Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Waterloo House, St Mawes Upper Castle Road St Mawes Cornwall TR2 5AE The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynda Kirtland
Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home
Name of care home: Address: Waterloo House, St Mawes Upper Castle Road St Mawes Cornwall TR2 5AE 01326270570 01326270570 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Simon Geoffrey Trundle Type of registration: Number of places registered: Royal Mencap Society care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD- maximum of 8 places Date of last inspection Brief description of the care home Waterloo House is situated in the village of St Mawes on the Roseland Peninsula. The home provides care and support for up to 8 adults with learning disabilities. The home is a large detached property with sizable grounds. All service users have their own bedrooms. The home has a large lounge, dining room, and bathroom and toilet facilities. The home also has an activities room in the grounds. Wheelchair users can use the garden and the ground floor of the building. Mr Simon Trundle has been appointed as registered manager. He works alongside Asa Bosley, who is applying to be joint registerd manager of the home. They have a deputy manager, and are seen Care Homes for Adults (18-65 years)
Page 4 of 34 Over 65 0 8 Brief description of the care home by the people who live and work at the home positively. The range of fees at the time of the inspection is three hundrede and forty eight pounds to nine hundred and eighty five pounds per week. There are additional charges e.g. for hairdressing, newspapers etc. Care Homes for Adults (18-65 years) Page 5 of 34 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: A key inspection took place on 14 and 18 November 2008 and lasted for approximately eleven hours. The purpose of the inspection was to ensure that people who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that peoples placements in the home result in good outcomes for them. Information received from and about the home since the last inspection has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with the people who use the service. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the staff and management team. We talked to the people Care Homes for Adults (18-65 years)
Page 6 of 34 using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for two people. This is called case tracking. There were opportunities to directly observe aspects of peoples daily lives in the home and staff interaction with them. Some comments received from the people who use the service, plus surveys seen written by them included I dont think they staff could be more supportive, I have a good home and good friends, I cant think of what they could do better. A relative commented in a survey the staff are always friendly, approachable and clearly have my sons health and interests at heart. In discussion with staff they commented that the management team are supportive, are open to new ideas for improving practice and that they enjoy working at Waterloo House. The Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered person completed. The AQAA describes the services and facilities that Waterloo House provide and identifies what areas they do well in and where they want to make further improvements. What the care home does well: People who use the service have lived at waterloo House for a number of years and it was evident from talking with them, and observations of their daily lives that they are relaxed and enjoy each others company. It was also observed that staff interaction with people who use the service is also relaxed, managed at the individual persons pace and with appropriate humour. The homes statement of purpose and Service Users guide has been recently updated. The Statement Of Purpose is presented in written format. The Service Users guide is presented pictorially and in written format and sets out in clear concise language, pictures all about the home, what to do if you have a complaint and how to keep safe. The home operates like a shared domestic dwelling with staff support provided where it is needed to assist people to develop and maintain their skills and independence. People who use the service are encouraged and supported to develop their skills and independence in many ways. They are involved in developing their own care plans with assistance and support from staff. They attend reviews so that they know why they are placed at the home and via their person centred planning process identify what aspirations they are aiming to achieve e.g. developing a particular element of self-care to promote their skills and independence. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Access to health care is appropriate for the individuals needs and the medication systems in the home are satisfactory so that the risk of medication errors is to a minimum. People who use the service have access to social, educational, employment activities. People who use the service told me of holidays and day trips that they have been on, and their attendance at day centres, work placements and clubs. Activities are planned with the individual so that they have a choice as to which activity they would like to attend so that it makes it more person centred. Daily records are completed by either the person who uses the service or staff, which demonstrate the level of activities that take place for each individual both in and outside of Waterloo House. People who use the service have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. People who use the service participate in the choices of and preparation of food. People who use the service are involved in menu planning and the management teams stated this area is constantly being reviewed and discussed with people who use the service to ensure that peoples choices are catered for. People who use