Inspection on 03/11/05 for 4 Homeground

This inspection was carried out on 3rd November 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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Homeground 05/09/06

4 Homeground 16/06/05

4 Homeground 17/03/05

4 Homeground 16/11/04

4 Homeground 15/03/04

4 Homeground 16/12/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Homeground (4) 4 Home Ground Wootton Bassett Wiltshire SN4 8NB Lead Inspector Pauline Lintern Unannounced Inspection 3rd November 2005 10:00 Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Homeground (4) Address 4 Home Ground Wootton Bassett Wiltshire SN4 8NB 01793 849495 01793 849495 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) White Horse Care Trust Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2005 Brief Description of the Service: 4 Homeground is run by White Horse Care Trust. It offers accommodation and personal care to three people with learning disabilities. The home itself is a detached house in a residential estate on the outskirts of Wootton Bassett. Each service user has a single room on the first floor. There is a lounge, dining room and a garden to the rear of the property. The bathroom is on the first floor and there is a toilet on each floor.The service users receive personal care and support throughout the day from a permanent staff team. There are two members of staff on duty throughout the day, one in the evening and one sleeping in. The philosophy of care emphasises the importance of an ordinary, domestic type home environment and the involvement of people with a learning disability within the wider community. Each service user is offered a range of daytime and leisure activities. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a four hour period. The inspector met with the manager, the deputy and two staff. Two service users were at the day centre, however the inspector had the opportunity to meet with one service user who was at home. During the inspection care plans and risk assessments were sampled. Medication records and heath and safety files were examined. The inspector toured the premises after asking the service if they were happy for them to do so. One service user returned to the home after lunch, as they were feeling unwell whilst at the day centre. What the service does well: What has improved since the last inspection? Staff morale has improved and there is a new energy due to better staffing levels. Having a full compliment of staff enables service users to regularly access activities such as swimming. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 6 Care plans are now regularly updated and reviewed and all staff sign to say that they have read and understood the documents. The presence of a Manager has impacted on the service and has clearly helped with the direction of the service. 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. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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): 2 and 5 Prospective service users have a full assessment to ensure that the home can meet their needs. All service users have a copy of their contract and a service users guide to the home. EVIDENCE: Each service user has a copy of their contract, which outlines the terms and conditions. There is also a pictorial copy. There is evidence that shows that staff have gone through the contents of the contract and service users guide with the service user. The service users guide includes information, in picture format on health, daily living, ‘what you will share’, communication and fees. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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, 7,8, 9 and 10 The ethos of the home is to empower individuals to make decisions about their life and to enable them to take risks, which have been assessed to ensure their safety where possible. EVIDENCE: Each service user has a care plan which is regularly reviewed. The plans contain all information relevant to the persons changing needs, what they feel their strengths and needs are and their likes and dislike. Service users are encouraged to attend their review meetings if they wish. One service user attended his last review, however as he is unable to vocalise his wishes, staff were able to recognise if the service user is happy or not by having a sound knowledge of the person and by body language and facial expression. The service users’ key workers from day services attend the review meetings, which ensures that any changing needs are identified. No service user in the home has access to an independent advocate at the present time. No service users manage their own money at the present time. After discussion with the deputy it was agreed that it might be appropriate to empower one service user to take some control over her day-to-day spending; this would be dependant on the outcome of a risk assessment and clear Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 10 guidance and tuition from staff. The guidelines would need to be documented in the service users care plan and their Person Centred Plan, outlining the goals and the steps needed to achieve it for the person. The inspector discussed with the manager and deputy, ways to implement Person Centred Plans and empower service users to be able to make more decisions and choices. The home is working towards making all documents user-friendly. One service users plan identified a need for staff support when eating, this was supported by a risk assessment that had been reviewed in May 05. Formal house meetings do not take place, however informal meetings do. It is recommended that staff record these meetings and record points that were discussed. The use of pictures and photographs may encourage more participation from service users. All service users have individual risk assessments on activities that are relevant to their own lifestyle. There is evidence that these are reviewed regularly and all staff have read and understood them. During the inspection the inspector observed the staff treating the service users with respect and encouraging their participation in all discussions and activities. Staff asked the service user who was present if it was okay for the inspector to have a cup of coffee. Staff then supported the person to make the coffee and bring it into the lounge. During the inspection staff checked with the service user that it was acceptable to share information with the inspector before doing so. The service users facial expression showed that they were happy for this to happen. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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): 12, 13, 15, 16 and 17 Individuals are encouraged to take part in activities and access the local community. Family contact is encouraged and staff support service users to visit their families when possible. Meals provided are varied, healthy and flexible. EVIDENCE: Social meetings take place between service users from Homeground and service users from other Trust homes. One service user is planning to invite another person over to the home for tea. These meetings include activities such as ‘Music Alive’, and arts and craft sessions. One service user is attending a college course on ‘Self Advocacy’ and is supported by the day centre to attend this. During the summer months the service user enjoys attending football-coaching sessions. The home has its own vehicle, which is used to access amenities. Staff commented that although staffing is much improved, it could still be difficult to access evening activities for service users as only one staff member is on shift. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 12 It is recommended that the manager arrange for additional staff support on occasions to enable service users to experience some evening activities. Staff provide in house activities such as video and takeaway meals and music sessions when they are unable to go out. Records showed that visits have taken place to the local water park, shopping, swimming and pub meals. Activities have improved since all staffing vacancies have been filled. One service user was planning to go swimming on the day of the inspection. The other two service users were attending their day centre. During the inspection staff received a call from the day centre to say that one service user was feeling unwell. Staff immediately went to the collect them. On returning to the house staff introduced the inspector and explained why they were visiting. Staff asked the service user if they wished to go to bed and offered them a cup of tea. They were caring and respectful; making sure that the person was comfortable and supported. Health checks were carried out on the service user to eliminate certain causes of discomfort. There is evidence of family contact with service users. One service user goes home every other weekend and families and friends are welcome at the home at all times. The inspector joined the staff and service user at mealtime. The meal observed was healthy and well balanced. The service user was offered fruit to follow their meal. When asked if they were enjoying their food the service user demonstrated that they were happy with it and asked for second helpings. Staff reported that they are looking at ways of involving the service users more when drawing up the menus. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 the following standard(s): 18, 19, 20 and 21 Service users are protected by the homes policies and procedures for administration of medication where possible. Personal support is provided as identified in the service users care plan. Health Action Plans are not in place yet, nor is there evidence of OK Health Checks. The subject of death has been addressed with sensitivity. EVIDENCE: All support needed with personal care is clearly identified in each individuals acre plan. The care plan informs the reader on each service users morning and evening routines and the amount of support required. Staff reported that all service users did need support with personal care. All personal care is carried out in private either in the bathroom or the individual’s bedroom. Although it was reported that Ok health checks had been completed, the inspector could not find evidence to support this. It is recommended that staff ensure that each service user has a Health Action Plan, which is completed with staff support. Service users have access to specialist services such as Psychologist, Diabetic Nurse, Day services and their own GP. There was evidence to suggest that staff need training on specific areas of health care procedures e.g Invasive treatments and diabetes. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 14 Each service user has medication guidelines in their care plan and staff have signed them. The inspector examined the recording of medication and staff reported on the procedure for disposal and returns of medication. Care plans contain a section where any specific wishes, in the event of the death of a service user are identified. It also states if a service user has no understanding of death. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Provision is in place for service users to make a complaint if they need to do so. Where possible service users are protected from abuse, neglect and self – harm. EVIDENCE: The Trust has a system in place, where each service user has an addressed post card available to them, to enable them to make a complaint knowing it will reach the appropriate person. Although the inspector was unable to ask the service users if they knew how to make a complaint due to communication difficulties, the inspector observed that each service user had a pictorial copy of the complaints procedure in their file. There have been no complaints reported since the last inspection. Staff who met with the inspector reported that they knew how to make a complaint and were all aware of the Wiltshire and Swindon guidance ‘No Secrets’. The home has a ‘Whistle blowing’ policy and Protection from Abuse guidelines in place. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 16 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 and 30 The home is homely, comfortable and clean. All furnishings are of a good standard and every effort has been made to ensure individual needs are met. EVIDENCE: At the time of the inspection the home was well presented, tidy and free from any offensive odours. With the permission of a service user the inspector toured the house. Each bedroom is personalised and staff reported that service users had chosen the décor of their rooms. Service users have family photos and their own possessions in their bedrooms. One service user likes to spend time alone after visiting the day centre. There is a comfortable armchair for them to sit in. Music systems are available, as are televisions if they wish to watch them alone. One service user has a double bed. Staff reported that one service user helped staff to decorate his room with sensory equipment and optic fibre lights to enable him to relax in his room when he wished. The bathroom has recently been re-decorated and re-tiled. It was clean and tidy on inspection. Staff said that service users had adequate time to complete their morning shower routines and were not rushed. There is a gate that slides across the top of the stairs for safety at night. There is an underpinning risk assessment in place to support this. Staff have a Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 17 pager system in place, which alerts the sleep-in staff if any individual comes onto the landing at night. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 18 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, 35 and 36 Staff are provided with training in various subjects, however some additional training would be beneficial to meeting the needs of the service users. All new staff receive induction training and refresher training when necessary. EVIDENCE: Staff told the inspector that morale was much better within the team now that staffing levels were improved. Staff reported that the training provided by the Trust is good, however they would like more specific training on subjects such as diabetes. The training plan showed that staff have attended training in First Aid, Manual Handling, communication, Autism, Down syndrome, Fire, Abuse awareness, drug competency and O’Brian principles. One staff member reported that they had completed their LDAF award and is eager to start their NVQ. One staff member said that they have completed their NVQ level 2 and one other staff member is currently doing level 3. Staff reported that they receive regular supervision from their line manager and that they feel adequately supported. Regular team meetings also take place. The deputy reported that new staff had received a POVA First check and that they had received full CRB clearance before commencing work. The inspector was unable to access the personnel files at the time of the inspection. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 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 The service has benefited from having a manager in place to help direct the team. A method for monitoring Quality Assurance needs to be developed. The health and safety and welfare of service users are protected by the homes policies and procedures where possible. EVIDENCE: The manager reports that they are keen to implement Person Centred Planning into the home. The manager demonstrated that she has a good knowledge of this subject and promotes the empowerment of service users. Although the home has a Quality Assurance file, which contained a master copy of a questionnaire to send to families, there is no evidence of any responses. It is recommended that a format is developed to ensure that the views of service users, families and the relevant funding authority are obtained. During the inspection the inspector observed that covers protected all radiators and windows have restrictors fitted to them. The manager is required to ensure that there is a generic risk assessment in place to support this. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 20 Household risk assessments that were sampled showed that they had been recently reviewed and that there was evidence that staff had read them. All health and safety checks have been carried out; Fire Alarms last tested on 27/10/05, Fire drill on 19/09/05, Emergency lighting tests on 01/04/05 and a Fire inspection report on 16/05/05. The inspector viewed the accident/incident reports, which were recorded appropriately. All staff have received manual handling training. The laundry facilities allow the staff to access the washing machine without entering the food preparation area. Infection control assessments take place on a regular basis, staff report that they have not received infection control training. It is recommended this be arranged as soon as possible. All COSHH materials are securely locked away in accordance with the 1999 Regulations. There is periodic monitoring of the water supply and the risk of Legionella. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 2 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 4 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Homeground (4) Score 3 2 3 3 Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 3 x DS0000028669.V261697.R01.S.doc Version 5.0 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 YA13 Regulation 16(2)(m) Requirement The registered person must ensure sufficient staff are on duty to enable service users on occasion, to pursue their own interests and hobbies in the evening The registered person must ensure staff receive appropriate training to meet the needs of the service users The registered person shall ensure that service users have documented health care checks Timescale for action 03/12/05 2 YA37 18(1)© 03/01/06 3 YA19 12(1)(a) 03/12/05 Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 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 3 4 5 6 Refer to Standard YA14 YA39 YA8 YA7 YA42 YA7 Good Practice Recommendations The registered manager should ensure all service users have a holiday or mini-break. The registered manager should develop ways to monitor Quality Assurance All informal / formal house meetings should be recorded. Person Centred Plans should be implemented. Staff should receive infection control training. Staff should support service users to control their own spending money. Homeground (4) DS0000028669.V261697.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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