Inspection on 29/10/07 for The Wheel House

This inspection was carried out on 29th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 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 26/03/08

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 29th October 2007 09:30 The Wheel House DS0000063400.V353728.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.V353728.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.V353728.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.V353728.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. 31/01/07 2. Date of last random 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.V353728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. The inspection was carried out over a period of 7.75 hours. During this time the inspector was able to meet with staff and service users, observe care practices and view records. One care manager was spoken to during the inspection and a further two were spoken with by phone the following day. The manager completed an Annual Quality Assurance Assessment (AQAA) prior to the inspection. This sets out the homes achievements and plans for the future. This document was not comprehensive and no timescales were given for improvements. Two service users completed questionnaires prior to the inspection. What the service does well: The Wheel House provides a comfortable homely environment for service users. It is ideally situated to access the countryside and local facilities. All prospective service users are assessed prior to being offered a place at the Wheel House and are able to visit the home to meet with staff and service users. Care managers stated that the home is open and approachable and they have good communication with the manager. There are opportunities for service users to access leisure facilities and people are assisted to keep in touch with friends and family. Staff observed, and spoken to, were enthusiastic about their jobs and interacted well with service users. Senior staff demonstrated a good knowledge of individual service users. Practices in respect of medication are good and minimise the risks to service users. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Since the last inspection the home has been registered for an additional 4 people. There are now three self-contained flatlets where people receive one to one support throughout the day. New service users have very complex needs and not all staff have received training specific to their needs. The home now need to ensure that they seek the advice and support of appropriate health and social care professionals to ensure that complex needs are being met in the way that is most appropriate. Records of staff training are poor and the home need to introduce a system to ensure that staff receive regular up dates in line with current good practice. Staff have not received training in safeguarding vulnerable adults and are frequently in a position where they are making decisions for service users who may lack the capacity to make decisions for themselves. Staff have not received training about the Mental capacity Act and there is no documentation to evidence how decisions have been made. Risk assessments, care plans and behavioural management plans are not routinely up dated and do not always give clear guidelines for staff to follow. Staffing levels in the home need to be monitored. The duty rota seen by the inspector showed that on more than one occasion there have only been four staff on duty between the hours of 6.30pm and 8.30pm. This is insufficient to meet the needs of the current service user group. There are no formal quality assurance systems in place and therefore no ways in which to monitor the quality of care or develop a programme of ongoing improvement. At the time of this inspection the up to date certificate of registration was not displayed and the home have not informing the Commission for Social Care Inspection of significant events in the home. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 7 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.V353728.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.V353728.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, 2 & 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All prospective service users are able to visit The Wheel House before making a decision to make it their home. EVIDENCE: Since the last inspection the home has increased the number of people that it is able to provide care for. The home has updated their statement of purpose and service user guide in line with the changes that have occurred. The service user guide does not give clear details about what is included in the fee and what service users may be expected to pay for from their personal allowance. All prospective service users have their needs assessed before being offered a place at the Wheel House. If the manager feels that the home are able to meet their needs they are invited to visit the home and spend time with staff and other service users. The first three months of any stay is considered a trial period. The inspector was able to meet with one care manager who stated that they had originally visited their client weekly when they first moved to the home. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 10 They had been able to assist with the formulation of the care plan and offer advice and support to the home. