CARE HOME ADULTS 18-65
Ics - Wembrook Close, 8 & 12 8 & 12 Wembrook Close Attleborough Nuneaton Warwickshire CV11 4LJ Lead Inspector
Justine Poulton Key Unannounced Inspection 30th November 2006 13:30p Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.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 Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.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. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ics - Wembrook Close, 8 & 12 Address 8 & 12 Wembrook Close Attleborough Nuneaton Warwickshire CV11 4LJ 02476 327797 01527 546888 allan.smith@individual-care.com 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) Individual Care Services Mr Stephen Northcote Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 8 & 12 Wembrook Close operate as a single, linked service, with a shared staff group and manager. May provide accommodation and personal care for up to 5 people in the category of learning disability (3 at number 8 & 2 at number 12). 15th March 2006 Date of last inspection Brief Description of the Service: 8 and 12 Wembrook Close accommodates up to 3 and 2 residents respectively, in the category learning disability. The houses are situated opposite each other in a small close. There is one staff group and one manager. One of the homes is a detached bungalow whilst the other is a detached house. They are in a quiet residential area on the outskirts of the town of Nuneaton. The accommodation in each is similar comprising of a shared lounge, kitchen and bathroom. 12 Wembrook Close has two bedrooms on the ground floor. 8 Wembrook Close has two bedrooms on the ground floor and has a further two bedrooms on the first floor, one of which is used as the office/sleep-in staff room. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first key inspection in relation to Inspecting for Better Lives. Identified key standards were looked at. The pre fieldwork documentation was completed, as well as a site visit to the home, during which time staff, service users and the manager were spoken with. Two residents were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. Records, policies and procedures were examined and the environment was looked at. All of the service users were at home for all or part of the inspection. The inspector would like to thank the service users, manager and staff for their hospitality and co-operation during the inspection. Information about the level of fees charged by the home was not made available for this inspection. What the service does well:
The home consistently meets or exceeds the key national minimum standards ensuring positive outcomes for the service users. Service users care plans continue to be detailed and informative, ensuring that staff are able to meet assessed needs. Comprehensive risk assessments enable service users to take meaningful risks in a safe manner. Service users are actively supported to make decisions about their lives both on a daily and more long term basis. Consideration is given to service users interests, hobbies and leisure pursuits when planning activities. Some service users are supported to attend formal day services whilst others have a day care programme provided by the home. The involvement of families and friends is considered to be of paramount importance, and is encouraged by the home. Clean, tidy, well stocked kitchens enable service users to choose from a range of meal options. The home promotes healthy eating and encourages service users to follow a healthy diet. Personal care is provided sensitively and discreetly where necessary, in line with service users individually assessed needs. The health and wellbeing of service users is promoted via attendance at routine and more specialized healthcare appointments as necessary. Medication is managed safely on the service users behalf. The home has both a complaints policy and an adult protection policy in place. The complaints procedure has been provided in a format that is meaningful to service users. No complaints have been received by the home or the Commission for Social Care Inspection. Staff were aware of their
Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 6 responsibilities regarding adult abuse. No allegations or suspicions of abuse have been made or received by the Commission for Social Care Inspection. The two properties covered by this registration are comfortable, clean and nicely decorated. Three women share the house whilst two men share the dormer bungalow. The standard of accommodation was considered to be excellent at this inspection. The home employs satisfactory staff numbers to meet the service users needs. The staff team demonstrates a commitment to the service users. An ongoing training programme ensures that the service users are supported by a competent sufficiently knowledgeable team. The home is managed by a suitably qualified experienced manager. Both the service users and staff team appeared to have a good rapport with the manager and spoke highly of him. The home has a quality monitoring system in place that ensures that the service users views are at the forefront of service development. Health and safety is managed effectively within the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): X Quality in this outcome area is not applicable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new residents have moved into the home since the last inspection therefore this standard is deemed to be not applicable on this occasion. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. Comprehensive, detailed care plans and risk assessments ensure that the well being and safety of the service users are promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plan files were looked at as part of this inspection. Comprehensive information detailing all aspects of care and support required by the residents was available as was information about individual skills and abilities, aspirations and changing needs. Examples of information contained within the care plans looked at included self care, eating and drinking, daily living skills and health. Information to confirm that care plans are reviewed on a 6 monthly basis was available. Risk assessments were also available within the files looked at. These reflected the care plans that were in place, and contained information that would enable
Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 10 the service users to take risks within a safe framework. Again there were records available to confirm that the risk assessments were being reviewed on a 6 monthly basis in line with the care plans. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. Service users are offered a variety of age, peer and culturally appropriate activities that make best use of in house and community facilities. Relationships with families and friends are promoted. A healthy, nutritious diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In discussion staff said that the service users participate in a varied range of both formal and informal activities. Information detailed in one of the files looked at confirmed that the service user chooses to attend a day centre for three half days each week. Information regarding other activities, hobbies and interests recorded within the file as being enjoyed by the service user included reading, doing jigsaw puzzles, going out for meals and visiting places of interest. During the inspection the service user went out shopping, and then later sat in the lounge completing a jigsaw puzzle. The records for the second
Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 12 service user that was case tracked through the inspection indicated that no formal day service was attended during the week. This service user is able to access the community independently. Staff spoken with said that he visits organisations such as New Horizons several times a week, and likes to go swimming, shopping and to the pub. This was confirmed in conversation with the service user who went out christmas shopping during the early evening of the inspection. Other service users spoken with during the inspection told of how they had been out christmas shopping with relatives and about the day centre that they attend. The organisation considers family involvement and relationships to be of paramount importance to the service users and provides any support that they may need to maintain these. A letter addressed to a relative was seen in one service users file looked at, that requested agreement with the revised care plan. One Service user returned home from a day out with a relative during the inspection. Others spoken with talked of spending christmas with their families. The home has a kitchen / diner, which was clean and tidy on the day of the inspection. The cupboards, fridges and freezers were well stocked. Plenty of fresh fruit was also available. Sample menus were in place for residents to use should they wish. Residents were seen to be asked what they would like for their evening meal, which was prepared for them as they wanted it. Health and safety records pertinent food and kitchen hygeine were in place and complete. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. Service users receive personal support in line with their assessed needs. Service users healthcare needs are monitored and addressed. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plan documents looked at clearly identified the levels of personal care and support needed by the service users. These ranged from being totally self caring through to verbal prompting and “hands on” support. Details of service users being supported to meet their health care needs were available within the two files looked at. These included both the routine health matters such as visits to the dentist and optician, and more specialised healthcare needs such as epilepsy, hypothyroidism and mental health needs. Records of visits to healthcare professionals were maintained, however it was noted that on a couple of occasions staff had not made an appropriate record following either the cancellation of an appointment or attendance at an Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 14 appointment. This was discussed with the manager who undertook to address it with the staff team at the next team meeting. The home manages the service users medication on their behalf. It is supplied in blister packs that are accompanied by medication administration record charts (MARS). The storage of medication was appropriate. Records to confirm that staff have received training in medication administration were seen. Two instances of none recording were highlighted with the manager on the MAR charts looked at which were addressed during the inspection. All staff have received training in the administration of medication. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. The homes policies on complaints and protection from abuse ensure that service users views are listened to and acted upon, and that service users are safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place that has been compiled using pictures and text so that it is accessible to service users. A copy of this was available in the service users files looked at. Service users spoken with said that they were very happy living in the home, and were able to say what they would do if they were unhappy with anything. One relative spoken with said that there had been a few initial teething problems when her relative had first moved into the home, but these had been dealt with swiftly and successfully, and she was very happy with the care and support her sister receives. The home has a policy on the protection of adults from abuse. Staff have received training in this and were aware of their responsibilities should abuse be disclosed or suspected. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is excellent. Both properties within this registration provide clean, comfortable good quality accommodation to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This registration covers two properties in the same road, one of which is a large house whilst the other is a dormer bungalow. Both properties were in immaculate condition, being nicely decorated with good quality furniture and soft furnishings. Both properties were clean, tidy and well ordered with fresh and pleasant smells throughout. The laundry facilities in property number 8 were located in the garage which has been converted for the purpose. Cleaning products for both properties were also stored in this room. Control of substances hazardous to health (COSHH) data sheets were available for the products that the home uses.
Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 17 The washing machine and tumble dryer for property number 12 was located in the kitchen, however this did not appear to be hazardous as they were away from the food preparation and cooking areas. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 Quality in this outcome area is good. Service users benefit from sufficient numbers of competent, knowledgeable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One staff team covers both of the homes that come under this registration. Eleven care staff are employed who work to a four weekly rolling rota. The homes rota indicates that there are 3 staff on duty throughout the day, covering both houses, with one staff member sleeping in each house over night. This level of staffing was in place on the day of the inspection. Staff spoken with during the inspection said that staffing levels were satisfactory based on the needs of the residents in both houses. The manager confirmed that no new staff have been employed since the last inspection, therefore as this standard was met at the previous inspection of the home it was not looked at on this occasion. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 19 The home has a training analysis in place that provides details of training that has been and is to be undertaken by staff. This confirmed that an ongoing training and development plan continues to be in place. Information provided in the pre inspection questionnaire received states that staff have undertaken training in dementia awareness, care planning, bi polar awareness, adult abuse awareness and first aid at work refreshers. Seven staff have also completed their NVQ II in care award. All of the staff have also completed the Learning Disability Awards Framework (LDAF) induction. Staff spoken with during the inspection said that the organisation places great emphasis on the importance of training and demonstrates an investment in the staff team trough the training that is provided. Each staff member has an individual training record in place. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is excellent. The home benefits from a competent manager. An effective quality monitoring system ensures that service users views are at the forefront of service development. Health and safety is managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed by an experienced, suitably qualified manager. Staff and residents appeared to have a good relationship with the manager, who appeared cheerful, approachable and amenable. He also displayed a good knowledge of the needs of the service users in discussion. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 21 The home has a quality monitoring system in place that takes into account the views of service users and other key stakeholders to ensure that they are at the forefront of service development. Questionnaires are sent to external professionals that have links with the home; the NVQ Assessor and relatives, as well as to the service users themselves. It was noted that the staff are not consulted as part of the quality monitoring process. This was discussed with the manager during the inspection and is recommended for consideration. A letter was seen in one of the files looked at regarding quality monitoring and providing feedback on the service received. Reports from regulation 26 visits were available to look at, as were minutes from staff meetings and service users meetings. Health and safety is maintained within the home. Dates of when the most recent maintenance checks were undertaken were provided on the pre inspection questionnaire. A sample selection of health and safety records in the home which included fire safety records, portable appliance testing records and equipment servicing records all confirmed that they were in place and up to date. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 22 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 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 x x 3 x LIFESTYLES Standard No Score 11 x 12 3 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 3 x 4 x x 3 x Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 23 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 YA39 Good Practice Recommendations It is recommended that the staff team be included in the homes formal quality monitoring process. Ics - Wembrook Close, 8 & 12 DS0000004364.V321320.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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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