CARE HOME ADULTS 18-65
Carwood Residential Home 16 Carwood Stirchley TELFORD Shropshire TF3 1YA Lead Inspector
Rebecca Harrison Announced Inspection 17th January 2006 2:00 Carwood Residential Home DS0000059615.V267779.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 Carwood Residential Home DS0000059615.V267779.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. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Carwood Residential Home Address 16 Carwood Stirchley TELFORD Shropshire TF3 1YA 01952 592436 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) Telford & Wrekin Council Paul Andrew Shirley Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th July 2005 Brief Description of the Service: 16 Carwood is registered with the Commission for Social Care Inspection to provide accommodation and personal care to a maximum of 13 adults with a learning disability aged between 18-65 years. The home is situated in Stirchley, Telford and is owned and managed by the Borough of Telford and Wrekin Council. Mr Paul Shirley is the Registered Manager and Mr Paul Taylor is Head of Adult Services and is the Responsible Individual. Both the Manager and Responsible Individual are well qualified in the field of learning disability and have numerous years experience working for the local authority. Carwood was extensively refurbished to create five flats across two floors with a passenger lift and reopened in 2004. Accommodation in each flat comprises single bedrooms with en-suite facilities, a kitchen/dining area, a lounge, laundry room and a bathroom. The home offers access to local amenities, transport and relevant support services. The Mission Statement is To provide support to people learning disability, based on individual needs as identified through Community Care Assessments and Person Centred Plans. We aim to meet individual needs wherever possible. We aim to promote and increase individual service users independence, opportunities, choice, dignity, rights and quality of life. Create a home, which is safe, comfortable and personal to individuals. Therefore enabling service users to live and participate within their community. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and commenced at 2.00 p.m. and lasted 3.5 hours and involved talking with service users, managers, staff on duty, observing activity, inspection of a number of records and a brief tour of the home. Personnel files were later reviewed on 25th January 2006 at the Civic Offices over a period of 1.5 hours. The service users, manager and the staff on duty were most welcoming and co-operated fully throughout the inspection. The purpose of this announced inspection was to review the progress made by the home since the last unannounced inspection undertaken on the 11th July 2005 where one recommendation was made. This inspection reviewed outstanding key standards only as the home is currently considered to be performing well and thus warrants the application of a reduced methodology. No complaints have been referred to the Commission of Social Care Inspection since the service was last inspected. There have been no referrals made to adult protection. What the service does well:
The people living at Carwood are supported by staff that are committed to their work and have a good understanding of the needs of the people they support. Staff are provided with good training opportunities. Nine staff have obtained an NVQ qualification in Care and a further five staff are currently undertaking the award. The home has recently been nominated by the Health and Safety Department to receive a Corporate Health and Safety Award. Comments received from the department in preparation for the CSCI inspection stated ‘We use the home as an example within our work as excellent practice’. Service users continue to live in a comfortable, clean and homely environment and are provided with a choice of well-balanced meals taking into account their likes and dislikes. In preparation for the inspection the CSCI received positive feedback from visiting Health and Social Care Professionals, Health and Safety and relatives. Comments received overall indicated that people are satisfied with the overall care provided to service users within the home and included: ‘Excellent care
Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 6 provided and staff are very sensitive to the needs of the service users’. ‘Paul and his staff have been very supportive towards a client and his family who are very pleased with the service’. Nine comment cards were received from service users who were supported by an independent advocate to complete the forms. Comments overall were positive and included the following: ‘I would like to move into independent living, which is currently being pursued’. ‘Staff are good advocates’. ‘I would like more support to go out and socialise’. ‘I get on well with staff and am happy with what I do’. Another person felt that they are ‘well cared for’. The manager continues to work well in partnership with managers from another of the department’s residential service and community service for adults with learning disability in developing policies and procedures, induction, training, quality assurance. An open day is planned for parents and carers later this month for information sharing about the services. What has improved since the last inspection? What they could do better:
