CARE HOME ADULTS 18-65
Waters Park House Exmouth Road Stoke Plymouth Devon PL1 4QQ Lead Inspector
Brendan Hannon Unannounced Inspection 7th March 2006 10:45 Waters Park House DS0000003617.V274505.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 Waters Park House DS0000003617.V274505.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. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Waters Park House Address Exmouth Road Stoke Plymouth Devon PL1 4QQ 0175) 567755 01752 562111 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) Waters Park Limited Miss Elizabeth Waters Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23), Physical disability (23) of places Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Water Park House is owned by Waters Park limited and managed by Miss Elizabeth Waters. Waters Park House provides intensive rehabilitation support for up to 23 service users who have suffered a brain injury. The home is situated in a pleasant residential area of Stoke, adjacent to the park and within a short distance of Stoke Village. The home provides 22 units with en suite accommodation which includes 3 flats, 8 bed sitting rooms and 9 bedrooms. Six units offer self-contained accommodation. Communal areas include a large lounge room, a dining room with a kitchen area and a separate kitchen. In addition to the communal areas, the home offers a number of therapeutic training areas, including a workroom, an art room, a kitchen and a physiotherapy suite. There is level access to all areas of the home and a passenger lift provides access to the first floor. There is a sheltered patio area with seating where service users may smoke if they wish and a small but pleasant garden area. The large staff team includes rehabilitation care staff, occupational therapists, physiotherapists, therapy, education and activity assistants, a workshop co-ordinator, maintenance, catering and domestic staff as well as administrative staff. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was Unannounced. Preparation for the inspection included analysis of the previous inspection report and contact with the home over the last 5 months. An inspection plan was developed from this information. The inspector was in the home from 10.45am to 1.30pm. The inspector spoke with eight service users. The building was partially inspected. The director of clinical services was spoken to at length during the inspection. Care delivery records, general records, and health and safety records, were inspected. What the service does well:
The unit has a stable management team. The management and staff aim to provide a homely and comfortable place for the service users to live. The unit provides good information about the service to potential new service users, and their representatives, so that they can make an informed choice about whether to use the service. The planning and delivery of service users care is good. There is an individually planned scheme of therapy provided by qualified staff to enable service users abilities to be improved as far as possible. The service has exceeded standard 11 and is commended for the quality of the service provided in this area. There is an individually planned scheme of appropriate activity for each service user that ensures that all the service users enjoy leisure and valued life activity. Service users receive enough, varied, good food and their tastes and preferences are respected. Therefore the home has exceeded standard 17 and is commended for the quality of the service provided in this area. An effective staff team meets Service users’ personal care needs. The service is commended in this report for the quality of delivery in this area. The system of medication administration in the unit is managed effectively. The service works intensively to meet services users health needs and therefore the unit has exceeded standard 19 and is commended for the quality of the service provided in this area. The service users benefit from a homely, comfortable, clean and well maintained building that has been appropriately designed and is highly adapted to meet their needs, and therefore the unit has exceeded standard 29 and is commended for the quality of the service provided in this area. The service has exceeded standard 25 and is commended for the amount of personal space available to residents. All the accommodation in the home is en suite with shower. The service has exceeded standard 27 and is commended for the quality of washing facilities
Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 6 provided. The service has exceeded standard 28 and is commended for the amount and quality of communal areas available to residents. Enough trained staff meets Service users needs. There is an effective management team to support the work of the staff team. 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. Waters Park House DS0000003617.V274505.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 Waters Park House DS0000003617.V274505.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): This section was not inspected on this occasion. EVIDENCE: This section was not inspected on this occasion as standards one, two and three were inspected at the last inspection in October 2005, at which time these standards were met. Waters Park House DS0000003617.V274505.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): 6,7,9 Good care planning and risk assessment of residents needs is being maintained by the service. EVIDENCE: Service users care plans were sampled. All the service users had a care plan and risk assessments in place. The care plans detailed care needs; social, leisure and educational interests; aims and objectives; risk assessments relating to activities of daily living and planned programmes of rehabilitative activities aimed to increase independence, confidence and skills. Regular reviews of this information were documented. The service was advised to bring together the care plan and risk assessment information into the care plan file available to rehabilitation assistants, and to reduce this file in size to make information more accessible to these care workers. The service was also advised to separate the management of behaviours that challenge the service, from the body of the care plan. The home’s multi-disciplinary team, service users and their families are involved in the decision making process to safeguard the service users’ well being, and promote normal daily activity and choice.
Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 10 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): 11,12,13,14,15,17 Service users have enough appropriate activity to ensure a good quality of life while living at the unit. Service users receive enough, varied, good food. EVIDENCE: The service offers comprehensive rehabilitative support through occupational therapy; physiotherapy; counselling; leisure and sport activities; educational activities; work activities in the unit’s workshop and activities relating to normal daily activities such as cooking. Service users are supported to use the local community facilities, such as sports centres and the local College of Further Education. The unit either provides transport or service users are encouraged to use public transport. The service is commended in this report for the quality of enablement taking place at the unit. Discussion with service users and examination of records indicated that service users were supported to participate in activities in the community. The service organised activities that included shopping, the cinema and theatre, pubs, cafes and restaurants, garden centres and other places of interest. Information and advice leaflets were available to service users on the notice board. The unit had a 4-week set menu that is changed seasonally, offering a choice of nutritious and balanced meals. A record of meals taken by service users was recorded. Service users had access to a kitchen next to the lounge room to
Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 11 prepare themselves drinks and snacks and also a kitchen where with supervision they were able to prepare meals. Staff confirmed that a Dietician was involved to offer advice and support to a number of service users with additional nutritional needs. The service is commended in this report for the quality of food provision taking place at the unit. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 12 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 The service maintains the health and welfare of the service users. EVIDENCE: Service users rooms’ are all single and provide en suite shower facilities; therefore all personal or medical care is undertaken in private. Service users support needs are documented to ensure consistency, respect of personal choice and the promotion of independence. Photographs were used to demonstrate service users’ preferred positioning in bed or in a chair. Each service user has a named group of staff that facilitate and review their care needs and who are involved in the service users’ 3-monthly review. Equipment and aids were provided individually to service users to maximise their independence. Discussion with service users and staff indicated that health care needs were assessed prior to and on admission and were kept under review. Each service user was registered with a local GP and the District Nursing Service provided support for both service users and staff for those service users with additional health care needs, such as Diabetes, artificial feeding or catheter care. The service is commended in this report for both the quality of personal care delivery and the support of service users access to health care. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 13 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): This section was not inspected on this occasion. EVIDENCE: This section was not inspected on this occasion as standards twenty-two and twenty-three were inspected at the last inspection in October 2005, at which time these standards were met. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 14 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): 24,25,26,27,28,29,30 The service users benefit from a homely, comfortable, clean and well maintained building that has been appropriately designed to meet their needs. EVIDENCE: Service Users’ bedrooms were light with adequate ventilation and controllable heating. Furnishings in the bedrooms and the communal rooms were of a good quality. All areas of the unit were accessible by way of ramps and handrails and a passenger lift provided access to the first floor. All of the 22 accommodation units exceed 12 sq.m of useable space, and have en suite shower rooms. The service is commended for the amount of personal space available to each service user. Each service users’ room is personalised according to the service users tastes and it was evident that service users were able to bring some personal possessions with them. All bedroom doors were lockable and staff had a master key for access in an emergency. All bedrooms provided en suite shower facilities. In addition a further bathroom was provided on the ground floor as well as a number of toilets close to the communal and therapy rooms. The service is commended for the quality of bathroom and toilet facilities available to the service users. Aids and adaptations were suitable for the needs of the service users and included hoists, raised toilet seats, shower seats, adapted bath and basin taps,
Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 15 wheelchairs, seating of various heights and work surfaces in the main therapeutic kitchen that could be altered. As the home employed Occupational Therapists and Physiotherapists, service users’ changing needs could be reviewed and responded to immediately. The unit also provides gymnasium equipment in the physiotherapy suite. A call bell system was provided throughout the building. Equipment storage areas were provided. The service is commended in this report for the quality of the adaptations and equipment provided to meet service users physical disability needs. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 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): 32,33,34,35,36 Service users’ needs are met by enough competent, properly vetted, and trained staff. EVIDENCE: The Director of Clinical Services stated that there is always an adequate number of staff on duty to meet the needs of the service users. A thorough basic training programme is run by the service to ensure that skilled staff meets service users’ needs. An appropriate structured induction programme is in place for all new members of staff. This induction includes certificated internal training on understanding and working with brain injury. Approximately one third of the staff team are qualified at present. However this figure is obtained largely through the inclusion of the group of qualified Occupational Therapists employed by the home. The service has implemented an NVQ based training programme for the rehabilitation assistants that will in time provide the service users with a staff team that is made up of 50 NVQ2, or equivalent, qualified staff. Personnel records were available in the home to verify the recruitment procedure carried out for each member of staff. The service has experiencing a very high staff turnover but this has now stabilised through careful recruitment practices. A programme of individual staff supervision sessions is carried out for each member of staff. This monitoring will help to ensure that the quality of staff practice delivered to the service users is maintained at a good standard.
Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 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): 37,39,42 The management of the service is effective which ensures that good quality care is consistently delivered to meet the service users’ needs. EVIDENCE: The management and staff were seen to be working well together. Good working relationships amongst the care team promotes better quality support for the service users. The service has developed a quality assurance system that is focussed on meeting service users needs. The system is based on questionnaires. An annual development plan is devised partly from this questionnaire information. Waters Park Ltd is advised that under regulation 26 of the Care Homes Regulations a representative of the company should visit the unit monthly and in accordance with this regulation write a short report for the Registered Manager and send a copy of this report to the CSCI. The following section relates to Health and Safety issues. The record of fire protection checks is well maintained. Staff are receiving fire protection training and regular fire drills take place. Self-closing fire doors are no longer being Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 18 wedged open. The management was advised to put in place approved hold open devices when clients want to keep their bedroom door open. An environmental Health Inspection took place on the 20/09/05 and no problems were found. Comprehensive safety checks have been carried out during the last year, as noted in the pre inspection questionnaire, including gas appliances, Legionella and electrical equipment. Good management of health and safety protects the welfare of the residents. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 4 26 3 27 4 28 4 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 X X 3 X 3 X X 3 X Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 20 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. 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 YA9 Good Practice Recommendations All agreed boundaries and restrictions should be documented in clients individual risk assessments. Waters Park House DS0000003617.V274505.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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