could stay in bed, which they had agreed to. She said that she would have preferred that they did not wake her up this early. This was discussed with the manager. People were encouraged to bring their own personal possessions with them and bedrooms that were seen were comfortable and had been personalised. The cook was spoken with during the inspection visit. Although people are provided with menu information in their own room, this was a full four weekly menu and did not easily allow people to work out the menu for the day. It was explained that the menu is normally written on whiteboards, although on the day of the inspection visit there was only one whiteboard with this information, away from where most residents were sat, and it did not accurately reflect the menu. The manager was told about this and immediately ordered new whiteboards for the dining room areas and agreed that the cook would take responsibility for writing the menu. There was not a real choice at lunchtime. The cook explained that there was usually one main course, but if she had been made aware that someone did not like this then she would offer cauliflower cheese, omelette or jacket potato. The cook was not aware that two people living at the home were diabetic and therefore had not been providing diabetic options. She said that the quality of food that was delivered was excellent, meat from the local butcher and fresh fruit and vegetables. All the people that were spoken with said that the food was of a very good standard. One person wrote on our survey we have a good cook. One person spoken with said that, the food is good, there are some lovely soups . Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 16 Information provided was that all care and catering staff had received training in safe food handling. Staff spoken with confirmed this. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 17 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. People who use the service are able to express their concerns and are protected from abuse. EVIDENCE: There were 6 complaints recorded at the home since the last inspection visit. 3 were upheld after investigation. Records show that complaints and concerns were taken seriously and action was taken to learn from any complaints made. The Derbyshire County Council Social Services complaints procedure was displayed at the entrance. This did not include the address and telephone number of the Commission for Social Care Inspection (CSCI). People spoken with said that they would talk to staff or the manager if they had a complaint. A visitor spoken with said that issues were quickly resolved. Training records showed that care staff had attended training in safeguarding vulnerable adults and care staff confirmed that they had attended this training and were aware what to do if they suspected abuse of a vulnerable adult. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 18 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): 19-26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home is a new establishment, built 2 years ago. The building is light, airy, spacious, and built to a high standard. The main door was locked with a bell to alert staff. Everyone has their own bedroom with en suite facilities including a shower. The ensuite facilities had bi fold doors for easy accessibility. There are 39 single rooms, as well as 1 double room available for a couple. Each bedroom has a door to the outside garden area. The bedrooms were pleasantly Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 19 furnished and decorated with lockable facilities. Although all bedrooms had their own TV and telephone points, it was explained that there were insufficient telephone lines and the managers were in the process of negotiating these so that more people could have a personal telephone. There was however a payphone in one of the corridors. Four bedrooms are used for short-term care. A tour of the building showed that the home was clean and well maintained. People spoken with said that they were happy with the level of cleanliness at the home, and all surveys that were returned were positive about the home being fresh and clean. There were 2 large dining rooms and each had easy access to outside patio areas. We were told that people could eat out there in the summer months if they so wished. There were 2 large sitting rooms, both with TVs and music facilities. One TV receives Sky channels. One lounge also had a piano, which people living at the home can play if they wish. There were specially adapted chairs in the lounges that provide easy accessibility for disabled people. There were grab rails and other aids around the home to assist people and maximise their independence. There is a conservatory to the front of the building where people can sit and watch the comings and goings of visitors to the home, which people said that they enjoyed. There were two assisted, adapted baths, for anyone that did not wish to use the shower in their bedroom, and 2 communal toilets. There were adequate storage areas to ensure that equipment etc was stored safely. There was a well-equipped hairdressing room, with photos of residents that have had their hair done. Laundry facilities were sited away from the main areas where food was stored and prepared. This was a large area and had 2 industrial washers with sluicing facility and industrial dryers. People spoken with were satisfied with the laundry service. Some staff commented that people coming in for respite care did not always label their clothing and therefore it was difficult to return them to the right person. The managers were addressing this with families. There were small kitchen areas where people living at the home and their visitors could make snacks and drinks. These were infrequently used and staff were looking at ways to encourage use of these areas. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 20 Staff had worked hard to make the home bright and inviting. There were photographs displayed around the home of residents taking part in activities and of staff doing their work. There were also, thoughts for the week around the home, written by staff and residents. There were signs in place to help people orientate around the home. The outside areas were secure and attractive and very much appreciated by people living at the home. The manager was in the process of purchasing a thatched gazebo to further enhance the garden. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 21 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. The recruitment practices and staff training programme were good and ensured that people were protected by competent, well-trained staff. There were not always sufficient numbers of staff available to support the people who use the service. EVIDENCE: The duty rotas were checked and discussed. The managers explained that there should be five care staff on duty in the morning and four in the afternoon, with two care staff working at night. At the weekend this is reduced to four care staff all day. The manager stated that this reduction at weekends was due to budget constraints although they were quieter at weekends. On the day of the inspection visit there were only two care staff working from 2:30 p.m.