Inspection on 01/11/06 for The Well House

This inspection was carried out on 1st November 2006.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Well House 30/09/08

The Well House 10/11/05

The Well House 13/05/05

The Well House 05/01/05

The Well House 06/04/04

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Thorndene

Insight - Eastchurch

Southfields

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Dovedale Court

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

CARE HOME ADULTS 18-65 The Well House Golden Cross East Sussex BN27 4AJ Lead Inspector Paul Taylor Key Unannounced Inspection 1st November 2006 11:20 The Well House DS0000046484.V313370.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 The Well House DS0000046484.V313370.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. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Well House Address Golden Cross East Sussex BN27 4AJ 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) 01825 873389 The Well House Nicola Cross Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is nine (9). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated of which two (2) may have an additional physical disability. The home will offer planned short term/ respite accommodation for a maximum of six months at a time only. 10th November 2005 Date of last inspection Brief Description of the Service: The Well House is a nine bedded respite unit for adults with learning disabilities between the ages of eighteen and sixty five. The maximum stay for residents is six months although most service users stay for short periods of respite care. Two places are specifically for residents who have an additional physical disability. The home is situated on the A22 just outside Golden Cross and comprises a large detached house, some of which is over four hundred years old, a large garden and a play/craft room. All nine bedrooms have en-suite facilities with a washbasin, toilet and either bath or shower. There are four bedrooms on the ground floor. Two of these bedrooms is designed for the use of residents with physical disabilities. There is wheelchair access to all parts of the ground floor. The remaining five rooms are on the upper two floors of the home. The home has it’s own transport and in addition there is easy access to local bus services. The cost of staying at The Well House is between £100 and £187 per night dependent on a service user’s needs. Information about the home can be accessed by contacting the manager. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection of The Well House took place on 1st November 2006. The Inspector arrived at the home at 11.20 a.m. and left at 5 p.m. During the inspection the Inspector met with two service users, three members of staff, the manager and co-proprietor. Additionally the Inspector received three questionnaires from relatives of service users, spoke to three relatives of service users on the telephone and spoke to a placing social worker on the telephone. A number of records were also examined as part of this inspection. What the service does well: What has improved since the last inspection? The training offered to the staff team is now more planned and structured and the Inspector saw evidence of a good variety of training which had been offered to members of staff. Supervision is now achieved on a regular basis and the Inspector saw evidence, which suggested that the monitoring of records and care plans, was being consistently achieved. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 6 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 Well House DS0000046484.V313370.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 The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessments of potential service users are thorough and ensure that they are placed appropriately in the home. EVIDENCE: Three care plans were examined and these contained assessments as to service users abilities, aspirations and where necessary what levels of supervision they needed in partaking in activities such as shopping and going out from the home. All service users have assessments carried out on them by the home and by placing authorities. The assessments were thorough and covered areas such as risk assessments, family contact, personal support needs and communication methods. The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users aspirations, needs and choices are known to the staff team and so they are enabled to make choices and decisions commensurate with their abilities and vulnerabilities. EVIDENCE: The three care plans which the Inspector examined reflected what had been assessed prior to the service users admissions. The care plans described the service users abilities to communicate their preferences and choices and how the service users were to be supported especially at times of distress or self injurious behaviour. The Inspector met two service users who were aware of their care plans and plans for their future as well as who their key workers were and how they could contact their social workers. The care plans had been checked every six months and had been endorsed when this had been done. If the care plans had needed amending in between the six month checks then this was also endorsed in the care plans. Service users abilities to make decisions about day to day living are recorded in their care plans. The members of staff who met with the Inspector were The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 10 aware of service users preferences and how these were communicated for example verbally, by signing or by their behaviour. Service users who can manage their own finances are supported by the staff in this process and records of spending and transactions are kept if this is needed to assist service users in the process. There was guidance in place for one service user with regards to the need for restrictive physical intervention at times of self-injurious behaviour. This had been agreed with input from the placing authority and the service user’s parent. During the inspection the service users were seen to make their preferences known with regards to activities on offer and one service user was actively involved in pursuing a placement at a local college. There were numerous risk assessments in place and these were personalised to each