Inspection on 18/04/05 for Four Winds

This inspection was carried out on 18th April 2005.

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

Four Winds 20/09/07

Four Winds 10/12/05

Four Winds 10/11/04

Four Winds 29/09/04

Four Winds 08/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Four Winds 32A Church Road Brightlingsea Essex CO7 0JF Lead Inspector Pauline Dean Final Unannounced 18/04/05 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 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 Stationary 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. Four Winds Version 1.10 Page 3 SERVICE INFORMATION Name of service Four Winds Address 32A Church Road Brightlingsea Essex CO7 0JF 01206 308176 01206 308961 talk2gam@btinternt.com/gam@careconsortium. com Community Care Mission 2000 Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Vasudha Lavangi Gunasene Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Four Winds Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 6 persons). Date of last inspection 10/10/04 Brief Description of the Service: Four Winds is a detached six bedroom bungalow offering care to six adults with learning disabilities. It is situated in a residential area of Brightlingsea, close to shops, post office, G.P. surgery and the seafront. Public transport is available, with the home having their own transport; a people carrier or car. Accommodation is in single rooms with en-suite wash hand basins and toilets. Shower and bathing facilities are found in the bathroom with a separate shower room. In addition there is a separate toilet. Staff have a shower room off the office/staff room. Service users have the use of the dining room and communal lounge. There is a television and music centre in this room. Both the kitchen and separate laundry/utility room are domestic in character. There are gardens at the rear and in the centre of the bungalow. The centre quadrangle is an enclosed patio area with garden seating and the rear garden is laid to lawn with a paved patio area, fruit trees, flowers and bushes. Both a summerhouse and garden sheds are used for storage. There is off the road parking at the front of the bungalow. Four Winds Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Four Winds is a small, established care home for adults with learning disabilities. Four Winds was originally registered under the Registered Homes Act 1984, initially for five service users and following the addition of a sixth bedroom for six service users. All service users living at Four Winds are in the age group of 18 –65 years and have a diagnosis of learning difficulties, mental health needs and severe challenging behaviour. This was an unannounced inspection, which took place over one day in April 2005. This was the first inspection of the inspection year 2005-2006. Throughout the day there was discussion with the deputy manager and Mr Gamika Rasal Gunasene, Responsible Individual for Community Care Mission 2000 Limited. All service users were met during this inspection and during this visit they were spoken with. No visitors or relatives were present during this inspection. A tour of the premises was conducted at this inspection and both care and staff records were sampled. In addition some of the policies and procedures in the home were sampled and inspected. Twenty-four of the forty-three standards were inspected, of these nineteen were met with five standards either almost met or not met. What the service does well: The home offers a homely environment with every effort made to access community activities, as appropriate to the individual. Some service users are able to access both leisure and educational pursuits as they wish and are available. Whilst there have been changes to the staff group in the staff had joined the staff team since the last inspection, a now in place. Planned and ongoing training opportunities are skilled and competent to meet individual service users’ past and some new stable staff group is ensure that all staff needs. Three service users spoken with during the course of this inspection gave examples of events, which had been pleasurable. One new admission said that they were settling into the home well and were happy at Four Winds. Four Winds Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Four Winds Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Four Winds Version 1.10 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 standard(s) 1, 2 and 5. Clear detailed information by way of the Statement of Purpose and the Service Users’ Guide is provided to placing authorities and prospective service users and their families to enable them to make a choice as to whether they wish to be admitted to the home. A detailed and thorough pre-admission assessment is in place with care and attention given to ensuring that the home can meet the service users’ individual needs. Service users do not have individual contracts/statement of terms and conditions to clarify services offered. EVIDENCE: Amendments and changes have been made to both the Statement of Purpose and the Service Users’ Guide and these now meet requirements. The pre-admission assessment paperwork for the most recent admission to the home was inspected and was found to meet requirements. An assessment of needs had been completed by the service user’s previous care home and both a risk management and assessment tool and an assessment and care management assessment had been carried out by the placing authority. Four Winds had completed their own assessment, which met requirements as detailed in the National Minimum Standards – Standard 2.3. Service user contracts are now in place between the local authorities and home. There is still a need to fully implement costed contracts/statement of terms and conditions between individual service users and the home. It is Four Winds Version 1.10 Page 9 acknowledged that service users will need to be supported by family, friends and/or advocates when drawing up these documents. Four Winds Version 1.10 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 standard(s) 6, 7 and 9. With some exceptions, Service Users assessed and changing needs and personal goals are detailed in their individual care plans to ensure that their personal needs are met. Care planning records detail service users right to make decisions about what they wish to do and staff enable service users to take responsible risks, with both risk assessments and risk management