Inspection on 10/05/06 for 44 Wilton Road

This inspection was carried out on 10th May 2006.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

44 Wilton Road 06/02/08

44 Wilton Road 05/12/05

44 Wilton Road 17/05/05

44 Wilton Road 21/12/04

44 Wilton Road 25/08/04

44 Wilton Road 26/02/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Wilton Road (44) 44 Wilton Road Salisbury Wiltshire SP2 7EG Lead Inspector Alyson Fairweather Unannounced Inspection 10th May 2006 10:00 Wilton Road (44) DS0000028684.V292706.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 Wilton Road (44) DS0000028684.V292706.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. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wilton Road (44) Address 44 Wilton Road Salisbury Wiltshire SP2 7EG 01722 410724 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) wiltonroad@rethink.org www.rethink.org Rethink Vacant Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (2) Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: 44 Wilton Road is an 8 bedded home for adults who have chronic long-term mental health problems. The registered provider is Rethink, and the building is owned and managed by Shaftsbury Housing Association. The building was formerly two houses, and has been very sympathetically renovated. The home offers easy access to local amenities and is situated in a quiet cul-de-sac. There is ample parking to the front of the home, and ramped access is available. There is a large secluded garden to the rear of the house, with a patio area and a conservatory. It is located in the city of Salisbury in Wiltshire and is within walking distance of the city centre. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in May, when four residents and three staff members were spoken to. Three family members and one member of the CMHT sent their comments about the home in writing. Mr Brent Peplow, the manager at 44 Wilton Road, is currently on secondment from another Rethink service. He has a great deal of experience of working with people with mental health problems, and has been registered with the Commission for Social Care Inspection (CSCI) for a number of years. It is envisaged that this situation is a temporary measure until July. Various documents and files were examined, including care plans, health & safety procedures, risk assessments, staff files and medication records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The home had previously been asked to make sure that all risk assessments were signed and dated, and this had been done. Risk assessments themselves were much more clear and related to specific things which might cause concern for residents. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 6 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. Wilton Road (44) DS0000028684.V292706.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 Wilton Road (44) DS0000028684.V292706.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): 2 Prospective residents have their needs, hopes and goals assessed and recorded before they move in to the home so that staff know how best to support them. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: No new residents have been admitted to the home for a while, although there is a standard assessment procedure which would be used if this was to happen. An application form would be completed by the referring mental health team, detailing the potential resident’s background history, skills and activity levels. This referral would include a copy of the current multidisciplinary care plan (CPA) and any current risk assessments, which gives details of how the potential resident can best be supported with their mental health needs. The manager would also meet with prospective residents and complete the home’s own assessment form. Visits to the home would be encouraged if it was thought that they could meet the person’s needs, and admission would be on the basis of a month’s trial. Wilton Road (44) DS0000028684.V292706.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 and 9 Residents are fully involved in care planning and agree and sign any changes after a review. Residents make decisions about their lives with support, where necessary, and they are supported to take risks as part of an independent lifestyle. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: Support plans examined showed that residents had clearly taken part in reviews, and had signed their agreement with any changes, action plans or risk assessments made. Staff have recently introduced a system where significant incidences are recorded and reviewed. This helps residents and staff to see if there are any obvious reasons for the incident and may lead to a change in the recorded plan. This system appears to be an extremely helpful tool when care planning. Support plans generally were of a good standard, although there was a tendency to combine mental and physical health needs into one. It is recommended that there should be more separation between mental health needs and physical health needs when planning how to support residents, and that mental health needs have a separate care plan. One family member said Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 10 that her son “could not be cared for better in any other home in the country” and a care manager said “I have always been impressed by the high standards of care, professionalism and client satisfaction”. Residents indicated that they were able to make decisions about their own lives with support and guidance from the staff. The interaction observed between the residents and staff also reflected this. Any restrictions are appropriately assessed and recorded, for example staff are supporting one resident to cut down his smoking. People are encouraged to manage their own finances where possible. Risk assessments were on file for all service users, and these are reviewed regularly. They included things like and these included what to do when a resident didn’t want to take their medication, what to do if mental health symptoms got worse and how to manage careless smoking. Risk assessments completed at CPA meetings are also on file. The home had previously been asked to make sure that all risk assessments were signed and dated, and this had been done. Staff place great emphasis on encouraging residents to be as independent as possible, while trying to minimise any risk to their safety. Wilton Road (44) DS0000028684.V292706.