Inspection on 22/10/07 for Warrington Community Living - Twiss Green

This inspection was carried out on 22nd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Warrington Community Living -... 28/09/06

Warrington Community Living -... 06/12/05

Warrington Community Living -... 25/07/05

Warrington Community Living -... 25/01/05

Warrington Community Living -... 03/08/04

Warrington Community Living -... 02/12/03

Warrington Community Living -... 04/09/03

Warrington Community Living -... 11/09/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Warrington Community Living - Twiss Green 53 Twiss Green Lane Culcheth Warrington Cheshire WA3 4DQ Lead Inspector David Jones Unannounced Inspection 22 and 29 October 2007 10:00 Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 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 Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warrington Community Living - Twiss Green Address 53 Twiss Green Lane Culcheth Warrington Cheshire WA3 4DQ 01925 766982 01925 766982 leswhittle@hotmail.com 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) Warrington Community Living Leslie Andrew Whittle Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4), Mental disorder, excluding of places learning disability or dementia (1) Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximum of 4 service users to include: * Up to 4 service users in the category of LD (learning disability not falling within any other category. * Up to 4 service users in the category of LD (E) (learning disability over the age of 65) may be accommodated. * 1 named service user in the category MD (mental disorder) may be accommodated. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidance that may be issued through the Commission for Social Care Inspection The registered provider must ensure that Mr Leslie Whittle achieves the Registered Manager’s Award by 1st November 2006 28th September 2006 2 3 4 Date of last inspection Brief Description of the Service: Twiss Green is a care home for four adults with learning disabilities. It is owned and run by Warrington Community Living, a registered charity. The establishment is a domestic style four-bedroom bungalow in a residential area of Warrington and blends in with neighbouring properties. The building has been adapted to accommodate the needs of people with a disability. There is level access throughout the home and preparations are being made to provide additional bathroom facilities. Information about Twiss Green, including copies of the most recent inspection report, is made available to each resident and their representatives and can be acquired by contacting Warrington Community Living on 01925 246870. Fees range according to the needs of the individual. Contact Warrington Community Living on 01925 246870 for further information. There are no additional charges made other than transport costs, which are shared between the four people who live at the home. They also pay staff’s expenses for admission fees, food and drink when staff escort them on outings. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of 53 Twiss Green Lane was unannounced. It included a visit to the home that took place over two days taking 7 hours and 10 minutes in total. The visit was just one part of the inspection. Before the visit, the registered manager was asked to complete a questionnaire to provide detailed information about the home and how it is meeting the needs of the people who live there. CSCI questionnaires were also made available for the people who live at the home, their families and health and social care professionals, such as nurses and social workers, and their views have been taken into account. Other information received since the last key inspection was also reviewed. During the visit, various records were looked at and a tour of the home was carried out. Observations were made of how staff interacted with and provided support and care for the people who live at the home. One of people who live at the home was spoken with. They gave their views and these have been included in this report. What the service does well: Twiss Green Lane is well maintained and the needs and preferences of the people who live there have been taken into account in the decoration and furnishings so they live in clean, comfortable surroundings that suit their needs. There are thorough and established processes to make sure that the needs of people moving into the home can be met there and to help them to settle into their new home. This includes encouraging people to visit several times before they move in to get to know the home and the other people who live there. Care plans for each person are drawn up with them so appropriate arrangements can be made to meet their needs in the way they prefer. The manager and staff have good working relationships with health care staff who are involved with the care of the people who live at the home. This ensures good joint working to make sure that people’s healthcare needs are met. One person who lives at the home said they were happy with the care provided and a health care professional commented on how much one person who had moved in had gone from strength to strength. Managers and staff work to help people who live at the home to develop their skills, including social, emotional, communication, and independent living skills. Where resources permit support staff help people to take part in social Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 6 and recreational activities in the community so they may lead fulfilling and active lives. What has improved since the last inspection? Care plans continue to improve. They are more detailed and include a wider range of personal care and support needs and are generally kept up-to-date. This means that staff have access to appropriate guidance on meeting the health and basic social care needs of the people who live at the home. Health care is monitored and any problems and indications of ill health are dealt