Inspection on 05/03/07 for Warwick House

This inspection was carried out on 5th March 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Warwick House 23/03/06

Warwick House 18/05/05

Warwick House 11/11/04

Warwick House 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Warwick House 12 Grosvenor Road Paignton Devon TQ4 5AY Lead Inspector Susan Samways Unannounced Inspection 5th March 2007 10:00 Warwick House DS0000055762.V320432.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 Warwick House DS0000055762.V320432.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. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warwick House Address 12 Grosvenor Road Paignton Devon TQ4 5AY 01803 663421 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) warwick@moduscare.com chalkhill@moduscare.com Modus Care Limited Mr Steven Hugh Smith Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 7 Service Users within the Learning Disability category may reside at the home. 23/03/06 Date of last inspection Brief Description of the Service: Warwick House is a large detached house in Paignton which has easy access to shops, public transport and other community facilities. The home provides services for up to seven adults with a learning disability, in particular autistic spectrum disorder. All the bedrooms are en-suite and the communal rooms are spacious and well decorated. The home also benefits from a large rear garden. Warwick House is owned by a company which has other care homes and hospitals specialising in the care of people with autistic spectrum disorders. Fees charged are based on the assessed needs of each Service User and the degree of staffing input required. The range of fees currently charged are £1500 – 2300 per week. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which lasted for seven hours. The registered manager was on duty and remained for the duration of the inspection. The responsible individual was also present for part of the time. At the time of the inspection there were four Service Users resident in the home, three of whom had completed questionnaires. Surveys were also received from a member of staff, two relatives and two visiting professionals. Time was spent talking to two of the Service Users on an individual basis and to a group of staff. Documents, including Service Users’ records, were examined and discussions took place with the registered manager and responsible individual. What the service does well: The Service Users, relatives and visiting professionals who had completed surveys all expressed a high degree of satisfaction with the service. One relative described the staff as “excellent”. The Service Users said that the staff provide them with support with all activities, that they treat them with respect and that they listen and act on what they say. They also said that they are involved in the running of the home and are given the assistance they require with household tasks. Warwick House is a well run home for adults with autistic spectrum disorders. The manager clearly knows the Service Users well and observation showed that staff have good relationships with them. Service Users were seen to be treated with respect and spoken to appropriately. Care and support is provided in an individual way with Service Users being encouraged to be as independent as possible. Assessments, care plans and risk assessments are detailed and clearly identify the support each Service User requires to achieve their goals. Service Users can access a wide range of educational, social and leisure activities both in the home and in the local community and are encouraged to do so. They are also encouraged to maintain family contact. The home operates a key worker system which ensures that individual service user’s needs are met. The home has a good relationship with the dietetic service at the local hospital which ensures that the service users’ nutritional needs are met. There is a good staff recruitment procedure and the staff training programme is comprehensive with a training plan identified for each member of staff which includes refresher training. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Warwick House DS0000055762.V320432.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 Warwick House DS0000055762.V320432.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): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment is made of prospective Service Users, who are also given a detailed Service Users’ Guide, which provides sufficient information to enable all those concerned to make the decision as to whether Warwick House is an appropriate home for them. EVIDENCE: A new Service User has moved in to Warwick House since the last inspection. The registered manager visited the Service User where they were living on two occasions. These visits contributed to the assessment process, gave an opportunity for the manager and the Service User to get to know each other and for the Service User to learn about their prospective new home. The Service User then visited Warwick House, with the support of a carer, for an overnight stay. The existing Service Users were prepared for the visit which included giving them a photograph of the visitor. They had a meal together and spent the evening in the lounge getting to know one another. The new Service User was asked if they would like to move in and was given a choice of rooms. During Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 9 the inspection the Service User was able to confirm that this took place and said that they were given the choice of whether they moved in or not. Warwick House provides each Service User with their own individualised copy of the Service Users Guide which contains information about the home and how it runs. It also includes details of the training provided for all the staff of the home to enable them to meet the needs of the Service Users. Staff spoken to showed a clear understanding of the needs of those living at Warwick House. The files for two service users were examined. They were found to have very detailed needs assessments which also included past history, personal details and likes and dislikes. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 10 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): 6,7,8,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service Users can be confident that their care plans clearly identify their needs and how they will be met. EVIDENCE: The files for two Service Users were examined. Each contained detailed information about the Service User which included the individual programme plan, personal profile, risk assessments, health and medication records and reviews. Service Users’ needs were clearly identified and how they would be met. Service Users’ signatures on various documents showed their involvement in their plans and reviews. Relatives comment cards confirmed their involvement in decision making when required. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 11 The Service Users’ Guide clearly states that each Service User is expected to participate in all domestic activities and this was supported by the four week rota detailing the tasks to be undertaken. Service Users are encouraged to be as independent as possible and the degree of assistance required by each Service User is included in their individual programme plans and risk assessments. Risk assessments are detailed and clearly show what action should be taken to support the Service User and reduce the risk. These are reviewed at least every six months, sooner if there is a change in the Service User’s circumstances or behaviour and this was reflected in the records seen. The registered manager stated that the care plans are currently being redesigned. Each aspect of the care plan is on a separate sheet which will make modifications to the care plan following a review easier to record. Daily records log Service Users’ activity on an hourly basis. A daily diary has been introduced which is completed at the end of each day. It is used to summarise the days events and give an overview of what the Service User has been doing for relatives and other interested parties. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service Users are provided with good support to enable them to access social and educational opportunities. Service Users’ contact with friends and relatives is positively encouraged. EVIDENCE: Service Users’ records show that they are all encouraged to participate in a wide range of activities both in the home and in the local community. Each Service User has an activities sheet showing their programme for the week. This includes educational courses such as literacy and numeracy, physical activities like horse riding, bowling and swimming and domestic and leisure activities within the home. They also have membership of local organisations such as the zoo and the Torbay Coast and Country Trust. Service Users have Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 13 the use of a computer which has a broadband connection and two of them use e-mail to contact family members. A newsletter is also sent to parents every three months giving information about what the Service User has been doing and where they have been and includes photographs. The staff have access to lease cars which can be used to take service users to appointments and to attend college or social events. The staff have to have had a driving licence for at least 12 months and are required to pass the company’s driving test before they are permitted to drive the lease cars. Service Users are expected to assist in the running of the home. With support they keep their own rooms clean and are encouraged to help with other household tasks such as cleaning and washing up. One Service User, who is working towards more independent living, helps with food preparation and cooking and also does some ironing under supervision. During the inspection the Service User expressed their appreciation of the support provided by the staff. Service Users’ dietary requirements and preferences are recorded and their menus developed with them on an individual basis and reviewed every two months. The home has a good relationship with the dietetic service at the hospital and changes of menu are discussed with a dietician to ensure that a good nutritional balance is maintained. One service user has been enabled to lose weight by being encouraged to stick to her diet with explanations being given of the consequences of different food choices. Service Users make their own drinks under supervision and work alongside staff baking cakes and making sandwiches or toast. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 14 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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users receive personal care and support in the way they prefer and which promotes privacy, dignity and independence. Medication is managed in a way which safeguards Service Users. EVIDENCE: The home operates a key worker system which ensures that each Service User’s individual needs are met. Support required with personal care is recorded in the Service Users’ care plans including how that support should be provided. For example what assistance is required with bathing, whether the member of staff remains in the bathroom or in the vicinity. Prompts regarding aspects of personal care are given as required and recorded in the daily records. Service Users’ records provide evidence that they are involved in managing their own health care and that health care professionals are Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 15 accessed as required. Support is provided by staff as identified by the care plan or as requested by the Service User. The home operates a good system for the administration of medication. All staff receive training in the safe administration of medication and are required to observe an experienced member of staff at least three times before they are supervised administering medication themselves. Two staff work together when dealing with medication. Medication is received from the pharmacy in blister packs. Medication to be administered is read out by one member of staff and the other puts the blister pack into a box which is then locked. One member of staff signs to say that it has been removed. The box is then taken to the Service User’s room by both staff. The blister is popped in front of the Service User and the medication given to them. On return the pack is put back into the medicine cabinet which is locked. The other member of staff signs to say that the medication has been given. Support regarding medication, especially PRN medication, is available out of hours from staff at the company’s hospitals. Service Users’ consent to medication is recorded in their care plans. Medication records examined were seen to be in order and the medication stored securely. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 16 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Users who completed surveys all said that they knew who to speak to if they were not happy and also knew how to make a complaint. One Service User had been supported by the staff to make a formal complaint in writing. They had received a reply from the responsible individual. During the inspection they confirmed that they had been satisfied with the response they had received. The home’s complaints procedure is included in the Service Users’ Guide as is a questionnaire that Service Users can complete if they wish to express their views about the home. All staff attend in-house training regarding the protection of vulnerable adults. The manager and other staff spoken to stated that the home’s team of staff would have no qualms about addressing issues of poor practice. The manager said that he had confidence that incidents of abuse or poor practice would be reported. Warwick House DS0000055762.V320432.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): 24,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Warwick House provides Service Users with a homely, comfortable and safe environment in which to live. EVIDENCE: Information regarding Warwick House states that each Service User has their own room with en-suite facilities. These were not inspected on this occasion but Service Users spoken to said that they liked their rooms and could personalise them as they wished. The registered manager said that when a Service User moved out one of the others asked if they could move in to that room. This was agreed and the Service User was given the option of having it re-decorated. The communal space includes lounge, dining room, large kitchen and quiet room. There is a large garden to the rear of the property which is enclosed and fairly private. The manager stated that the bedrooms Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 18 currently not in use would be refurbished and decorated when required by a Service User and following discussion with them regarding colour schemes. The furnishings in the communal areas were comfortable and of good quality. The manager reported that the communal areas were due to be re-decorated and that this would be discussed at house meetings to enable everyone to be involved in the choice of colours. The laundry area is well organised. Hazardous substances such as cleaning materials are stored in a locked cupboard. All areas seen during the inspection were clean and hygienic and the home was free from offensive odours. Warwick House DS0000055762.V320432.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): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs sufficient staff who have the skills, training and understanding to meet the needs of Service Users. EVIDENCE: Training records showed that staff attend both internal and external courses which equip them to meet the needs of Service Users, especially those with challenging behaviour. The training chart in the office shows the training each member of staff has done, that which is planned and when refresher training is due. The company employs a training co-ordinator who monitors all staff training and who is also an NVQ assessor. Staff are encouraged to undertake NVQ in care and at the time of the inspection three staff were doing NVQ level 3. Staff were observed interacting with Service Users in an appropriate and supportive way demonstrating an understanding of each Service User. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 20 The home has a good recruitment policy and procedure and staff files examined showed that these had been followed. CRB checks were not available as these are held at the head office of the company which owns Warwick House. Each new member of staff follows a detailed induction programme and has their competency in various aspects of working in the home assessed. Further training is offered if an acceptable level has not been reached. The manager stated that the same recruitment procedure and training programme is used for bank staff as for permanent staff. Staff supervision should take place every six weeks and there is a structure in place to identify who is supervised by whom. However, staff reported that it was difficult to find time for formal supervision which they regretted. They did say that there was a lot of informal contact with senior staff which was helpful. This was addressed with the manager and responsible individual during the inspection. Warwick House DS0000055762.V320432.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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users can be confident that the home is well run and that their views will be taken into consideration in the plans for the home. EVIDENCE: Warwick House is part of a larger company which provides a supportive structure to enable the manager to run the home. Since the last inspection there has been a change of manager. The current manager was managing another of the company’s homes which closed. He is currently undertaking NVQ level 4 in care. In discussion the manager showed a good understanding of the needs of the Service Users and of their behaviour and how this should Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 22 be managed. He was also aware of the training the staff needed in order to fulfil their role. Service Users expressed their satisfaction with the way in which the home is run. They said that they are able to air their views directly to a member of staff. They also said that they felt the staff listened to them and acted on what they said. The manager stated that any views expressed, especially if the Service User was worried about something, would be discussed with them. The home has developed a quality assurance system to monitor all aspects of the home with weekly, monthly and six monthly checks being carried out. Service Users, relatives and care managers had been given surveys. Those that had been returned were very positive about the service. One relative had raised an issue which was being addressed. Risk assessments for the premises have been completed and policies and procedures for safe working practices are in place. All policies and procedures are currently being reviewed. Staff training includes first aid, infection control and food hygiene. Accidents and incidents are recorded including action to be taken to reduce the likelihood of a re-occurrence. Warwick House DS0000055762.V320432.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 3 2 3 3 3 4 3 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 3 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 4 3 3 4 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Warwick House DS0000055762.V320432.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA36 Good Practice Recommendations The registered manager should ensure that regular staff supervision is re-instated. Warwick House DS0000055762.V320432.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Warwick House DS0000055762.V320432.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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