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): 12, 13, 15, 16, 17 Social and leisure activities are varied and tailored to individual need, with residents choosing what they wish to do. Contact with family and friends is encouraged and supported, and people’s rights and responsibilities are recognised in their daily lives. Residents are offered a healthy diet and enjoy their meals and mealtimes. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: None of the service users were in employment. However, activities are discussed at residents’ meetings, and people go shopping, out for meals and have video evenings. One resident goes out for a coffee each day, another goes to group events, and there are various in-house events such as games nights. Leaflets were available about local courses and events and staff were aware of local facilities. One resident said he didn’t enjoy group activities much, but was happy to potter about on his own. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 12 Residents can entertain family or friends either in the privacy of their own bedrooms or in the communal areas available. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some family members who cannot visit keep in touch with regular phone calls. Residents can choose when to be alone or in company, and when not to join an activity. They have unrestricted access to the home and grounds, and can come and go as they please. One resident went out into town on the day of the inspection. Staff enter residents’ bedrooms only with the individual’s permission, and were seen to knock on the bedroom door and wait for a response. Residents’ responsibility for housekeeping tasks, such as doing their laundry or tidying their room is specified in their care plan. An advocacy worker has started to visit the home. Residents are encouraged to be as independent as possible in the kitchen, and can prepare their own snacks, although staff support them when cooking main meals. Residents’ care plans outlined the support each person needed with this task. Healthy options are encouraged, and fresh vegetables, juices and yoghurts were available. The style of the kitchen is modern and domesticated, and a dining area is available in the large lounge. At lunchtime, residents were seen to be eating different foods, including soup and sandwiches, prepared by themselves. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 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 and 20 Healthcare needs of residents are written in care plans so that they can receive support in the way they need and prefer. Residents are protected by the home’s policies and procedures for dealing with medicines, although selfmedication could be further encouraged and supported. No residents need personal care. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: All residents are registered with a GP and other health professionals are involved as required. All residents also attend mental health reviews on a regular basis, and care plans may be amended at this time. The home has a policy in place for all medication, including controlled drugs, and all staff have medication training when they first start work. All staff have been working on a Level 2 Certificate in safe Handling of Medication. Selfmedication is encouraged and supported as much as possible, and residents control some of their medication. Medication is sent from the pharmacy in blister packs, and staff sign the medication administration record each time medication is administered. Although no one totally self medicates, support Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 14 and encouragement is given to those residents who want to try, and staff are actively pursuing ways of supporting more residents to do this. The Monitored Dose System is in use, which means that most medicines come supplied from the pharmacy ready made up in dossette boxes or blister packs. However, there were two people who have their medication delivered in boxes or bottles, and staff described how they carried this medication to the individual residents’ rooms. One person’s medication was carried to their room in a plastic pot, and another had the bottle of liquid carried to the room each morning. There were good reasons for this, including one person’s poor mental health and another’s poor physical health. This means that staff could potentially drop the medication before they got to the room. Discussion with staff showed that these residents could potentially look after their own medication, and this was to be further investigated. The manager has been asked to make sure that all medication is administered according to the home’s procedures, and not be carried in pots to residents’ rooms. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 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 Residents’ views are listened to, and any concerns are acted on. The policies and procedures the agency has in place try to ensure that clients are safeguarded from abuse, neglect and self-harm. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: The home has a complaints procedure which gives details of the time in which complaints will be investigated, and who will be responsible for making sure it happens. It also gives details of how to contact the Commission for Social Care Inspection (CSCI). All residents are given a copy of the home’s complaints procedure, and a copy is available in the hall. The manager and staff take all complaints seriously, and would record the nature of the complaint, any action taken and the outcome. Regular residents’ meetings are held, and one resident said that if he has any concerns he can talk to staff. There have been no complaints made either to the home or to the CSCI. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. Three staff members have recently received training in the protection of vulnerable adults and all are encouraged to report any incidences of poor practice. A “Whistle Blowing” procedure is also available for all staff. Risk assessments are in place for all residents. One care manager said “I wish more homes for vulnerable people were this excellent”. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 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): The care which residents and staff take to maintain the home means that residents live in a homely, comfortable safe environment, which is clean and hygienic. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: 44 Wilton Rd was formerly two houses, and has been very sympathetically renovated. It is a comfortably furnished home with large airy rooms. Residents’ bedrooms were homely and each contained individual personal items. There is a large, secluded garden to the rear of the house, with a patio area and a conservatory. There is ample parking to the front of the home, and ramped access is available. The ground floor bathroom has been refurbished to include a shower, and this has proved extremely popular with residents. Staff are to be congratulated in their determination to have this work done in order that the residents can now choose whether to have a bath or a shower. The home was clean and hygienic, with policies and procedures in place for the maintenance of the building. Residents are encouraged to help with household chores, although staff take these over when necessary. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Residents are supported by competent and qualified staff, and their individual and joint needs are met by staff who have had induction and some specialist training, and are undertaking NVQ. They are supported and protected by the home’s recruitment policies Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: All new staff receive induction training and there is an on-going programme of mandatory training such as health and safety, anti-discriminatory practice, mental health awareness and corporate induction. Further training completed in the last year includes team building and leadership, listening skills, negotiation skills, assertiveness skills, and management supervision. All staff except the trained nurse have had training from Salisbury College in Safe Handling of Medication. Four members of staff have done NVQ level 2 or above. Staff recruitment is assisted by Rethink’s human resources department. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Two written references are also required. All the staff files looked at contained the appropriate Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 18 documentation. Residents are encouraged to be part of the interview panel, but often prefer not to do so. Potential staff are always introduced to residents and visit the home. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 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 Residents benefit from a well run home, although further quality assurance mechanisms would ensure that residents’ views underpin the home’s development. The health, safety and welfare of residents are promoted and protected. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to this service. EVIDENCE: Although the current management procedures last only until July, Mr Brent Peplow has been registered with CSCI for some years, and is a qualified RMN. He has a great deal of experience of working with people with mental ill health, and has completed his Registered Managers Award. He has also completed training in Leadership and Team Building. The home has several quality assurance methods in place. As stated elsewhere in this report, the residents have the support of an independent advocate who visits and attends meetings with them, and a Rethink manager visits the home Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 20 on a regular monthly basis to make sure that that it is running smoothly and to identify any problems. Staff said that they were clear that they wished the service to be run in the interests of the residents. At the last inspection it was noted that the questionnaire which should be sent to residents and their families to ask for their feedback on how the home operates had not been done for around two years. The manager was asked to make sure that this was done. However, since that time she has been away from the home. The new manager has again been asked to make sure that the residents’ questionnaire is sent out, and reminded of the potential serious consequences of failing to do so. The home has detailed health and safety policies and procedures in place. Staff have training in basic food hygiene, and food temperatures are recorded on a daily basis. One staff member takes responsibility for fire safety procedures, and provides training for the rest of the staff. The fire bell and emergency lighting are tested regularly. Fire extinguishers are serviced annually by an outside contractor, as are portable electrical appliances. Fire drills are held on a quarterly basis, with a record kept of all resident and staff who attended. Rethink also undertakes a quarterly Health and Safety Audit of the home. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 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 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 X 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 N/A 3 2 X 3 X 2 X X 3 X Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 22 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 All medication should be administered according to the home’s procedures, and must not be carried in pots to residents’ rooms. The quality assurance questionnaire must be sent to residents and their families. Comment: This is the second time that this requirement has been made. Timescale for action 10/05/06 2. YA39 24 10/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations It is recommended that there should be more separation between mental health needs and physical health needs when planning how to support residents. Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI Wilton Road (44) DS0000028684.V292706.R01.S.doc Version 5.1 Page 24 - 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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