Inspection on 23/06/08 for 31 Whitwell Road

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

31 Whitwell Road 16/03/09

31 Whitwell Road 22/02/07

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Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 31 Whitwell Road Southsea Hampshire PO4 0QP Lead Inspector Nick Morrison Unannounced Inspection 23rd June 2008 10:30 31 Whitwell Road DS0000067311.V365155.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 31 Whitwell Road DS0000067311.V365155.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. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 31 Whitwell Road Address Southsea Hampshire PO4 0QP 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) 02392 793941 02392 341476 Bayrose Limited Mrs Sheila Anne Musselwhite Care Home 9 Category(ies) of Learning disability (9) registration, with number of places 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users only to be admitted between 18 and 55 years of age Date of last inspection 22nd February 2007 Brief Description of the Service: 31 Whitwell Rd is one of a number of diverse services run by Sheila Musslewhite of People First to provide support services to adults with learning disabilities. The home accommodates nine service users and is situated in a residential area of Southsea close to the seafront and local amenities. Accommodation is organised across three floors, with an office in the basement. There is a small, enclosed garden with a conservatory leading to the communal dining room and kitchen. There is a lounge and one of the 2 double bedrooms on the ground floor. The other bedrooms are sited on the upper 2 floors. There are 2 communal bathrooms and a statement in the service user guide for the home identifying this shortfall in provision. The home aims to provide residential services that promote the independence of the service users, in line with current best practice. Monthly fees in the home range between £1443.57 and £3376.25 and the Provider advised us that this includes the cost of toiletries and daytime recreational activities. Evening activities are additional. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 23rd June 2008 and lasted five hours. During this time the Inspector toured the premises, looked at the files of four service users, spoke with two service users and observed the support they were receiving. We also met the Manager and two members of staff and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to the service’s own self-assessment of the home. What the service does well: What has improved since the last inspection? What they could do better: The home needs to improve the record keeping in relation to the system for administering mediation. The Manager highlighted to us, through the AQAA and in discussion that further improvements were needed in the home’s quality assurance system and in ensuring that all staff receive regular, formal and recorded supervision. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 6 The Manager is also intending to introduce Health Care Action Plans for people living in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 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 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs and aspirations assessed prior to moving into the home. EVIDENCE: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does it’s own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment. Care packages were only agreed and offered once the home was clear it was able to meet the needs of the person moving in. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions. EVIDENCE: Individual care plans were in place for each person living in the home and were clearly related to the initial assessment and the ongoing information the home had gathered on each person over time. In addition, each care plan was reviewed on a monthly basis in the home and records were kept. Service users were fully involved in this process too. Care plans were written from the point of view of each service user and included information about the person’s history and the things that were important to them. Personal preferences were made clear throughout the care plan and the care plan responded to these. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 10 Service users said that staff were available to help with decision-making, but they were clear that their decisions were their own. Staff spoken with and observed demonstrated an understanding of the need to help people make decisions rather than make decisions for them. Care plans were clear about how service users made decisions and about what things were important to them. Risk assessments were clearly written and reviewed on a regular basis. Staff were clear about risk assessments for each person and the importance of supporting people in line with the risk assessments. Risk assessments were used to promote independence and support people living in the home to be involved safely in the activities they wanted to do. Risk assessments were in place for a variety of general activities as well as specific activities for specific service users. There was recorded evidence that risk assessments, as well as being regularly reviewed, were updated in response to changes in circumstances. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 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. 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 visit to this service. Service users benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. EVIDENCE: Records of activities and discussion with service users and staff showed that service users are supported to make use of a wide variety of local facilities and to be involved in the activities they had chosen. The home employs additional staff during the daytime to facilitate support for people living in the home to make use of the community. Activities were organised in response to aspirations identified with service users through their care plans. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 12 On the day of the inspection visit the Manager arranged a meeting at a local college for two people living in the home who had identified an interest in this through the planning process. The Manager reported that they had tried to find employment for some people living in the home, but this had proved too difficult at the present time. However, the home is planning to get some service users involved in a local community allotment group. Food in the home was of good quality and people spoken with during the inspection visit said they enjoyed their meals. There was a weekly menu in place that had taken account of the individual preferences stated by service users on their care plans. Service users were able to change their minds and deviate from the menu if they chose to and were also supported to be involved in the preparation of meals if they chose to. Service users were also occasionally supported to eat out or to walk to the take away for their meal. The home’s Annual Quality Assurance Assessment told us that they were planning to introduce pictorial menus to assist service users in contributing to and understanding the menu. People living in the home were supported to maintain contact with their friends and families. Records were kept of visits from families and of people going to stay with families. People were also supported to maintain contact with their families over the telephone and staff assisted them to make telephone calls if necessary. Feedback from service users and their families confirmed that the home was supportive in helping them to maintain contact. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their healthcare needs met but would benefit further from being fully protected by the home’s medication practices. EVIDENCE: There had been a requirement from the previous inspection that in the interests of safe medication handling all medication must be administered directly from the original container to the service user, and not placed into a secondary container for later administration by another person. Advice must be taken from the pharmacist. We found that the home had begun to address this requirement and advice had been sought. The system for administering medication in the home relies on a process of double dispensing whereby the person administering it to the service user does not take the medication out of the original container. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 14 Medication is taken out of the original container the previous night and put into individual medication boxes for each person for the following day. These are kept in individual service users’ rooms in a locked container bolted to the wardrobe or bedside cabinet. Those people who require help taking their medication then receive that help from the member of staff who is working at the time they need the medication. This member of staff takes the medication out of the box in the locked container and gives it to the service user. Both the members of staff taking the medication out of the original container and those administering it to service users sign records to confirm they had completed their part of the process. The Manager explained to us that the reason for the double dispensing was to support service users in working towards independence with their medication. Where it is identified as a need for a particular individual to develop independence in administering his or her own medication there should be a record of this on the person’s care plan. In the interest of reducing medication administration errors the practice of transferring medication into a second container for later administration is strongly discouraged. The preferred method of providing medication in these situations is to obtain a separate supply of appropriately packaged medication from the pharmacy. Should it prove necessary to transfer medication to another container then a documented risk assessment and a written procedure must be in place for staff to undertake the transfer of medication from the original labelled containers, as received from the pharmacy, into another container for later administration either by care staff or the service user themselves. This will need to cover: • which members of staff are to be permitted to undertake this procedure • what containers medication is to be put in • what information is to be provided with the medication, such as the name of the medication, who the medication is for, the dose and frequency for administration, any cautions and additional information provided on the dispensing label e.g. with food, swallow whole. a clear record of which member of staff has been involved in each stage of the procedure There were weekly recording sheets for medication and most of these had not been dated. We discussed this with the Provider and she identified that she needs to date these sheets before they printed. The Manager has recently attended training on using Health Care Action Plans for people and is planning to introduce these into the home. Good clear records were kept of the monitoring of each person’s health and of the healthcare treatment they had received. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their views listened to and are protected by the home’s policies and practices. EVIDENCE: The home has a complaints policy in place and service users spoken with said they were clear about how to complain if they wanted to, but had not felt the need to make formal complaints, as issues were resolved in house meetings or in conversation with the manager or their keyworker. No complaints had been received at the home. Feedback from service users and their families told us they knew how to make a complaint if necessary. There were behavioural supports plans in place for people whose behaviour occasionally caused problems for other people in the home. The way the plans were written demonstrated a positive approach to such behaviour and that individual service users were involved in the plans put in place for them. Any incidents were recorded. The home has good policies and procedures in place for dealing with allegations or suspicions of abuse. The service user spoken with had some knowledge of their rights and of abuse issues. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 16 Service users are encouraged to manage their own money as far as possible and to collect it from the bank and pay their contributions to the house. Support was available for people to do this and to budget their own money. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a clean, comfortable and safe environment. EVIDENCE: The house is homely and blends in well with the local community. Service users’ bedrooms are well equipped and they have been able to bring their own possessions with them to the home. There had been a requirement from the previous inspection that action must be taken to ensure the risk of cross infection is minimised. This related to the use of cotton hand towels instead of paper towels. The Manager explained how the cotton towels were used in an attempt to make the house more homely. She also told us that they were changed three times a 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 18 day and were laundered adequately in order to ensure cross infection was minimised. The home was clean throughout, while remaining comfortable and homely. There were cleaning rotas in place for each day of the week to ensure that cleanliness was maintained and clear records were kept of what cleaning had been done. Service users were supported to be involved in the cleaning of the house if they had identified this as something they had wanted to do. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by adequate numbers of welltrained staff and are protected by the home’s recruitment policies and practices. EVIDENCE: Recruitment records in the home demonstrated that all staff were employed within the home’s recruitment policy and that all necessary pre-employment checks had been undertaken prior to them beginning work in the home. Staff spoken with confirmed they had been required to provide all relevant information prior to beginning work in the home. There were two members of staff on duty throughout each part of the day and two staff sleeping in during the night. In addition the Manager was available during the daytime. Feedback from service users and their relatives told us there were sufficient staff available in the home to meet the needs of the people living there and to 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 20 ensure that they could go out and use local facilities when they wanted to. Staff spoken with also felt the staffing was sufficient to meet people’s needs. Staff training was well managed and good records were kept of the training that each member of staff had received, what training they still needed to do and when updates were required. Staff told us the training was useful and relevant to their role and that access to training was good. It is the policy of the home that all new staff complete their initial induction programme and then progress on to National Vocational Qualifications at level two as a minimum. Records demonstrated that training courses were arranged for staff in response to the identified needs of service users. There were clear guidelines in place for staff so that they were aware of what was expected of them. These included Keyworker guidelines and a list of daily jobs that needed to be done. We discussed staff support and supervision with the Manager who acknowledged that formal and recorded supervision needs to take place for all staff on a more regular basis. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well managed home that is safe and responsive to their needs. EVIDENCE: The Manager is registered and has demonstrated that she has the skills, qualifications and experience to manage the home. We discussed the home’s Annual Quality Assurance Assessment (AQAA) with the Manager as it was lacking in detail. We have explained to the Manager how the next AQAA needs to improve and have directed her to our website for guidance on how to complete them properly. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 22 The home’s own quality assurance processes are basic and need to be improved upon. The Manager explained to us that they have regular questionnaires for service users and their families but they got little response from these. The AQAA told us that the home is planning to develop the quality assurance process and introduce service users meetings, which will contribute to a more effective quality assurance system. Feedback from service users and their relatives told us the service was good at responding to individual wishes on a daily basis and that this helped in ensuring that the service was based around the needs and wishes of the people who use it. There had been a requirement from the previous inspection that you are required to store cleaning materials in accordance with Control of Substances Hazardous to Health regulations (COSSH) 1999. Observation throughout the inspection showed that this requirement has now been met. No other health and safety issues were identified as a result of the inspection. 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 23 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 X 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 24 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 YA20 Regulation 13 (2) Requirement The medication system in the home must be supported by adequate record keeping and risk assessment. Timescale for action 11/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 31 Whitwell Road DS0000067311.V365155.R01.S.doc Version 5.2 Page 26 - 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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