the service are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist them with their needs quietly Care Homes for Adults (18-65 years) Page 8 of 34 and unobtrusively. People who use the service were consulted about the decoration and furnishings of their rooms so that the home is personalised to reflect their tastes and preferences. It was clean and tidy throughout. The staff team demonstrated throughout the inspection positive interactions with people who use the service and assisted them with personal care needs in a discrete manner. Staff have had a comprehensive and valuable induction to the home. Staff confirmed access to training is available. The inspector was welcomed to the home in a friendly manner by staff and people who use the service. All were aware of the reason of the inspection. What has improved since the last inspection? What they could do better: No statutory requirements were identified at this inspection. Recommendations are identified to improve practices in the home further. These are in the areas of medication. The management team need to ensure that accurate monthly audits of Care Homes for Adults (18-65 years) Page 9 of 34 medicines is undertaken so that all medicines in the home are accounted for, and if there are any discrepancies this must be reported to us under regulation 37. By doing thorough audits, which are signed to say who has completed them it is hoped this will prevent medication errors. In addition when staff handwrite medication on to medicine sheets, known as transcribing, this needs to be witnessed by another member of staff as written correctly to again prevent medication being given for example at incorrect times. Lastly the medication cabinet needs to be attached to the wall for security. The only improvement that people who use the service could identify was more vehicles please. As the home is in a rural location, access to public transport is very limited. People who use the service attend a variety of activities individually and on occasions as a group and there is high demand for the use of the vehicle. The management team agreed that they do rely on staff good will to use their own personal cars as the homes car is always in use. It is recommended that the provision of a further vehicle is seriously considered especially in light of the fact that people who use the service contribute towards the cost of transport and would either not be able or would have great difficulty to attend their activities if further transport was not available. Staff levels should be reviewed. At the previous inspection it was recorded that two members of staff were on duty during waking hours. However this has reduced to a minimum of one person with other staff members contracted to work with identified people who use the service at specific times. Staff said in the main this does work especially during the week, as there are a number of staff coming to take people who use the service on particular activities. However at weekends staff commented that there are less staff around and at times you can be managing the whole shift, particularly form 1pm on to 10pm on your own with the responsibility of monitoring eight peoples care. The management team said they were aware of this issue and were reviewing staff rotas to look at particular times when more staff should be around and were aware that up to 8pm could be a time when more staff are needed to be available. However they are also in a dilemma as staff negotiates with people who use the service as to when they wish to use their contracted hours and form the rota around this. Therefore it is recommended that the management team review the staffing levels in the home, particularly around evenings and weekends taking into account peoples dependency needs to see if changes can be made for the benefit of people who use the service and for staff safety. It was observed that some areas of the home have difficulties with damp, which is showing in the lounge, dining area, quiet room, in particular. This must be addressed, as it looks unattractive and could cause difficulties for people who experience respiratory problems. Mencap have recently appointed a company to undertake fire risk assessments on all their homes, however Waterloo House have not had one completed and this needs to be organised to ensure that the home adheres to current legislation. Fire records were maintained satisfactory. Waterloo House will be reorganising two bedrooms, so that people who use the service will have the more comfortable bedroom. In light of this they must undertake a risk Care Homes for Adults (18-65 years) Page 10 of 34 assessment to ensure that changing of the rooms will be safe for people who use the service and staff and send a copy of this to the Commission. The inspector would like to thank people who use the service, staff, and management team for their kind assistance during this inspection process. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The homes Statement Of Purpose and Service Users guide inform people who use the service of the services and facilities that Waterloo House provide. People who use the service are involved in the admission process to the home so that they and the staff can make an informed choice if the home will be able to meet their needs. Each person has a tenancy agreement so that they are clear as to what is expected of them when living at Waterloo House. Evidence: From observations and talking with people who use the service it was evident that they are settled in the home, and that they get on well with each other and with the staff. A copy of the homes Statement of Purpose and Service Users guide is accessible at all times. The Statement Of Purpose is presented in written format. The Service Users guide is presented pictorially and in written format and sets out in clear concise language all about the home, what to do if you have a complaint and how to keep safe.
Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: From case tracking recent admissions to the home it is evident that the person who was referred to Waterloo House was fully involved in the admission process. A survey from a relative stated it has been 500 percent easier than I thought was possible. Documentation from other professionals to support the referral to Waterloo House was received so that the management team could include their assessments of what care needs to be provided and to assess whether the home could meet this. Each person who uses the service has a pictorial tenancy agreement which outlines the terms and conditions of residency at the home. In addition there are funding contracts with the sponsoring authority. Care Homes for Adults (18-65 years) Page 14 of 34 Individual needs and choices
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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 who use the service are aware of their care plans, which fully address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. Evidence: People who use the service, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. These are in written and pictorial form. Care plans provide people who use the service with specific goals to work towards, and inform and direct staff in how to support the individual to achieve this goal to encourage them to fully maximise their skills for independent living. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: In discussions with staff all said that they found the care plans easy to understand and were aware of the care planning processes. People who use the service have an identified key worker who ensures that the care plan is kept updated and the persons views are included in its development. People who use the service are involved in their monthly summaries, either writing them themselves or talking through with a member of staff who then records them, what they have done and achieved over the last month. People who use the service participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. There are also formal meetings held monthly so that they can discuss issues and make household decisions as a group. Staff were observed supporting individuals who required it, to make decisions about what to do during the day. People who use the service written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. People who use the service can choose the level of privacy they wish to enjoy in their private accommodation. People who use the service are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. Care Homes for Adults (18-65 years) Page 16 of 34 Lifestyle
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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 who use the service are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. Evidence: Individual care plans and daily care records provide good evidence that the persons interests and abilities are fully considered in planning their daily activities, which are planned with them individually. Some activities include attendance at day centres, work placements, college, clubs, swimming and walks for example. A daily record plus
Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: discussion with people who use the service confirmed the level and range of activities that they participate in. At the time of the inspection people who use the service were engaged in a variety of different and appropriate activities in and out of the home, with staff support provided as necessary. In addition daily care records show that they access a wide range of community resources with staff support, depending on their individual needs and abilities. The only improvement that people who use the service and staff could identify was the need for more vehicles. Currently the home has one vehicle to transport people who use the service to activities, work placements clubs etc. However as people who use the service are often on sole activities and due to the location of the home, which has limited public transport links, this means that the use of the vehicle is in high demand. The management team acknowledged that this is an issue as they rely on staff good will to use their own vehicles, as there is often a need for people to attend a variety of activities in one day and therefore not enough cars. It is recommended that this be reviewed, as people who use the service are reliant on transport to be provided for them by staff due to the limited public transport links. People who use the service do pay towards a transport service, which is provided by the home. People who use the service said, confirmed by records that they are encouraged to maintain valued relationships with their families and friends, with staff support as necessary. In addition the surveys from people who use the service and relatives confirmed this. People are able to make telephone calls in private if they wish. People who use the service said they could get up and go to bed when they wish and that staff knocked on their doors before entering (also observed). Locks are fitted to bedroom doors and a lockable tin to store money and valuables are available. People who use the service are supported and encouraged to eat healthily. People who use the service said they help with the choosing of food, planning for and preparing meals with assistance from staff. A rota showing that all agreed with the menus for that week was on display as was a rota showing who was responsible for what catering task on each day i.e. washing up, cooking etc. Nutritional needs and preferences are considered as part of the care planning process. People who use the service looked healthy and well nourished and said that they like, the food at the home. The majority of staff has gained the basic food hygiene course. Others are booked to attend. Records needed to be kept in respect of the handling of foods and cleaning schedules are maintained. The last environmental Health inspection was in January 2007 no issues were identified. Care Homes for Adults (18-65 years) Page 18 of 34 Care Homes for Adults (18-65 years) Page 19 of 34 Personal and healthcare support
