Inspection on 30/09/08 for The Well House

This inspection was carried out on 30th September 2008.

CSCI found this care home to be providing an Good service.

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 01/11/06

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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Insight - Eastchurch

Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Well House The Well House Golden Cross East Sussex BN27 4AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alexis Reilly     Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Well House The Well House Golden Cross East Sussex BN27 4AJ 01825873389 01825873379 maria.wellhouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Nicola Cross Type of registration: Number of places registered: The Well House care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 9 Brief description of the care home 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 its 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 users needs. Information about the home can be accessed by contacting the manager. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection began at 9.30 am and lasted until 1.45pm. As part of the inspection the inspector case tracked three residents one of these was a new admission into the service. The well house is registered to take up to 9 residents in total. On the day of the inspection the home had 7 residents. As part of the inspection the inspector also looked at the risk assessments for these three residents, pre admission documentation and evidenced that any needs had been identified in the homes assessment and Incorporated into the care plans. The activities plan for individual residents case tracked and the record of activities completed was also inspected as were the record of accidents and incidents that had taken place in the home and copies of regulation 37 notifications sent to the CSCI. Evidence of health input and external reviews from visiting professionals was also seen on the inspection. The record of concerns and Care Homes for Adults (18-65 years) Page 6 of 26 complaints in the home, menus, service users finances, service user guide and personal terms and conditions of contract were also examined. As were staff recruitment files, record of staff training, supervision notes, team meeting notes and the staffing rota for the last month and the skills for care induction package. A full environmental tour was carried out of the home, but not the garden. One staff member was interviewed, the Registered Manager and the Deputy Manager of the home and the views of a visiting professional were gained. A sample of records of the administration of medication sheets were also examined. The inspector spent a brief time with two of the residents in the home, and the quality assurance feedback forms were seen. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service understands the importance of having sufficient information when choosing a care home. Admissions are not made to the home until a full needs assessment has been undertaken The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. Evidence: As part of the inspection the inspector examined the care plan of a resident who had recently been admitted to the service. The inspector also spoke to a staff member and the Registered Manager and Deputy manager. A resident had particular complex needs around deliberate self harm and the staff member spoken with was aware of these and aware of the procedure to adopt in the event of a incident happening. The service has demonstrated it Carrys out a thorough assessment of prospective residents prior to offering them a place in the service, and that it ensures the staff are aware of the complex needs of residents on the start of their placement. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service involves individuals in the planning of care which affects their lifestyle and quality of life. Care plans are person centered and are agreed with the individual. Plans are written in plain language are easy to understand and look at all areas of the individuals life and includes a range of information that is important to them. The care plan is a working document reviewed regularly involving the person and their representatives, as appropriate. Residents receive a good comprehensive package of care. Evidence: As part of the inspection the inspector evidenced and case tracked three residents in the service. This showed that the assessment process forms the basis for a comprehensive care plan and even if in a clients is referred in an emergency, the Registered Manager and Deputy Manager always met the client to discuss the placement and their care plan with them and with their family. Assessments are carried out by Registered Manager and Deputy Manager only. As the ethos of the Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: service is of respite most people will have a monthly review, people who are more long term will be reviewed with the external placing agency every six months. Care plans were detailed and informative and reflected the needs assessed in the placing referrals. More longer term stays are now arranged, for those clients who are staying for longer periods care plans are formulated which have more long term goals. It is a recommendation that in relation to one particular service user their risk assessment is updated to include a historical event which should form part of an up to date risk assessment. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run with a respite ethos in mind and has a strong commitment to enabling residents to develop and maintain their skills, including social, emotional, communication, and independent living skills. The staff practices promote individual rights and choice, but also considers the protection of individuals in supporting them to make informed choices. The service ensures that service users are involved and participate in interesting and varied activities. Evidence: As part of the inspection the inspector case tracked three clients in the home, spoke with the Registered Manager and the Deputy Manager, interviewed a staff member and spoke with two residents briefly in the home. The inspector was also able to speak to a placing professional who was visiting the home on that day. The inspector also examined the list of activities in the home. Evidenced found during the inspection Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: confirmed that clients have access to varied and interesting activities, examples of these are going to watch the horse racing in Brighton in the summer and have also going to see the Tricia Show being filmed. Most of the clients do not have family visitors that come to see them at the well house as it is meant to be a respite placement, clients are able to telephone friends and relatives and the home is big enough to offer different venues for visits. Telephone contact with families is promoted. The home has guidance in place for staff to follow in the event the service users form intimate personal relationships and this is underpinned by the staff team knowing about individual service users abilities and vulnerabilities. Service users are offered keys for their rooms and two residents had keys on the day of the inspection. One resident was heard to confirm to her self I have my key in the my pocket, as she was due to go out. An example of the service organizing and making the most of opportunities for the residents are three residents were taken to London, one to visit their family and two others had the opportunity to spend the day in London. Comments from professionals visiting the home were X likes go carting and the service found out were this is on and has taken X several times. On the whole service users do not take part in housekeeping duties in the home 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. Menus are set on the daily basis, and were varied and appealing. The service has recently implemented the safer food better business program. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal and health care support using a person centered approach with support provided based upon the individual needs of the client. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded in each persons care plan. However the service would benefit from following good practice guidelines in the administration of medication. Evidence: As part of the inspection the inspector case tracked three clients in the home, and looked at the health input each received. The inspector also spoke with the Registered Manager, Deputy Manager and staff member. Evidence collected confirms that clients are supported to attend a variety of appointments GP, dentist, physiotherapy, and outpatient appointments. Clients who are staying on a longer term basis are registered with the local GP, and clients who are staying for shorter periods are registered as temporary patients. The service has a policy in place to ensure clients are supported in the way they choose in relation to the provision of personal care and by staff members of the same sex. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Medication is administered by two members of staff and clients who wish to self medicate can do so once a risk assessment is completed. The service would benefit from a sample of staff signatures for administering medication and also photographs of the clients on the MAR sheets. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a complaints procedure in place and ensures that any new clients are made aware of this as part of their induction into the home. Staff have undertaken training on Safeguarding Vulnerable Adults and in the main the home has notified the CSCI of any significant incidents in the service. Evidence: The service has policies and procedures in place with regard to the protection of vulnerable adults, the acceptance of girts, whistleblowing and dealing with residents finances. All staff members have completed the Adult Protection training course, and the senior care officer has also attended a one day train the trainer course in adult protection. Evidence form the AQAA and discussions with the Registered Manager confirmed that the complaints procedure is discussed with the prospective client as part of the induction into the home. The inspector evidenced the record of incidents in the home and these were all minor apart from one, which the inspector advised the Registered Manager to send in retrospect to the CSCI. The inspector was informed that the Registered Manager had however already sent this to the clients social worker and family. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a pleasant safe place to live. The service has a maintenance plan in place to ensure the home is kept in good order. However the Registered Manager must ensure risk assessments are carried out on infection control procedures in the home. Evidence: As part of the inspection the inspector carried out a full environmental tour of the home. The accommodation is set over three floors, the ground floor and garden is wheelchair accessible, there is also a craft room in the garden and all bedrooms have en suite bathroom with toilet, wash hand basin, shower or bath. For clients who require assistance with bathing and personal care tasks, hoists and manual handling equipment is available. There are cleaning checklists in place to ensure that all areas are kept clean, and a cleaner has been employed. Over the last 12 months carpets on the ground floor communal areas and corridor have been replaced, the dining room and lounge layout have been moved around and new sofas have been purchased. The lounge and dining room has been redecorated and new flooring is in place, all downstairs hallways and staircases to the first floor have been redecorated, bedrooms 9,10,2 & 3 have also been redecorated. Freeview has also been installed in all Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: bedrooms which was a request from the client feed back forms. The service was clean on the day of the inspection, however the Registered Manager must risk assess infection control procedures as the service have not installed liquid soaps. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All staff receive relevant training that is focused on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training and supervision to meet the individual needs of people in a person centered way. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognizing the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Evidence: As part of the inspection the inspector examined the staff recruitment files of one new staff member, evidenced the training matrix for staff and spoke to the Registered Manager, Deputy Manager and one staff member. The well house has a low turnover of staff no staff member has left within the last 12 months, if the service has to use agency staff they try to ensure it is the same member of staff wherever possible. Management will regularly cover any shortfalls in the shifts. All staff attend regular refresher training in first aid, fire safety, manual handling food hygiene and infection control. Each of the three staff who take turns to lead the shift are either NVQ level 2 or NVQ level 3 qualified. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: The Well House has a comprehensive recruitment policy in place, written references, POVA and CRB checks are carried out prior to staff commencing employment in the home. Staff have a formal induction period and a three month probationary period. All staff have 6 supervisions a year, and regular monthly staff meetings in which clients needs are discussed and recorded. The service has three staff on duty during the day and afternoon shifts plus the Deputy Manager and Registered Manager. There is 1 sleep in night staff and 1 waking night staff. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager has the required qualifications and experience and is competent to run the home. The Registered Manager has a clear understanding of the key principles and focus of the service, based on organizational values and priorities. They work to continuously improve services. They provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centered thinking. There is a strong ethos of being open and transparent in all areas of running of the home. Therefore ensuring residents receive a comprehensive package of care in a well run home. Evidence: As part of the inspection the inspector spent time talking with the Registered Manager and Deputy Manager of the home, the inspector also spoke with visiting professionals and spoke with two clients in the home, and evidenced the feedback questions from previous clients. The Registered Manager and Deputy Manager have many years experience of working with clients with learning disabilities, as has one of the Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: proprietors of the home. The Registered Manager, Deputy Manager and Proprietor have all worked at the Well house since it opened in 2003 and were all involved in the registration process prior to this. All three of them regularly cover shifts and work alongside care staff proving hands on care, they have a clear aim of how they wish the house to run and this is communicated to all other members of staff, either through work practice, staff meetings or supervision. Both the Manager and Registered Manager have completed their Registered Managers Award. The service provides a clients focused, client led respite service to people with a learning disability. Comments recorded in the client feedback forms were Things you like best Costa coffee nice come again. I liked drumming best. down the pub,I liked all of it, I liked going to the no wait Indian buffet. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 That in relation to one client their risk assessment is updated to include the historical event in the placing assessment. The service would benefit from a sample of staff signatures with regard to the administration of medication and also photographs of individual clients on their Mar sheets. The Registered Manager must ensure that all significant incidents are reported to the relevant organizations and the CSCI. The Registered Manager must ensure that a risk assessment is carried out on infection control procedures within the home. 2 20 3 23 4 30 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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