Inspection on 20/09/05 for Renwick

This inspection was carried out on 20th September 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Renwick 18/12/08

Renwick 08/01/07

Renwick 01/03/06

Renwick 13/10/04

Renwick 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Renwick Dragon Lane Manningford Bruce Pewsey Wiltshire SN9 6JE Lead Inspector Tim Goadby Unannounced Inspection 20th & 21st September 2005 10:00 Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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 Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Renwick Address Dragon Lane Manningford Bruce Pewsey Wiltshire SN9 6JE 01672 563026 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) Steven@StevenAbbott.wanadoo.co.uk Mr Steven Abbott Mrs Jane Abbott Mrs Carol Bottoms Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2002 Brief Description of the Service: Valued Lives is a private organisation, which operates 5 care homes for adults with learning disability. All are small establishments, intended to offer a normal domestic lifestyle. The main lead for the organisation is taken by one of the registered persons, Mrs Jane Abbott. She is supported by other senior colleagues, including family members. Each of the Valued Lives homes is situated in Pewsey, or nearby small villages. Pewsey itself offers a range of amenities. The market towns of Marlborough or Devizes are within 15 minutes’ drive. Or, slightly further afield, there are the larger centres of Salisbury and Swindon. The organisation has a number of vehicles used to transport service users. They contribute towards the costs of these. Most service users now cared for by the organisation have been with them for a number of years. Time may have been spent in more than one of the homes that Valued Lives operates. Valued Lives also operates the Activity, Opportunity & Development centre (AOD). This is a day care facility which most of the organisation’s service users access, for at least part of each week. They pay a small weekly sum towards this. The unit is attached to the home in Ball Road, Pewsey. Renwick is in the small village of Manningford Bruce. The home is registered for up to three service users. But it had been empty for some months, until an emergency admission was accepted shortly before this inspection. Bedrooms are upstairs, as is the bathroom. Other areas are on the ground floor. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in September 2005. All 5 Valued Lives services were visited over the course of 2 days. There are many common features across the organisation. So, where appropriate, inspection findings have been applied to each establishment. The lead inspector was accompanied for part of the first day by the pharmacist inspector, who checked medication systems and practice. A total of 12 inspector hours were spent carrying out these unannounced visits. The following inspection methods have been used in the production of this report: indirect observation; sampling of records, with case tracking; discussions with service users, staff and management; tour of the premises. What the service does well: The inspectors met briefly with service users during this unannounced inspection. It is not easy to access their views directly, especially on brief contact. But they appeared well cared for and content. The organisation promotes an active and varied programme for each individual. Trips to access community facilities are a daily occurrence. People also have the opportunity to go further afield. For instance, over August and September all service users were to spend at least a few days away on holiday, making use of a caravan that Valued Lives have in Dorset. There are clear systems in place to uphold the dignity and rights of service users whilst receiving personal care. A range of health care needs are addressed. In addition to responding to any issues that develop, the services also ensure regular check-ups and reviews. This helps with health promotion. For Renwick, initial care plans and risk assessment information had been speedily put in place for the emergency admission. The individual had been successfully integrated into the usual programme of activities for the organisation. Multi-agency systems were working effectively to keep the placement under review. Valued Lives appeared to have been successful in offering the person a place of safety, and a period of stability, whilst options for their longer term future were being considered. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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 Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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 the following standard(s): 2&3 The process of emergency admission had been conducted and reviewed appropriately, upholding the welfare of the service user concerned. The service was meeting the present needs of its temporary resident. EVIDENCE: Renwick was supporting one service user at the time of this inspection. The individual had been admitted as an emergency a couple of weeks earlier, following the breakdown of their usual long term placement. The CSCI had been informed of the admission when it occurred. Contact from other agencies demonstrated that the individual was being kept under appropriate review. A multi-agency meeting took place on the second day of this inspection, which Mrs Abbott attended on behalf of Valued Lives. The final outcome of the emergency placement was yet to become clear. But it was seen that relevant systems were in place to support an effective decision making process. The service user themselves appeared settled and happy in their temporary placement. Following some initial disturbed incidents, the organisation had been successful in stabilising the individual’s mood and behaviour. The approach taken was working well to allow the person a place of safety whilst their longer term future was being considered. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 9 Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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): 6&9 Appropriate information was in place regarding the needs of the emergency admission, ensuring that staff had relevant guidance to assist them in delivering effective support. EVIDENCE: The service user admitted to Renwick had been an emergency admission only a couple of weeks before this inspection visit. In the circumstances, an appropriate level of information was in place in their care record. Various material had been supplied from the individual’s usual home. In addition, Valued Lives had drawn up their own guidance on some key topics. There was also a good level of daily recording and monitoring in place, which would be helpful in evaluating the individual’s progress. The placement was being kept under ongoing review. A number of professionals had visited to carry out assessments, and give appropriate input. Telephone contact was being maintained daily by a consultant psychiatrist, ensuring access to advice whenever needed. Multi-agency meetings were taking place to consider overall issues relating to the future of the individual. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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): 12, 13 & 14 Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. EVIDENCE: Valued Lives aims to meet all of its service users’ needs. Day care is provided in the Activity, Opportunity & Development centre (AOD), which is attached to the home in Ball Road, Pewsey. Here, people are able to participate in a programme that includes a mix of craft activity, musical experience, story telling, and environmental awareness. Work includes annual projects, which result in something tangible that service users have been involved in producing. The organisation has invested in a range of materials and equipment that can be used for various sessions. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 12 The unit is facilitated by care staff. They do not have any specific training in the provision of a day service. But users appear to enjoy attending it. Additional external facilities are not routinely considered. Weekly programmes for all service users were under review, following the withdrawal of Valued Lives from another local day service facility that it had been involved with. When not attending the AOD, people have one-to-one staff time to undertake other activities. Service users from different homes will link up for this. The sessions offered are based on the known likes and preferences of each user. Physical activities, such as trampolining, are accessed at a centre near Marlborough. There is regular use of community facilities, including local shops and pubs. Further afield, people access various leisure amenities. For instance, trips to the cinema or theatre, and ten pin bowling. Once a fortnight, most users attend a local club for people with learning disability. All service users are given the opportunity of holidays at a caravan owned by the organisation. It can accommodate up to 8 people at a time. But groups go in varying sizes. Length of break can also be tailored to individual needs. The caravan is also close enough to be able to bring someone home without great difficulty, if that is needed. The service user admitted to Renwick was being involved in the full range of activities offered by the organisation. This was to include the opportunity for a few days’ holiday. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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): 18, 19 & 20 Service users are supported to address their personal and health care needs effectively. Medication is handled safely in the home. EVIDENCE: Service users are assisted with various levels of personal care and supervision. This varies depending on their individual abilities. There is a policy regarding any cross gender personal care. This provides suitable safeguards for both users and staff. There is a strong focus on health promotion, and also responding to any needs that do arise. All service users receive regular health monitoring. An appropriate level of information was in place relating to the service user recently admitted to Renwick. The medication for this home was being stored and administered to the service user at Heads Meadow during the day, in line with the organisation’s policy of only using trained staff to administer medicines. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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): 22 & 23 Service users are safeguarded by the home’s policies and procedures for complaints and protection. EVIDENCE: The organisation has various information available regarding complaints. The procedure was last updated in September 2004. A pictorial version is available within the Service User Guide. Contact details for the CSCI are included. No complaints have been received. The aim is to minimise any likelihood of this, by having strong recording systems that make all staff accountable for the actions of each particular shift period. There is also a wide range of information about adult protection issues. This includes details about multi-agency procedures within Wiltshire. The organisation has various safeguards in place. These include recruitment checks, staff training, and key individual abilities and relationships that contribute to upholding someone’s welfare. Physical interventions may be used with some service users on occasions. Individual guidelines describe the holds which may be used. Staff have received appropriate training in these techniques. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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): 24 & 30 Service users live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: Renwick is in the village of Manningford Bruce. It is a quiet rural location. The nearest amenities are in Pewsey, which is approximately 3 miles away. The property is rented by Valued Lives. As Renwick had not been used for service user accommodation for several months, a number of items had been stored there. But appropriate steps had been taken to make it habitable for the recent emergency admission. They had been provided with one bedroom, whilst another was being used by staff sleeping in. The communal areas downstairs were homely and comfortable. The home appeared clean and hygienic in all areas seen at this unannounced inspection. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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 & 35 Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by effective recruitment practices. EVIDENCE: Each home within Valued Lives has some staff specifically allocated to it. Cover is then made up by other staff, who work in more than one setting. The owner’s aim is to employ sufficient people so that, even if they are one staff member down, there are still enough to cover all the organisation’s services without needing to rely on external agencies. Since Renwick had been put back into use, staff had been allocated to work there to support the new service user. Cover was provided by an overnight sleep-in. The individual then spent the day at the organisation’s larger home in Pewsey, or undertaking community activities. They were supported by staff for all of these. Initially, two staff had slept in, whilst the new admission was being assessed. This had now reduced to one person, as the level of risk was judged to make this appropriate. If the placement were to continue for any longer than Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 17 envisaged at the time of the inspection, the organisation’s intention would be to review the staffing arrangements again. There had been no staff changes within Valued Lives since the previous inspections, in March 2005. There are policies which govern the organisation’s recruitment and selection practices. Staff records are held centrally, and were made available for inspection. The sample seen showed that all required checks had been carried out. When posts are advertised, interested candidates are asked to visit the home. They meet informally with service users. Shortlisted applicants attend for interview. Once appointed, new starters undertake an initial short induction. They are also on a three month probationary period. During this time they work under supervision. Sleep ins are done alongside a colleague at first, until someone is judged competent to work alone. Two care staff were covering the sleep-ins at Renwick. One of these has achieved an NVQ in care, at Level 3. Other training is provided when necessary. Systems are in place to track when each staff member is due to undertake refresher sessions in key areas. Training materials, such as videos and written information, have been obtained on various issues. Sessions are arranged periodically on topics relevant to the care of individual service users. These have included autism, and dementia in people with Down’s Syndrome. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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): 37, 39 & 41 The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Quality assurance measures need to be implemented, to ensure the home is conducted and developed in line with service users’ needs and preferences. Effective record keeping is maintained, upholding service users’ best interests. EVIDENCE: The registered person is Mrs Jane Abbott. She has lengthy experience of working with people with learning disability, and has owned and operated her own services for many years. She is supported by other senior staff within the organisation. Together, they oversee all five services currently run by Valued Lives. Mrs Carol Bottoms is registered manager for Renwick, and for Roman Court in Pewsey. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 19 Mrs Abbott’s brother, Mr Patrick Jones, is the registered manager of 6 Rushall Road, North Newnton. All three registered managers within the organisation can provide support to the various homes if needed. Mrs Abbott and Mrs Bottoms are currently working towards the NVQ Level 4 award, as required of registered managers by the end of 2005. Mrs Abbott’s husband, Mr Steve Abbott, has obtained this qualification, and is also now undertaking the Level 4 award in care. The organisation has not yet fully implemented a quality assurance system. A comprehensive tool has been purchased. But it may be difficult to apply to smaller scale homes, such as the ones that this organisation operates. At previous inspections it has been suggested that a possible approach could be to apply the full audit over a longer period – perhaps three years, instead of one. Areas of particular importance could still be focussed on more regularly. The organisation also needs to show that the views of service users, relatives, and other relevant people are obtained. From completion of a quality audit, the organisation needs to generate a development plan. This can focus on any identified strengths and deficits, across all areas of service delivery. Goals for improvement can then be set, against which future progress can be measured. Record keeping is of a good standard. Most required areas appear to be covered. Renwick DS0000028214.V251986.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Renwick Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x 3 x x DS0000028214.V251986.R01.S.doc Version 5.0 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 YA39 Regulation 24 Requirement The persons registered must continue implementing an effective quality assurance system, ensuring that the views of all stakeholders are accessed. COMMENT: No further progress had been made since the previous inspection. Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. Timescale for action 31/03/06 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 Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Renwick DS0000028214.V251986.R01.S.doc Version 5.0 Page 23 - 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!