Care Home: Whittingham House

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What the care home does well When people are considering moving into Whittingham House, they know that through assessment and discussion they will be helped to decide if it is the right place and suitable for them. People are always able to welcome their visitors so that they can maintain contact with friends and family. The building is suitable for people and meets their needs. What has improved since the last inspection? A new manager has recently been appointed who is keen to improve the home and ensure that it provides a good service for people. A new `key worker` system has been introduced to try and provide better continuity for people. People can now feel confident that their medicines will be managed in a safe and effective way. The way people`s care is planned for and carried out has improved, so people should receive care that is more consistent and better meets their needs. Care records are better co-ordinated so that information about a person and their needs is all in one place and more accessible. The home are working more closely with community based health care professionals to ensure that people`s healthcare needs are more consistently recognised, referred and attended to. Signage at the home has been improved to help people find their way round. Staffing records have been improved so that it is possible to see that staff are safely recruited and properly supported in their role. Staff training has been ongoing and has reflected the areas where improvements were needed, as highlighted by recent safeguarding investigations. What the care home could do better: Although care planning has improved there are still shortfalls. There is not always a `joined up` approach to ensuring that people`s needs are fully identified, assessed for risk, acted upon and met in practice on a day to day basis. Although people are asked about their cultural needs and preferred activities, this needs to take more account of any spiritual needs that people might have, with arrangements being made to meet any needs identified. The new manager and care standards officer are keen to promote an individual and person centered approach to care. Work needs to continue with the staff group to achieve this, and reduce institutional practices. Key inspection report Care homes for older people Name: Address: Whittingham House Whittingham Avenue Southend On Sea Essex SS2 4RH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 2 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Whittingham House Whittingham Avenue Southend On Sea Essex SS2 4RH 01702614999 01702436536 whittingham24@tiscali.co.uk www.southendcare.com Strathmore Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 77 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 77 The registered person may provide the following categories of service: Care Home only - Code PC 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 Dementia - Code DE Date of last inspection Brief description of the care home Whittingham House provides care and accommodation for 77 older people. The home is also registered to provide care for people who have dementia. Whittingham House is situated in a residential area close to Southend on Sea. It is close to local amenities and bus routes. The home is purpose built on two floors with a passenger lift to enable access to both levels. There is a total of 71 single bedrooms and 3 double bedrooms. Care Homes for Older People Page 4 of 30 Over 65 0 77 77 0 0 6 0 1 2 0 1 0 Brief description of the care home All rooms are en suite and for rooms in the new parts of the building this includes a shower facility. The home has a large dining room, a variety of lounges and a garden area. The Statement of Purpose and Service Users Guide and a copy of the last inspection report are available within entrance area of the home. A copy of the Service User Guide/Residents Handbook is also available bedrooms. The current scale of charges as quoted at the site visit ranged from £395.78 to £553.00 per week. Fees charged depend on level of needs and funding arrangements. There are additional charges for hairdressing, chiropody, toiletries, newspapers and other personal requirements. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent seven hours and a half at Whittingham House. As the home is large two inspectors undertook the site visit. However although the home is registered to provide care and accommodation for seventy seven people, only forty three were being accommodated when we visited. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. Care Homes for Older People Page 6 of 30 The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for Whittingham House was completed by the manager. Although not well completed it gave us some information and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents and staff. We received responses from eleven people living at the home, or their relatives had completed these on their behalf, and two members of staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the acting manager, care standards manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Although care planning has improved there are still shortfalls. There is not always a joined up approach to ensuring that peoples needs are fully identified, assessed for risk, acted upon and met in practice on a day to day basis. Although people are asked about their cultural needs and preferred activities, this needs to take more account of any spiritual needs that people might have, with arrangements being made to meet any needs identified. The new manager and care standards officer are keen to promote an individual and person centered approach to care. Work needs to continue with the staff group to achieve this, and reduce institutional practices. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that staff will try, through assessment processes, to ensure that the home will be suitable to meet their needs. Evidence: We saw that the home had a Statement of Purpose and Service Users Guide in place. The Service Users Guide had been reviewed in January 2010. It contained good information for people, including details of fees charged. Packs of information which included the Service Users Guide, Residents Handbook, and information about the Company and the homes that they own and manage, were available in the entrance area. Management confirmed that these were given to people when they expressed an interest in the service. Copies of the Residents Handbook were noted to be available in peoples bedrooms for them to refer to once they had moved in. On surveys most people said that they had been given sufficient information about the home before they moved in. People spoken with said that they or their families had been to look around the home before deciding to move in. Care Homes for Older People Page 11 of 30 Evidence: So that people interested in moving in, and management, know that the home will be suitable to meet peoples needs, the Company employs a placement co-coordinator. They carry out pre-admission assessments with people interested in moving into any one of the homes owned by the provider. Information is discussed with the manager and the admission arranged. We looked at the files of three people who had most recently moved into the home. We saw that good pre-admission assessments had been completed so that the home were aware of peoples needs when they moved in. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to receive the basic care and support they need, but this may not be based on robust planning that they are fully involved with. Evidence: On surveys and during the day of the site visit people living at the home and relatives told us that they were generally happy with the care they received at Whittingham House. People said, My friends and family have noticed how I have come on and how much better I am, I am more than happy here, and, The staff are generally caring and look after us well. Relatives said, Generally my [relatives] care is good and staff are kind and attentive. One relative said that although they were reasonably happy with the care provided that, I have noticed that sometimes standards slip. On surveys when we asked people if they received the care and support they needed, five people said that they always did, six that they usually did and two that they sometimes did. On the day of the site visit people appeared well groomed and were appropriately dressed. Staff were attentive to peoples needs. Management at the home are working hard to ensure that the care offered at the home continues to improve. For example the training manager for the organisation is working alongside Care Homes for Older People Page 13 of 30 Evidence: staff on a day to day basis to monitor practice and establish good standards. The care standards officer for the organisation is based at the home and working with the manager to make improvements to the service offered, and ensure that documentation fully supports and underpins the care and support offered to people. We saw that people living at at Whittingham House had individual care files in place containing various assessments, risk assessments, care plans and daily documentation. We looked at six care files to see how well care is planned for and arranged. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how staff are helped to meet peoples needs in an individual way. Since the previous inspection there has been a further change of manager at Whittingham House. The new manager has only been in post for a few weeks. Together with the care standards manager they are continuing to work on care plans to try and make them person centred and adequate to meet peoples needs. We saw that a number of changes and improvements had been made since our last visit. Care staff, through a new key worker system, are now being encouraged to be more involved with establishing and maintaining care plans. All records relating to each individual are now in one care file, this means that staff must access the care plans on a daily basis rather than concentrating on just maintaining daily records. There is guidance available for staff about how to maintain good daily records and the sorts of things they should be recording. Care files are being regularly audited by management to identify where the shortfalls are and highlight improvements needed. Where people are cared for in bed we saw that there were care records for fluids, turning and so on available that had been well maintained. Care in the home and supporting documentation has improved since our last visit. However, there is still some work to to to ensure that care for people is individual and based on good person centered care planning and robust record keeping. Care plans are divided up into ten different aspects of care for example personal care and skin care, and mobility, exercise and physical activity. These sections are then sub divided further to prompt staff to identify all aspects of needs. There was little evidence to show that people were proactivly involved in planning for their care. The care standards manager however said that she did sit down with people where possible and go through things with them to establish their needs and preferences. Care plans would generally enable staff to have a good idea about peoples individual needs, but they did vary in the level of detail and quality. Some were good and described peoples preferences and needs such as what time people liked to go to bed, covers and pillows required and so on. On others there was less detail. For example statements such as X needs assistance to dress and X needs assistance for oral care Care Homes for Older People Page 14 of 30 Evidence: will not assist staff in understanding peoples individual needs and help them to deliver care in a person centered way. In two instances we saw that the pre-admission assessment had identified the persons preferred term of address which was a shortened version of their name. In both cases this had not been picked up on by staff. Staff referred to them still by their full name, and this was the term that their care plans used. This does not demonstrate a person centered approach. In one instance we saw that although care plans had been reviewed they did not properly reflect the persons current needs. This may cause confusion for staff. We saw that risk assessments had been undertaken in relation to different aspects of peoples care such as the use of bed rails, however this information had not then been reflected in care plans, so may get missed by staff. On one file viewed the risk assessments had not been reviewed since January 2008. The care standards manager was aware of this and is continuing to review and update all care plans and risk assessments. Training records showed us that some staff have undertaken training relating to peoples health care needs such as continence, pressure area care and nutrition. We saw that further training dates