CARE HOME ADULTS 18-65
7 Wychwood Close Sonning Common Reading RG4 9SN Lead Inspector
Marie Carvell Unannounced Inspection 28 January 2008 11:00
th DS0000013220.V353021.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 DS0000013220.V353021.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. DS0000013220.V353021.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 7 Wychwood Close Address Sonning Common Reading RG4 9SN 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) 01189 722678 jenny.pearce@new-support.org.uk www.new-support.org.uk Dimensions Mrs Jennifer Pearce Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (3) of places DS0000013220.V353021.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 3 10th August 2006 Date of last inspection Brief Description of the Service: 7 Wychwood Close is a three bedroomed house situated in a quiet residential area in Sonning Common. It is close to shops and other amenities. It provides residential care for up to three adults with learning disabilities, both under and over the age of 65. All those being supported are admitted on a permanent basis. Their physical independence is decreasing as they become older and the home cannot be fully adapted to meet these needs. Therefore, the home cannot currently guarantee to be a home for life. This is being addressed and those being supported are to be given more suitable accommodation. Community and Social Care purchase all the places at the home. The home is run and managed by New Support Options Ltd, a not for profit organisation established in 1989 and part of the New Dimensions Group. New Support Options Ltd has a wealth of experience in providing services for those with learning disabilities and operates in West Berkshire, Hampshire, Surrey and Norfolk, in addition to Oxfordshire. The fees for this service are £641.18 per person per week. The home contributes towards costs for clothing and some holidays. Service users purchase their own toiletries, magazines, hairdressing and some outings. DS0000013220.V353021.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes.
The Commission has, since 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘key Inspection’. The inspector arrived at the service at 11:00 and was in the service until 17:00. It was a thorough look at how well the service was doing, and took into account detailed information provided by the manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. Two service users, three members of staff, one relative of a service user, one GP and a healthcare professional responded to surveys that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. Time was spent with the three service users and a service user from another home, a visiting relative, the manager and the area manager. A tour of the premises was carried out and a sample of records required to be kept in the home were examined, including the case tracking of the three service user’s files. At the last inspection in August 2006, one good practice recommendation was made this is referred to in the body of the report. Feedback was given to the manager and area manager throughout the inspection. What the service does well:
Service user’s rights and responsibilities are respected and this is evidenced in service user records. Staff and other service users do not enter bedrooms without permission from the service user, privacy and the right to be alone is respected. DS0000013220.V353021.R01.S.doc Version 5.2 Page 6 In discussion with a visiting relative, it was evident that visitors to the home are encouraged. The manager and staff were described as very friendly and welcoming. Service users are encouraged to maintain regular contact with family members and friends. In discussion with the relative it was commented that it was appreciated that relatives are invited to social events. Service users are involved with menu planning and food shopping. Menus demonstrated that a varied and balanced diet is provided and a record is maintained of food eaten by service users. Food stocks were plentiful with fresh fruit, vegetables and salad. One service user enjoys cooking and assists staff with some food preparation. Service users spoken to said that if they were unhappy, then they would speak to a member of staff. A survey completed by a relative and a discussion with a visiting relative also confirmed that they were familiar with the home’s complaints procedure and would initially speak to the manager. The home has not received any complaints since the last inspection and the Commission has not received any information regarding complaints about this service since the last inspection. The home is in good decorative order and furniture is of a good standard. Service users expressed their satisfaction of the home and its facilities. One bedroom was seen at the invitation of the service user and was well furnished and reflected the personality of the service user. The home is comfortable, domestic in size and homely. What has improved since the last inspection?