with at an early stage. A visiting health care professional was complimentary about the staff team confirming they work in partnership to make sure the health care needs of each person who lives at the home are met. The recommendations of the speech therapist on helping people with their meals and swallowing is included in each person’s care plan. Support staff were seen to be sensitive to the needs of these people when helping them with their meals and to be following the guidance given so each person was comfortable and at ease. Some progress has been made to introduce person centred planning for each of the people who live in the home. Some background work has been completed and special review meetings known as individual personal planning meetings or IPPs have been arranged so staff can work with each person’s representatives help them plan their care to make sure they do the things they want to do and receive care and support in the way they prefer. Staff training records have been improved so managers and staff know what training staff have had and what further training they need to do to meet the needs of the people who live at the home. Almost 70 of the staff team either have a recognised qualification in care or are working towards one. This means that the majority of staff employed at the home have the skills they need to meet people’s needs and ensure their well being. Some new staff have received training on equality and diversity which will help them understand the rights and differing needs of all people who may use the services provided by the home and Warrington Community Living. Further progress has been made to introduce effective quality assurance processes in the home. Warrington Community Living is revising quality assurance procedures and the manager is involved in a pilot project with other senior staff within the organisation. This work has not yet been put into practice but the manager expects to be able to produce a report on quality issues in the near future. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 7 What they could do better: Information provided by the home including the statement of purpose, service users guide, and complaints procedure should be produced in a range of easy read formats so people with a learning disability are helped to understand it. They should also be provided with a document that confirms terms and conditions so they know their rights and responsibilities in relation to the services they receive. Care plans and care planning arrangements have improved since the last inspection; however risk assessments and risk management plans must be put in place for all people who live at the home so they are safe and their independence is promoted. Other important records including care plans and complaints records must be kept up-to-date and available in the home so managers and staff can use the information to make sure that care needs are met. Support staff need to interact with the people who live at the home in a way which reinforces their rights and promotes dignity and respect. They should also help them to interact with each other and welcome visitors to their home so their independence is promoted and their rights reinforced. Appropriate arrangements need to be made to meet each person’s social needs and senior staff should report all unmet needs to the specialist learning disability social work team so they can help in making alternative arrangements, where possible. This will make sure that each person’s social needs are met as far as possible. Plans to improve and provide appropriate bathroom facilities must be put into practice so all people who live at the home have the bathing facilities they need. There should be enough staff available with a skill mix suitable to meet the needs of the people who live at the home. When it is known that there will not be enough staff at any one time, action must be taken so other arrangements are made to ensure that the needs of people are met. New staff must not be employed to work in the care home until all appropriate recruitment checks and required documentation are in place so vulnerable people are protected from the potential for abuse or poor practice. All new staff must receive the training they need so they have appropriate skills and knowledge to meet the needs of people who live at the home before they are allowed to work with them in an unsupervised capacity. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 8 Records of the handling of each individual’s money must be sufficiently detailed to confirm what has been spent on staff to pay for their meals and drinks or other expenses during escorted outings. Recommendations made by the Health and Safety Auditor should be acted upon without delay to ensure the health and safety of staff, visitors and people who live at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 9 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 Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs assessed to make sure they receive the care and support they need. EVIDENCE: There are established procedures for introducing new people to the home. These are designed to enable the individual and their representatives to make an informed choice. The manager and support staff work closely with the individual and their representatives including family members, health and social care professionals to make sure that the person’s needs are assessed before they move in. Care plans are drawn up with the individual so appropriate arrangements can be made to meet their needs in the way they prefer. People interested in living at the home are encouraged to make a number of visits so they can familiarise themselves with the accommodation and meet and get to know the other people who live there. There is a statement of purpose that sets out the objectives and philosophy of the home and a service users guide, which provides information on facilities and services provided. The manager is looking at ways of making these documents available in a range of formats including using photographs and Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 11 illustrations to make the information easier to understand. The service users guide needs development to include a standard form of contract. This will ensure that the people who live at the home and their representatives have written information about terms and conditions so they know their rights and responsibilities. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and the staff recognise the right of people who live at the home to take control of their lives and to make their own decisions. However, risk assessments are not in place for all people who live at the home and staff lack some of the guidance and support they need to make sure each person’s needs are met. EVIDENCE: Reading of case records and discussion with manager, support workers and people who live at the home confirmed that the care plans for the people who live at the home have continued to improve. They are more detailed and include a wider range of personal care and support needs and are generally kept up-to-date. However it was noted that arrangements for one person’s health care had changed after visiting their GP but the care plan had not been updated since the visit. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 13 Support staff were generally aware of each person’s basic health and personal care needs and said that they had enough information to meet those needs. However, one support worker who was on duty alone in the home was unaware of important aspects of two individual’s care and had not received the training they would need to ensure their health and safety in the event of an emergency. Over the last 18 months, managers and staff have been working to improve the care planning arrangements used in the home by introducing “Essential Life Style Planning” so arrangements for care and support are more person centred. Essential Lifestyle Planning is a way of helping the people who live at the home to express their diverse needs from their own point of view and personal outlook on their lives. However, only limited progress has been made in introducing this new system. Some background work had been done but staff were unable to find this for one person. Although a planning meeting had been arranged for this person the following day, staff were unaware of what preparations had been made for the meeting. It is important that the manager and staff build on the work done so far and incorporate the outcomes of the “Essential Life Style Planning” assessments in each person’s care plan. This will make sure that staff are clear about how they are working to meet each person’s needs and goals. The manager advised that staffing problems had prevented staff from developing the home’s person centred care planning processes but further “Individual Personal Planning” meetings, known as IPPs, had been arranged. These will help staff to develop arrangements for care and support so each person receives care in the way they prefer. Risk assessment is central to the home’s care planning system and support workers were aware of the importance of helping the people who live at the home to explore their opportunities and take an element of risk as part of an independent lifestyle. However, this was not always confirmed in their respective case records. Usually, case records include a detailed risk assessment that identifies potential hazards in each person’s daily life and provides guidance on how risks are to be managed. This will make sure that the individual is safe but their quality of life is not unduly restricted by unnecessary safety measures and controls. However it was noted that there were no risk assessments for one person who had complex needs. Therefore it was not clear how staff were helping this person to manage risks associated with new activities and possible complications in their daily lives. For example, this person had diabetes and although this was well managed there was no evidence within the case records to confirm that staff had risk assessed this or considered what would need to be done to help the individual should they experience hyperglycaemia. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home are supported to maintain family links and daily routines promote individual choice and freedom of movement. However, a lack of available staff and inadequate planning has meant that some people have missed out on activities and opportunities for leisure, recreation and social interaction. EVIDENCE: Managers and staff work to help people who live at the home to develop their skills, including social, emotional, communication, and independent living skills. Where resources permit, support staff help people to take part in social and recreational activities in the community. One person can attend a day centre on a regular basis and others are encouraged to get out and about in the community visiting cafes, going for walks and shopping. However, staffing shortages have resulted in people missing out on activities, including planned activities, because there have not been enough staff to support them or Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 15 transport them to the day centre. Information provided by health a social care professional indicates that alternative arrangements could have been made to cover this if contact had been made with the social work team when it was clear that there was a lack of available staff. The manager advised that he is introducing person centred planning to ensure that staff take a more proactive approach to care planning and providing adequate support. This will help each person to identify their goals and help staff to focus resources on providing them with the help they need to achieve their goals or enjoy new experiences. Discussion with staff and observation confirms that they help the people who live at the home to take part in day to day domestic tasks such