service user. The risk assessments took into consideration service users aspirations, abilities and vulnerabilities. Additionally the home has a policy and procedure for the staff to follow in the event that a service user goes missing. The risk assessments are included in the care plans and are revisited when the whole care plan is checked on a six monthly basis. The Inspector recommends that each risk assessment is endorsed and dated to ensure that they continue to be relevant. The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users in the home are able to make choices with regards to the lifestyle they experience at The Well House. They have good opportunities to maintain a community presence and to maintain contact with friends and relatives. EVIDENCE: The Well House offers respite care which is primarily accessed on a short term basis by the service users who go to stay there. Therefore the ethos behind the home is one of offering service users a holiday experience in an environment where they have come to have a break. In this respect the home offers a flexible approach to service users and they have the opportunity to partake in numerous activities if they wish. For those service users who are staying for longer periods care plans are formulated which have more long term goals. For instance a service user living in the home at the time of the inspection had managed to find voluntary employment in a local shop and was pursuing a college place at a local agricultural college. Service users have numerous opportunities to maintain a community presence. Opportunities include participation in a drama group, bowling, weekly bingo, pub trips, belly dancing and trips to church. One parent told the Inspector in a The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 12 telephone conversation that ‘They go out of the way to support my daughter in the community.’ ‘Nothing is too much trouble’ and ‘I can’t speak highly enough of them.’ Most of the service users do not have family visitors when they are at The Well House as they are staying on a short term basis for a break. The Inspector spoke to two service users who were staying for longer periods of time. Both confirmed that they have visitors and are able to go out with them if they wish. Service users are able to telephone friends and relatives and the home is spacious enough to offer different venues for visits. The home has guidance in place for staff to follow in the event that service users form intimate personal relationships and this is underpinned by the staff team knowing about individual service users abilities and vulnerabilities. Service users were observed to be making choices about whether they wished to join in with activities during the inspection. Two service users had chosen to have a lie in whilst others were on computers, singing on a karaoke machine and one was drawing. Service users are offered keys for their rooms although to date the manager told the Inspector that none had taken up this offer. On the whole service users do not partake in housekeeping tasks unless they are staying for longer periods of time and independence skills have been identified as needing to be developed as part of their care plan. The Inspector saw a copy of menus in the home. These offered variety and healthy options. Two service users reported that the food was of good quality. Fruit and snacks are available during the day and the dietary needs both cultural and health related are known to the staff team. The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of service users are met by the home with support from health professionals if needed. EVIDENCE: The personal care needs and service users preferences about how they are supported are very clearly outlined in their care plans. Additionally the home has a policy and guidance in place for the staff to follow with regards to personal care: this includes outlining the need for personal care to be administered by members of staff of the same sex. Continuity of care is maintained by key workers and senior members of staff via oversight of the service users care plans and by service users needs being discussed in team meetings. The health needs of the service users are outlined in the care plans. The Inspector saw evidence of support and appointments that service users had attended with regards to issues such as continence support, outpatient appointments, dental appointments and contraception appointments. At the time of the inspection there were no service users that were self medicating. A senior member of staff showed the Inspector the process for storing, administering and recording of medication. The records were up to date and reflected what had been set out in each service user’s care plan. All staff who administer medication have attended training in this. The Inspector The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 14 saw that refresher training had been planned later in November 2006 for two members of staff. The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are kept safe and have their views listened to by the staff in the home. EVIDENCE: The home has a complaints process in place and this is contained in the home’s Statement of Purpose. All questionnaires returned to the Inspector reported that relatives knew who they could complain to. Two service users who met with the Inspector knew who they could complain to if they were unhappy. The home had received no complaints since the last inspection and The Commission for Social Care Inspection had received no complaints about the home. The members of staff that met the Inspector were aware of what to do in the event that they concerns about service users welfare. The Inspector saw a record that confirmed that all members of staff who work in the home had received training with regards to adult protection. One senior member of staff was due to be trained as a trainer in adult protection within quality assurance month of the inspection. The home has clear policies and procedures in place with regards to staff involvement in service users financial affairs, whistle blowing and the acceptance of gifts. These policies had been reviewed and endorsed by the manager in September 2006. The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was comfortable and clean and service users are able