CARE HOME ADULTS 18-65
New House Behoes Lane Woodcote Reading RG8 0PP Lead Inspector
Nancy Gates Unannounced Inspection 8th March 2006 11:30 New House DS0000013117.V284052.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 New House DS0000013117.V284052.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. New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service New House Address Behoes Lane Woodcote Reading RG8 0PP 01491 681874 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) stephenrees@milburycare.com londonroad@tiscali.co.uk Milbury Care Services Limited Care Home 8 Category(ies) of Learning disability (8) registration, with number of places New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: New House is a detached home in the small Oxfordshire village of Woodcote near Reading. The home provides support to seven people who have a learning disability. Each person has a variety of needs; some individuals needing support for mobility issues. Residents are supported on a 24-hour basis by a staff team who are employed by Milbury Care Services who are part of the Paragon Group. New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector was in the home from 11.30am until 3.00pm on a weekday. Residents were in the home at various times within the inspection visit. There were seven staff members on duty including the manager and the deputy manager. Residents and staff members were generally friendly and welcoming. The inspector looked around all of the building, including residents’ bedrooms. A number of records were inspected including the personal records of service users. Two staff members and the manager were spoken with. No visitors were available to speak with. What the service does well:
Residents are supported to make decisions about their lives with guidance and support from staff members. Residents’ decisions and wishes are respected. Guidance is also provided from appropriate professionals allowing for support to relate to needs and wishes. Staff are attentive and respectful to residents. Residents are also supported to make lifestyle choices, which recognise individuality and individual communication needs allowing individuals to take risks within these choices. Residents’ personal and healthcare needs are appropriately supported, any changes in health status are recognised and acted upon. Access to additional support from health care professionals including members of the Community team for People with Learning Disabilities (CTLD) is consistent and meets residents’ health needs. A clear complaints process is available to residents and their representatives and the protection of residents is assured by the availability adult protection guidance. The qualifications to be attained by staff e.g. NVQs and the Learning Disability Award framework (LDAF) underpin the support needs of residents. Increased regular contact with the home and continued quality monitoring has ensured that the service is now monitored effectively. New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection?
The care and support records held for residents have been reviewed in an attempt to ensure that individual needs are recognised and supported. The manager has acknowledged that further work needs to be completed in consultation with the residents, their representatives and staff members. The inspector welcomes the commitment to ensuring that plans will reflect who people are as individuals moving away from the previous task orientated support methods. Acknowledgement is given to the improvements made to care and support plans; a requirement remains due to the identified timescale for completion. An improved relationship with the CTLD has provided scope for the communication needs of residents to be assessed and supported in relation to individual need. The administration of medication is appropriately monitored. Staff skills have been reviewed to ensure the safety of residents when medication is being administered. A review of mealtimes has been completed involving the views of residents, staff and a behavioural specialist within Milbury. The inspector acknowledges and welcomes the proposals. The review has engaged residents and staff acknowledging and respecting contributions. This supports the view that mealtimes can be a social opportunity whilst recognising the behavioural support needs of individuals. New dining furniture has been purchased. A number of small tables that can be used separately or can be pushed together will give residents the opportunity to choose to be alone when eating or to join other household members. Significant changes and ongoing refurbishment are improving the comfort and cleanliness of the home. Milbury have committed a large amount of money to ensure that the standard of accommodation is improved significantly recognising that it is the resident’s home. Issues of environmental health and safety, bars at a bedroom window, risk assessment, kitchen cleanliness, fire exit restriction, infection control within the bathrooms and radiator covers have or are being addressed. The CSCI has received an application for registration from the manager, ensuring that the responsibility for all aspects of care and the health and safety of residents can be monitored on a regular basis. The inspector again welcomes and acknowledges the quick response and commitment of the provider to address the issues highlighted within the previous inspection. New House DS0000013117.V284052.R01.S.doc Version 5.1 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. New House DS0000013117.V284052.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 New House DS0000013117.V284052.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): 2 No new admissions have been made to the home. The standards in this section have not been assessed on this occasion and are judged as not applicable for this inspection year. EVIDENCE: New House DS0000013117.V284052.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): 7 Residents are supported to make decisions about their lives with guidance and support from staff members. Guidance is also provided from appropriate professionals allowing for support to relate to needs and wishes. Residents’ decisions and wishes are respected. EVIDENCE: Consultation with the Speech and Language Therapist from the Community Team for People with Learning Disabilities has resulted in a recognised communication system being used for a number of residents. ‘Objects of Reference’ focuses on recognisable objects relating to an activity or daily tasks for people to touch and make a decision about what they want to do. There is also concentration to ensure that people are enabled to communicate through smell and touch. Staff members have expressed a clear commitment to undertake training in ‘Intensive Interaction’ to ensure the sounds and gestures of individuals are acknowledged and understood as far as possible.