strategies in place. EVIDENCE: Three care plans and risk assessments for service users were sampled and inspected. All aspects of personal care and social support and healthcare needs were considered in these documents. However, of those sampled one was found to have a requirement of an outstanding review and another needed a review of a care plan objective following a review of a risk assessment. More detail was required in the risk assessment and the possibility of a review and revision of a care plan objective was highlighted and discussed with the deputy manager. Four Winds Version 1.10 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 standard(s) 12, 13, 15, 16 and 17. Service users are supported and enabled to have opportunities for personal development through the provision and promotion of appropriate leisure and training activities in the community. Family contact and visiting arrangements are open and relaxed, with family links promoted and encouraged. The home offered a healthy, varied, planned menu, with consideration given to preferences and dietary requirements. EVIDENCE: The skills of service users at Four Winds are such that they are limited with regard to the development of employment. One service user enjoys gardening and they are being encouraged and involved in the gardening tasks at Four Winds and another care home within the company. The service user in question spoke positively of being able to do some gardening and was looking forward to developing this further this summer. This service user also attends a pottery course and a second service user attends a numeracy course each week. Four Winds Version 1.10 Page 12 All service users are enabled to access local facilities such as shops, pubs and the sea front and parks. The home has a mini bus to transport service users, although some are able to walk into Brightlingsea, which is only minutes away. Family links and contact is maintained through regular telephone calls, visits to family and visits by family and friends to the home. Records evidenced these contacts and staff and management spoke of purchasing and sending birthday cards to relatives as appropriate. Two staff members interviewed outlined the ways in which they respect service users’ privacy and dignity. They gave examples of steps they would take to ensure that these needs are met and evidence was seen of this during this inspection. The home operates a four-week rotational menu, with some seasonal changes made. Care staff are involved in the preparation and the clearing away after meals. Nutritional records are kept of food eaten, both the detail of the content of the meal and the portions of food served. These records were seen and found to be in good order. Two service users spoken to confirmed what meals they had eaten that day and highlighted what their favourite meal was. They had some understanding of what the main meal of the day in the evening was to be. Whilst the home’s designated ‘Shopper’ was on leave on the day of inspection, food supplies were found to be varied and ample. Local shopping trips were planned whilst this person was on holiday. Fresh fruit and vegetables were seen in the home and one service user was assisted to have an item of fruit as they wished. Four Winds Version 1.10 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 standard(s) 18, 19 and 20. Service users’ personal and healthcare needs are met within the home and records evidenced that service users are supported to access healthcare professionals as needed. The administration of medication for service users was found to be detailed and well recorded, to help ensure that service users’ health needs are met. EVIDENCE: Care plans evidenced that the home ensures that service users receive personal care and support in the way that they prefer and require. Three service users’ files were sampled and inspected. All service users are registered with the local General Practitioners’ surgery and records were seen of input from healthcare professionals. Referrals are made to various clinics e.g. mobility, speech, dental and health clinics. Medication storage, administration and medicines entering and leaving the home were sampled and inspected for three service users. These records were found to be in good order. Recommendations were made regarding detailing the date of commencement on all liquid and cream medication. Two staff interviewed confirmed that they have attended basic medication training. Four Winds Version 1.10 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 standard(s) 22 and 23. Appropriate practices were in place to ensure that the service users views are listened to and acted upon and their protection is promoted. Staff training, the awareness of the management and staff, policies and procedures and staff recruitment practices promote this. EVIDENCE: The home’s complaints procedure was seen to be in place and is contained in the Service Users’ Guide. Both of the care staff interviewed were aware of this procedure and said that should they have any concerns they would take this to the manager, deputy manager or the registered provider. Equally they had a good understanding of the Adult Protection Procedure and they said they would raise concerns with management and the home if needed. The Adult Protection Procedure and Whistle Blowing Procedure were both adequate to protect service users from harm or abuse. Details of the Protection of Vulnerable Adults (POVA) training as offered by Essex County Council was left with the home for them to pursue. Since the last inspection, allegations of physical abuse have been made and progressed in line with interagency procedures. Management and staff have co-operated and assisted fully with the Police investigations and subsequent multi-agency considerations. No evidence has been found to substantiate the allegations. Disciplinary procedures are now ongoing and all agencies are awaiting the outcome of these procedures. Four Winds Version 1.10 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 standard(s) 24 and 30. Overall, the premises were clean, comfortable, well maintained and safe. Some shortfalls were noted and highlighted as requiring immediate attention. EVIDENCE: Four Winds was found to be clean, homely and comfortable. The Responsible Individual spoke of ongoing maintenance and repairs. Records relating to premises issues were not inspected at this inspection. A tour of the premises highlighted some