to personalise their rooms. EVIDENCE: The Well House is set over three floors. The ground floor is accessible to wheelchair users and had bedrooms with hoists and lifting equipment. The house is large and there is plenty of space for service users to use especially if they wish for time alone. The grounds are also spacious and there is a craft room set in an outhouse in the grounds. During the inspection a tour of the premises was undertaken. The Well House has now been open for three years and the Inspector noticed that the carpets in the front lounge and outside the kitchen were stained and worn. These need to be cleaned or replaced by the end of December 2006. The manager informed the Inspector that there is a refurbishment process planned and this had been agreed in management meetings. The Inspector recommends that the refurbishment programme is formally set out as a working document rather than being based on verbal agreements made at meetings. It is also recommended that repairs to defects and repairs are formally recorded so that the time between a fault being reported and repaired can be evidenced. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 17 The Inspector saw a record of a fire inspection undertaken by the Fire Brigade in April this year; this reported that the fire precautions were satisfactory. The décor in the home was homely and domestic in character. Service users were comfortable, had en suite facilities and had been personalised. The home was clean and there was written guidance in place for the staff to follow with regards to hygiene and infection control. The home has a laundry room with an impermeable floor. The Well House DS0000046484.V313370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the service users are met by a competent and trained staff team who receive regular supervision. EVIDENCE: The Inspector examined the recruitment records of three members of staff. These contained all the information required by the National Minimum Standards. The Inspector met with three members of staff who said that they are offered a good range of training. Four members of staff were undergoing N.V.Q. Level Two and two members of staff have achieved N.V.Q. Level Three. The manager has a computer record of training which records all the training attended by the staff team and what refresher training needs to be attended. The Inspector noted that refresher training in first aid, adult protection and moving and handling had been planned for different members of staff. The Inspector examined records of supervision and this appeared to have been achieved on a regular basis. Members of staff who met with the Inspector were positive about the quality and regularity of supervision. The Inspector recommends that the staff receive formal annual appraisals as part of their professional development as these have not been completed yet. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well by committed and approachable managers who ensure that service users and staff are kept safe and whose views are valued. EVIDENCE: The registered manager of The Well House is experienced in working with adults with a learning difficulty. Additionally she has been the manager of the home once it opened and has been able to ensure that the leadership and approach to the care of the service users has been consistently maintained. The registered manager is due to finish N.V.Q. Level 4 in care by June 2007. She then plans to study for a formal management qualification once the N.V.Q. has been achieved. The Inspector recommends that this is achieved. The Inspector received unanimous feedback from members of staff, parents of service users, service users themselves and a social worker with regards to the approachability of the registered manager. The Inspector saw written records of team meetings and saw written questionnaires completed by service users, The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 20 their relatives and social workers asking for feedback on the conduct of the home and the care provided therein. Comments received by the Inspector included ‘They are relaxed and approachable, they work on the floor.’ ‘The managers pitch in and are approachable.’ One members of staff reported that she had been encouraged by the managers to update and develop care plans and that innovations in the service were welcomed. As already mentioned the home actively seeks feedback from service users, their families and placing social workers. Other aspects of monitoring included the auditing of safety records and care plans and the endorsing of policies and procedures when they had been reviewed and checked as still being up to date and relevant by the registered manager. Examples of safety records examined and found to be up to date and in order by the Inspector included the checking of the boiler, an electrical certificate, checks of hoists, a fire inspection report from 27/4/06,a fire drill carried out on 20/10/06, fire equipment checks and a record of accidents. The home has regular training for members of staff on the subject of moving and handling and the Inspector saw evidence that training was due in this subject on 13/11/06. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 4 3 X X 3 X The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 22 No 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 YA24 Regulation 23 (2) (b) Timescale for action That the carpets identified during 31/12/06 the inspection as being in need of replacement or repair have this achieved by 31/12/06. Requirement 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 2 3 4 Refer to Standard YA2 YA24 YA36 YA37 Good Practice Recommendations That risk assessments pertaining to individual service users are updated and endorsed. That a formal refurbishment plan is developed for the home and all maintenance issues have a record of when they were reported and then completed. That all members of staff have formal annual appraisals. That the registered manager undertakes formal management training as set out in The National Minimum Standards. The Well House DS0000046484.V313370.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 The Well House DS0000046484.V313370.R01.S.doc Version 5.2 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. 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