CARE HOME ADULTS 18-65
Watchbell House Watchbell Street Rye East Sussex TN31 7HA Lead Inspector
Jason Denny Unannounced Inspection 3rd February 2006 14:10 Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Watchbell House Address Watchbell Street Rye East Sussex TN31 7HA 01797 222059 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) Canterbury Oast Trust Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. People will be over eighteen and under sixty five years of age on admission 17th May 2005 Date of last inspection Brief Description of the Service: Watchbell House is one of two care homes, owned by the Canterbury Oast Trust in the picturesque and historic town of Rye. The home provides social and residential care for six adults with mild to moderate learning disabilities. Accommodation is on three floors, having sufficient [3] bathroom and toilet facilities. At the rear of the premises there is a small, private courtyard garden with patio, barbeque area and gazebo. This home offers a particularly attractive and homely setting for the small group of able-bodied Residents accommodated. Watchbell House is a listed building situated in an elevated position with extensive views. The shopping areas, rail and bus links are within safe walking distance. The home has its own people carrier vehicle. The Trust provides a range of work opportunities such as in a local Restaurant and at the Rare Breeds centre a farm based near Ham street 10 miles from the home. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 2.10 and 5.20 pm. The Inspection found that of the 15 National Minimum Standards inspected, that all [15] of these were met. The overall focus of the inspection was on following up on the requirements and recommendations of the last inspection along with looking at new areas such as health needs, staff recruitment and training. The inspector started the inspection by speaking with 5 of the 6 current residents who were available during the visit along with observing routines and staff. A discussion with the acting manager took place around progress since the last inspection. Care and staffing records, along with medication arrangements were inspected with a focus on a particular resident and a new person who has recently moved into the home. Comment cards were sent to the home prior to the inspection, which were completed, by Residents and relatives with positive comments made. Positive comments continue to be made by social services that fund Residents. This report should be read in conjunction with the last Unannounced Inspection report of 17/05/05, which covered 21 areas some of which are not covered in this report such as lifestyles, contracts, and trial visits. What the service does well:
The Inspector found a pleasant, warm and comfortable atmosphere during his visit. Health needs are closely monitored and met. The overall care needs of all residents are regularly reviewed. All residents were observed to be relaxed with arrangements with them socialising well together. All residents had clear routines based on their choice and were confident about approaching staff and stating their views and choices. Staff were observed to be positive, along with being knowledgeable and attentive to residents needs. All residents were found to have active lifestyles and came and went from the home throughout the inspection. New residents are only admitted to the home after all information is gathered and only after the person has visited the home several times to test things out. Other resident’s view on anyone new is sought. The group of women in the home were found to be highly compatible and are encouraged to take sensible risks to improve independence. Staff are clear about how to both identify possible abuse and report it. Staff operated with a clear sense of direction with clear plans in place, which helps them fully meet resident’s needs. The home was found to smoothly manage itself based on resident involvement. Residents are regularly consulted about their views with this recorded. Activities, food, trial visits, and quality assurance along with other areas not inspected here, were found to be met at the last inspection. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The home has improved the accessibility and accuracy of the information in its guide with only minor improvements recommended. Standard 2, 4, and 5 were all found to be met at the last inspection 170505 with standard 4 exceeded. EVIDENCE: The Resident’s guide [service user] to the home and organisation was found to be clearly on display in the home along with most recent inspection report. Since the last inspection all the information in the guide has been updated and is now presented in a more accessible way for people with learning difficulties/ disabilities. The guide contains a range of useful information and views of Residents with their picture included to aid identification. Information about the complaints procedure and the various levels of management in the organisation were found to have been updated. It was again recommended that a talking tape be produced summarising the information in the guide to aid those with reading difficulties. One resident informed the inspector that she did not know how her views had been reflected in the last inspection report and what recommendations had been made. This was discussed with the acting manager who advised that future inspection reports would be discussed at residents meetings and possibly put on tape. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&7 Care-Plans were found to contain good information subject to regular review with all relevant people. Care-planning goals were found to be met A particular resident was found to be especially benefiting from independent advocacy and other support organised since the last Inspection. Standard 9 was found to be met at the last inspection 170505 EVIDENCE: The key worker together with the manager and the resident carries out care planning. Residents have access to their plans and may choose who is to attend their review meetings. The care plan includes an assessment of all aspects of personal and social support and healthcare needs. Daily notes and risk assessments also form part of the care planning process. Two care-plans were examined one relating to the newest resident and another of a resident identified in the last inspection report of urgently requiring independent advocacy. Both plans were found to be full and up to date with reviews taking place every 6 months. The new acting manager indicated how the long serving staff team are familiar with all aspects of the plans and routines, although the manager is working on developing shorter daily careWatchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 10 plans to complement the larger care-plan folders, and routines, to aid the information given to staff especially if any new staff join the home and need summarised daily information to follow. The shorter plans are designed to show how needs are met in practice on a daily basis. All staff seen during the inspection clearly show an understanding of how best to meet residents needs in line with their preferences and their care-plans. Both residents indicated in discussion that they were happy with the home and that all their needs were being met. The newest resident was found to have settled in well to the home as seen in records and observation. Since the last inspection a resident whose records showed that she needed independent advocacy has had this arranged along with fortnightly support from a psychologist as confirmed in records. The resident indicated how helpful she was finding this support where it has improved her quality of life. which was observed in the inspection. It is also noticeable that there has been a reduction in challenging behaviour with all staff more knowledgeable about how to meet her needs, which included changes to her daily care-plan. Residents attend reviews where they discuss their needs with the organisation, their care manager, and their parents. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. All these standards were found to be met at the last inspection 170505. EVIDENCE: Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 12 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 & 20 Residents health needs are closely monitored and reviewed. All Residents receive good care and attention based on helping them to be as independent as possible and to have a good quality of life. Medication arrangements are sound. EVIDENCE: Discussions with the acting manager and a review of one Resident’s records showed the close way that a particular mental health condition was being monitored with a range of support to help the Resident have a better quality of life which is affected by the condition. Records showed continuous review of medication and follow up medical appointments. Since the last inspection there has been a change to the frequency of a prescribed drug, which has had the positive effect of this Resident having more energy as confirmed by the Residents and records. Closer working with specialist services and her psychologist has assisted. The resident confirmed how improved support from staff and other services has improved her self-control and well being. The Resident was found to be well during the inspection. All staff were seen to treat Residents with respect and dignity with all encouraged to become as independent as possible within a sensible risk assessed framework. Care-plans, observations, and discussions with Residents and staff showed how Residents personal care needs are sensitively met with full regard given to
Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 13 their rights, dignity, and respect. Comment cards filled in by relatives all indicated satisfaction with the care being provided to residents. The inspector looked at medication stocks, record keeping, training records and observed trained staff dispensing medication all of which was found to be in order. The acting manager discussed the range of checks carried out in relation to medication arrangements. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home has improved both the organisation, and the level of detail and clarity in its complaint file in accordance with the standard and the home’s own policy and procedure. Standard 23 was found to be met at the last inspection 170505. EVIDENCE: The new acting manager has introduced a new system of organising the complaints file, which allows for all information on a complaint to be filed in one place to aid accessibility. The file includes standard letters and forms for acknowledging complaints and investigating them with the involvement of the complainant along with confirmation of the outcome. No new complaints were found to have been made to the home since the last inspection. A “Grumbles book” has also been introduced to record minor concerns from Residents about their peers or the running of the home with a section to show how the issue is resolved Key workers are trained to respond to Resident’s wishes, suggestions, or concerns. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Outstanding maintenance jobs at the front of the home have been addressed since the last inspection creating an exceptional overall impression. Resident’s benefit from living in a character building which feels and looks like an ordinary home at the high end of the market in an historic town. Resident’s benefit from a homely, safe, comfortable, well equipped, and appointed home. Standard 26 and 30 were all found to be met at the last inspection 170505. EVIDENCE: The home provides shared and private rooms that meet space requirements. There is a separate lounge, a dinning room, also used for craftwork, and a spacious entrance hall. Resident’s artwork is displayed on the walls. The pointing and redecoration needed on front of the home was found to have been addressed since the last inspection. A refit of the kitchen along with some painting of communal areas was found to be planned to take place within the current year with the full involvement of Residents. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 & 36 Resident’s benefit from sufficient numbers of skilled staff who are carefully selected and supervised, and benefit from regular training. EVIDENCE: The duty rota shows staffing levels that reflect the needs and number of residents. The numbers remaining at the home varies according to the daily, off-site activities that Residents are engaged in. The duty rota more clearly show hours worked by each staff member along with their capacity and qualifications, and those by the manager in relation to what hours were management time and which were spent working in the home. Since the last inspection the acting manager has improved the written rota to clearly show the person in charge at any time. Written supervisory records were looked at for two staff, which showed that fully detailed supervisions were now set to occur at least six times yearly. Both records showed supervisions that occurred in January and which were detailed and showed an improvement on previous records. Both staff were also found to have undergone suitable recruitment checks when they both joined the home several years ago. No new staff have been employed at the home since the last inspection. Both staffing file’s showed a full range of basic staff statutory training with one of these person’s having gained National Vocational Qualification in Care at Level 3. Staffing records showed clear job descriptions, with staff seen to operate with a clear sense of direction during the inspection with a clear on Residents.
Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 42 Resident’s benefit from a home, which is well managed in their best interests. The home is well run in the absence of a permanent manager. Health and Safety maintenance has improved along with the organisation of paperwork. Standard 39 and 43 were all found to be met at the last inspection 170505. EVIDENCE: Since the last inspection the organisation, which oversee the home, appointed a manager who then left her employment in December 2005. The organisation was found to be in the process of appointing a suitable long term manager who can also achieve registration. The home is currently overseen by an experienced manager [20 hours peer week] who manages a nearby home, along with regular visits from the area manager. This acting manager is well qualified and motivated. The home was found to unaffected by the lack of a permanent manager with improvements introduced by the acting manager Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 18 particularly to the administration of the home and the support to a particular resident who spoke highly positively of the management arrangements. The homes team leader who deputises in the manager’s absence is studying for a National Vocational Qualification level-4 in Management and Care. The organisation of the health and safety records in the home was found to have improved with all information easily accessible. All necessary equipment such as portable electrical equipment [04/05] is regularly serviced. The Gas boiler was serviced on 090705 following a requirement for confirmation, made at the last inspection. The home ensures that there is always a qualified first-aider on shift at all times, with a range of regular safety training available to all staff including those who work in flexible non-permanent-roles. A fully completed visitors book is maintained in the home. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X X X X 3 X Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA1 YA1 Good Practice Recommendations That the home produces a summary of the Residents [Service User] guide on a talking tape to assist Resident’s access information. That the summary of the most recent inspection report is discussed and confirmed with all residents. Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Watchbell House DS0000021279.V281593.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