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not routinely up dated in line with changing needs or wishes meaning that there are not always clear guidelines for staff to follow. Staff assist service users to make decisions and choices in their day to day lives but would benefit from training to enable them to appropriately assist people to make more complex decisions. EVIDENCE: Each service users has a care plan. The inspector looked at two in detail. Plans of care gave details of service users abilities and needs. One care plan had not been up dated in line with the timescales set by the home and it was difficult to ascertain whether or not the information presented a clear picture of the support currently needed by the service user. For example the personal care The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 12 plan was due to be reviewed in August 2007 but no details of a review were written. At a random inspection carried out earlier in the year it was noted that risk assessments were not being regularly reviewed. It was also noted that some practices in the home placed restrictions on service users when no risk had been identified. An immediate requirement was issued to ensure that if a high risk was identified for one individual then the measures put in place to minimise the risk should not restrict the freedom of movement of other service users. This requirement has been complied with but at this inspection it was again noted that risk assessments had not been reviewed and some had not been dated when put in place. There were some guidelines in respect of behaviours that may be challenging but in one instance these were not sufficiently detailed to ensure that practice in the home was always consistent and appropriate. There was a behavioural protocol for one service user, which was detailed and up to date, unfortunately the behavioural monitoring chart for this person was not dated. Staff write daily records for each person in a separate daily records book and these are summarized at end of each month and added to the care plan. Staff assist service users to make decisions about their day to day life, such as the clothes they wear and the food they eat. One service user spoken to stated they were able to decide what time they got up and when they went to bed. It was noted that service users were able to spend time in the communal areas or in their rooms. Some of the service users do not have verbal communication skills and others are unable to fully express themselves. It was apparent that staff were able to respond to service users behaviour in determining their wishes. For example it was clear from listening to staff that people were able to have a lie if they appeared reluctant to get up when first asked. No service users living at the home manage their own finances. The manager acts as a financial appointee for some service and some personal allowance is kept in the home. The inspector viewed the personal allowance records and found that monies held correlated with records kept. The manager gave assurances that all service users who he acts as an appointee for have separate bank accounts and these are audited by people outside the home. Staff have not received training in the Mental Capacity Act and in some instances it was unclear how decisions were being made. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 13 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): 12, 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. All service users have access to leisure activities at the home and in the local community. EVIDENCE: Daily routines in the home are flexible, there are no set times to get up or go to bed and people take part in leisure activities in line with their preferences. There are extensive grounds around the home and many rural walking areas. There is a trampoline and adult size swing in the garden. Some service users have TV and music centre in their rooms. In the grounds of the home there is a woodwork department and communal room where people are able to play pool. One member of staff stated that they are currently looking at these facilities to ensure that they are in line with the preferences of service users. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 14 All service users have opportunities to take part in activities outside the home and use local community facilities. People go shopping in the local town and use the sports centre, which is within walking distance of the home. On the day of the inspection one service user told the inspector that they regularly went to the gym. The new annexe of the home has three self contained flatlets were people are supported on a one to one basis, meaning that they are able to take part in activities at the home and in the community with a dedicated member of staff. Two service users completed questionnaires prior to the inspection one answered ALWAYS and the other answered USUALLY to the question ‘Are there activities arranged by the home that you can take part in?’ The home encourages 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. A small number of service users have been away on holiday with the home and they are looking at arranging further holidays. One service user told the inspector that they had been away on holiday with their parent. Two service users have keys to their rooms. No one living at the home currently has employment, paid or unpaid, outside the home. The main meal of the day is in the evening when everyone is at home. A weekly menu is set and at the present time care staff are responsible for cooking. Some service users are able to access the kitchen to make drinks and snacks. Some with staff support some without. The inspector saw that the kitchen was well stocked with good quality products including fresh fruit. One service user did some cooking with a member of staff on the day of the inspection. The home are currently in the process of employing a full time cook which will mean that care staff no longer need to take responsibility for cooking the main meal. The inspector noted that two service users had lost considerable amounts of weight since moving to the Wheel House and this needs to be closely monitored to ensure that people are receiving an adequate diet for the level of activity which they are undertaking. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 15 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. Staff assist people with personal care in private. Staff and service users would benefit from advice and support from outside professionals in relation to behavioural needs. EVIDENCE: All service users 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. There are occasions when there may be two male members of staff on duty at night and the manager needs to ensure that female service users are comfortable with this. All service users are registered with local GPs and records of all medical appointments are maintained in care plans. Many of the people living at the home have complex behavioural needs and advice and support should be The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 16 sought from appropriate professionals to ensure that staff are providing care in the most appropriate way. Many staff working at the home have not received training specific to the needs of the service users and behavioural management plans are not always comprehensive. The home uses a monitored dosage system for medication and senior staff have undertaken training in safe handling and administration. 