Inspection on 05/12/05 for 44 Wilton Road

This inspection was carried out on 5th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 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 10/05/06

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 5th December 2005 2:00 Wilton Road (44) DS0000028684.V253860.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 Wilton Road (44) DS0000028684.V253860.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. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 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 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.V253860.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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, formerly NSF, 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 to the city centre. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon in December. Three residents were at home, as well as two members of staff and the manager. The inspector walked round the premises and examined several records, including care plans, medication records and staff files. What the service does well: What has improved since the last inspection? What they could do better: At the last inspection it was found that some risk assessments were not up to date, and therefore did not always contain accurate information. The same thing was found again, with several risk assessments not dated, making it difficult to know how recent they were. One person’s risk assessment mentioned “Physical Restraint” although the manager was clear that this was a clerical error and that the home had a policy of no physical restraint being used. The manager must ensure that all risk assessments are dated and contain accurate information. Any reference to physical restraint must be removed. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wilton Road (44) DS0000028684.V253860.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 Wilton Road (44) DS0000028684.V253860.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 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. EVIDENCE: Considerable information from the referring mental health team is sent to the home when a new resident is planning to move in. Information is also received from medical teams and from various other professionals. Residents talk to staff at the home about their hopes for the future and what they would like to do with their daily routine before they move in, during the trial visits. The referring mental health teams provide a copy of the most recent Care Programme Approach (CPA) plan, which gives details of how the potential resident can best be supported with their mental health needs. Wilton Road (44) DS0000028684.V253860.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 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. EVIDENCE: Care 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 care plan. This system is being piloted initially with two residents, but appears to be an extremely helpful tool when care planning. 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. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 10 There were several risk assessments on file, 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. However, several risk assessments were not dated, making it difficult to know how recent they were. One person’s risk assessment mentioned “Physical Restraint” although the manager was clear that this was a clerical error and that the home had a policy of no physical restraint being used. The manager must ensure that all risk assessments are dated and contain accurate information. Any reference to physical restraint must be removed. Wilton Road (44) DS0000028684.V253860.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): 16 and 17 Residents’ rights are respected and responsibilities recognised in their daily lives. Residents are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: 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 had gone 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, and often attends the residents meetings. Residents prepare their own breakfast and lunch, with some support from staff. The evening meal is chosen by a resident and is cooked sometimes by them with support from the staff, or by staff when residents are unwell. Food Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 12 shopping is done weekly and residents are encouraged to participate with the shopping. A selection of fresh fruit and vegetables is always available. The style of the kitchen is modern and domesticated, and a dining area is available in the large lounge. Supper on the day of the inspection was sausages, new potatoes, cabbage and green beans. One resident commented that he usually enjoyed the food, and liked the fact that he could choose what meal to have. Wilton Road (44) DS0000028684.V253860.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): 20 Residents control their own medication where possible, and although errors in staff recording when they administer medication could mean that residents are at risk. EVIDENCE: 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. Self medication 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 are meant to sign the medication administration record each time medication is administered. However, there were several gaps in these signatures, and no record to indicate whether tablets had been given or had been refused. The manager has been asked to ensure that all staff sign the medication administration record each time medication is given. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 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 Residents’ views are listened to, and any concerns are acted on. EVIDENCE: There is a complaints procedure in the home which outlines the steps to take if any one has a complaint. This gives details of how residents and families can contact the Commission for Social Care Inspection (CSCI) if they prefer to complain to an outside person. One resident said that if he has any concerns he can talk to his keyworker. There have been no complaints made either to the home or to the CSCI. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 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): 27 Residents’ toilets and bathrooms offer them privacy and choice. EVIDENCE: There is a toilet and a bathroom on each floor. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 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 and 34 Residents are supported by competent and qualified staff, and are supported and protected by the home’s recruitment policies 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 offered includes conflict management, de-escalation techniques, racial equality and setting professional boundaries. All staff, except the trained nurse, are having training from Salisbury College in Safe Handling of Medication. One new member of staff is able to use sign language, and this has proved to be very helpful in communicating with one resident who has a hearing impairment. 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 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.V253860.R01.S.doc Version 5.0 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 and 39 Residents benefit from a well run home, although further quality assurance mechanisms would ensure that residents’ views underpin the home’s development. EVIDENCE: Since the last inspection, a permanent manager has been appointed. Ms Williams had been working in the home part time prior to her appointment, so was familiar with both residents and staff. Ms Williams has started an NVQ level 4 course and her Registered Manager’s Award. Unfortunately, CSCI has not received an application to date, so the registration process has not yet begun. The manager reported that a quality audit had been conducted by Rethink earlier this year, although this was unable to be found. Regular monthly visits on behalf of the organisation are conducted, and reports of these visits are sent to the CSCI. As stated elsewhere in this report, the residents also have the support of an independent advocate who visits and attends their meetings. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 18 It was, however, reported that the questionnaire which should be sent to residents and their families to ask for their feedback on how the home operates, hadn’t been done for two years, and the manager has been asked to ensure that it is done within the next three months. Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 1 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wilton Road (44) Score N/A X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X X DS0000028684.V253860.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 13 (4) (b) Requirement The registered person must ensure that all risk assessments are dated and contain accurate information. Comment: This is the second time that this requirement has been made. The registered person must ensure that the reference to “physical restraint” is removed from the risk assessment. The registered person must ensure that all staff sign the medication administration record when dispensing medication. The registered person must ensure that the quality assurance questionnaire is sent to residents and their families. Timescale for action 05/01/06 2 YA9 13 7 05/12/05 3 YA20 13 2 05/12/05 4 YA39 24 05/03/06 Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 21 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 Wilton Road (44) DS0000028684.V253860.R01.S.doc Version 5.0 Page 22 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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