Inspection on 13/05/05 for The Well House

This inspection was carried out on 13th May 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 10/11/05

The Well House 05/01/05

The Well House 06/04/04

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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 Endersby Unannounced 13 May 2005 9:00 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 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 Stationary 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 H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Well House Address The Well House Golden Cross East Sussex BN27 4AJ 01825 873389 None None The Well House Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nicola Cross Care Home 9 Category(ies) of Physical disability (PD), Learning disability (LD), registration, with number 9. of places The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home will offer accommodation to up to nine adults, between the ages of 18 and 65, with learning disabilities, one of who may have an additional physical disability 2. The home will offer planned short term / respite accommodation for a maximum of twenty (21) consecutive days at a time only 3. There will be no emergency admissions Date of last inspection 5 January 2005 Brief Description of the Service: The Well House is a nine-bedded respite unit designed 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 of a large detached house, some of which is over four hundred years old, a garden and a play/craft room. All nine bedrooms have en-suite facilities with a washbasin, toilet and either a bath or shower. There are four bedrooms on the ground floor, which are for less able residents. One of these bedrooms is designed for service users with physical needs. There is ample room for wheelchair access to all parts of the ground floor. There is no lift or stair lift to the upper two floors, which contain the remaining five bedrooms. The home has its own transport and in addition is well served by local bus routes. Local amenities are limited although the home does make use of the local church, public house and hotel/restaurant. The home is service user focused and aims to provide safe and holistic care. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place during a morning and early afternoon in May 2005. The Inspector met with one of the partners and a senior staff member plus other members of staff and the two residents who were staying at the home at the time. The Inspector reviewed a range of documentation including care plans, records and some policies and procedures. The inspection also included a tour of the building. The inspection lasted 4.5 hours. What the service does well: 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 7 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 standard(s) 1, 3, 4 & 5 The homes Statement of Purpose and Service Users Guide provide prospective residents with helpful information when making a decision about admission to the home. However the assessment process needs to be improved and action taken before admission to ensure the home is able to meet all the needs of residents. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 8 EVIDENCE: The Well House has both a comprehensive and well presented Statement of Purpose and a detailed Service Users’ Guide that inform prospective residents and/or their representative of the services provided by the home. An illustrated and more user-friendly Service Users’ Guide has also been developed. Assessments are undertaken by senior staff of the home, which establishes the home’s ability to meet the needs of prospective service users. Additionally social work assessments are received. Notwithstanding this further action needs to be taken to meet the needs of individual residents. At the time of the inspection one of the residents did not have English as his first language. However there was only one member of staff who was able to communicate effectively with him. The need to be able to communicate effectively should have been taken into account during the assessment process, and before the home agreed to accept him. Prospective residents are introduced to the home in a way that meets their needs. This is usually either by a visit or an overnight stay, with a tour of the premises and meeting staff. Each resident has a contract, which has been agreed with his or her placing authority. In addition an illustrated contract between the service provider and individual resident has been prepared. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 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 standard(s) 8 & 9 There is evidence that residents are supported and encouraged to expand and develop their daily living skills and that staff work with individual service users within a risk assessment framework. However the absence of clear direction in care plans in regard to responses to some risk assessments could lead to inconsistent care. EVIDENCE: Residents only stay at the home for a maximum twenty-one days at any one time. It is evident that the culture of the home is that residents are consulted regarding the day-to-day running of the home. This was confirmed by staff and observed by the Inspector. Risk assessments are carried out prior to admission, and risk management strategies are agreed with residents and their carers. It is evident that staff are aware of the importance of following these assessments in working with residents both within the home and when going out. Notwithstanding this, the action required in response to individual risk assessments are not always explicit in the care plan. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 10 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 standard(s) 13, 14, 15 & 16 The leisure time activity programme encourages the concept of stays at The Well House as being a holiday. The overall approach taken by staff respects resident’s rights. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 11 EVIDENCE: Staff have good knowledge of the local area including the locations of different leisure time activities. It is evident that staff ensure that residents have access to, and choose from, a wide range of leisure activities and encourage or assist them in making decisions. Recent outings have included a golf driving centre, local pubs, picnic in the local Forestry Commission woodlands. Residents are able to bring with them small personal items e.g. videos, CDs and cassettes. It is evident that the ethos at The Well House is to give the residents an enjoyable stay in a ‘holiday’ type of environment. Therefore the emphasis is on getting out and about in the local community and taking part in ‘fun’ activities. This is clearly valued by residents. It is also evident that maintaining of links between residents and their friends and family during their stay at The Well House is important. Visitors are welcomed and given tea/coffee or a meal as appropriate. Staff respect residents wishes and the interactions witnessed at the time of the inspection were informal but respectful. Although most residents do not take up the offer of a room key, staff always knock before entering residents rooms. From interviews with staff it is apparent that residents have free access to the house and garden, but do not go out in the local area unescorted. Recognizing resident rights and responsibilities is an integral part of the culture of the home. Dependent on their abilities, residents contribute to the day-to-day running of the home. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 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 standard(s) 19 & 20 The arrangements made by staff ensure residents health and medication needs are met. EVIDENCE: Although resident’s stays are brief they are all registered with a local GP for the duration of their time at The Well House. Any residents from the local area retain their own GP. Staff are experienced and aware of the individual health needs of residents. It was confirmed that residents see medical/health care professionals in private if they so choose. Residents bring their medication with them for their stay, and retain responsibility subject to risk assessment. For the remainder staff assume responsibility. The record of medicines administered was checked and found to be well maintained. Medicines are kept secure. No controlled drugs are held at present. Staff who handle medication have received appropriate training. Additional medication on prescription is obtained during the stay as needed. Comprehensive policies and procedures have been prepared for the guidance and instruction of staff involved in medication. A copy is included in the policies and procedures handbook. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 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 standard(s) 22 & 23 Arrangments for protecting residents from abuse are satisfactory. EVIDENCE: The home has a detailed complaints procedure that is included in the Statement of Purpose and service Users Guide. Currently no copy is publicly displayed. The option to contact the Commission for Social Care Inspection is clearly stated. Currently no illustrated copy of the complaints procedure has been prepared. A record of complaints is maintained. The home has an Adult Protection procedure in place and training for staff is provided on adult protection and challenging behaviour. However the policy is not to accept any resident who presents severe challenging behaviour. The home does not act as appointee or agent for any resident but holds small sums for residents during their stay. A record checked showed that records are fully up to date and that the money held was up to date and accurate. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 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 standard(s) 26 & 28 The overall layout and décor of the building including bedrooms and shared space provides a safe and comfortable environment for residents EVIDENCE: The home provides bedrooms of variable size and outlook for residents. As residents only come for respite stays, they do not bring in their own furniture to the room they will occupy although they personalise their rooms by bringing in photographs and other small items. Where possible residents occupy their preferred room on each stay. Residents rooms are lockable although the type of lock is not recommended and could result in staff being prevented from entering in an emergency. It was reported that all residents are offered a key, but that to date none have taken up the offer. The home has a large garden with a barbeque and the service provider employs two gardeners. The garden is well fenced and provides safety and security for residents. The kitchen and laundry are domestic in scale. There is a no smoking policy in operation. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 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. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 34 The staff training programme together with the collective experience of the team provides effective support to residents. Robust recruitment procedures and practices help ensure the safety of service users. EVIDENCE: All staff participate in a comprehensive training programme to improve and develop their skills and competence. In addition to basic or core training, staff also attend training courses related specifically to the needs of residents. All staff have either achieved or planning to commence NVQ training. The home has developed a thorough and robust recruitment process. Staff files were examined in detail and the items required were to hand including copies of terms and conditions of employment. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 40 & 42 The senior managment of the home ensure the home is well run and for the benefit of residents including the arrangements made to provide a safe environment. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 17 EVIDENCE: It was evident through documentation, discussion with staff and the Inspectors overall observations that the home is well run. The manager, who was not present at the time of the inspection, is very experienced both as a practitioner and a manager. However she has not yet commenced training to achieve the recommended qualification in care and management. Some of the other staff also are very experienced in the care of people with learning disabilities. The home has all the policies and procedures in place recommended to safeguard the rights and best interests of residents. It is evident that appropriate action to ensure the health, safety and welfare of service users and staff has been taken. Staff training includes moving and handling, first aid, infection control and food hygiene. However there is no professional training for staff in fire safety. There are regular checks of the gas and electrical systems and appliances. The first floor windows have been fitted with restrictors. Regular checks of the building in respect of safety have been introduced and the outcome recorded. Appropriate safety procedures, are placed in the building. The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 2 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 2 x 3 x x Standard No 11 12 13 14 15 16 17 x x 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 2 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME 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 2 x x 3 x 3 x H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 19 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 3 Regulation 12(1)(a) (b) Requirement Timescale for action 13.05.2005 2. 3. 9 26 4. 37 The providers must ensure that the staff group has the skills and experience to meet the needs of residents. 15(1) Action to be taken in response to identified risk should be clearly set out in the care plan 12(4) Locks must be provided on service users doors that ensure accessibility to staff in emergencies. Keys should be offered to service users. 9(1)(2)(b) The registered manager must (i) undertake training to achieve a qualification, at NVQ level 4, in management and care or equivalent. (Outstanding from the last report). 13.05.2005 30.04.2006 31.12.2005 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. Refer to Standard 22 32 Good Practice Recommendations An illustrated ccopy of the complaints procedure should be prepared. There should be a minimum of 50 of the staff trained to H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 20 The Well House NVQ level 2 or above by the end of 2005 The Well House H59-H10 S46484 The Well House V225626 130505 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection 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. 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