shortfalls, namely a broken bath panel, a damaged bed and lounge seating. The Deputy Manager said that the latter two items had been highlighted as needing replacements and the bath panel would be attended to immediately. A food safety inspection and a health and safety inspection had taken place in May 2004 and recommendations made had been complied with. In-house laundry/utility facilities of a washer and dryer, domestic in character are found at the rear of the home. Care staff ensure that the laundry is completed during the day, with night carers completing the ironing. Mr Gunasene confirmed that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. Four Winds Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36. Staffing levels and skills are appropriate to the needs of service users. There are appropriate recruitment procedures in place. An induction and basic staff training programme helps to ensure that training and skills requirements are identified and met. EVIDENCE: From discussion with management and reviewing staff rotas, there is evidence that staffing levels are met. Management hours were detailed as 09.30 hours to 14.30 hours with care staff covering three shifts of 07.30 hours to 14.30 hours, 14.30 hours to 21.30 hours and 21.30 hours to 07.30 hours. Staffing levels were as agreed with the placing authorities of 1:1 i.e. six care staff to six service users and staffing levels are reviewed regularly to reflect the service users changing needs. The files of two care staff were sampled and inspected. These contained evidence that all the required checks (including references and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been satisfactory carried out and copies of relevant identification documents had been obtained e.g. birth certificate, passport and photograph. Staff contracts and the General Social Care Council (GSCC) code of conduct and practice were not considered at this inspection. Four Winds Version 1.10 Page 17 Training certification and documents were inspected in the two sample care staff files. Evidence was found of induction training, which meets the Sector Skills Council specifications, and of individual basic training courses. Basic training included Moving and Handling, First Aid and Infection Control. In addition evidence was seen of training courses in Report Writing, Communication, Epilepsy Awareness training, Boots Medication training, Administration of Rectal Diazepam and Physical Intervention training. Evidence was seen of a formalised structured supervision system in the home. Records detailed topics of discussion, training and examples, which had been used for training purposes in these 1:1s. Both staff interviewed confirmed that regular supervision sessions took place and clarified and confirmed topics covered and considered in these sessions. Both spoke of being supported through supervision and in the day-to-day management and running of the care home. Four Winds Version 1.10 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42. An effective quality assurance and quality monitoring system is still required to ensure that service users views are taken into account when monitoring, reviewing and developing the service. Records required to protect service users’ needs were found to be in place and safety certification sampled was found to meet requirements to help ensure the safety and welfare of service users and staff. EVIDENCE: Quality Assurance questionnaires have already been distributed and some returns have been received from service users, relatives, advocates and Community Nurses. On receipt of these returns, the deputy manager spoke of undertaking a review with the need to develop an Annual Development plan with a systemic cycle of planning-action-review. Safe working practices are ensured through the introduction of basic training opportunities and specialised training course applicable to the individual needs of service users and staff. Four Winds Version 1.10 Page 19 Safety certifications were sampled and inspected. Records are held of hot water testing at outlets used by service users. Both the Electrical safety certification and Portable Appliance Testing (PAT) were current with inspection due this year. Accident Record Keeping and the management of Regulation 37 Notification to CSCI was considered and recommendations were made. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 1 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No Four Winds Version 1.10 Score Page 20 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score x 3 3 x 3 x 3 31 32 33 34 35 36 x x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x Four Winds Version 1.10 Page 21 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 5 Regulation 4, 5, 17 Requirement Timescale for action 04/07/05 2. 6 15, 17 3. 9 14, 15 4. 24 23 The registered manager must develop and agree with each individual service user a written and costed contract/statement of terms and conditions between the home and the service user. (This is a repeat requirement. Previous timescale of 07/01/05 not met. ) 04/07/05 The registered manager must ensure that care plans are reviewed with the service user(involving significant professionals, and family, friends and advocates as agreed with the service user) at least every six months and updated to reflect changing needs and ensure agreed changes are recorded and actioned. The registered manager must 04/07/05 ensure service users are able to take responsible risks, that there is good information on which to base decisions, within the context of the service users individual plan and the homes risk assessment and risk management strategies. The registered person must 04/07/05 ensure that the homes premises Version 1.10 Page 22 Four Winds 5. 39 24 are safe and well-maintained e.g. lounge and bedroom furniture and bath panel. The registered person must ensure that there are effective quality assurances and quality monitoring systems in place to measure success in acheiveing the aims, obtjectives and statement of purpose of the home. (This a repeat requirement. Previous timescale of 07/01/05 not met.) 04/07/05 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 Good Practice Recommendations Four Winds Version 1.10 Page 23 Commission for Social Care Inspection 1st Floor Fairfax House Causton Road Colchester, Essex, CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Four Winds Version 1.10 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!