The home’s complaints procedure has been updated. Mandatory training has been provided to all staff. Staff undertaking NVQ training and this training is now being offered to bank staff. Staff are being recruited to previously vacant posts. DS0000013220.V353021.R01.S.doc Version 5.2 Page 7 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. DS0000013220.V353021.R01.S.doc Version 5.2 Page 8 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 DS0000013220.V353021.R01.S.doc Version 5.2 Page 9 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): Standard 2 and 4. Quality in this outcome area is good. Service users are assessed prior to moving into the home and are given the opportunity to stay for short periods to be clear whether the home meets their individual needs. Service users are given a contract of residency, which is available in appropriate formats. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection one service user has transferred from a home jointly managed and staffed by the same team. The service user already knew the home and the other two service users well. The three female service users are over the age of sixty five and the transfer has had a positive impact on the service user and the other two service users. Service users are given an individual statement of terms and conditions of their residency in the home. These need to be updated as some information recorded is out of date. DS0000013220.V353021.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): Standards 6,7 and 9. Quality in this outcome area is adequate. Service users have detailed care plans and are involved as much as possible with decision making. Risk assessments are in place, these need to be reviewed and updated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are completed with input from the service user, key worker and the service user’s representatives, as appropriate. Care plans are detailed and include the likes, dislikes and preferences of the service user, daily routines and activity programmes. Care plans are updated and regular review meetings are held to ensure that any changing needs are identified. Relatives confirmed that they are invited to attend annual reviews and attend if possible. It was
DS0000013220.V353021.R01.S.doc Version 5.2 Page 11 acknowledged that care managers (social workers) are also invited to attend annual reviews, but rarely accept the invitation. Risk assessments and behavioural guidelines are in place however, some risk assessments are minimal in contents and need reviewing and updating as most have not been updated for several years, despite the changing needs of the service user. New documentation has been developed for risk assessments and the manager and areas manager confirmed that all risk assessments and behavioural guidelines will be reviewed and updated by the end of February. Care plans will be amended to reflect the changes made. DS0000013220.V353021.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): Standards 12,13,15,16 and 17. Quality in this outcome area is good. Service users are assisted to make informed choices about all aspects of their daily life; this is sometimes dependent on staff resources. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have a weekly programme of activities and these are recorded on a daily basis in service users records. The home has its vehicle, which is shared with a second home, currently only two members of staff are able to drive, and therefore use is restricted. On the day of this visit one service user was attending day services. The majority of activities are undertaken in the home, such as watching television, knitting, visits from family and shopping. Over the next twelve months the manager is hoping to find a wider range of activities for the service users to undertake. Comments made on a survey completed by a relative included ‘ staff numbers and X care needs are not
DS0000013220.V353021.R01.S.doc Version 5.2 Page 13 always matched to full capacity. Staffing shortages have limited opportunities (to meet the different needs of people), but efforts are made to achieve things in due course’. Comments made on a survey completed by a service user with assistance included ‘ Has to fit in with arrangements made available to her’. One service user showed the inspector photographs of a trip on the Orient Express and said that she had, had a lovely day with her carer. Another service user said that she was going to a concert to see her favourite singer. Service users take holidays each year; this may be for a week, a long weekend or day trip, depending on the preferences of the service user. Service user’s rights and responsibilities are respected and this is evidenced in service user records. Staff and other service users do not enter bedrooms without permission from the service user, privacy and the right to be alone is respected. In discussion with a visiting relative, it was evident that visitors to the home are encouraged. The manager and staff were described as very friendly and welcoming. Service users are encouraged to maintain regular contact with family members and friends. In discussion with the relative it was commented that it was appreciated that relatives are invited to social events. As in many other care homes, there is a wider range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with the manager, the inspector considers that the home would be able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Service users are involved with menu planning and food shopping. Menus demonstrated that a varied and balanced diet is provided and a record is maintained of food eaten by service users. Food stocks were plentiful with fresh fruit, vegetables and salad. One service user enjoys cooking and assists staff with some food preparation. DS0000013220.V353021.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): Standards 18,19 and 20. Quality in this outcome area is good. Service user’s personal and healthcare needs are well met. Medication storage, administration and recording are well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user’s physical, personal and emotional care needs are detailed in care plans and recorded in daily records. Service user’s records evidenced that healthcare checks are undertaken as necessary. One of the areas the manager is hoping to improve over the next twelve months is to ensure that health booklets are updated. Comments made on a survey completed by a healthcare professional included ‘ recommended treatments have always be followed up by staff. I have found the staff extremely caring and helpful and the atmosphere in the home is always happy
DS0000013220.V353021.R01.S.doc Version 5.2 Page 15 and I enjoy my mornings there. I would feel confident if a relative of mine were to live there’. Comments made on a survey completed by a GP to the question does the care service seek advice and act upon it to manage and improve individuals’ health care needs stated ‘ usually’. To the question are individuals’ health care needs met by the care service the GP stated ‘usually’. All staff who have responsibility for the administration of medication, receive appropriate training. Medication administration records and storage were seen to be satisfactory. None of the current service users retain, administer or control their own medication. A community pharmacist visits the home on a yearly basis and advice given is acted upon. DS0000013220.V353021.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): Standards 22 and 23. Quality in this outcome area is good. The home has a complaints procedure in place and procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is recently updated complaints procedure in place and it is available in alternative formats. Service users spoken to said that if they were unhappy, then they would speak to a member of staff. A survey completed by a relative and a discussion with a visiting relative also confirmed that they were familiar with the home’s complaints procedure and would initially speak to the manager. The home has not received any complaints since the last inspection and the Commission has not received any information regarding complaints about this service since the last inspection. There are policies and procedures in place for safeguarding adults from possible abuse and whistle blowing. All staff have received training in safeguarding adult procedures and refresher training is being arranged for all staff. Evidence was seen that all staff have been given a copy of the whistle blowing policy. DS0000013220.V353021.R01.S.doc Version 5.2 Page 17 No adult protection investigations have been undertaken since the last inspection and no referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults list). DS0000013220.V353021.R01.S.doc Version 5.2 Page 18 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): Standards 24 and 30. Quality in this outcome area is good. The home is homely, comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in good decorative order and furniture is of a good standard. Service users expressed their satisfaction of the home and its facilities. One bedroom was seen at the invitation of the service user and was well furnished and reflected the personality of the service user. The home is comfortable, domestic in size and homely. During the next twelve months the manager is hoping to upgrade the bathroom and kitchen. Decking is to be provided in the rear garden to enable one service user to gain easier access. The home was found to be clean, well maintained and free from unpleasant odours. There is a cleaning schedule in place, which was seen to be up to date.
