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 28th September and 4 October 2006 10:00
th Warrington Community Living - Twiss Green DS0000027022.V306840.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.V306840.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.V306840.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.V306840.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. 6th December 2005 Date of last inspection Brief Description of the Service: Twiss Green is a care home registered with the Commission for Social Care Inspection to provide personal care and accommodation for four adults with learning disabilities. The establishment is a domestic four-bedroom bungalow set within a residential area of Warrington and blends in with neighbouring properties. The premises have been adapted to accommodate the needs of people with a disability. There is level access throughout the bungalow. Preparations are being made to provide additional bathroom and toilet facilities. Residents have specially adapted transport enabling them to access the local community. 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 other than transport costs shared between the four residents. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Key unannounced inspection of Twiss Green included a site visit to the home. This was completed on two days over 6 and quarter hours in total. This key inspection, takes into consideration the developments in the home since the last inspection. It is focused on the experiences of residents and the people who support them. The views of residents’ representatives including health and social care professionals were gathered by survey questionnaires before the site visit. All three residents were also spoken with but discussion was limited due to communication difficulties with two of the residents. Time was spent with the residents observing their interactions with staff. The manager and some staff were spoken with and the inspector looked around the building to assess its suitability to provide a comfortable, safe and homely environment. What the service does well:
Twiss Green Lane is the established home of three younger adults. It provides comfortable, spacious and well-equipped accommodation, which is decorated and furnished to reflect the needs and characters of residents. The home is clean and free of malodours. Warrington Community Living has established procedures for introducing new residents to the home. All new residents have their needs assessed and are encourage to visit the home on several occasions so they can make their own assessment of its suitability before they move in. Residents are supported to maintain family links and daily routines promote individual choice and freedom of movement. The atmosphere in the home is relaxed, welcoming and sociable. Residents are at ease and confident in the home’s environment. They take part in the day to day domestic routines associated with running the home by observing staff cleaning and tidying the house and accompanying them on shopping trips to the local community. There is an established team of staff who conduct their work with care, good humour and affection for the residents. Visiting health care professionals speak highly of the staff team. Staff are said to work in partnership, demonstrate a clear understanding of the care needs of each resident and communicate effectively. One of the residents said that they like the staff who help them when needed.
Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 6 Two of the three residents are unable to express themselves verbally and rely on other means to communicate their needs. It is very positive that their care plans have been developed to confirm advice and guidance provided by the speech therapist in this regard and it is evident that staff seek to involve residents in decision-making, as far as they are able. Satisfactory arrangements are in place for the protection of vulnerable adults and making complaints. No complaints have been received since the date of the last inspection. Fire precautions are in place and routine maintenance checks of gas and electrical systems, hoist, electrical appliances, fire alarms, extinguishers and emergency lighting systems are undertaken and are up to date. What has improved since the last inspection? What they could do better:
The manager must finalise his work on the statement of purpose and service users guide and make these documents available to all residents. Without this information residents are disadvantaged when making decisions about the home. The registered persons should explore ways and means of developing the service users guide and statement of purpose to make them more accessible to current and potential residents. Audio and visual methods of communication my prove useful including audiotapes, compact disc, and digital videodiscs. Residents’ and their representatives’ views should feature in the home’s service users guide, where appropriate.
Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 7 There have been some improvements in the home’s assessment and care planning systems but more needs to be done to make sure that staff have the guidance they need to meet residents personal health care needs. Care practice must be evaluated against the guidance provided by health and social care professionals and where appropriate referrals must be made for treatment, further guidance and any equipment that may be required to ensure each individuals health and well being. Staff have done some good work developing “Essential Lifestyle Assessments”. The home should build on this work by sharing assessments and care plans with relatives and visiting health care professionals. This will help staff to develop arrangements for care, which reflect the individual’s needs, aspirations and personal preferences. Appropriate bathing and toilet facilities must be provided in accordance with residents’ assessed needs. Staff have completed a lot of training in the last 12 months but the information to confirm what they have done and what remains to be done is not available in the home. It is important that staff training needs are met. This will help to ensure that all staff are trained to an appropriate level and have the skills they need to do their work and meet residents’ needs. The staff induction-training programme should be developed to reflect “Skills for care” criteria. Warrington Community Living staff recruitment procedures must be followed to ensure that residents are appropriately protected. Quality assurance systems require further development to ensure that residents, aided by their representatives, are consulted on quality issues and action is taken to address matters raised. 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. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 8 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.V306840.