CARE HOME ADULTS 18-65
Wimborne Road (104) 104 Wimborne Road Southend On Sea Essex SS2 4JR Lead Inspector
Mr Trevor Davey Unannounced Inspection 22 February 2006 09:15a
nd Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 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 Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 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 Adults 18-65. 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. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Wimborne Road (104) Address 104 Wimborne Road Southend On Sea Essex SS2 4JR 01702 603698 01702 603698 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) MCCH Society Limited Mr Michael George Sharp Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14/09/05 Brief Description of the Service: 104 Wimborne Road provides accommodation and personal care for up to six adults with a mental disorder. The premises are a two-storey house in a residential area situated in Southchurch, Southend-on-Sea and is in close proximity to all local community facilities, amenities and transport links. The accommodation includes six single bedrooms all of which have call bells, television and telephone points. There are separate lounge and dining areas, kitchen, and a small garden with a patio. The surrounding area provides good parking facilities. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 22nd. February 2006 lasting three hours. The inspection process included discussions with the shift leader who was in charge at the time, and an agency member of staff. In addition, the Inspector had conversations with two of the residents who were in the home at the time. A tour of the premises took place and a sample of policies and records were inspected. Seventeen standards were covered and requirements and recommendations are listed in the report. What the service does well: What has improved since the last inspection?
Since the last inspection, the bathroom floor surface has been renewed and a new freezer installed in the kitchen. Staff are currently in the process of working through booklets with individual residents regarding their expectations
Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 6 of the service which is an initiative funded by the Department of Health. This is intended to look at the outcomes of social care for adults from a carers and users point of view. This includes questions relating to social life, advocacy, help with finances, relationships with mental health workers and other relevant issues. This is one process, which the home is adopting to clarify more specifically, the opinions and comments of residents regarding services provided and their accessibility. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective residents individual aspirations and needs are assessed as part of the pre-admission process to determine the suitability of the home and the services to be provided. EVIDENCE: Supporting evidence was available to show that the individual aspirations and needs of prospective residents had been taken into account. This included mental health assessments as well as the role of the care co-ordinator and consultants names. Other details included reasons for referral, personal history, sensory problems as well as communication difficulties. These records also included past and present mental health issues with supporting networks. Other supporting evidence was available from which care plans had been prepared. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&7 Residents are consulted on a regular basis regarding their changing needs, which are reflected in individual care plans. Not all risk assessments had been updated to reflect changing needs and circumstances. EVIDENCE: Personal care records included signed protocols indicating where residents had been involved in discussing the level of care and support required. Because of the special working arrangements, which exist, keyworkers from the staff team have a specific role in carrying out this process. Some of the personal care records sampled during the inspection, were not always cross referenced with regard to review dates and where changes had occurred. One care plan relating to a depot arrangement had been dated April 2005 without further reference for this to be reviewed. A risk assessment had been drawn up in December 2004 in respect of mobility issues affecting one of the residents when going out which had been reviewed in February 2005. It is understood that this risk assessment is no longer applicable as medication had been reduced by the community psychiatric nurse with the result that the resident was able to walk outside the home unaided. The risk assessment had not been
Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 10 signed off to reflect this change in circumstances. Monthly evaluations had been completed which give an overview of holistic care and issues encountered. This information included behaviour, moods, incidents, physical health, opportunities and goal/care plans. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 The home’s philosophy of care enables residents to be involved in making decisions regarding their lifestyle and daily activities, ensuring that individual rights and responsibilities are respected. Residents are involved in selecting and preparing their own meals. EVIDENCE: Some of the residents were out during the inspection and daytime activities include: art and craft/pottery, shopping and attending sporting events. Staff accompany residents on outings as well as visits to local shops. Day trips and holidays are discussed and arranged in line with resident choice having looked at brochures and other information. These outings included Beatles weekend in Liverpool and visits to the Christmas lights in London. Staff encourage and accompany residents to attend various day-care facilities but at the same time, respect the wishes of residents who may choose not to attend on a regular basis. Some of the residents spoken to confirmed that they were able to make their own decisions and that these were respected by staff and that they were able to have the freedom of choice to choose their own preferred daily routines. Some of the residents have good relationships and regular contact with members of their family. Staff are frequently involved in supporting and advising relatives with issues which may arise as a result of tensions
Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 12 experienced when home visits take place. At the time of inspection, there were no infringement of rights with protocols and support arrangements, being successfully discussed and agreed with residents. Residents had also agreed to carry out domestic chores in the home on a rota basis. Weekly menus had been agreed and signed for by residents indicating, as necessary, alternative meals preferred. A record of meals provided was also in place. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19 A holistic approach is taken in meeting the health and personal needs of residents. The service received from some health care professionals is good but this is not always consistent, particularly when support of an urgent nature is required. EVIDENCE: A recommendation was made in the last inspection report that an approach be made to the Primary Care Trust with a view to improving the continuity of support provided to residents where there are on-going mental health care needs. In emergency situations, Crisis Intervention has been contacted by the staff team and if unable to respond, the home was advised to contact the local police. Some of the residents often see different community psychiatric nurses and consultants when attending their individual appointments which raises the anxiety level of residents. Whilst regular reviews may be agreed as necessary to monitor the mental health care needs of residents, these do not always take place unless appointment dates are initiated by staff of the home. This is seen as unacceptable and can be frustrating for residents as well as being difficult for staff to manage, particularly when emergency situations occur. These issues have initially been raised by the Registered Provider as well as the Commission for Social Care Inspection with the Primary Care Trust and the Registered Provider should continue to liaise with the P.C.T. to find ways of improving the delivery of service.
Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X EVIDENCE: Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Procedures are in place for on-going maintenance and upkeep of the premises to ensure residents live in a homely, comfortable and safe environment. EVIDENCE: Procedures were in place for the regular maintenance and servicing of the premises. Appropriate furnishings and equipment had been provided in the home and the floor surface of the bathroom had been renewed since the last inspection. A new freezer had also been installed. Residents have single bedrooms giving private individuals space and the building is both functional and lends itself to a homely atmosphere. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Residents are supported by an effective staff team where individual and joined needs are met. Training needs are identified and appropriate instruction/courses are provided to improve the skills of the staff team. EVIDENCE: At the time of inspection, sufficient levels of staff were available with appropriate skills mix in order to support and meet the needs of residents. A current rota was displayed showing the deployment of staff and cover throughout a 24 hour period. It was not possible to inspect the recruitment records on this occasion as the manager was off duty. These will be assessed at the next inspection. Written confirmation was available, however, showing that the agency had checked recruitment records for their own staff who work in the home. One of the agency staff who was working on shift at the time of inspection confirmed that he had been to the home on a number of occasions and that the permanent staff had been supportive. Training completed included moving and handling, medication administration and an awareness of the reporting procedures for the prevention of harm to vulnerable adults. Other staff training records were available and courses completed included challenging behaviour, care planning and it is the practice for staff training needs to be discussed in supervision with courses being arranged accordingly. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Residents’ benefit from a well managed home and their views are sought regarding services provided. Whilst residents comments are taken into account, there was no clear indication that the Registered Provider had given any response or feedback to residents relating to the ongoing development of the home. The health and safety of residents are promoted and protected. EVIDENCE: The Manager is experienced and has demonstrated managerial skills in the daily operation of the home in the interests of residents as well as promoting the skills of the staff team. Key staff have been delegated responsibilities and good communication/training takes place to assist in the smooth running of the home. A record of meetings held with residents was available which take place each month although not all residents choose to attend. Regular visits take place to the home on behalf of the Responsible Individual each month to monitor progress and obtain the views of residents. Staff are going through individual booklets with residents to obtain their views and expectations of services both in the home and in the local community. This initiative has been developed by the Royal College of Psychiatrists, Research Institute and the
Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 18 National Schizophrenia Fellowship as well as the Department of Social Work, University of East Anglia. It is understood that views expressed by residents and the staff team are referred to meetings of Area Managers but there was no feedback of outcomes from the Registered Provider to show service users regarding any possible future development of the home/service. Current gas and electric safety certificates were in place and health and safety policies are referred to by the staff in the interests of residents and the staff group. Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x x x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 x x 3 x 2 x x 3 x Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 14(2) Requirement The Registered Person must ensure that care plans and risk assessments are kept under review and revised at any time when it is necessary to do so, having regard to any change of circumstances. The Registered Person must ensure that clear & reliable arrangements are in place with the Primary Care Trust to ensure proper provision for the care and where appropriate, treatment and supervision of service uses is provided and that any necessary advice and other services from the mental health care team are available. The Registered Person shall establish and maintain a system for reviewing at appropriate intervals, and improving the quality of care provided at the care home. A copy of any report in respect of any review conducted should be sent to the Commission for Social Care Inspection and a copy made available to service users. Timescale for action 31/03/06 2 YA19 12 & 13 31/03/06 3 YA39 24 01/10/06 Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wimborne Road (104) DS0000015488.V280988.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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