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.V353728.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. Procedures and practices in the home do not adequately protect service users from abuse. EVIDENCE: Since the last inspection three concerns have been raised with the Commission for Social Care Inspection (CSCI). As a result of the first concern a random inspection was carried out and requirements made. The two further concerns have been looked into as part of this inspection. The manager stated on their Annual Quality Assurance Assessment (AQAA) completed prior to the inspection that 2 complaints had been made to the home in the last 12 months. Records are kept relating to complaints made but there is no complaints log. One concern raised with the CSCI concerned the restrictions placed on a particular service user, which the complainant felt compromised their dignity. This incident was looked into by the inspector and will be further investigated by the manager who will report back to CSCI. The inspector observed that some guidelines for staff when dealing with behaviour that challenges were not clear which may lead to an inconsistent approach and possibly inappropriate responses to behaviour. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 18 Staff have not received training in the protection of vulnerable adults and the home does not have a copy of the up to date County Council procedure for Safeguarding Vulnerable Adults. It was clear that in some instances staff were making decisions for service users where they were unable to do so. Staff spoken to were not aware of the Mental Capacity Act 2005 and decisions made were not documented in line with the Act. All service users have a copy of the complaints procedure in symbol form. Staff stated that many service users would not be able to understand the procedure but they were aware of behaviours that would indicate that someone was not happy. The inspector viewed the recruitment records of four newly appointed staff. All had been checked against the Protection Of Vulnerable Adults (POVA) register and had undergone an enhanced Criminal Bureau Check (CRB) 3 staff files did not contain 2 written references. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Wheel House provides a comfortable homely environment for service users. EVIDENCE: Since the last inspection the home has undergone major building work and is now registered to provide support to up to 10 people. There are now three self-contained flatlets where people are supported on a one to one basis and seven bedrooms with en suite facilities. All bedrooms are a good size and have been personalised to reflect the personalities and needs of service users. The home is located in a quiet residential area on the edge of Wellington. It is within walking distance of the sports centre and other local amenities. Flatlets have their own lounge/kitchen areas and there is a communal lounge and kitchen/dining room in the main part of the home. Service users have unThe Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 20 restricted access to the lounge area and the kitchen/diner has a keypad that is locked when staff are away from the area. Some service users are able to make snacks and drinks and are able to use the keypad to access the kitchen area. The home is surrounded by spacious secure gardens which service users have access to. There is a laundry in the main part of the home which is appropriate to the needs of service users. On the day of the inspection all areas seen by the inspector were clean and fresh. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 21 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 & 45. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well motivated and interact well with service users. There is no staff training and development programme in the home to ensure that staff have the knowledge and skills to support the service user group. Recruitment practices are not robust and do not adequately protect service users. EVIDENCE: The home employs 16 care staff, 5 (31 ) have a National Vocational Qualification in care at level 2 or above. There are currently three senior carers who co-ordinate each shift and offer support and guidance to less experience staff. The inspector was able to meet with two of the senior carers and both were able to demonstrate a good understanding of individual service users and their needs. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 22 Staff working at the time of the inspection appeared enthusiastic and well motivated. Due to the recent expansion of the home several new staff have been employed. One new member of staff stated that they felt that they had received a good induction and were well supported by other members of staff. All new staff initially work alongside more experienced staff. The new staff member stated that they had not been asked to do anything that they were not confident with. The Wheelhouse does have its own induction programme but this would benefit from being made more comprehensive in line with the ‘Skills for Care’ 12 week induction programme. Although staff were generally happy with the training opportunities available to them, there appears to be no formal training plan for staff. The manager stated that ongoing staff training is something that the home needs to work on in the next 12 months. Staff spoken to stated that generally the home was adequately staffed but acknowledged that there had been times when the extension was first opened that they had not been staffed as highly as they felt the home needed. The inspector viewed the duty rotas and noted that there is usually 6 or 7 staff on duty up to 6.30 in the evening. At times the numbers drop as low as 4 staff between 6.30 and 8.30 at night. This is not sufficient to meet the needs of the service users and this was discussed with the manager. The manager stated that he often works in the home in the evening and this should therefore be recorded on the duty rota. Overnight there are two waking night staff. There is no senior carer on through the night but a senior carer is on call. One care manager was spoken to during the inspection, they stated that they felt that their clients needs were well met by the staff team at the home. The inspector viewed the recruitment files of the four most recently appointed members of staff. All had been checked against the Protection Of Vulnerable Adults (POVA) register before commencing work and all had undergone an enhanced Criminal Records Bureau (CRB) check. 