are planned. On the day of the site visit a district nurse carried out a training session with some staff relating to the application of emergency dressings. This should assist them in supporting residents. On surveys nearly everyone said that they always received the medical support they needed. Records showed that people access appropriate health care to meet their needs such as district nursing, chiropody, opticians and general practitioners. Since the previous inspection work has been undertaken to improve the working relationship and co-ordination with the district nursing team. A treatment room has been set up for their use, and a member of staff is designated to assist the nurse when they visit. There is however still work to do to ensure that people are protected and cared for properly through good records and communication being maintained. For example, although risk assessments are undertaken in relation to peoples nutritional needs, tissue viability, risk of falls and so on, where these highlighted increased risk factors these concerns were not then carried forward into the persons care plan to make staff aware of any observations or remedial actions needed. Care files provide recording sheets for both general practitioner visits and any specialist visits. These were not being properly maintained. For one person there was no record on this sheet, or in their daily notes, that they had recently seen a specialist nurse for their condition. Sometimes district nursing visits had been recorded and sometimes not. For two people currently being treated by the district nurse their care plans did not reflect this or identify any actions needed. We noted that one person had a dressing on their leg. When we asked them about it they said they had caught their leg on a wheelchair a few weeks ago had seen the district nurse once, but not since. We saw that an accident record had been completed for the injury on 08/04/10. Their last record of seeing a district nurse was Care Homes for Older People Page 15 of 30 Evidence: on 10/04/10 when the wound had been cleaned and dressed. There was no record of the injury on their body chart. The care standards manager undertook to look into this. These issues have the potential to compromise peoples care. We did however see that people are regularly weighed to highlight any potential concerns. Nutrition records are maintained to monitor peoples diet. During the day people were encouraged to drink plenty. As part of this inspection we looked at medication systems and records and found that they were well maintained. Since the previous inspection the home have reviewed procedures and addressed the issues raised at that time. We saw that all expected records and documentation was in place. The records we sampled were accurate. There were clear records in place including a photograph of the resident details of any contraindications, where relevant information about any specific medications they were taking, and protocols in place for any medicines to be taken on an as and when required (PRN) basis. A good audit trail was being maintained of medicines in the home. We saw from care records that the medicines that people take are kept under review by their doctor. Staff have received recent training in the administration of medicines and we saw that clear guidelines were available to underpin staff practice. When we observed a medication round we noted that medication was left unattended on a dining table while the member of staff went to deliver medication to someone in the lounge. This needs to be addressed to ensure that there is no risk of anyone accessing these medicines while they are left unattended. Observations through the day showed that staff approached residents in a calm and kind manner. Staff treated residents with respect. Doors were kept shut when personal care was being carried out so that peoples privacy was maintained. We saw that staff knocked on peoples doors before they entered. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have some opportunities for occupation and activity. Evidence: Opinion about the level of activity available in the home was varied. On surveys when we asked if activities were arranged that people could take part in four people said that there always were, five that there usually were and four that there sometimes were. People said, The home provides outings and celebrations for birthdays, Easter, Christmas parties, entertainment afternoons at least once a month where we can all join in. Bingo and activities take place every week, The entertainment sessions are very good, Activities are provided three times a week by a staff member who also does this for other homes in the group, and, For the size of the home I feel that residents would benefit from daily activities. The organisation employs an activities co-ordinator whose hours are shared between different homes in the group. They work at Whittingham House on two or three days each week. They were working there on the day of the site visit. Staff do what they can to provide activity and stimulation when the activities co-ordinator is not available, but comments above indicate that this is not always achieved. There was an activities timetable in place to guide staff about what activities to undertake, with people being allocated to this role each day. We saw that activity assessments and activity questionnaires are now held within Care Homes for Older People Page 17 of 30 Evidence: peoples care files, although the activity is co-ordinator still keeps some separate records. Care plans sampled provided limited information or personal history that would assist staff in engaging residents on a personal level. At this visit staff observed did engage more with residents but did not routinely use everyday tasks as opportunities for engagement. One person told us, I feel the residents would benefit from more personal attention geared specifically to their needs rather than them all herded into one lounge area where one staff member can watch over them. Although most activities take place in one of the homes lounges, the home has a pleasant activity area that can be used. The activities folder included a record of the activities undertaken by people living in the home. These included bingo, board games, song and dance, skittles and so on. We saw that people also enjoyed reading papers and looking at books. Activities records showed that where people are cared for in their rooms that the activities co-ordinator also makes