as cleaning and tidying the house and making shopping trips to the local community. One care professional said that the person they support had been able to develop their confidence and was now more inclined to take part in activities and venture out into the local community. One of the people who lived at the home said they liked the staff and they were kind. However interactions between support staff and other people who lived at the home were observed to be infrequent and task orientated rather than person centred. For example, when one of the people returned after a shopping trip the accompanying staff member did not greet the other people who lived at the home or initiate greetings between each individual. In another instance when a person who had no verbal communication presented with agitated behaviour staff did not respond to them to identify the probable cause. When staff were asked they suggested that the agitated behaviour could be caused by lack of stimulation and they put the radio on. This appeared to have a positive affect as the individual relaxed and enjoyed the music but another staff member turned the radio off because they needed to concentrate on something. Support staff should always seek to reinforce the rights of the people who live at the home by putting their needs first and acknowledging that it is their home by greeting them and interacting with them. Social interaction should be stimulated between each individual so they may benefit from each other’s company and companionship. The records and discussion with staff confirms that a healthy, varied and nutritious diet is provided. One person who lives at the home said the food was good. They were aware of their own dietary needs and were satisfied that an appropriate diet was provided. Support staff were seen to be sensitive to the needs of people who needed help with eating meals. They were aware of the importance of following guidelines provided by the speech and language therapist and gave assistance at the pace of the individual, making sure they were comfortable and at ease. Links with family members are supported and relatives are generally kept informed of significant events in the home. Relatives said they were satisfied with the standard of care facilities and services provided but concerns have been raised regarding the lack of available staff which has had a negative Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 16 impact on the staff team’s ability to meet the social needs of all people who live at the home. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on individual needs but staff do not always have the knowledge, skills and guidance to make sure health care needs are met. EVIDENCE: The aims and objectives of the home reinforce the importance of treating people with respect. Personal support is provided in private and individual preferences are recognised and met. However, some care practices observed did not reflect good practice. For example, a support worker approached a person who lives at the home from behind and moved their wheelchair to take them to their room without attempting to communicate with them or tell the person what was happening. In other respects staff were seen to be skilled and sensitive in their approach, including helping people when eating their meals, which was done well with attention to detail by making sure the individual was at ease and the care plan followed. Each person’s health care needs were recorded in their respective care plans along with guidance for staff on how they are to be met. Health care needs Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 18 are monitored and potential problems and indications are identified and dealt with at an early stage. A visiting health care professional was complimentary about the staff team indicating they work in partnership to ensure each person’s health care needs are met. “Anticipatory Care Calendars” have been introduced to help staff monitor each person’s health and well-being. These had not been completed since the beginning of September for one of the people living at the home and not since the beginning of October for the three others. Staff said that these documents had been misplaced. However relevant information confirming contact with health care professionals was recorded in each person’s daily diary. Arrangements for the storage, recording and administration of medicines were satisfactory in the main. All staff, with the exception of one, had received training in the administration of medication. However one recently recruited staff member was on duty alone and unsupervised did not know the circumstances in which prescribed rescue medication would be given. They were aware that one of the people who lived at the home had been prescribed rectal diazepam to be given in the event of a severe epileptic seizure but were not aware that another person had also been prescribed the medication to be used in certain specific circumstances. The staff member had received training on administration of medication but had not received training in the administration of rescue medication. This meant that two of the people who lived at the home were at risk of not receiving their medication when needed and their health and welfare was at risk. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a detailed complaints procedure and are protected from abuse. However, action must be taken to ensure complaints are recorded so managers and staff can demonstrate accountability and complaints can be reviewed to make sure they are acted upon. EVIDENCE: Warrington Community Living has a detailed complaints procedure. This should be made available in a format that is suitable and accessible for the people who live at the home and their representatives. Various methods of communication should be explored including using illustrations and possibly audiovisual media. Two complaints received since the last inspections were not properly recorded. The complaints records at the home made no reference to these complaints and the complaints book kept at the head office of Warrington Community Living head office only made reference to one of them. Further discussion with the registered manager and chief executive confirmed that both complaints had been acted upon and where necessary action had been taken to address concerns identified during the investigation process. However it is important that a record of all complaints about the operation of the care home and action taken in respect of any such complaint is kept up to date and within the care home available for inspection. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 20 Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. Information provided by the manager confirms that most care staff have received guidance in the implementation of adult safeguarding procedures so they will know what to do in the event of any suspicion or evidence of abuse. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained so the people who live there have comfortable, bright and cheerful accommodation of a design and layout that generally meets their needs and action is being taken to improve bathroom facilities. EVIDENCE: Twiss Green Lane is a bungalow in keeping with the local community. It provides comfortable, bright and cheerful accommodation that is generally suitable for the needs of the people who live there. Adaptations have been made to the building over time to meet the changing needs of the people who live there, including the provision of overhead hoist tracking and level access throughout the home. Automatic hold open-closing devices have been fitted to bedroom doors and specially designed beds have been acquired in accordance with the recommendations of a visiting occupational therapist. Further improvements are planned to make the bathroom accessible to all people who live at the home. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 22 The home does not have a sluice facility. However appropriate arrangements are made for the handling and disposal of waste and infection control. The home is clean and well presented throughout. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are generally trained skilled and provided in sufficient numbers but there have been occasions when there have been enough staff to make sure that all the people who live in the home can take part in social activities. Staff induction training procedures do not ensure that all new staff have the skills and knowledge so they can meet the needs of the people who live at the home and ensure their well being. EVIDENCE: The manager said that four staff have left and two have taken long-term leave since the last inspection. Existing staff have worked additional hours but have not been able to cover all vacant posts. The manager advised that he is reluctant to use agency staff to cover vacant shifts because of the complexity of the needs of the people at the home. There are a number of bank staff used by Warrington Community Living but they have not been available in sufficient numbers. This has meant that there has been times when there was not enough staff to meet the social needs of the people who live at the home. Ordinarily the home operates with a minimum of two staff on duty with three staff available in the afternoons to ensure that there is sufficient staff to Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 24 accompany people going out into the community. The manager confirmed that there have been as many as six occasions when there has only been one member of staff available and the social needs of people living at the home have not been met. When it is known that there will not be enough staff available, action must be taken to make other arrangements to ensure that the needs of people are met. Contingency arrangements should be developed to cover staff shortages and consideration should be given to using appropriately skilled and experienced agency staff. The manager said that there had been a recruitment drive and all posts have been filled. The staff team would be complete when all new starters had done their induction training. Two staff recruitment files were read as part of the inspection. Appropriate references and criminal record checks (CRB) including a check of the Protection Of Vulnerable Adults list had been obtained before one of these staff had started work but the other person had started work with vulnerable people before all appropriate recruitment checks had been completed. This person had been started on the basis of a POVA First check. This is a preliminary check of the Protection Of Vulnerable Adults list that is made through the Criminal Records Bureau before it is possible to complete the check on criminal records. It is permissible to start new staff without a CRB on the basis of the POVA First check, but only if all other recruitment checks and documentation required by the regulations is in place. However there was no reference from this person’s previous employer and no confirmation as to why they were leaving their current post to take up employment with Warrington Community Living. The manager said he had tried to confirm the reason why they were leaving their previous employment but had been unsuccessful. He said that he had sent a written request for a reference and had followed this up with a telephone call, but there were no records or further evidence to support this. This means that the people who live at the home are not adequately protected from the potential for abuse or poor practice. Information provided indicates that new staff undergo induction training and work in a supernumerary capacity until they are assessed as competent to undertake their role. The manager said that all new staff, with the exception of the latest recruit, had completed induction training but no records of this had been made. One staff member stated in the CSCI survey that they had not received induction training and another spoken with during the