New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 11 The needs of two residents who share a bedroom with limited privacy have been reviewed. Discussion with care managers, advocates and the staff team has ensured that the issue has been given a higher priority for review on a regular basis. A review of the documents stating what the home is able to provide has been completed, the manager stating that this will now be completed on a regular basis. New House DS0000013117.V284052.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 & 16 Residents are supported to make lifestyle choices, which recognise individuality and individual communication needs allowing individuals to take risks within these choices. EVIDENCE: A large activity chart using pictures has been produced, each picture representing activities for individuals throughout each day. It is planned that pictures will be related to objects of reference allowing staff to make clear links to an individual’s communication needs and for individuals to make a clear choice about participating or choosing to do something different. A cutting guard/attachment comb for hair clippers was found in a service user’s room at the previous inspection. It was stated that staff would cut resident’s hair due to a behavioural incident that appended in a hairdresser. New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 13 An appropriate review has been conducted in relation to the individual’s need and has been recorded within the individual’s support plans. Staff will continue to cut two residents’ hair, although it was agreed that this would be reviewed on a regular basis. The inclusion of residents’ families has been welcomed by the manager and staff. Families, advocates and members of the local community were invited to afternoon tea and remarked on an enjoyable afternoon. A review of mealtimes has been completed involving the views of residents, staff and a behavioural specialist within Milbury. The inspector acknowledges and welcomes the proposals. The review has engaged residents and staff acknowledging and respecting contributions. This supports the view that mealtimes can be a social opportunity whilst recognising the behavioural support needs of individuals. New dining furniture has been purchased. A number of small tables that can be used separately or can be pushed together will give residents the opportunity to choose to be alone when eating or to join other household members. A height adjustable table has also been purchased for individuals who require the use of a wheelchair. A speech and language therapist is reviewing the support needs of an individual to ensure their health and safety whilst eating. New House DS0000013117.V284052.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents’ personal and healthcare needs are appropriately supported. Changes in health status are recognised and acted upon appropriately. Access to additional support from health care professionals is consistent and meets residents’ health needs. EVIDENCE: A review of care and support plans has resulted in clear guidance being written which places emphasis on how an individual likes to be supported. The manager made a clear commitment to ensuring that the plans are reviewed on a regular basis. Slings and hoists have also been looked at and are due to be reviewed by a District Nurse in the near future. The manager has developed links with the local Community Team for People with Learning Disabilities and has used the opportunity to ensure that residents are receiving appropriate health care support when required. New House DS0000013117.V284052.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 A clear complaints process is available to residents and their representatives. Protection of residents is assured by the availability of adult protection guidance. EVIDENCE: No complaints have been received at the home since the last inspection. A complaints policy, procedure and information for residents are available at the home. Staff members confirmed that they have been made aware of the whistle blowing policy. Milbury policy guidance regarding the protection of vulnerable adults is available to staff. The manager completed the contact details required by the policy within the inspection. New House DS0000013117.V284052.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The standards in this section were assessed at the previous inspection. Judgements regarding standards 24, 25, 26, 27, 28, 29 and 30 have been included within the inspection report of the 14th December 2005. EVIDENCE: New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 17 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 Staff were attentive and respectful to residents. The qualifications to be attained by staff underpin the support needs of residents. EVIDENCE: Interaction with residents was positive and respectful. The manager is aware that staff are expected to complete an NVQ qualification to support their skills. It is expected that staff will complete an NVQ qualification linked to the Learning Disability Award Framework (LDAF), again in order to support skills. New House DS0000013117.V284052.R01.S.doc Version 5.1 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 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 Increased regular contact with the home and continued quality monitoring has ensured that the service is now monitored effectively. EVIDENCE: The Operations Manager of Milbury care visits the home every month to gain the views of residents and staff regarding the quality of support offered. A report of the visit is produced and provided to the manager and the CSCI. The Regional Director and Operations Manager have been visiting the home on a regular basis following the issues identified during the last inspection ensuring that the manager feels supported and can highlight any further issues to be addressed. A detailed action plan was produced following the previous inspection. Timescales have been met as far as possible with significant improvement to a number of rooms and a considerable effort to improve care and support plans for residents. The manager acknowledges that further development and
New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 19 review of the plans is required but this can be built upon in consultation with residents and staff members. A development plan for the home has not been formally produced although the action plan submitted to the CSCI is currently acting as the basis for development in the short term. New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 20 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 N/A 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X X X 3 X X X X New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 21 YES 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 YA6 Regulation 15 Requirement The registered person must ensure that residents have clear, up to date assessments and support plans. Timescale for action 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations New House DS0000013117.V284052.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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