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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems are satisfactory so that people who use the service health needs are managed safely. Evidence: Care plans address their individual personal care needs and with sufficient bathroom facilities the person is able to attend to their personal care privately. Healthcare needs are considered as part of the care planning process and regularly reviewed. In discussions with people who use the service and documentation showed that they access external healthcare providers, including specialists, when they need to. People who use the service records provide evidence that they access a range of local NHS healthcare providers on a regular basis so that they maintain good physical health and emotional wellbeing. The management team described how the home links with local specialist services to assist people with specific behavioural and emotional needs
Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: and consults with external professionals to ensure their needs are managed effectively and appropriately. All staff that handles medication are appropriately trained and there are certificates to provide evidence of this. Medication is stored in a locked cupboard but this needs to be attached to the wall for extra security. The mediation policy is in the main satisfactory but would benefit from expansion i.e. in the areas of as when required medication and homely remedies. Staff record medication that it has received, administered and disposed of. Documentation demonstrated that medication is administered and disposed of appropriately. There are no controlled drugs on the premises but one medicine is stored as controlled as per recommended guidelines. There was a discrepancy in the amount of medication that was recorded for this medicine and the actual amount in stock. This was identified on the first day of inspection and the management team took immediate action to identify how this error had occurred. On the second visit to the home the management team had identified that there was staff confusion as to which paperwork should be completed when this medicine was administered plus it was believed one of the tablets was administered on a holiday, and therefore could account for the discrepancy. The management team discussed in the staff team meeting the discrepancy and have clearly informed staff of which records should be used to ensure a repeat does not happen again. We were satisfied with the response of the management team and hence a recommendation has been made to ensure that a though monthly audit of all medicines, and a record of who has undertaken the audit, is taken and any errors must be reported to us under regulation 37. It is further recommended that when a staff member transcribes (hand writes) medication to be administered on the medicine charts that this is witnessed by a second member of staff to ensure that it is written as prescribed by the doctor so that medication is given accurately and at correct times. It was observed that in some cases the medication was recorded to be given as in the evening and in fact this was incorrect time. Again due to the management teams response in addressing this immediately a recommendation to this effect has been given at this time. A copy of the latest medicine guidance, Safe Handling of medicines in care homes was provided to the management team for guidance. From documentation seen it was evident that some discussions have taken place around the event of a persons death and their wishes. These are then documented in the persons individual file. Care Homes for Adults (18-65 years) Page 21 of 34 Care Homes for Adults (18-65 years) Page 22 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 who use the service are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. Evidence: People who use the service were encouraged to speak to the inspector if they wished so that they could make their views known or raise any concerns. No concerns were raised. People who use the service are aware of how to raise any concerns and Mencap have a formal complaints procedure, which has just been updated and is being cascaded to staff. It is a lengthy document and covers all the stages of the complaint procedure. However it is encouraging that the summarised version of how to make a complaint is on display for people who use the service. There are also informal opportunities (e.g. monthly house meetings, care plan reviews and 1:1 time) for people who use the service to raise any concerns with staff before they become serious complaints. People who use the service said if they had concerns they would be able to speak with staff. Some complaints have been received from people who use the service, being around the difficulties at time of living together as a group, and how these were investigated and what action was taken as a result of
Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: these was recorded. It was noted that the home has received compliments from family members and people who use the service through surveys and letters received at the home. There is a robust policy in respect of safeguarding both for people who use the service (pictorial) and for staff (written). It is advised that Mencap consider including the area of deprivation of liberty in the safeguarding policy and procedure in light of new legislation. Staff confirmed they have been on the multi disciplinary or adult protection courses and in discussions demonstrated a sound knowledge of adult protection issues and procedures. There is also a satisfactory whistle blowing policy. The care planning process explains how a persons money is to be looked after, which the individual has contributed too. Some people who use the service manage their own finances others receive staff support. From inspecting finances it was evident that there is a clear process in place for monitoring peoples money, expenditure and deposits and records of all transactions are kept and tally with the amounts kept in the home. People who use the service were observed to request money for activities and this was responded to promptly. The policy that the home keeps in respect of managing peoples money was still in draft stage dated 2006 and it needs to be clarified if this is the current policy in use. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. People who use the service are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Care Homes for Adults (18-65 years) Page 24 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The homes environment provides people who use the service with an ordinary, domestic setting so that they can develop their skills and independence in a noninstitutional setting. In the main the home is decorated and furnished to a good standard but further improvements are needed. It is safe and clean so that People who use the service are protected from risks of cross-infection. Evidence: From a tour of the home it was observed that the home was furnished to a good standard throughout. People who use the service confirmed that they helped with the choices of furnishings in the home and had personalised their bedrooms. However it was observed that there are several areas in the home, which have been affected by damp, living room, lounge, quiet room and this must be addressed as it looks unattractive and could affect people who may have respiratory difficulties. The management team have referred the issue to the maintenance team, which was recorded, but they acknowledged this has been an ongoing difficulty. This must be addressed for reasons stated above. The management team have completed environmental risk assessments to ensure that the premises are safe. They are aware of and addressing the on going maintenance that is needed in the home. New carpets
Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: were being ordered during the inspection and the management team said that it is planned for the bathrooms to be upgraded. Staff were aware of COSHH and relevant lockable storage was in place to store these items. Staff have attended infection control courses. It is recommended that to promote infection control further that the use of disposal paper towels, anti bacterial hand wash is used in the kitchen and toilet areas rather than using the current soap bars and towels. The management team agreed to address this. Waterloo House has spacious gardens, which they maintain with people who use the service. During the inspection it was agreed the sleeping in room would be moved to a downstairs room. The downstairs bedroom, which is currently vacant, has a small window in it, which allows limited natural light to enter the room, the room always has to have an electric light on during the day, as the room is dark. The upstairs sleeping in room is more airy and has a larger window and therefore more natural light enters the room. This change would promote a persons health and wellbeing further. The change of room would mean that the management team must undertake some risks assessments as the existing sleeping in room is next to a fire exit and therefore they will need to look at the risk of a person leaving the property at night, how they would know and also to assess what noise level the staff member would hear if people who use the service were needing assistance during the night. It is recommended some form of alarm system be installed. The management team agreed to undertake a risk assessment taking into account the above. Care Homes for Adults (18-65 years) Page 26 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. There are qualified staff on duty so that people who use the service can have confidence in their competence and skills. Staff training is encouraged so that up to date research and knowledge can be gained for the benefit for the people who use the service The homes recruitment policies and practices are fair, safe and effective so that people who use the service can be assured that staff are suitable to work in a care setting. Staff receives regular, formal supervision. Evidence: There is a minimum of one member of staff on duty at all times with other staff members contracted to work with identified people who use the service at specific times. Staff said in the main this does work especially during the week, as there are a number of staff coming to take people who use the service on particular activities as was observed during the inspection. However at weekends staff commented that there are less staff around and at times you can be managing the whole shift, particularly from 1pm on to 10pm on your own with the responsibility of monitoring eight peoples care. It is also noted that in the previous inspection report that two members of staff were on duty at the weekend and evenings. The management team said they were aware of this issue and were reviewing staff rotas to look at particular times when more staff should be around and were aware that up to 8pm could be a time when
Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: more staff are needed to be available. However they are also in a dilemma as staff negotiates with people who use the service as to when they wish to use their contracted hours and form the rota around this. Therefore it is recommended that the management team review the staffing levels in the home, particularly around evenings and weekends taking into account peoples dependency needs to see if changes can be made for the benefit of people who use the service and for staff safety. One member of staff sleeps in at night. Staff said they felt this was satisfactory, as the current resident group need minimal assistance during the night. Care staff support people who use the service with their personal care plus assistance with cleaning and some cooking tasks. From observations of staff interaction with people who use the service it was evident that they communicate with them in a competent, fair, patient manner and work with them at their pace. People who use the service said, as did surveys, that they like the