The diversity of need of the people living at the home is currently challenging the service. Discussions held with staff indicate that they are not confident that the home is able to continue meeting all of the needs of the people accommodated, within the current resources. One person commented ‘There needs to be a true recognition of the individual needs of the people living at the home’. The homes Statement of Purpose has somewhat moved away from having units of ‘specialism’ to having a diversity of need spread across all five Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 7 units. Staff reported the need for staffing levels in the first floor flats to be reviewed as soon as possible. The high levels of staff sickness and providing cover is having a significant impact on the homes staffing budget. One person commented that the organisation should look into redirecting finances i.e from paying sick leave to improving staffing levels. Staff also commented that the organisation should recognise and value the qualified work force and pay incentives for this. One comment received in preparation for the inspection stated ‘The staff would benefit from more training in the prevention and de-escalation of challenging behaviours’. Comments received from a number of staff indicate that there is a need to review staffing levels within the home and to look into the compatibility of individuals within each unit. Managers also have to cover a number of shifts, which is placing additional pressures on them, which may eventually impact on service delivery. Staff commented that the home would benefit from having a conservatory addition to provide service users with a quiet place to welcome their visitors. 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. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 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 Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is currently unable to meet the needs of one individual in particular who continues to challenge the service, potentially placing service users and staff at risk. EVIDENCE: The intended outcomes for Standards 1 – 5 were reviewed and met at the previous inspection of the service. Two people have been admitted to the home since the last inspection and there is currently one vacancy. A recommendation was made at the previous inspection for the person currently challenging the service to be closely monitored with regular multidisciplinary reviews held to ensure the service is able to fulfil his needs. Discussions held and numerous account of incidents seen evidence that Carwood is unable to provide the appropriate level of support required, given the diversity of need presented by the current service user group. The manager was able to clearly evidence that the home has made every attempt to support the individual, however such behaviours are having a significant impact on staff morale and may pose a risk to others living and working at the home. The manager reported that a Case Conference is planned and the individual is fully aware that the placement is at risk. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The intended outcomes for key Standards 6,7 and 9 were assessed and met at the previous inspection of the service and were not reviewed on this occasion. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Service users are offered a varied, well balanced diet, which takes into account individual likes and dislikes. EVIDENCE: The intended outcomes for key Standards 12,13,15 and 16 were assessed and met at the previous inspection and were not reviewed on this occasion. The menus submitted to the CSCI in preparation for the inspection appeared well balanced. Each flat has a separate four weekly menus and designated shopping days. It was reported that a support worker, who was a former housekeeper, works with the service users to prepare the menus, which are kept under review. Service users spoken with stated that they go shopping weekly to local supermarkets with the staff and walk to the local shop to purchase basic provisions such as bread and milk. People with special dietary requirements are well catered for and it was reported that the local Communication and Swallowing Team (CAST) also have a lot of input with individuals. Service users are also supported to have regular meals out or Take Away evenings.
Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 12 The home has been successful in maintaining the Gold Healthy Eating Award by the Borough of Telford and Wrekin. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The intended outcomes for key Standards 18,19 and 20 were assessed and met at the previous inspection and were not reviewed on this occasion. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 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): x EVIDENCE: The intended outcomes for key Standards 22 and 23 were assessed and met at the previous inspection of the service. No complaints have been referred to the registered manager or to the Commission of Social Care Inspection since the service was last inspected. There have been no referrals made under adult protection procedures. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 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): 30 Service users are provided with a clean and hygienic home to live. EVIDENCE: The intended outcomes for Standards 24,25,26,27,28 and 29 were assessed and met at the previous inspection of the service and were not reviewed on this occasion. Service users continue to live in a comfortable, clean and homely environment. Two domestic staff are employed and the manager is looking into the possibility to recruit a third staff member to assist with cleaning the kitchen areas and cookers etc in each flat as this work is currently undertaken by support staff and is beginning to infringe on care duties. The home was found very clean and tidy during the inspection and the necessary policies and procedures are in place for infection control, COSHH and the disposal of clinical waste. Training in relation to Infection Control has been sourced and the domestic staff will undertake the training in March followed by support staff. Each flat has a separate laundry and sluice facility. It was reported that service users are encouraged to assist with their laundry duties as much as possible. The necessary COSHH data sheets are maintained in each flat and a main copy retained in the office.