inspection confirmed they had completed some training but had not received training in other important aspects of care. This meant that they did not have the skills and knowledge they needed to meet the health care needs of two of the people who live at the home and because they were on duty on their own, people were at risk of their health care needs not being met. The home’s induction arrangements do not currently incorporate the standards of the national training organisation, Skills for Care and should be further Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 25 developed so staff have the training, skills and knowledge they need to meet all people’s needs before they are left to care unsupervised. The staff training chart shows that most of the staff, with the exception of some of the new recruits, have received training in First Aid, Moving and Handling, Fire Safety Awareness, Protection of Vulnerable Adults, Mental Health Awareness and medication. Two of the new recruits have received additional training in Equality and Diversity and Health and Safety which is to be made available to existing staff in the future. Five of the home’s ten support workers have achieved an NVQ in care at level 2 or above and two are working toward level three. Induction training and training in the administration of rectal diazepam is not listed on the staff-training chart. This would help the manager and senior staff to ensure that all staff have the training they need. All staff responding to the CSCI survey and those spoken with during the inspection confirm that they receive appropriate levels of support and one to one supervision from the manager on a regular basis. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the necessary experience to manage the home but needs be more hands on to ensure that the needs of people who live at the home are planned for and met so their well-being is assured. EVIDENCE: The management structure is suitable for the home’s for stated purpose and comprises the manager, assistant manager and ten support staff. Both the manager and the assistant manager are registered nurses learning disabilities. The manager has many years experience in the field of learning disabilities but does not hold a management qualification so is working towards the “registered manager’s award”. He had aimed to acquire this qualification by November 2006 but has been unable to complete the programme due to the external assessor moving on. It is important that the manager completes this Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 27 qualification so he can demonstrate that he has the necessary skills to manage the home effectively and ensure all the needs of the people who live at the home are planned for and met. There have been some improvements in care planning since the last inspection and there are positive outcomes for the people who live at the home. For example, a social care professional commented that a person who lives at the home has gone from strength to strength; her health has improved and she is developing confidence to go out more. Unfortunately the risk assessment processes have not kept pace with these developments and the introduction of person centred planning has not gone to plan. The manager has had to deal with severe staff shortages over the summer, which has had a negative impact on the staff team’s abilities to meet the needs of the people who live at the home. Information provided by a social care professional indicates that some of these problems could have been prevented if a more proactive approach to meeting people’s needs had been adopted. The multidisciplinary team were not made aware that the home was dealing with staff shortages until a complaint was made. Planning to address this issue and involving the multidisciplinary team at an earlier stage would have meant that alternative arrangements could have been made to meet people’s needs. The drawing up of staff rotas has been delegated to a support worker who did not have sufficient knowledge about each staff member’s skills, abilities and training needs to ensure adequate staffing levels and skill mix. The manager needs to take charge of the staff rota to ensure that staff are deployed in appropriate numbers and skill mix to ensure the well being of the people who live at the home. Information provided by the manager confirms that some further progress has been made to introduce effective quality assurance processes in the home. Warrington Community Living is revising quality assurance procedures and the manager is involved in a pilot project with other senior staff within the organisation. This work has not been put into practice but the manager expects to be able to produce a report of quality issues in the near future after consulting the people who live at the home and their representatives. There is a reasonable awareness and understanding of equality and diversity issues amongst staff and two new staff have attended a relevant training course. The manager advises that all staff will be offered training on equality and diversity within the next 12 months. There is a policy and procedure for staff handling the money of the people who live at the home. Written records of all transactions are kept along with receipts. The current policy shows that people who live at the home pay for staff’s incidental expenses during outings, if these are an integral part of the outing, including admission fees, meals and drinks. Receipts are kept of all expenditure but records were not sufficiently detailed to confirm what items Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 28 had been purchased for staff. The chief executive of the organisation advised that this policy is under review and it is anticipated that the home will be provided with a budget for staff expenses so people who live at the home do not have to pay for staff meals and drinks. In the mean time the manager must make sure that records of expenditure are sufficiently detailed to confirm what has been spent on staff. This will help monitoring and review and ensure accountability so the people who live at the home are protected from the potential for abuse. Warrington Community Living seeks to ensure the health and safety of all employees and residents and employs a health and safety assessor to conduct a health and safety audit of the home. However, the last health and safety reports indicates that a recommendation, marked high priority, regarding inspection of the water supply and development of a risk assessment regarding the control of Legionella had not been addressed. The manager should ensure that this recommendation is addressed so staff and people who live at the home are safe. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 2 X 2 X 2 2 X Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 30 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 YA9 Regulation 13 (4) Timescale for action Risk assessments and risk 31/12/07 management plans must be developed for all people who live at the home to make sure that any activity they enter into is free from unnecessary and avoidable risk or unnecessary restrictions so they are safe and their independence is promoted. Appropriate arrangements for 30/11/07 the administration of rescue medication must be made so that all staff know how to give it as and when required and the health care needs of people who live at the home are met. The registered persons must 30/05/08 ensure that appropriate bathroom facilities are provided to meet residents needs. (Previous timescale 31/12/06 not met) Staff must receive induction 30/11/07 training in accordance with their assessed training needs so they have appropriate skills and knowledge to meet the needs of all the people who live at the home before they are allowed to work with them unsupervised. DS0000027022.V346631.R01.S.doc Version 5.2 Page 31 Requirement 2 YA20 13 (2) 3 YA27 23 4. YA32 18 (c) (i) Warrington Community Living - Twiss Green 5 YA33 18 (1) (a) 6 YA34 7 YA37 8 YA41 Staff must be available in sufficient numbers and skill mix so the needs of the people who live at the home can be met. 19 (1) (a) The registered persons must not employ a person to work at the home until all appropriate recruitment checks and required documentation is in place as in accordance with the National Minimum Standards and the regulations. (Previous timescale 31/10/06 not met) 18 (c) (i) The manager must complete an appropriate management qualification so that he can show he has the necessary skills to manage the home effectively and ensure all the needs of the people who live at the home are planned for and met. (Previous timescales of 11/06 and 31/03/07 not met.) 17 (1) Records required by the and 17 regulations must be kept up to (3) date and available for inspection at all times, including care plans and the record of all complaints and the action taken in respect of any such complaint so staff have access to up-to-date information which can be reviewed and evaluated to make sure the needs of people who live at the home are met. 30/11/07 30/11/07 31/03/08 30/11/07 Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The service user’s guide and statement of purpose for the home should be made available in formats that are easier for the people who live there and their relatives to understand. All the people who live at the home and their representatives should be given a copy of the statement of terms and conditions for the home so they know their rights and responsibilities in relation to receiving the service. Appropriate arrangements should be made to meet each person’s social needs and to report all unmet needs to the specialist learning disability social work team so they may assist in making alternative arrangements, where possible. This will make sure that each person’s social needs are met as far as possible. Staff should help the people who live at the home to interact with one another and welcome visitors to their home to promote independence, reinforce their rights and the fact that it is their home. Steps should be taken to make sure that all staff frequently interact with the people who live at the home and always before they attempt to move a person so the principles of dignity and respect are promoted, people know what is going on and feel valued. The complaints procedure should be available in a format that is suitable and accessible for people with a learning disability. The home’s staff induction training should incorporate the Skills for care standards so staff have the training, skills and knowledge they need to meet people’s needs before they are left to care unsupervised. 2 YA5 3 YA13 4 YA15 5 YA18 6 7 YA22 YA35 Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 33 8 9 YA37 YA39 10 YA41 11 YA42 The staff rota should be arranged so staff are deployed in appropriate numbers and skill mix to ensure the well being of the people who live at the home. Quality assurance processes should be put into practice and following consultation of the people who live at the home, their relatives and other representatives, a report on quality issues should be collated and made available to all interested parties including the CSCI, so the service can develop in accordance with changing needs and expectations and people who use the service know they are listened to and their view’s acted upon. Records relating to the expenditure of the money of the people who live at the home should clearly show what has been spent on staff to cover their expenses, so the records can be monitored and evaluated and people are protected from possible abuse. The recommendations made by the Health and Safety Auditor should be acted upon to ensure the health and safety of staff, visitors and people who live at the home. Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warrington Community Living - Twiss Green DS0000027022.V346631.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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