Inspection on 24/06/05 for 2a Waterloo Street

This inspection was carried out on 24th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

2a Waterloo Street 24/05/07

2a Waterloo Street 16/01/06

2a Waterloo Street 06/09/04

2a Waterloo Street 07/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 2A Waterloo Street Cockermouth Cumbria CA13 9NB Lead Inspector Gordon Chivers Unannounced 24 June 2005 09:15 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 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 Stationary 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. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 2A Waterloo Street Address Cockermouth Cumbria CA13 9NB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01900 827749 West House Elizabeth Marie Clements Care Home 10 Category(ies) of LD - Learning Disability registration, with number LD(E) - Learning disability, over 65 of places 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 10 people over 18 years of age with a learning disability (LD), some of whom may be over 65 years of age (LD(E)). 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 06 September 2004 Brief Description of the Service: West House are the Providers of the services and care at 2a Waterloo Street for ten people who have a learning disability and who may be older adults. The home is situated in a quiet side street near to the centre of the town of Cockermouth. The home blends into the surrounding community and there is level access to local amenities and facilities. 2a Waterloo Street operates as two units for five people on both the ground and first floors. Private bedrooms are situated on both floors and access to the upper floor is by either stairs or chairlift. There is a small garden to the rear of the home that includes a public footpath. There are car-parking facilities adjacent to the home. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over six and a half hours from 09.15 to 15.45. The manager was absent on holiday, but Nichola Bancroft, a support worker, took responsibility in assisting the inspector. A tour of the home was undertaken, and a sample of case files and a range of other documentation was examined. Two service users were interviewed in private and five members of staff were spoken to. The inspector would like to thank the service users and staff for their welcome and cooperation throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Admissions of new service users to the home should be thoroughly documented. Service users and their representatives should participate in care planning and reviews. Management time and support should be increased, and staffing reviewed periodically. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 6 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. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The only admission in the last fifteen years was made on the basis of a full assessment of needs, but it is not clear whether the admissions procedure was thoroughly implemented. EVIDENCE: The home has only had one new admission (December, 2004) since it opened fifteen years ago. The case file reveals that that particular service user was admitted from another ‘Westhouse’ home in the area. Nevertheless the home undertook its own assessment using Westhouse’s assessment tool as well referencing information provided by the service user’s previous home. References to this transfer/admission are to be found in various sections of the case file such as the assessment section, the care plan, the daily recording and the periodic review. However, there was no specific section in the file which collated the admission process. It was not possible to determine the extent to which the procedure had been implemented, nor was there a record of any formal meeting which formalised the admission on a permanent basis. There was no evidence that the home had referred the service user to the advocacy service “People First”. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Each service user has a comprehensive, individual plan of care based upon their assessed needs, including their health needs. They are treated with respect, are supported in making decisions for themselves and about domestic issues, and are supported in undertaking activities within the context of risk assessments. EVIDENCE: The sample of case files examined all had full plans of care complimented by person-centred plans. The care plans are comprehensive in that they translate assessed needs into service objectives and the actions necessary to meet those objectives. The person-centred plans identify the service users’ likes and dislikes, ‘must haves/dos’ and ‘must not haves/dos’, and weekly plans of activities. In some cases strategies to manage challenging behaviours have been developed. However, the evidence of the files examined did not confirm that all service users, their family or other independent representatives, participate directly in developing, agreeing and reviewing care plans. Care plans are reviewed on a six monthly basis at least, and some are reviewed more frequently where appropriate. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 10 Two of the service users living in the home were interviewed in private. They both confirmed that staff treated them with respect and that they were supported in making decisions for themselves, for instance regarding bed times, clothes worn, meals, activities and leisure. All service users participate in drawing up the weekly menus. During the period of the inspection there were various instances which demonstrated that staff respected service users’ dignity. A risk assessment is in place for each service user and these are referenced by the person-centred plan which identifies the type and degree of support individuals require to undertake their preferred life choices and which options, such as the management of money or self medication, are not open to them for health or other reasons 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,17 Service users are supported in having some contact with the local community and in maintaining contact with their families They enjoy a balanced and varied diet in a pleasant environment. EVIDENCE: 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 12 Involvement in the local community is also supported by staff; this may vary from shopping, to church attendance, Two service users occasionally walk to the main street and sit and watch the world go by for a while before returning home. Those service users who have family are encouraged and supported to maintain contact if the service user and family so wished Service users’ specific, individual dietary needs, including blended and thickened food, are identified in the assessments and care plans. Service users are supported by staff to plan the menus a week at a time, and to participate in the shopping. The menus confirmed a range and variety of meals including fruit, vegetables and yoghurts. Meals are mostly taken in the clean, well appointed kitchen/dining rooms. Service users interviewed confirmed that they could exercise choice at meal times. Some service users are involved directly in baking for the home as part of their activities. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21 The health needs of the service users are met , and terminal illnesses and death are dealt with sensitively. EVIDENCE: The case files also contained full assessments on service user’s health care needs. Health needs formed part of every care plan and the files recorded contact with G.P.s, district nurses and medical specialists, either directly with the service users or on their behalf by staff. Staff are sensitive to the emotional health of the service users. The home has procedures on how to manage the terminal illness and death of service users, including the sensitive contact with family members. However, some of the case files examined contained no references to service user’s wishes at death and no reason for this absence of information is given. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users were confidant that their complaints would be taken seriously. EVIDENCE: The home has a complaints procedure which includes a reference to CSCI. The service users interviewed had some awareness that they could complain to the manager, their key-worker or any member of staff. Unfortunately the complaints record book was not accessible at the time of the inspection. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27,28,29,30. The home is well maintained and decorated and has with nice furnishings. It is kept clean and hygienic and presents as homely. There are sufficient communal areas and facilities. EVIDENCE: The home is well furnished and nicely decorated throughout. It presents as very homely, and the service users present during the inspection appeared comfortable and at ease. Safety devices such as smoke detectors, fire extinguishers and fire doors were in evidence. All radiators have guards fitted to them. A pair of metal gates have been sited at the top of the stairs to ensure the safety of service users who now reside on the ground floor. These gates would now appear to be redundant. All the bedrooms are single occupancy, although none are en-suite. They are all well decorated and furnished. Service users are encouraged to personalise their rooms with pictures (in one case pictures painted by the service user) and posters and personal effects. Bedrooms contain washbasins integrated into units, an easy chair and adequate storage space. There is a bathroom including toilet on both floors and an additional toilet on both floors. Baths and toilets are equipped with aids to support the service 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 16 users. They are maintained in good condition with non-slip floor coverings and are well ventilated. There is a lounge and kitchen/diner on both floors. These rooms are well furnished (although the door to the downstairs kitchen is badly marked through wear and tear) and have facilities for leisure pursuits. They are adequate for the five service users on each floor. However, there are aidememoirs to the staff posted on the walls of the bathrooms and kitchens and these detract from the homely nature of the home. As well as the specialist equipment in the bathrooms such as electric bath chairs, there is also an electric chairlift on the stairs. The home is kept clean and there are no offensive odours. There is a locked cupboard on both floors for the storage of cleaning materials, and a cleaning rota/schedule for the home. Communal areas are cleaned every day and each bedroom is thoroughly cleaned once a week. The carpet in the general corridor area downstairs is worn and faded through use. There is a pleasant garden area between the home and the neighbouring church, with a lawn and bench seat. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34 Staffing input into the home appears to be approximately right, but should be monitored as service users’ needs change over time. The service users are directly involved in the selection process of new staff , giving them some measure of control over their lives. EVIDENCE: Without the manager’s input to the inspection it was not possible to determine how the staffing compliment had been calculated, or whether it was correct. However, the monthly staffing rota provides for 1671 support/care hours. Using the Residential Forum model, this is the equivalent provision for ten medium-needs service users, each of whom is absent from the home (day activities) for an average of 40 hours per month. From the inspector’s observations and understanding of the range of service users in this home, this input would appear to be approximately right. Staff interviewed considered the staffing input to be sufficient and cover for sickness/holiday absences is evidently arranged. However, concerns were expressed over the fact that the service users are all becoming older and their levels of dependency are changing accordingly. Moreover, on the day of the inspection one member of staff had to support two service users who were in hospital and no cover had been provided in the home. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 18 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,42 The manager has the respect and support of the staff, but the staffing structure reduces her effectiveness. The health and safety of service users is promoted by the provider’s policies and procedures. EVIDENCE: Unfortunately the home’s manager was absent on the day of the inspection. However, all the staff on duty during the day of the inspection commented upon the fact that the manager’s working week includes two five-hour care shifts, and that there is no senior support worker in the home’s structure. The staff were of the unanimous opinion that this arrangement detracted from effective management of the home. The service provider has policies and procedures in place which aim to ensure the safety and welfare of the service users. For example, the home has had a comprehensive premises risk assessment undertaken by Westhouse’s Quality Manager. There are procedures requiring daily/weekly and annual checks of different aspects of the internal environment. Records are maintained of all the checks and servicing of the home’s specialist and safety equipment and 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 20 infrastructure such as heating and lighting systems. Fire drills are regularly undertaken and the premises are inspected by the fire service. The local authority has not undertaken an environmental health check of the home for several years, although Westhouse undertake COSSH reviews and inspections. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 2 3 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x x 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 2A Waterloo Street Score x 3 x 2 Standard No 37 38 39 40 41 42 43 Score x 2 x x x 3 x F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 14 Timescale for action The case files must be structured 31/7/2005 and presented in such a way. that admissions are comprehensivley documented and collated in one section. Service users, their family or an Immediate independent advocate, must participate directly in the development and reviews of care plans. Staff must endeavour to Immediate ascertain service users wishes at death, and to record the reasons if this is not possible. Staff notices must be removed 31/7/2005 from the walls of bathrooms and kitchens, and a new door fitted to the downstairs kitchen. The carpet in the general 31/7.2005 corridor area must be replaced. The registered provider must 31/7/2005. provide CSCI with the calculations upon which the homes monthly staffing input is based. The manager must be provided 30/9/2005 with sufficient time and adaquate support in order to manage effectively. Requirement 2. 6 15 3. 21 12 4. 28 23 5. 6. 30 33 23 18,19 7. 38 12,18 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 23 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. 2. Refer to Standard 24 33 Good Practice Recommendations The metal gates at the top of the stairs should be removed as their original purpose is now redundant and they detract from the homeliness of the home. The registered provider should monitor the overall increase in needs as the service users in the home grow older and review the staffing input accordingly. 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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 2A Waterloo Street F58 F10 s22556 2a Waterloo Street v234618 240605 ui Stage 4.doc Version 1.40 Page 25 - 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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