Inspection on 26/03/08 for The Wheel House

This inspection was carried out on 26th March 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Wheel House 03/07/08

The Wheel House 29/10/07

The Wheel House 31/05/06

The Wheel House 04/10/05

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

CARE HOME ADULTS 18-65 The Wheel House Linden Hill Wellington Somerset TA21 0DW Lead Inspector Jane Poole Unannounced Inspection 26th March 2008 10:30 The Wheel House DS0000063400.V361414.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 Wheel House DS0000063400.V361414.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 Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wheel House Address Linden Hill Wellington Somerset TA21 0DW 01823 669444 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) Mr William Gilbert Gillespie Mr William Gilbert Gillespie Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 10. 29th October 2007 2. Date of last inspection Brief Description of the Service: The Wheel House is situated on the outskirts of Wellington but has easy access to all local amenities and facilities. The home is currently registered to provide a service for ten service users with a Learning Disability. The home is owned by Covenant Care and the registered manager is Bill Gillespie. There are extensive grounds with mature gardens and large patio areas. The home also has facilities on site for woodwork, gardening and arts and crafts. Fees at the home range from £1252.00 to £2503.00 per week. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Since the last Key inspection carried out on 29/10/07 three random inspections have been carried out to monitor the homes progress in meeting the requirements set. Some of the findings of random inspections have been referred to in this report. This inspection was carried out by two inspectors over a one day period. The inspectors were able to talk with people who live and work at the home, observe care practices; tour the building and view records. The manager and deputy manager were available throughout the day. The inspectors were given unrestricted access to all areas of the home and all records requested were made available. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The home is well located in a quiet semi rural area but within walking distance of many local amenities. The house provides a comfortable homely environment. All rooms are for single occupancy and all have en suite facilities. People living at the home are able to personalise their rooms to their own tastes and needs. Anyone wishing to move to the home is able to visit with their family or representative and have a trial stay before deciding if it is the right place for them to live. Once people move into the home staff assist them to keep in touch with important people and visitors are always made welcome. Care plans are detailed and very personal to the individual they give information about peoples likes and interests as well as their needs. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 6 Medication in the home is securely stored and administered and recorded in line with good practice guidelines. The management in the home is described as very approachable and everyone asked said that they would have no hesitation in speaking with the manager if they had any concerns. What has improved since the last inspection? What they could do better: The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 7 As mentioned above a full training programme has been put in place. The home need to ensure that this is ongoing and gives staff up to date skills specific to the home. For example; there needs to be ongoing training in communication to ensure that people living at the home are able to express their views and make choices. Information in the home needs to be made more accessible to people. Pictures and symbols should be more widely used to ensure that people are kept informed about subjects such as staffing, food and activities. The home has undergone significant staff turnover in the past, which has led to staff shortages at times. Rotas seen by the inspectors showed that levels of staff are still not consistent and this needs to be monitored to ensure that there are always sufficient numbers of staff on duty to meet the needs of the people who live at the home. Many staff have undertaken training in the protection of vulnerable adults but staff spoken to were unaware of the local Somerset policy on Safeguarding Vulnerable Adults (May ’07). The manager needs to ensure that all staff have access to this document and are aware of the correct procedures to follow should an allegation be made. Currently only shift leaders and the management team administer medication. The manager needs to ensure that there are always sufficient numbers of staff competent to administer medication at prescribed times and in emergency situations. The home need to ensure that there are good hygiene practices in place to minimise the risk of the spread of infection in the home. This includes the provision of protective clothing such as gloves and aprons. 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 summary of this inspection report can be made available in other formats on request. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 8 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 Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No new people have moved to the home since the last inspection. There are opportunities for people to visit the home, and to stay on a trial basis, before deciding to move in permanently. EVIDENCE: No one has moved into the Wheel House since the last inspection. There is currently one vacancy and on the day of this inspection someone was viewing the home. The manager stated that anyone wishing to move in is able to visit with their family or representative and spend time getting to know people living and working at the Wheel House before deciding to make it their home. Everyone who moves in does so initially on a trial basis to ensure that the home suits their lifestyle and that it is able to meet their needs. Since the last inspection the service user guide has been up dated and now gives clearer guidelines about what is included in the fee. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans give clear guidelines for staff to assist people in their chosen activities. People living at the home are able to make decisions and choices about their day-to-day lives but this could be further expanded upon. Risk assessments are in place but these do not give clear guidelines of the procedure to follow if control measures are unsuccessful in minimising the risk. EVIDENCE: At this inspection two care plans were viewed in detail and a further 2 were sampled. Since the last inspection a clear pen picture of each individual has been put in place. This gives staff an overview of the persons’ needs, abilities and lifestyle preferences. Each pen picture seen was very personal to the individual. Care The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 11 plans and support protocols were up to date and there was evidence of regular review. Care plans gave evidence that people living at the home are able to make choices about their day-to-day lives even though some people may not be able to express their views verbally. For example in one care plan seen it stated how the person would indicate to staff that they wished to get up or go to bed. Many of the staff in the home have now received training about the Mental Capacity Act 2005 and how to assist people to make decisions. Further training in this area is planned. Documentation seen demonstrated that the home is aware of peoples rights to make their own decisions even if staff do not feel that it is in their best interests. The majority of people living at the home are unable to manage their personal finances. Currently the manager acts as a financial appointee for some people but he is in the process of applying to the Court of Protection to pass on this responsibility. The home also keeps small amounts of personal money for each person to ensure that they have access to their money to spend when they wish to. This money is securely stored and records are maintained of all transactions. Records viewed by the inspectors correlated with monies held. The home uses some pictures and symbols to assist people with decisions but it is suggested that this be expanded upon to allow people further independence. Care plans seen contained risk assessments in respect of individuals and the activities that they took part in. These risk assessments gave information about how staff working with the individual could minimise risk involved but gave no guidance about the procedure to be followed if the control measures in place were not successful. For example one risk assessment in respect of someone leaving the building without support did not give guidelines about what to do if the person was found to be missing from the home. Staff write daily records about each person and this is summarized on a monthly basis. Some of the language used in reports was not respectful or clear and this was discussed with the management during the inspection. All care plans have a front sheet where staff sign to say that they have read and understood the information. This should ensure that staff are consistent in the way that they assist and respond to people who are living at the home. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to access a wide variety of leisure facilities at the home and in the wider community. EVIDENCE: There are no strict routines in the home and care plans show that people make choices about the time they get up and when they go to bed. There are extensive grounds around the home and many rural walking areas. There is a trampoline and adult size swing in the garden. Staff spoken to during the inspection felt that the opportunities for people to take part in activities had improved since the last inspection. Each person living at the home has a weekly activity programme that includes activities The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 13 within the home and in the wider community. The home has three vehicles which allows people to go out individually and in small groups. On the day of the inspection some people went to a local arts and crafts class in the morning, one person went to a music session in the afternoon and other people went out for coffee with staff. One member of staff stated that they were not always able to take people out on an individual basis, which they felt people benefited from. This was discussed with the manager who stated that they would look at ways that this can be facilitated in the future. Care plans seen gave information about peoples interests and hobbies. Records seen showed that people take part in a variety of activities including, skittles, horse riding, swimming, walking and shopping. The inspectors observed that people living at the home were able to spend time in communal areas or in the privacy of their personal rooms. Some people have TVs and music centres in their rooms and there is a TV in the communal lounge. In addition to the main house there is an annexe with three single occupancy flat lets where individuals are supported by a dedicated member of staff throughout the day. Currently no one living at the home has a job outside the home and no-one is attending college. The home assists people to keep in touch with family and friends. The home organises transport for some people to visit family and visitors are always welcomed at the home. One person told the inspectors that they had recently been to stay with parents and another said that they see their family every week. The main meal of the day is in the evening and there is a lighter meal at lunch time. Since the last inspection the home has employed a cook 4 days a week. Staff stated that this had been a very positive step as it meant that they could concentrate on their care duties. There is a four-week menu that shows a variety of food. The inspectors saw that the kitchen was well stocked with food including fresh fruit and vegetables. Special diets are catered for. Currently the menu for the day is not displayed in an accessible format for people living at the home. Staff stated that people were told what was for lunch or dinner if they asked. It is recommended that the days menu is displayed in format that is understandable for people living at the home. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are assisted with personal care in private and encouraged to maintain independence. People have access to healthcare professionals in line with their assessed needs. EVIDENCE: All rooms at the Wheel House have en suite facilities where personal care can be carried out in private. The home employs both male and female carers meaning that service users are able to have some choice about the gender of the person who assists them with personal care. Care plans seen by the inspectors gave details of the level of support people require with personal care. There was evidence that people are encouraged to be as independent as possible to maintain privacy and dignity. Care plans stated when people required guidance with choosing appropriate clothing. People living at the home are assisted by key workers to shop for clothes and personal items. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 15 Everyone is registered with a local GP and all appointments are recorded. Records in individual files showed that people have access to healthcare professionals in line with their individual needs. These include chiropodists, dentists and psychiatrists. There are now clear protocols in place for each individual to ensure consistent approaches to behavioural and emotional issues. The home has put in place an extensive training programme for staff and it is recommended that there is ongoing training for all staff in issues that are specific to the people living at the home. This should include subjects such as autism, communication and epilepsy. The home uses a monitored dosage system for medication and senior staff have undertaken training in safe handling and administration. One member of staff stated that as only shift leaders had received appropriate training they sometimes had to work additional hours to ensure that medication was dispensed at the correct times. The home must ensure that there are always sufficient numbers of staff who are competent to administer medication at prescribed times and in emergency situations. The inspector viewed the Medication Administration Records (MARs) and found them to be well maintained and correctly signed. There are protocols for the use of PRN (as required) medication, these are currently kept in individual files but it is recommended that copies be kept in the medication records as well to ensure staff administering medication have easy access to this information. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Since the last inspection systems have been put in place to minimise the risk of abuse to people living at the home. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing. Staff spoken to stated that they would be confident to raise any concerns with the manager in the home but were also aware of the ability to take serious concerns outside the home. Since the last inspection protocols for working with each individual have been drawn up. This means that there are now clear guidelines for staff to follow to ensure consistent and appropriate responses to people living at the home and the behaviour that they may display. A previously stated individual risk assessments are in place but they do not give guidance about what to do if the control measures suggested in the assessment are unsuccessful. For example if someone leaves the home without supervision. The majority of staff have now completed training in the protection of vulnerable adults and this training is being repeated for anyone who was unable to attend. Training about the Mental Capacity Act 2005 has also been made available. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 17 Staff spoken to were unaware of the local policy and procedure to follow in the event of an allegation being made. It is strongly recommended that the home makes a copy of the Somerset Safeguarding Vulnerable Adults policy (May 2007) available to all staff working at the home. The main kitchen at the home is kept locked by a keypad. Risk assessments are in place in respect of this practice as it restricts the freedom of movement of people living at the home. The inspector noted that during the inspection people where able to use the kitchen facilities with the support of staff. There is unrestricted access to personal rooms and the communal lounge. One person living at the home chooses to lock their bedroom. There is now a complaints log in place and there is a suggestion box so that people can make suggestions about the running of the home, anonymously if they wish to. At a random inspection carried out on the 8th February 2008 serious concerns were identified regarding the recruitment procedures in the home. The poor recruitment procedures potentially placed people at risk and a Statutory Notice was issued by the Commission for Social Care Inspection to the home. This notice was fully complied with within the required timescales. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Wheel House provides a comfortable, homely environment. Hygiene practices in the laundry could be improved to minimise the risk of the spread of infection within the home. EVIDENCE: The home is located in a quiet residential area of Wellington. It is within walking distance of the sports centre and other local amenities. There are extensive gardens with seating. All areas of the home are fitted with a fire detection and emergency lighting system, which is regularly tested in house. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 19 Accommodation is set over two floors. There are seven single en suite bedrooms and three self-contained flat lets for single occupancy. Flat lets have there own lounge/kitchen area and there is a kitchen/diner and lounge in the main part of the home. There is a toilet on the ground floor for communal use but this was out of order on the day of the inspection. This is the only communal toilet on the ground floor in the main part of the home so therefore needs to be reinstated as soon as possible. There is a laundry, which is shared by everyone living at the home. The laundry is appropriate to the size of the home and the needs of people living there. There is a small sink in the laundry for hand washing but on the day of the inspection hand drying facilities were not clearly visible. There appeared to be no aprons or gloves and there was no lid on the bin. The home need to ensure that there are good hygiene procedures in place to minimise the spread of infection within the home. The inspectors toured the communal areas of the home, and a sample of bedrooms, it was noted that most areas were reasonably clean. Some areas, for example the upstairs bathroom, are looking tired and are now in need of decoration to bring them back to a good standard. Bedrooms seen had been personalised to reflect the tastes and wishes of their occupants. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures have improved and now minimise the risks of abuse to people living at the home. There is now a training programme in place for all staff. Staffing levels need to be monitored to ensure that there is always sufficient staff on duty. EVIDENCE: The home employs 18 care staff, 5 have a National Vocational Qualification (NVQ) at level 2 or above. Other members of staff are working towards National Vocational Qualifications. As part of the home’s improvement plan an extensive training programme for all staff has been put in place to ensure that everyone has the skills to care for the people living at the home. The induction programme in the home is now in line with the ‘skills for care’ core standards. Staff spoken to stated that the The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 21 induction and ongoing training programme was good and relevant to their work. The home needs to ensure that the programme includes ongoing training in areas specific to the needs of the people living at the home. There has been a high turnover of staff in the past six months and some staff commented that there had been times when they experienced staff shortages. Additional staff have been employed, including bank staff, and there is now only 1 full time vacancy. The deputy manager gave the inspector copies of the duty rotas for March 2008. These show that there are usually 7 care staff on duty until 6.30pm and 5 people from 6.30pm till 8.30pm. At times, according to the rota, this drops to 6 during the day and 4 in the evening. Overnight there is always two waking night staff. The manager and deputies hours are in addition to this. There is always a senior member of staff on duty who co-ordinates the shift and offers supervision and support to less experienced members of staff. Staff spoken to stated that they felt well supported by other members of staff and the management. Staff observed interacted well with people living at the home and those spoken to demonstrated a commitment to providing a good quality service. People felt that there was good communication in the home and high staff morale. The home does not currently hold regular staff meetings. At the last key inspection (29/10/07) a requirement was made to ensure that the recruitment procedures were robust and that no staff were employed without two written references. On the 8th February 2008 a random inspection was carried out and this requirement had not been complied with. A Statutory Notice was issued by the Commission to improve staff recruitment to ensure that people living at the home were adequately protected. Ten staff recruitment files were viewed at a random inspection on the 14th March 2008 and this gave evidence that the Statutory Notice had been fully complied with within the set timescales. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Formal quality control measures have been put in place to monitor the quality of care at the home. The management team is described as very open and approachable. EVIDENCE: The registered provider and manager is Bill Gilllespie. He has owned the home since it opened in May 2005. He has many years experience of working with people who have a learning difficulty and is undertaking the Registered Managers Award (NVQ level 4) The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 23 Since the last inspection a deputy manager has been put in place to strengthen the management and give clearer lines of responsibility. Staff spoken to stated that the management team in the home was open and approachable. Everyone asked stated that they would have no hesitation in speaking to the manager or deputy about any concerns. After the last key inspection the home was required to supply the Commission with an improvement plan to demonstrate the measures that were being put in place to improve the standard of care in the home. A comprehensive improvement plan was put in place. 3 random inspections and this key inspection have demonstrated that the manager has worked hard to implement the improvements required. The home has put in place an internal quality control audit, which will be carried out by the manager every three months. This will enable the manager to identify areas that require attention and take appropriate action to address them. The home has taken reasonable steps to ensure the health and safety of people living and working in the home. There is an up to date certificate for the electrical installation in the home and portable electrical appliances were tested in November ’07. An outside agency has carried out a full fire risk assessment. Records seen showed that fire detection equipment and emergency lighting is tested on a weekly basis. There are regular fire drills in the home. Staff stated that they have recently undertaken training in health and safety issues, including fire safety and moving and handling. All training undertaken in the home is now recorded. Up to date certificates of insurance and registration are displayed in the home. The Commission is now being informed of all significant events that occur in the home. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 24 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 3 2 x 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 2 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 3 3 x x 3 x The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 25 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 YA30 Regulation 13(3) Requirement The manager must ensure that there are good hygiene practices in place to minimise the risk of the spread of infection. Protective clothing must be made available where appropriate. The manager must keep the staffing levels under review to ensure that there are always adequate numbers of staff on duty to meet the needs of the people living at the home. Timescale for action 16/05/08 2 YA33 18(1)[a] 16/05/08 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 Refer to Standard YA7 Good Practice Recommendations The manager should consider expanding the use of pictures and symbols in the home to ensure people have accessible information. This should include staff on duty, activities and meals. The manager should ensure that risk assessments give clear guidelines for staff to follow when control measures DS0000063400.V361414.R01.S.doc Version 5.2 Page 26 2 YA9 The Wheel House 3 YA19 4 YA20 5 6 7 8 YA23 YA27 YA32 YA37 are unsuccessful. The manager should ensure that there is ongoing training for all staff in issues specific to people living at the home. This should include training in autism, epilepsy and communication. The manager should ensure that there are adequate numbers of staff that are competent to administer medication at prescribed times and in the case of emergencies. Protocols for PRN (as required) medication should be available with the Medication Administration Records. The manager should ensure that all staff are familiar with the Somerset policy and procedure for safeguarding Vulnerable Adults (May 2007) The manager should ensure that there are adequate communal toilet facilities in the main house. 50 of care staff should have a National Vocational Qualification in care at level 2 or above. The registered manager should have a National Vocational Qualification in care and management at level 4 or above. The Wheel House DS0000063400.V361414.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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