-3:30 p.m. then three carers for the rest of the afternoon. Several staff confirmed that there was often less care staff on duty than planned due to holidays and sickness. One carer said that staff had brought up the issue of staffing with managers but had been told that staffing was adequate. Care staff were also expected to undertake domestic duties including laundering of all residents clothing. This was discussed with the managers who explained that although they had relief staff, they were often not available to cover Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 22 shifts. The manager reported that there had been a reduction of 48 care hours the previous week due to care shifts not been covered. Information available in the statement of purpose is that there are an additional 99 hours described as, management care hours which was meant to be deputy managers undertaking care duties. However staff and the managers confirmed that although they would administer medication and help with care in an urgent situation, deputy managers did not generally undertake other care duties. They were trying to recruit new staff. One person wrote on our survey in response to the question concerning staff availability when needed, “most staff haven’t much time to listen, they always seem in a rush, but 1 or 2 take their time”. Another person wrote that, “ Could do with more carers, staff work very hard and are sometimes pushed, I think it’s an important issue”. One worker wrote in our survey that, “staffing levels are not adequate to deal with the number of service users that need more than one carer”. One staff member explained that the pressure on staff was much worse several weeks ago when they had people in with high dependency needs that had since been admitted to hospital. The managers were not using people’s level of dependency to assess staffing requirements. Staff records that were examined showed a safe recruitment procedure. Application forms were being completed and references and criminal record bureau (CRB) checks were being done before staff were appointed. The managers conduct probationary interviews over a six-month period with all new employees. This ensures that people living at the home are protected. There was an induction programme in place that met the Skills for Care standards and included first aid, food hygiene, moving and handling, hoist training, dementia care, safeguarding adults and bereavement. Information received was that staff turnover was low. The manager described a well-developed training programme, with training records to support this. Staff had achieved almost 100 of care staff with National Vocational Qualification, (NVQ), at level 2 which should be commended. All new staff received training in equality and diversity, and staff spoken with were very aware of the importance of being aware of and meeting diverse needs. Staff spoken with said that they were very pleased with the level of training provided. It was evident that staff have the skills and knowledge to care for older people. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 23 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): 31,32,33,35,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well managed, with effective quality assurance systems, ensuring that people are consulted and makes people living at the home central to their decision-making. EVIDENCE: The manager had recently arranged a job share with a second manager. The second manager was in the process of registering with CSCI. Both managers were working hard to ensure that they had a consistent approach. There were also 3 deputy managers. It was evident from discussions and observation that both managers were very experienced and committed to their job and ensured that the home was run in the best interests of people living there. A staff Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 24 member said that, the managers are very busy so don’t spend as much time with residents as they used to be able to A senior manager visits the home to support the manager and completes monthly reports. Several reports were seen and they showed that they were active in helping to continually improve the service provided. There were a number of ways that the managers ensured that people were given an opportunity to comment on the service. This includes an annual quality assurance survey sent out to people living at the home and their families. The results were compiled together and action taken to address any issues or suggestions. The last results displayed were November 2006. The manager said that surveys had been completed since then but the external quality assurance manager had not yet returned the results. Most people funded by Social Services had yearly reviews of their care, which involved a care manager from Social Services. This gives people living at the home and their families another opportunity to address any issues. Residents meetings were held to discuss how the home should be run, menus, outings, activities and entertainment. People were asked if they would like any changes made. People living at the home were recently consulted regarding how to make the building more homely and whether they wanted a TV in dining rooms, which they declined, preferring a radio. Information provided was that regular health and safety checks were being done and policies and procedures were available and reviewed when required. Chemicals were securely stored and staff were observed using gloves and aprons where appropriate. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 25 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 X 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x 3 3 Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Handwritten information on medication administration records must be accurate and signed by the person writing the information. To avoid errors they should also be checked and countersigned by a second person. The people providing food for residents at the home must be aware of any persons dietary needs, including people that are diabetic to ensure that individuals nutritional needs are met. The care staff hours must be reviewed. This review needs to take into account the number of people living at the home and their dependency levels, respite and day-care, time for activities as well as the number of hours care staff undertake domestic duties. This is to ensure that people’s needs are being met at all times. Timescale for action 24/07/08 2. OP15 16(2)(i) 24/07/08 3. OP27 18(1)(a) 24/09/08 Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 27 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. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The statement of purpose and service user guide should be reviewed to include the name, address and telephone number of CSCI so that people know how to contact us. Care plans (personal service plans) should be person centred and regularly updated to reflect preferences and changes to care that are presently recorded in daily records and monthly reviews. This is to ensure that they are a working tool to support care staff to provide good quality, individualised care. Each individuals social history and preferences should be recorded in their files to support care staff to provide individualised care. Individual records, including risk trigger tools and inventory of possessions should be completed for everyone living at the home. Staff should not ask people to sign blank documents. This is to ensure that peoples risks are assessed, their possessions are accounted for and their rights are upheld. The date of each persons admission to the home should be recorded in the file that is accessible to care staff. This is to ensure that staff have full information about each person. Activities should be planned on a regular basis. They should also be advertised to people living at the home. This is to ensure that people’s social needs are met. There should be a choice of main meal at lunchtime to all people living at the home. This is to promote people’s choice and independence. Information should be provided to people living at the home of the meals planned for the day to ensure that people can consider in advance their preferred choice. There should be sufficient telephone lines to ensure that every person living at the home can be provided with a personal telephone if they wish to have one. The complaints procedure displayed at the home should include the name, address and telephone number of CSCI so that people know how to contact us. Information provided by residents and staff at the home for the quality assurance surveys should be made DS0000062727.V366869.R02.S.doc Version 5.2 Page 28 3. 4. OP7 OP7 5. OP7 6. 7. 8. 9. 10. 11. OP12 OP15 OP15 OP24 OP16 OP33 Whitestones available so that people can see the outcome of these surveys. Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Whitestones DS0000062727.V366869.R02.S.doc Version 5.2 Page 30 - 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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