DS0000013220.V353021.R01.S.doc Version 5.2 Page 19 A survey completed by a service user commented that the home is only ‘sometimes’ fresh and clean. DS0000013220.V353021.R01.S.doc Version 5.2 Page 20 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): Standards 32,33,34,35 and 36. Quality in this outcome area is adequate. Staffing levels are stretched to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection one support worker has been recruited to work between this home and a second home, this member of staff is currently on maternity leave. The home continues to have vacancies for a full time senior support worker and two part time support worker posts. These vacancies are currently being advertised. At the time of this inspection the manager was on duty from 7:00 until 21:00 and was the only member of staff on duty, in addition due to staff training the second home that the manager has responsibility for had no staff on duty until late afternoon, resulting in one service user spending time at this home. The duty roster covers the two care homes. The duty roster did not accurately reflect staff on duty, the manager had previously advised the inspector that changes would be made to ensure that duty rosters clearly identify the name
DS0000013220.V353021.R01.S.doc Version 5.2 Page 21 of the member of staff, the hours rostered to work, in which home and whether the roster was actually worked. Staffing levels are minimal, one part time and five full time support workers are in post to cover two care homes, totalling 205 hours per week. One support worker has left since the last inspection. Four bank support workers, who work for day services, provide some cover to the home as overtime, when necessary. The duty roster demonstrated that there is usually only one member of staff on each shift. Two surveys completed by staff stated that there was ‘usually’ enough staff to meet the individual needs of the service users and one survey stated that there was ‘always’ enough staff. Two staff files were examined and contained a completed application form, references, identification and evidence that police checks had been undertaken. Files contained a job description and contract of employment. The manager is to involve service users with the recruitment of staff to the vacant posts. The manager confirmed that staff complete mandatory training and specialist training is provided as necessary. The home has a staff training and development programme in place. Two support workers have completed NVQ level II or level III and two support workers are to commence NVQ training in February 2008. Bank support workers now are able to access NVQ training. Staff surveys confirmed that they receive regular, planned supervision and this was evidenced from records available. Staff meetings take place on a regular basis and staff stated that they felt well supported by the manager. DS0000013220.V353021.R01.S.doc Version 5.2 Page 22 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): Standards 37, 38,39 and 42. Standard 39 was subject to a good practice recommendation at the last inspection. Quality in this outcome is adequate. The manager needs to be provided with sufficient time and resources to manage the home effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed by a well qualified and experienced manager. The manager also manages a second care home and divides her time between the two services. In addition the manager supports a service user who lives in the community. It is not evident that the manager has sufficient time to carry out her administrative and management responsibilities, as the manager also
DS0000013220.V353021.R01.S.doc Version 5.2 Page 23 provides direct care to service user, when covering shifts alone at both care homes and providing sleep in duties at both homes. All policies and procedures are to be reviewed and updated as the organisation New Support Options becomes Dimensions. Policies and procedures were available and it was evident that the manager is discussing specific policies and procedures with the staff team. At the last inspection a good practice recommendation was made that a copy of the outcomes of any quality initiative should be forwarded to the Commission. It was agreed that a copy of quality initiatives should be available in the home and available if requested. Only two provider representative monthly reports were available in the home for the last twelve months, these were dated 19/02/07 and 12/04/07. This was discussed with the manager and area manager. It was evident from records seen during this visit that regular visits are made to the home by the area manager and this was confirmed by service users. Records relating to health, safety and welfare were seen to be well maintained and up to date. DS0000013220.V353021.R01.S.doc Version 5.2 Page 24 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 x 3 3 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 2 33 2 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 x 12 2 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 2 2 x x 3 x DS0000013220.V353021.R01.S.doc Version 5.2 Page 25 None made 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 YA9 Regulation 13 Requirement Risk assessments and behavioural guidelines must be reviewed and updates to reflect the changing needs of the individual service users. Sufficient staff must be employed to meet the assessed needs of the service users. A report on the conduct of the home, written following a monthly unannounced visit to the home by a provider representative must be available in the home. Timescale for action 28/02/08 2 3 YA33 18 26 28/03/08 28/02/08 YA39 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA12 YA37 Good Practice Recommendations Make arrangements for service users to take part in valued and fulfilling activities, which are age, peer and culturally appropriate. Sufficient time should be available to the manager to run the home and meet its stated purpose, aims and objective.
DS0000013220.V353021.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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
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