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. New residents have their needs assessed before they move in. EVIDENCE: Warrington Community Living has established procedures for introducing new residents to the home. These are designed to enable the individual and their representatives to make an informed choice. A prospective resident visited the home for an introductory visit along with a relative, their social worker and occupational therapist. Their representatives advised that they had made a series of visits to familiarise themselves and make an assessment of the home’s suitability. Warrington Community Living provides a Statement of Purpose that is specific to the individual home. It sets out the objectives and philosophy of the service and is supported by a Service user Guide. The service users guide needs further development to include a standard form of contract. This will ensure that residents and their representatives have written information confirming their rights and responsibilities and help them to make an informed choice. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 10 The prospective resident had not been offered copies of the home’s service users guide and statement of purpose. The statement of purpose, service users guide and statement of terms and conditions should be made available to all residents, including prospective residents and their representatives. This will ensure they have the information they need when making decisions about the home. The statement of purpose and service users guide are not available in a format suitable for the current or possible future residents of the home. The registered persons should explore ways and means of developing this information to make it more interesting and accessible to current and potential residents. Audio and visual methods of communication my prove useful including audiotapes, compact discs, and digital videodiscs. Residents’ and their representatives’ views should feature in the home’s service users guide, where appropriate. Reading of case records and discussion with a prospective residents representatives including a relative, social worker and occupational therapist confirms that new residents have their needs assessed before they move in. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. Residents and their representatives are involved in decisions about their lives and planning the care and support they receive. EVIDENCE: Reading of case records and discussion with the senior support worker, manager and staff indicates that the home’s care plans have been improved in some respects. They are more detailed and personal issues such as how residents’ needs for affection are addressed. Staff report that care plans are used for guidance on a routine basis. The care plans have been reviewed on a monthly basis but certain arrangements to meet resident’s health care needs had not been evaluated. Both of the care plans seen require further development to make sure that staff have the information they need to meet residents care needs and ensure their health and well being. For example guidance provided by the speech therapist on how to address a resident’s swallowing problems was not confirmed in the care plan in the appropriate detail. Staff were observed to assist the individual with their meal in a manner
Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 12 that was contrary to the speech therapist’s guidance and potentially hazardous to the resident’s health. Two of the three residents are unable to express themselves verbally and rely on other means to communicate their needs. It is very positive that their care plans have been developed to confirm advice and guidance provided by the speech therapist in this regard and it is evident that staff seek to involve residents in decision-making, as far as they are able. Some progress has been made in developing the home’s “Essential Life Style Planning”. This is a person centred approach to enabling residents to express their diverse needs from their individual perspective and personal outlook on their lives. It is important that the home capitalises on this work and incorporates the outcomes of the “Essential Life Style Planning” in the home’s care plans. The manager advised that Individual Personal Planning” meetings known as IPPs, which aim to involve the resident, their family members and other representatives are to be arranged. These will help staff to develop arrangements for care and support. Risk assessments have been developed to identify and address hazards that may be presented to residents in the course of their daily lives. Guidance on managing risk and reducing hazards provided by the visiting occupational therapist have been incorporated in the respective individual’s case records. Records indicate that risk assessments are reviewed on an ongoing basis with the exception of two, which had not been reviewed by the given review date. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Residents are supported to maintain family links and daily routines promote individual choice and freedom of movement. EVIDENCE: Staff support residents to maintain family links subject only to restrictions detailed in the care plan. Residents’ rights to see who they wish to see are respected. Staff support residents to correspond with relatives who receive Christmas cards and are informed of significant events in the home. Staff were seen to talk with residents on a frequent basis engaging them in two-way communication. Reading of care records confirms that staff are working with health care professionals to develop and improve methods of communication with two of the residents. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 14 One of the residents said that they like the meals and is satisfied with the range of activities on offer. Residents activities outside of the house tend be focussed on shopping, running errands with staff and a visit to a café once a week. Discussion with the manager and senior support worker indicates that the home aims to help residents to identify and take advantage of other opportunities for leisure and social interaction. The essential lifestyle assessments and person centred planning systems, are being introduced to address these needs. Information provided after the visit confirms that one of the residents has joined the local library and attended a Coffee morning at Age Concern to explore what they have to offer. Records confirm that residents are offered a varied and nutritious diet and special dietary needs are catered for. Information is available to staff on how to meet special dietary needs. Discussion with staff and observation confirms that staff engage residents in the day to day domestic routines associated with running the home including cleaning and tidying the house and making shopping trips to the local community. Generally residents greet all visitors at the front door although one member of staff did not support residents to do this and did not introduce them to a number of visitors to their home. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. The health and personal care that people receive is based on their individual needs. EVIDENCE: Discussion with staff and observation of their interactions with residents indicates that they understand the key principles of giving personal support and are responsive to the varied and individual requirements of the residents. One of the residents said that staff are very nice and help her when help is needed. Generally care is provided in accordance with residents needs and the recommendations of health and social care professionals. However, there is inconsistency amongst the staff team as to how some personal care needs are met. Guidance provided by a speech therapist to address one resident’s swallowing problems and make a referral to the doctor was not implemented. There is a key worker system but this is not working effectively. Staff were observed to assist this resident with their meals in an inappropriate way. The resident had a tendency to lean to one side and staff were unable to assist her to eat in accordance with the speech therapist’s recommendations. This increased the risk of choking. Staff advised that they had contended with this
Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 16 problem for a long time but the matter had not been referred back to health care professionals to be addressed. Information provided after the site visit confirmed that appropriate action has been taken to address these issues. The manager and senior support worker are aware of these deficiencies in the care planning system and communication problems amongst the staff and management teams. They are taking action to address these issues. The key worker system is to be re-established and care plans are to be further developed to confirm the precise needs, preferred routines, likes and dislikes of residents. This will ensure that residents receive support in the way they prefer and consistent with their needs. This is important for all residents but will especially help those who are unable to communicate their needs and preferences verbally. Arrangements for the storage recording and administration of medicines are satisfactory. All staff have received training in the administration of medication within the previous 12 months. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Satisfactory arrangements are in place for the protection of vulnerable adults and making complaints. EVIDENCE: No complaints have been received since the date of the last inspection. Warrington Community Living has effective arrangements for receiving and handling of complaints that are confirmed in a detailed policy for the guidance of staff. This should be re-produced in a format that is suitable and accessible for current and future residents. Various methods of communication should be explored including audiovisual media. 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 all staff have received guidance in the implementation of adult protection procedures but training records were not up to date. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. The home provides comfortable, bright and cheerful accommodation of a design and layout that reflects the needs of the residents. EVIDENCE: Twiss Green Lane is a bungalow in keeping with the local community. It provides comfortable, bright and cheerful accommodation that reflects the needs of the residents. Adaptations have been made to the building over time to meet the changing needs of residents, including the provision of overhead hoist tracking and level access throughout the home. Automatic hold openclosing devices have been fitted to bedroom doors as in accordance with the recommendations of a visiting Occupational Therapist and further improvements are planned. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 19 Residents’ bedrooms are comfortably furnished and decorated in styles that reflect their characters. A risk assessment recently completed by an OT indicates that a resident requires an adjustable bed fitted with bed rails in the interests of safety. Information provided by the manager indicates that this has been ordered and delivery is expected in the near future. The bathroom is equipped with overhead hoist equipment. Unfortunately it is unsuitable to meet residents and there is an insufficient number of manager advised that plans have been drawn up to facilities in the near future. and specialised bathing the needs of one of the WC’s in the home. The provide appropriate toilet The home is not provided with 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.V306840.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to the service. Residents are not protected by the home’s recruitment procedures. EVIDENCE: Reading of staff files indicates that staff have not been recruited in accordance with Warrington Community Living’s established recruitment procedures. Two staff members were employed in the home before the receipt of appropriate protection of vulnerable adult register checks and criminal records disclosures. There was no record any employment or character references received for one of these staff members. There is an established team of staff. The vast majority of staff have been in post in excess of two years and have developed a good working knowledge of residents needs and they understand the principles of personal care. Health care professionals, including a GP, a supporting community nurse and an occupational therapist responded to the survey indicating that staff communicate clearly, demonstrate a clear understanding of residents’ needs and work in partnership to ensure needs are met. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 21 There is a key working system but there have been some communication difficulties and important information has been overlooked. The manager and senior support worker are aware of these issues and are taking action to ensure that arrangements for personal care are reviewed and evaluated on an ongoing basis to ensure that residents’ needs are consistently met. Worked staff rotas and information provided by visiting health and social care professionals indicates that staff are employed in appropriate numbers for the well being of residents. The manager advised that some of staff have received training in moving and handling, first aid, infection control administration and recording of medication, adult protection procedures, fire prevention, mental health awareness and health and safety issues in addition to a number of other relevant topics. Staff training records kept at the home but are not up to date. However, the manager said he was aware that some staff members needed training in certain topics and arrangements are being made to address these in the near future. Discussion with staff and a visiting health care professional indicates that staff would benefit from further training and guidance on diabetes and related health issues. Of the ten care staff members four have an NVQ level 2 in care or above and a further two are due to register for the qualification with an appropriate training agency in January 2007. New starters undergo induction training and work in a supernumerary capacity until they are assessed as competent to undertake their given role. The home’s induction arrangements do not currently incorporate skills for care criteria but the senior support worker is appropriately qualified to assess staff and intends to liaise with “Skills for Care” to make the necessary arrangements in the near future. . Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. The home is managed in the best interests of residents. EVIDENCE: The service is planned to be user focused, and generally works in partnership with families of residents and professionals. However there have been some communication difficulties and the home’s recently revised care planning systems have not kept pace with each resident’s developing needs. General review meetings for two of the three residents have not been held for over a year. The manager and senior support worker are improving and developing systems that monitor practice and compliance with the homes plans, policies and procedures. More work is needed in this area. However staff morale is buoyant and they appreciate the guidance and leadership provided by the manager and senior support worker. They are committed to improving communication in the home for the benefit of residents. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 23 The registered manager is a Registered Nurse Learning Disabilities and an experienced manager and practitioner in the field of learning disabilities with many years experience. He does not have an appropriate management qualification and is pursuing the “registered manager’s award”. Information provided by the manager confirms that some further progress has been made to introduce effective quality assurance processes in the home. The manager had introduced a “residents’, relatives” and other interested parties satisfaction questionnaire. This is to be sent out to all relevant people and the results are to be collated and published in a report on quality issues open to residents’ representatives. There is a reasonable awareness and understanding of equality and diversity issues amongst staff but it is not clear as to how these issues are promoted. Equality and diversity is not discussed at staff meetings or during staff supervision. Warrington Community Living seeks to ensure the health and safety of all employees and residents. Risk assessment and risk management is central to the conduct of the home. The manager and senior support worker ensure that risk assessments are carried out for all safe working practice topics and significant findings are recorded and reviewed. Information provided indicates that fire precautions are in place and routine maintenance checks of gas and electrical systems, hoist, electrical appliances, fire alarms, extinguishers and emergency lighting systems are undertaken and are up to date. Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 24 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 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 3 X 2 2 2 X X 3 X Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4 (2) and 5 (2) Requirement The registered persons must develop the service users guide to ensure it includes a standard form of contract and supply a copy of the statement of purpose and service users guide to the Commission and make a copy of these available on request for inspection by every resident and any representative of the residents. Previous timescale 31/01/06 not met. The registered persons must ensure care plans are updated to reflect residents’ changing needs. (Timescales 05/09/05 and 31/01/06were not met) The registered persons must conduct the home so as to make proper provision for the health and welfare of residents. Care practice must be evaluated to ensure that residents’ needs are met in a safe manner conducive with the recommendations of health care professionals. Timescale for action 30/11/06 2 YA11 15 (2) (b) and 15 (2) (c) 12 (1) (b) 30/11/06 3 YA18 31/10/06 Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 26 4 YA19 13(1) (b) 5. YA26 16 The registered persons must 31/10/06 make arrangements for residents to receive treatment and advice from health care professionals in accordance with their identified needs. The registered persons must 30/11/06 provide furniture and equipment suitable to the needs of service users. (Timescales 03/10/04, 20/02/05, 30/09/05 and 27/02/06 were not met) The registered persons must ensure that appropriate toilet facilities are provided. (Timescale 03/11/04 30/06/05 and 30/04/06 were not met) The registered persons must ensure that appropriate bathroom facilities are provided to meet residents needs. The registered persons must ensure that staff receive training in accordance with their assessed training needs. 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. The manager must achieve the registered managers award. The registered persons must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. 31/12/06 6. YA27 23 7 YA27 23 31/12/06 8 YA32 18 (c) (i) 31/03/07 9 YA34 19 (1) (a) 31/10/06 10. 11. YA37 YA39 18 (c) (i) 24 31/03/07 27/02/07 Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The registered persons should make the statement of purpose, service users guide and statement of terms and conditions available to prospective residents and their representatives. This will ensure they have the information they need when making decisions about the home. The registered persons should explore ways and means of developing the service users guide and statement of purpose to make them more accessible to current and potential residents. Audio and visual methods of communication my prove useful including audiotapes, compact disc, and digital videodiscs. Residents’ and their representatives’ views should feature in the home’s service users guide, where appropriate. The registered persons should capitalise on the outcomes of the “Essential Life Style Planning” assessments and incorporate findings and subsequent care arrangements in each resident’s care plan. The registered persons should arrange general reviews, (Individual Personal Planning” meetings known as IPPs) on behalf of each resident at least once in a 12-month period of at a higher frequency if circumstances change. The registered persons should assist residents to engage in community-based activities in accordance with the findings of each individuals “Essential Lifestyle” assessment and person centred plans. The registered persons should ensure that all staff enable residents to welcome visitors to their home to promote independence, reinforce their rights and the fact that it is their home. The registered persons should re-produced the complaints procedure in a format that is suitable and accessible for people with a learning disability various methods of communication should be explored including audiovisual media The registered persons should make sure that staff training records are kept up to date. 2 YA1 3. YA6 4 YA6 5 YA13 6 YA16 7 YA22 7. YA32 Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 28 8. YA32 The registered persons should ensure that all staff hold NVQ 2 or 3 or are working to obtain one of these qualifications by an agreed date. Alternatively the registered manager should demonstrate that staff without an NVQ 2 or 3 can meet the required standard through past work experience. The registered persons should ensure that the home’s staff induction training reflects “Skills for care” criteria. 9 YA35 Warrington Community Living - Twiss Green DS0000027022.V306840.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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