3 staff files did not contain 2 written references although there was evidence that these had been applied for but not returned. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 23 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, 41 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager is described as open and approachable. There are no formal quality assurance systems in place and therefore no ways in which to monitor the quality of care or develop a programme of ongoing improvement. EVIDENCE: The registered provider and manager is Bill Gillespie. He is currently undertaking the Registered Managers Award (NVQ level 4.) He has many years of experience of working with service users who have a learning disability and has owned the home since May 2005. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 24 The manager demonstrates a good understanding of the needs of service users living at the home. Care managers spoken to described him as extremely approachable and client focussed. Staff stated that he is very visible in the home and offers ongoing and advice and supervision. There is no deputy manager and when the manager is away from the home a senior carer takes responsibility with the manager on call. There are no quality assurance systems in place and the manager needs to look at ways in which the home can audit the quality of care provided and seek the views of interested parties. The home hold regular service user meetings but there now needs to be evidence that the home is considering and acting on suggestions made as part of their continual improvement plan. There are certificates in place for the electricity and gas installations in the home and portable appliances were tested in November last year. The home is fitted with a fire detection and emergency lighting system and records show that these are tested weekly by staff. Staff receive training in fire safety when they begin work at the home and there are regular fire drill practices. All staff spoken to stated that they received training in fire safety but records of training are not well maintained. Training records are kept in individual files and there needs to be a system to monitor when staff require up dates in health and safety issues such as manual handling and first aid to ensure that all staff are kept up to date with current good practice. Some risk assessments seen had not been dated when put in place and others had not been reviewed at the stated review date. Significant events that occur in the home are not being reported to the CSCI. Appropriate insurance is in place and the certificate is displayed. An up to date certificate of registration is not displayed. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 25 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 2 2 3 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 2 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 2 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 3 1 x 2 2 x The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 26 Yes 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 YA9 Regulation 13 (4) b Requirement Risk assessments in respect of individuals must be signed and dated when written and regularly reviewed to ensure that they continue to be appropriate. (Requirement made at previous inspection ) The manager must ensure that evidence of all staff training is maintained in the home. (Requirement made at previous inspection ) Timescale for action 30/11/07 2 YA34 19 (1)bSch 2 31/12/07 3 YA6 YA9 15 (2) 4 YA19 13 (1) [b] The manager must ensure that 30/11/07 care plans, risk assessments and behavioural management plans are comprehensive and give clear guidance to staff. These documents must be regularly reviewed and up dated to ensure they fully reflect the needs of the service users. The manager must ensure that 31/12/07 service users have access to appropriate health and social care professionals and that staff receive training and support to meet the physical and psychological needs of service DS0000063400.V353728.R01.S.doc Version 5.2 Page 27 The Wheel House users. 5 YA22 22 (8) The manager must maintain a complaints log containing a summary of all complaints made and the action taken by the home. The manager must ensure that there are safeguards in place to minimise the risks of abuse to service users. This includes the training of staff. The manager must ensure that at all times there are suitably qualified staff in such numbers as is appropriate to meet the needs of the service users. The manager must ensure that no staff are employed in the home until two written references have been obtained. The manager must inform the Commission for Social Care Inspection of all significant events in the home. An up-to-date certificate of registration must be displayed in the home. The manager must establish a system for reviewing and improving the quality of care provided in the home. The manager must ensure that all staff receive regular training in health and safety issues to ensure that they are up to date with current best practice. 30/11/07 6 YA23 13 (6) 17/11/07 7 YA33 18 (1) [a] 30/11/07 8 YA34 19 (1) schedule 2 37 (1)(2) 05/11/07 9 YA37 05/11/07 10 YA39 24 (1) 28/02/08 11 YA42 13 (4) (5) 30/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000063400.V353728.R01.S.doc Version 5.2 Page 28 The Wheel House 1 2 3 YA1 YA7 YA35 The manager should ensure that the service user guide gives clear details about what is included in the basic fee. Staff should receive training about the Mental Capacity Act 2005. The induction training programme should be in line with the Skills for Care 12 week induction programme. The Wheel House DS0000063400.V353728.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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