Inspection on 10/11/05 for The Well House

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Well House 30/09/08

The Well House 01/11/06

The Well House 13/05/05

The Well House 05/01/05

The Well House 06/04/04

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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 The Well House Golden Cross East Sussex BN27 4AJ Lead Inspector Paul Taylor Unannounced Inspection 10th November 2005 10:15 The Well House DS0000046484.V250130.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 The Well House DS0000046484.V250130.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. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Well House Address The Well House Golden Cross East Sussex BN27 4AJ 01825 873389 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) The Well House Nicola Cross Care Home 9 Learning disability (9), Category(ies) of registration, with number of places The Well House DS0000046484.V250130.R01.S.doc Version 5.0 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 one (1) may have an additional physical disability. The home will offer planned short term / respite accommodation for a maximum of twenty-one (21) days at a time only. 13th May 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 three weeks although some return for short stays. One place is 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. One of these bedrooms is designed for the use of a resident 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 Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection took place at The Well House on 10th of November 2005 between 10.15 a.m. and 4.15 p.m. The Inspector met with two service users, four members of staff, the manager and her deputy and one of the coowners of the service. A number of records were examined and the Inspector undertook a tour of the premises. The Well House is a well-managed service providing a good level of care to adults with a learning disability on a short-term respite basis. The staff are committed to supporting service users and to ensuring that stays at the home are a positive experience with a strong emphasis on providing a ‘holiday’ for those who stay at The Well House. The Inspector observed interactions between service users and members of staff, these were relaxed supportive and good-humoured. The Inspector met two service users who confirmed that they liked staying at The Well House. What the service does well: What has improved since the last inspection? The Adult Protection Procedure has been updated. The structure of ‘Client Profiles’ (Care Plans) is being reviewed. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 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.V250130.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 The Well House DS0000046484.V250130.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 and 3. The Well House staff conduct their own assessment process as well as using assessments carried out by other professionals. All service users have their needs met by the service. Feedback reports seen completed by both service users and carers were overwhelmingly positive about the periods of respite care experienced at The Well House. EVIDENCE: The Inspector examined assessments made by placing authorities and assessments made by members of staff working at the home. The manager and deputy manager explained that the assessments made by The Well House staff are more related to collating the day to day ‘mechanics’ of caring for prospective service users. Information for these assessments is gained from the service user, their main carer, other professionals and day centres where applicable. The wishes and aspirations of each service user are ascertained as part of this assessment process. Assessments seen by the Inspector and feedback from both service users and carers confirmed that the periods of respite care offered by the home have met their needs and provided a positive experience. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 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. The home sets short-term aims and goals for service users, which are in keeping with the holiday ethos and short-term care offered by the service. Service users are consulted on a daily basis and their preferences listened to. The new format for ‘client profiles’ will be a more thorough document than those being currently used. There is a need for senior members of staff to endorse care plans when they have been checked. The risk assessment process used in the home is somewhat basic and other models should be explored. EVIDENCE: Due to the short-term nature of stays at The Well House personal goals and aspirations of service users are concentrated on what they will experience as part of the holiday ethos operated by the home. Preferences are gleaned as part of the assessment process already described. Day to day preferences are gathered by consultation with service users with regards to such issues as outings and food etc. ‘Client Profiles’ (care plans) record service users likes and dislikes and care needs. The Inspector examined a sample of these. It is recommended that the senior member of staff who checks these documents endorses that this is done and when it has been done to ensure that care needs are constantly kept up to date. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 10 The Inspector saw an example of a new format for a ‘client profile’. This was a thorough and well thought out document. The home intends to update all the service users care plans into this format in the next six months. Samples of risk assessments were examined. These were adequate for their use. The Well House DS0000046484.V250130.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 and 14. The home offers a very good variety of outings and experiences to the service users. Preferences are ascertained and there is a strong ethos in the home of ensuring that all service users are offered the opportunity to be part of the community and to enjoy their stay at The Well House. EVIDENCE: The short-term care offered by the home means that hopes and aspirations of service users are concentrated more on enjoying the holiday experience offered by the home. There were records seen and feedback from members of staff confirmed that the service users take part in numerous activities in the community. Examples of activities were going to bingo, bowling, pub visits, cinema, watching football matches, going to speedway racing, going to church, listening to live music and a recent to trip to a horse racing meeting in Brighton. Additionally a record was seen of a service user attending short-term courses at a local education facility. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 12 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 and 19. Personal care and support is sensitively handled in the home. Administration of medication is carefully monitored and recorded and all staff are trained and competent in the administration of medication. EVIDENCE: The manager reported to the Inspector that support for personal care is offered by members of staff of the same sex as the service users. All the ‘client profiles’ that were examined did specify what levels of support service users needed. Staff who met with the Inspector confirmed that they knew how to operate the hoists which are used for service users who have mobility problems. The Inspector examined a record of medication administered in the home. This record was up to date and accurately maintained. All members of staff have attended training in the administration of medication. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 13 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. Service users views are listened to and valued as part of the ethos of the home. There is a comprehensive complaints policy and procedure in place. The Adult Protection Procedure has been updated and contains guidance and advice for staff to follow in the event of a concern. EVIDENCE: There is a thorough complaints policy in place in the home. The manager reported to the Inspector that research is being carried out on how to present the complaints procedure in a pictographic format. The learning disabilities of some of the service users mean that they do not understand the concept of a complaints procedure. Behaviour displayed by service users is indicative of their happiness or unhappiness. To support the process of ascertaining service users satisfaction, feedback questionnaires are completed after every stay by both the service user (commensurate with their cognitive ability) and the service user’s main carer. The home updated the Adult Protection Procedures in September this year. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 14 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): 26 and 30. Service users rooms are clean and pleasantly furnished. The home and grounds are spacious. The Well House a safe and comfortable environment. EVIDENCE: Service users are able to personalise their rooms when they come to stay at The Well House. The rooms and house were comfortably furnished and clean. The locks for service users rooms are due to be replaced by April 2006. 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/play room set in an outhouse in the grounds. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 15 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. Deleted: 35 the 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, 34 and 35. Staff training is regular and there is an active N.V.Q. programme in place. Supervision is provided to all contracted staff. ‘Bank’ staff should receive this as well. Training needs should be more formally recorded and training should be given in recording skills. The reference missing from a member of staff’s file needs to be found. The members of staff who met the Inspector were committed to providing a good level of care to service users, there was very positive feedback with regards to team work and the high quality of support forthcoming from the management team. EVIDENCE: The home has an active and ongoing N.V.Q. programme in place. Additionally the Inspector saw records of various training events that had been attended by members of staff during the year. The Manager and Deputy manager have a combined experience of working in the caring profession of 35 years. Weekly team meetings take place and are minuted. Training needs are identified via supervision meetings. The Inspector recommends that there is a more formal process of collating and recording training needs. Members of staff who met the Inspector gave unanimous positive feedback about the approach and good quality of support offered from the management team. Records of supervision were seen and these confirmed that staff on contracts were receiving supervision on a regular basis. The Inspector recommends that ‘bank’ staff receive supervision especially if they are used on a regular basis. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 16 Two staff files were examined by the Inspector. One contained all the information required by the National Minimum Standards. The other file was lacking a reference. The manager said that this had been received but that it could not be found at that point. The reference needs to be found and filed accordingly. Care officers have recently been expected to lead shifts as part of the process of professional development. The Inspector recommends that training in recording skills is provided so that members of staff become more confident in this area. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 17 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 and 42. The home is very well managed and the staff team feel very well supported. The manager and deputy manager should finish their management qualification by September 2006. There are good systems in place to record safety issues such as fire drills etc. Window restrictors need attention in Room 9 and the upstairs bathroom. EVIDENCE: The manager and deputy manager are both undertaking N.V.Q. 4 in Management and the Registered Managers Award. They expect to complete this by September 2006. There was very good feedback received from all the members of staff that the Inspector met regarding the approach, support and availability of the management team. The manager keeps records of safety checks as required. The Inspector saw records of fire drills, checks of the hoists, boiler safety check, and fire safety equipment. The Inspector saw a report from an Environmental Health Officer dated 12/8/05 regarding the kitchen. The report was very positive about the standard of cleanliness and hygiene. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 18 The window retainer in Room 9 needs strengthening or replacing and the window to the upstairs bathroom needs a restrictor to be put in place. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 19 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 3 X 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score X X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 4 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Well House Score 3 3 X x Standard No 37 38 39 40 41 42 43 Score 4 3 X X X 2 x DS0000046484.V250130.R01.S.doc Version 5.0 Page 20 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 2 Standard LD 34 LD 42 Regulation 19 4 (b) (i) 13 4 (a) Requirement That the reference missing from a member of staff’s file is found and filed accordingly. That the window restrictors in room 9 and the upstairs bathroom are made safe. Timescale for action 15/12/05 15/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard LD 6 LD 35 LD 35 LD 35 Good Practice Recommendations That ‘client profiles’ (care plans) are endorsed by a senior member of staff when they have been checked. That staff training needs are more formally assessed. That supervision is provided to ‘bank’ staff. That training in recording skills is provided. The Well House DS0000046484.V250130.R01.S.doc Version 5.0 Page 21 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.V250130.R01.S.doc Version 5.0 Page 22 - 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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