time to go and spend time with them. We saw that there was plenty of activity equipment available for people use. Each month a special event takes place relevant to the season such as May Day celebrations, a fathers day tea and summer barbecue and garden party. On the day of the site visit people participated in a music session and games in the morning and games in the afternoon. A mobile library visited in the afternoon and one resident went out with a member of staff. The local group of homes have access to a minibus that can be used to take people out. At the moment no church groups visit the home to provide an opportunity for people to fulfil their spiritual needs. Some pre-admission assessments identified that people were practicing in their religion and would like to attend church, but their care plans did not reflect this. Three people spoken with said they would like it if a church group visited the home so that they could sing hymns. This was relayed to the care standards manager who agreed to look into this. Visiting at Whittingham House is open and people can see their friends and family at any time. One relative said, They make families very welcome and several events throughout the year to which we are invited are well organised. During the day people came and went and were made welcome by staff. On one occasion however we observed that the visitors of one resident were offered and given drinks but the resident was not included in this. This perhaps demonstrates that further work is needed to develop staff and ensure that they think about their practice to ensure that it is resident focused and inclusive. During the day people were noted to spend time in their rooms or communal areas according to their choice. Care plans identified to a degree peoples choices in relation to daily routines such as getting up and going to bed. We saw that information on advocacy services was available, so that people will know where to go for independent support and advice if they wish. Care Homes for Older People Page 18 of 30 Evidence: People living at Whittingham House seemed mostly satisfied with the meals, although comments were varied. On surveys the majority of people said that they usually enjoyed the meals provided. That was a nice lunch, I usually have a choice but not always, The meals could have more choice, The food seems well thought out, but not really enough variety, and The food here is good were some of the comments made. The home offers a four week rolling menu that includes a choice of two main meals daily. Any changes made to the planned menus are recorded. The days menu was eventually written up on a white board for people to see. Some residents at the home require support to eat. We saw that this was carried out in a sensitive manner with the member of staff interacting well. Although people are reasonably happy with the food provided there is again a need to develop staff so that they start to operate in a less institutional and a more person centered way. Although staff told us that residents could have what they wished and Only had to ask, this was not actively promoted. For example at breakfast time we saw that people were given made up sandwiches as part of their meal. Two people told up that would like to have toast, but this had not been offered. Also at breakfast time the tea trolley took a long time to go round to everyone meaning that some people not only had a long wait, but that the tea was probably not very nice by the time it got to them. One person sitting in a lounge had not had a drink with their breakfast. They told us that they could have a drink in bed, but preferred to wait until they were up, but then had to wait a very long time before they got one. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their concerns will be dealt with and that they will be protected from harm and abuse. Evidence: The homes complaints procedure was last reviewed in April 2008 and it informed people about how to complain. On surveys five people said that they knew how to make a formal complaint. One person said They are very caring staff. Friendly and supportive and listen to our concerns. However six said that they did not know how to make a formal complaint. Management therefore need to ensure that people are fully aware of the ways in which they can raise any concerns. Complaints records showed that there had been four complaints made since the last inspection and all but one had been dealt with appropriately. The records detailed the nature of the concern/complaint, who investigated it, what actions had been taken and the outcomes. The fourth complaint was listed in the complaints log but there was no information in the file. The care standards officer told us that the home was waiting for information from the adult safeguarding unit before completing the appropriate forms. A discussion took place around the importance of recording the information at the time of the complaint/concern/allegation and the care standards officer confirmed that this would be done. The other three complaints recorded related to safeguarding incidents that had been referred to the safeguarding adults team. The complaints records showed that these Care Homes for Older People Page 20 of 30 Evidence: had led to safeguarding meetings taking place. The complaints forms were fully completed and showed the outcome of the complaint, which included the need for staff to attend an update in their safeguarding adults training and for staff to receive training in diabetes awareness. Whittingham House has a separate folder for recording compliments and we saw several thank you cards and letters in this folder. Some of the comments were very complimentary such as, I am very impressed with the kindness and care that XX received at Whittingham House, and, The home gave my relative a greater quality of life, they felt safe and secure, and lovely staff, kind and caring, and, I think that credit should be given to Strathmore for the quality and scope of the improvements made to the home. The AQAA showed that the homes adult abuse policy was last reviewed in April 2008. We viewed this at the last inspection and saw that it included information on the signs of abuse and the actions that staff needed to take should they suspect a person is being abused. The home has obtained a copy of the Southend Essex and Thurrock guidelines. The training matrix showed that twenty six staff had received safeguarding training in the past year and we saw certificates on the staff files to confirm this. Staff spoken with showed an awareness of the homes safeguarding procedures. Management are aware of proper procedures and the AQAA said, Should a safeguarding issues arise a SET SAF 1 form is completed and an investigation commenced. As indicated above the home has been the subject of a number of safeguarding investigations relating to the poor care and support of residents leading to health issues and hospital admissions. As a result of the number of concerns raised placements at the home funded by the local authority were suspended. The home have been working with social services and community health care professionals to address the issues raised and ensure that people receive proper care. As a result of this things are steadily improving at the home. One person told us, I feel happy, safe and secure here. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home. Evidence: Whittingham House generally provides a comfortable home for people. It is a large home consisting of seventy single and three double bedrooms. Rooms have en-suite facilities. Since the previous inspection the outdoor space at the home has been softened by planting and people were noted to use the outdoor space during the day. The home appeared well maintained. The home has access to a maintenance person and they check any faults that occur within the home. Records are kept of faults reported and when they have been addressed. Due to the number of extensions added to the original building, Whittingham House can be confusing to people. Since the previous inspection the home have tried to address this by improving signage and identifying different wings by letter. Feedback from the care standards manager indicated that this is helping people to be orientated and find their way round. The bedrooms that we looked at appeared comfortable, and people had many of their own personal possessions around them such as pictures, photographs and small ornaments. One person spoken with said I have not been too well because it has been very hot lately, but I am happy with my room and everything here. We noticed that the downstairs bedroom doors had pictures and photographs on to help people Care Homes for Older People Page 22 of 30 Evidence: identify their rooms, but these were not in place upstairs. The care standards officer told us that this is work in progress and will be completed soon. Although most rooms are of an acceptable standard, some rooms we noted to be in poor decorative condition with mismatched furnishings. The care standards officer told us that the refurbishment of the older parts of the building and the empty rooms was ongoing. When we looked around the home and we found that some of the bathrooms were not in use, with some being used for storage of equipment such as hoists wheelchairs. There were clear signs on each of the unused bathrooms to show that they were not in use but that they could be if required. The assisted baths had been recently serviced. As we walked around the building we noticed that a number of doors that should have been locked shut were left open and unlocked, these included sluice rooms. Other doors that were required to be kept shut according to the signs on them, were left open. The upstairs laundry room door was wide open giving people access to laundry products. As the home is registered to provide dementia care these issues could present a hazard to residents. Another potential hazard noted was that some areas of flooring in the dining area are lifting presenting a potential trip hazard. The care standards manager was aware of this and reported that options for dealing with the issue were being explored. When we visited the home was clean and fresh. Odour control was good. On surveys people said that the home was usually fresh and clean, and people generally felt that this aspect of the service was good. They made comments such as, The home is clean but occasionally a bit smelly, although I havent noticed any smell in the last month or so, Good clean accommodation, and, The home is clean and safe. As at the previous inspection there was one pair of yellow rubber gloves in both the upstairs and downstairs laundry rooms. This suggested that these gloves might be used by all staff undertaking laundry tasks which would not be consistent with good infection control practice. The acting manager later confirmed that disposable gloves and aprons had been placed in both laundry areas. The training matrix showed that most of the staff team had received infection control training in 2009. We spoke with one of the housekeepers that was working throughout the building and they told us that they had received good training and that there were generally two housekeepers on duty but sometimes there was three. There was no staff in either of the laundry rooms but both were well equipped, clean and tidy. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a competent, well-trained and supervised staff team, who are safely recruited. Evidence: Feedback on staff at the home was positive. People made comments such as, Most of the individual members of staff are very good, Staff are friendly, and, Very friendly and caring staff. We looked at the staff duty roster and it showed that depending on the level of occupancy there were between six to nine care staff in the morning and between six to seven care staff in the afternoon that were scheduled to work each day. In addition to care staff there is generally a cook, two kitchen assistants, two or three housekeepers, a laundry assistant and an activities co-ordinator working throughout the week. The activities co-ordinator is scheduled to work on a Monday, a Wednesday and a Friday each week. The duty roster showed that there was always four staff on duty throughout the night. The acting manager, the person in charge and the homes clerk all work full time throughout the week in addition to care and auxiliary staff and the care standards officer works between Whittingham House and the organisations other homes but told us that she is currently spending a lot of time in Whittingham House to support the new acting manager. On the day we visited the staffing provided seemed adequate to meet the needs of the decreased number of residents currently being accommodated. When we tested call bells staff responded within a reasonable time, call bells were not noted to be going for long periods of Care Homes for Older People Page 24 of 30 Evidence: time, staff seemed available to residents. However we