Inspection on 03/07/08 for The Wheel House

This inspection was carried out on 3rd July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Wheel House 26/03/08

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 28/09/2008.

CARE HOME ADULTS 18-65 The Wheel House Linden Hill Wellington Somerset TA21 0DW Lead Inspector Jane Poole Key Unannounced Inspection 3rd July 2008 10:15 The Wheel House DS0000063400.V366321.R02.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.V366321.R02.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.V366321.R02.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.V366321.R02.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. 26th March 2008 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.V366321.R02.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 2 star. This means the people who use this service experience Good 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. This inspection was carried out over a one-day period. During this time the inspector was able to talk with people living and working at the home, meet with the management, view records and observe care practices. The inspector was given unrestricted access to all areas of the home. 3 people living at the home, 5 staff, 1 healthcare professional and 2 relative/carers returned questionnaires to the Commission. The following is a brief 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 located on the outskirts of Wellington in a quiet residential area. There are extensive grounds which people have unrestricted access to. Nearby there are local amenities such as shops and a sports centre and many semirural walks. The home is adequately staffed by a well-motivated team. There is constant interaction between people living and working at the home resulting in a comfortable, happy atmosphere. Care plans are very personal to the individual and give clear guidance to ensure that people are assisted in their preferred manner. Up to date risk assessments are in place to make sure that people can safely take part in chosen activities. There is a wide range of activities available to people who live at home. People use local community facilities and there are three vehicles to enable people to access amenities and facilities further afield. One relative/carer who completed a questionnaire said that they were “very satisfied” with the care at the home and said it provided “a home from home.” The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The 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.V366321.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. 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. People wishing to move into the Wheel House have their needs assessed and are able to visit many times before deciding to make it their home. EVIDENCE: There have been no changes to the Statement of Purpose or Service User Guide since the last inspection. Everyone living at the home, who completed a questionnaire said that they had received enough information about the home before they moved in. No one has moved into the home since the last inspection but there is currently one vacancy. The home has begun assessing the suitability of one person who is interested in moving in. Staff have visited this person in their current living environment and they have been able to visit the Wheel House to meet with people living and working there. Potential residents are able to visit the home on more than one occasion to assist them to make a decision about moving in. The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 9 Everyone who moves in does so initially on a trial basis to ensure that it suits their lifestyle and that it is able to meet their needs. The Wheel House DS0000063400.V366321.R02.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 guidance to enable staff to assist people in their chosen way. People living at the home are supported to make decisions and these decisions are respected where possible. EVIDENCE: Everyone living at the home has a comprehensive care plan, which is very personal to them. All staff sign each care plan to say that they have read and understood it. The inspector viewed two care plans in detail. Both gave a clear pen picture of the individual including their likes and dislikes. There was clear guidance in The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 11 relation to peoples preferred routines to ensure that people receive care in their chosen way. The care plan covers all areas of care including personal care, communication and health. Abilities as well as needs are documented giving a positive picture of the person. Risk assessments are in place to ensure that people are able to take part in activities that interest them whilst maintaining individual safety. Staff have received training on the Mental Capacity Act and how to assist people with decision making. Risk assessments and care plans gave evidence that people are supported to make decisions about their lives and that their decisions are respected. The staff write daily about each person and this information is summarised at the end of each month. Since the last inspection the manager has carried out training with staff to ensure that records are written in a way that respects people. Staff stated that they had found the training useful as it had made them think about the language they use and the comments that they make about people living at the home. All information seen was up to date and gave evidence that changes are made when situations, needs and abilities change. All 5 members of staff who completed questionnaires answered ALWAYS to the question “ Are you given up to date information about the needs of the people you support?” The Wheel House DS0000063400.V366321.R02.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): 11, 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. People living at the home have opportunities to take part in a wide range of activities. Visitors are made welcome at all times. EVIDENCE: People who completed questionnaires prior to the inspection stated that they were able to choose what they did, during the day, in the evenings and at the weekend. Everyone has an activities programme. These show that people take part in a huge range of activities in line with their interests. Activities include horse riding, swimming, arts and craft, walking, music, skittles and trips out to local attractions. Staff assist people to shop for their own personal items. On the The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 13 day of the inspection everyone went out to take part in activities at some point. No one currently living at the home attends college but some people attend adult education classes locally. The home has a large garden with seating, a trampoline and adult size swing. The inspector observed that people had unrestricted access to the garden and some people spent time outside enjoying the sunshine. Staff were seen to interact with people living at the home in a friendly manner. Some people in the home assist with household chores. Since the last inspection a training kitchen and eating area has been developed away from the main parts of the home. This will be used for recreation and assisting people to learn and develop independent living skills. Staff stated that it can also be used for people to meet with, and provide refreshments for, friends and relatives away from the main house. People are encouraged to maintain contact with family and friends and many people enjoy days out and holidays with family members. Visitors are always welcome in the home. During the inspection one person went out for the day with their relative. There is a four-week menu in the home, which gives a good variety of meals. Healthy eating is encouraged but staff are aware that people have a right to choose what they eat. There is a kitchen/diner in the main part of the house and people living in the flatlets have facilities to prepare and eat meals. A cook makes the main meal in the evening and people living at the home are helped to prepare their breakfast and lunch. The inspector observed that lunch was a very relaxed affair with people living and working at the home eating together. The fridges and freezers in the home were well stocked with good quality foodstuffs. Fresh fruit is available for everyone. The Wheel House DS0000063400.V366321.R02.