Carwood Residential Home DS0000059615.V267779.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 and 35 Service users are protected by the home’s recruitment procedures and are supported by a trained staff team who are motivated and committed to their work, however staffing levels require review to ensure the individual needs of service users are well met. EVIDENCE: Observations made and discussion held with managers and staff on duty evidence that the staff are committed to their work and have a good understanding of the needs of the people whom they support. Staff are provided with the training opportunities required to develop their skills necessary to undertake the tasks they are expected to do and professional relationships have been developed with the Joint Community Learning Disability Team who have a regular input into the home. Managers reported that twenty care staff are employed of whom nine hold NVQ qualifications and a further five staff are currently undertaking the award. Staff spoken with during the inspection commented that they are well supported by their managers however the positive staff morale is currently being challenged by one service user and the high levels of staff sickness within the team. Records seen and discussions held evidence that staff
Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 17 sickness and cover obtained through permanent or agency staff, has had a significant impact on the homes staffing budget to date. The current staffing levels are five staff supporting twelve people across five units. Therefore each unit has an allocated staff member, however some individuals may be left unsupported for short periods of time in order to allow staff to move around the units to provide a higher level of support where required. Observations made and discussions held evidence that the diversity of the needs of the people living at the home are currently challenging the team and discussions held with staff indicate that they are not confident that the home is able to continue to meet the diversity of need within the current resources. One person commented ‘There needs to be a true recognition of the individual needs of the people living at the home’. The homes Statement of Purpose has somewhat moved away from having units of ‘specialism’ into a diversity of need across all five units. Staff stated that staffing levels particularly in the two first floor flats need to be reviewed as soon as possible. Staff were complementary regarding the management of the home and of the training opportunities that are provided and confirmed that they are in regular receipt of formal supervision and staff meetings, which are held regularly. The personnel files of the staff employed since the last inspection were reviewed by CSCI on 25th January 2006 at Civic Offices and were found to contain all the required documentation as required under Schedule 2 of The Care Homes Regulations 2001. All appointments are subject to a six-month probationary period. No volunteers currently work at the home. New staff employed undertake corporate induction provided by the Borough, In-house training and are also expected to undertake a ‘new employee competence evaluation’. The home has experienced difficulty accessing LDAF induction, however this is currently under review. The manager is working in partnership with another residential service and a community service in order to develop induction further. The manager has developed a matrix for the team for ‘Essential Staff Training’, which reflects training linked to the National Minimum Standards and mandatory training. Details of the numerous training courses undertaken and further ones planned were available for inspection and it is evident that staff are provided with good training opportunities with managers liaising closely with the training department. Each staff member is provided with an individual training record and checklist and a copy of all training applied for is also maintained on file. The manager has also utilised the skills of Community Nurses and Social workers who have visited the home and provided staff with training on epilepsy, managing behaviours and information specific to supporting particular individuals. The manager and his team have developed a Team Plan for 2006/07 and the
Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 18 inspector was provided with a copy of the document. This is very comprehensive and identifies objectives and targets for the forthcoming year. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41 and 42 The home has systems in place to review aspects of performance and promotes the health and safety and welfare of service users and staff. EVIDENCE: The intended outcomes for Standards 37 and 41 were assessed and met at the previous inspection of the service. The home has internal quality assurance and monitoring systems in place incorporating individual review meetings, staff supervision, team meetings and Performance and Development Plans (PPD). As previously stated a comprehensive Team Plan is in place for the forthcoming year. The manager stated that questionnaires have recently been distributed to families and stakeholders in order to seek their views on how the home is achieving goals for service users. An independent advocacy service is currently working with service users to ascertain their views on the home. The results of the survey will be reviewed at the next inspection of the service. An open day is planned for parents and carers later this month for information sharing about the service. Unannounced monthly visits, as required under Regulation 26, are
Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 20 being undertaken by the Acting Business Manager and a copy of the report is forwarded to CSCI. The standard of record keeping continues to be maintained to a commendable standard and systems are well managed. The home has recently been nominated by the Health and Safety Department to receive a Corporate Health and Safety Award. Comments received from the department in preparation for the CSCI inspection stated ‘We use the home as an example within our work as excellent practice’. Health and safety procedures appeared satisfactory at the time of this inspection. Records seen, evidence that the home meets the requirements of the local fire and environmental health departments. Inspection of the health and safety records indicate that regular checks and tests are being undertaken at the appropriate timescales and risk assessments for safe working practices were seen to be in place. Service certificates are held centrally and the manager was able to evidence that he has requested a copy of the necessary certifcates, therefore these will be reviewed at the next inspection. Staff have undertaken training in safe working practices and further mandatory training is planned for the forthcoming year. Appropriate data sheets for COSHH products have been obtained and these are maintained in each unit in addition to the office. A health and safety policy is in place. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 x 3 2 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 x 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x x x 3 x 4 4 x Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 22 N/A 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 YA3 Regulation 12(1) Requirement The Registered Persons must demonstrate that the home is able to fully meet the individual needs of all the people accommodated. Staffing levels must be reviewed to ensure the home has sufficient staffing to meet the needs of the people accommodated at all times. Timescale for action 28/02/06 2 YA33 18(1)(a) 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations It is recommended that the Statement of Purpose be updated to reflect the current service provided. Carwood Residential Home DS0000059615.V267779.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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