did receive some comments indicating that staffing levels can be an issue. People said, Although staff are very good there are definitely not enough of them especially as a lot of residents need a lot of attention. As a result some of the residents are left calling for help/attention for long periods of time creating a stressful environment for all, Senior staff seem to spend so much time on paperwork which doesnt leave them enough time to do their job of caring for the residents, and, There could be more staff on duty, sometimes it is difficult to find anyone to speak to. Staffing levels and deployment therefore need to be kept under review, particularly as the number of residents living at the home increases. We looked the files of the five most recently employed staff members. This confirmed that people living at the home are protected by robust recruitment procedures being in place. Each file contained all of the required documentation including a completed application form, references, criminal records bureau checks (CRB) and Independent Safeguarding Authority 1st (ISA 1st) checks where the person started work prior to the CRB being received. Each of the application forms was fully completed and there was no gaps in the employment history. So that people are cared for by a well trained workforce it is recommended that at least 50 of care staff working in a home hold a National Vocational Qualification (NVQ) in care at level two or above. The AQAA showed that out of twenty five staff, eighteen were either working towards or had obtained their NVQ level 2 in care or above. The training matrix showed that nineteen staff are now doing so, and that seven staff have or will be completing their NVQ level 3 in care. Whittingham House have therefore achieved a good level of NVQ training and show a commitment to having a well trained workforce. There was evidence of induction to the home having taken place on all of the staff files that we looked at. Staff spoken with said that they had either been given a full induction or were still in the process of completing this. We saw certificates of training on three of the staff files that we looked at and these included infection control, diabetes awareness, pressure area care, food safety, first aid, fire safety, medication, nutritional care, dementia, Mental Capacity Act, epilepsy, wound therapy, wound therapy and palliative care. The other two staff files belonged to staff that had worked at the home for less than one month and they showed that the induction process was being progressed and the training co-ordinator told us that training courses were being arranged for them. The company are currently building a staff training centre on the Whittingham House site, this will provide further training opportunities for staff. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe and adequately managed. Evidence: There has been several changes to the management at Whittingham House recently. The home has been managed by two acting managers and other interim arrangements since February 2009. The effective management of the home has suffered because of this and people have been concerned about changes in management. One person said, I am concerned about the frequent change in management by the owners. This gives the impression that they are either not up to the challenge or fighting a loosing battle, another that, Im not sure who the manager is now. The most recent acting manager has been in post since April 2010. The current acting manager has an NVQ level 3 in care and an NVQ in dementia and has worked in the caring field since 2006. They regularly update their practice. Recent training includes epilepsy, safeguarding adults, infection control, nutrition, health and safety, wound therapy, medication and the Mental Capacity Act. Due to training and leave they have only been in the home for a limited period of time, and are currently being supported by the care standards Care Homes for Older People Page 26 of 30 Evidence: officer for the group. It is therefore too early to fully assess if the current management arrangements for the home will be successful in continuing to make and maintain improvements to the service. The home now has more robust processes in place to monitor the home and ensure that people receive a good service. We were shown a copy of the homes last quality assurance report which was published in February 2010. This provided a good picture of the home and included many quotes from the people that were surveyed. In the past few months many audits have been carried out by the management team including audits of the medication, the care plans, the falls records, recreation and laundry and housekeeping. The audits detailed areas for improvement and showed how they were to be met. In addition to these regular audits, the care standards officer has also undertaken a Regulation 26 visit on behalf of the provider and she has informed us that she will be taking over this role and carrying out the visit on a monthly basis as required in the Regulations. If people wish the home to help them to look after their monies we saw that they can feel confident that this will be done in a way that protects their interests. We checked a random sample of the cash and transaction records belonging to people living in the home and we found them to be accurate and up to date. We looked at five staff files and we found supervision notes on three of them. The other two staff files did not contain supervision notes as the staff had started work at the home within the past eight weeks. The supervision notes that we looked at covered areas of staff practice and any training and development requirements. Staff spoken with said that they felt well supported and they told us that they had regular supervision. We checked a random sample of safety certificates and they were all up to date. The fire drill records showed that regular fire drills take place. A fire risk assessment was in place. This had recently been reviewed and agreed at the fire officers visit, which took place in April 2010. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 12 People must be confident 01/03/2009 that their personal and healthcare needs are properly identified and managed through a robust and joined up care planning system. People should expect that staff are aware of their needs and meet them in a professional and consistent way. Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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