staff team and felt able to approach them with any concerns or worries. During the inspection it was observed that people who use the service have a relaxed and respectful relationship with staff. Staff spoke positively about their recruitment, induction, and access to training and management support. They use regular relief staff when needed who know the people who use the service well and therefore provide consistency of care. The staff team are experienced in working in the area of learning disability. Over fifty percent of staff has a minimum of a NVQ level 2 with two people near completion of this qualification. All staff has a individual training programme and staff, plus documentation confirmed that access to training courses such as medication, health and safety, infection control, manual handling has occurred. The homes staff recruitment records indicate that staff are appointed on the basis of written application forms and equal opportunities interviews. People who use the service are involved in the recruitment process and notes of the interview are kept. Appropriate checks are made of their suitability to work with vulnerable adults in a care setting. Staff, confirmed by documentation, stated that there is regular formal supervision. Care Homes for Adults (18-65 years) Page 28 of 34 Care Homes for Adults (18-65 years) Page 29 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified and experienced to run a care home as are the rest of the management team. The home is well run for the benefit of people who use the service. There are formal and informal systems in place to ensure that people who use the service views are accounted for in the day-to-day running and ongoing development of the home. Policies and procedures are reviewed. There are systems in place to protect People who use the service, staff and visitors from avoidable harm and injury. Evidence: The registered manager, Simon Trundle has managed Waterloo House for two years. He has the Registered Managers Award and is near completion of his NVQ4 in health and Social Care. Due to a recent training secondment he now works at the home eighteen and a half hours per week and shares the management role with Asa Bosley. Asa Bosely is in the process of submitting his registered manager application to us. He has many years experience of working in social care and has a postgraduate certificate in management studies, he is currently studying for the NVQ4 in health and Social
Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: care. Both were viewed positively by the staff team, as is the deputy manager. They all keep their training up to date. From discussions with people who use the service, staff and the surveys inspected, all spoke positively about the management skills and felt they are approachable and listened to their ideas or concerns. From observations, all interacted with them in a relaxed manner. An annual quality assurance process occurs and the home is in the process of completing this years quality assurance. Results form this were positive in the care and facilities that the home provide. Monthly house meetings, plus fortnightly staff meetings, regular staff supervision and reviews via the care planning process also feed into the annual quality assurance procedure. The regional director last visited the home (called regulation 26 visits) in July 2008. Her visits had been monthly but the last couple had needed to be cancelled. These should be reinstated so that an overview of the service is maintained. The management team were informed that the findings of the quality assurance process should be forwarded to the Commission with any actions they intend to take. Records are stored confidentially, and recordings adhere to the Data Protection Act. The management team were advised when they need to report incidents or events are reported to the commission under regulation 37. Mencap review the operational policies and procedures on annual bases. The homes environment appeared safe and there are written individual and environmental risk assessments in place to minimise risks to people who use the service and staff working in the home. Maintenance of the home and its equipment are satisfactory. The homes fire safety records were completed and up-to-date. There are records of regular tests and checks of safety equipment and procedures in the home to ensure people who use the service, staff and visitors safety. People who use the service knew the fire procedure as this is practised regularly, and the fire poster is presented in pictorial and written manner. The Fire Company inspected the premises in May 2008. It is recommended that the home implement a fire risk assessment to ensure that it is compliant with recent legislation. Care Homes for Adults (18-65 years) Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 34 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 14 A review of the homes accessibility to transport for People who use the service should be reviewed to ensure that there is suitable, safe transport available to people who use the service at all times to meet their social, educational and work commitments. Monthly medication audits must be undertaken so that all medicines in the home are accounted for, and if there are any discrepancies these must be reported to the Commission under regulation 37.When transcribing medication this must be witnessed by a second member of staff so that the instructions on how to administer medication are recorded correctly and prevent medication errorsThe medication cabinet should be fixed to the wall for greater security. The damp areas in the home need to be repaired for the benefit of the People who live at the service. Staffing levels should be reviewed to ensure that there are sufficient qualified staff on duty at all times to meet people who use the service care needs and ensure their and staff safety. A fire risk assessment adhering to recent legislation must be undertaken to ensure the home is fully compliant with fire requirements.
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