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 have access to healthcare professionals in line with their individual needs. Staff are trained in medication administration to ensure safe practice. EVIDENCE: There are no strict routines in the home meaning people are able to choose what time they get up and when they go to bed. All rooms have en suite facilities so that personal care can be carried out in private. Both male and female carers are employed to enable people to have a choice about the gender of the person who assists with intimate personal tasks. Care plans give details of the level of support each person requires and these show that independence is encouraged. Everyone living at the home is registered with local GPs and staff assist people to attend appointments. One GP completed a questionnaire prior to the The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 15 inspection and commented “Residents mental and physical health seems to improve when living at the Wheel House.” Records are maintained of all appointments with healthcare professionals and these give details of the appointment and its outcome. These records show that people have regular dental and optical check ups, are seen by a chiropodist and other professionals according to their individual needs. There is adequate storage for medication and all staff who are responsible for administering medicines have received specific training. The Medication Administration Records (MARs) were viewed and these were well maintained, all medication is signed for when it enters the home and when administered or refused. This gives a clear audit trail. Since the last inspection personal protocols have been put in place for the use of PRN (as required) medication. These clearly state under what circumstances this medication should be given. The Wheel House DS0000063400.V366321.R02.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 good. This judgement has been made using available evidence including a visit to this service. The home has taken reasonable steps to minimise the risk of abuse to the people who live there. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Staff have received training in the Protection Of Vulnerable Adults. All spoken to were aware of local guidance and the ability to take serious complaints outside the home. Everyone living at the home who completed a questionnaire said that they knew how to make a complaint. Staff who returned questionnaires all answered YES to the question “Do you know what to do if a service user or advocate has concerns about the home?” The home has received one complaint since the last inspection. Records maintained show that the complaint was taken seriously and fully investigated. The complaints procedure is not clearly displayed in the home and one relative/carer who completed a questionnaire stated that they did not know how to make a complaint. The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 17 The main kitchen is locked by a keypad. Risk assessments are in place in respect of this practice as it restricts freedom of movement for some people living in the home. It was noted that people continue to have access to the kitchen with staff support. The manager currently acts as an appointee for some people living at the home but this responsibility is in the process of being taken over by the appropriate Local Authorities. The Wheel House DS0000063400.V366321.R02.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 good. This judgement has been made using available evidence including a visit to this service. The Wheel House provides a comfortable environment for the people who live there. EVIDENCE: The home is located in a quiet residential area on the outskirts of Wellington. It has extensive grounds and is within walking distance of local amenities including a sports centre. There are seven en-suite bedrooms arranged over two floors and three ground floor self-contained flatlets. Each flatlet has its own kitchen/lounge area and there is a communal lounge and kitchen/diner in the main part of the home. All areas are comfortably furnished in domestic style. The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 19 People living at the home are able to personalise their bedrooms in line with their own tastes and wishes. One flatlet has no curtains or window covering at the main front window. Staff explained that the person living there had removed them. To promote the privacy and dignity of this person the home need to ensure that people outside cannot see into the room. All areas seen by the inspector were clean and tidy. Each flatlet has its own washing machine and there is a small laundry for the main house. The laundry was well organised and hand washing facilities, gloves and aprons were available to promote good infection control practices. The Wheel House DS0000063400.V366321.R02.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): 31, 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff working in the home are enthusiastic and well motivated leading to a happy and comfortable atmosphere. Staff are provided with ongoing training to ensure that they have the skills and knowledge to care for the people who live at the home. EVIDENCE: The home employs 21 permanent care staff and 10 bank staff. 7 members of the care staff team have a National Vocational Qualification (NVQ) in care at level 2 or above. A further 12 members of staff are currently working towards the award. 5 staff completed questionnaires before the inspection, all were very happy with the support they received and the training that was available including a comprehensive induction. One person wrote “Courses are frequent and all staff attend” another said “ we have had training on all aspects of care.” The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 21 The home employs an outside trainer to ensure that staff have the skills and knowledge to care for the people living at the home. One member of staff spoken to stated that they had received excellent training which included moving and handling, first aid, autism, epilepsy, communication methods, the Protection Of Vulnerable Adults and the Mental Capacity Act. In addition to training provided by an outside facilitator the manager is also providing training for staff. One new person has been employed since the last inspection and the recruitment file showed that a thorough recruitment process had been followed. The new member of staff had undergone an enhanced Criminal Records Bureau (CRB) check before they begun work and written references had been received. There was evidence in the file of a comprehensive induction programme. All staff who completed questionnaires answered YES to the question “ Did the employer carry out checks such as CRB and references before you began work?” All stated that the induction covered everything they needed to know. On the day of the inspection the home was well staffed. There is always a senior member of staff on duty to give guidance and support to less experienced staff. Staff spoken to, and those who completed questionnaires, stated that the home was always adequately staffed and bank staff were used to cover holidays and sickness. Staff working in the home are well motivated and enthusiastic about their jobs. Everyone spoken to demonstrated a commitment to providing a high quality of care. The inspector observed that people living at the home were extremely comfortable with the staff on duty including the management team. There is ongoing interaction between the people living and working at the home providing a happy atmosphere. The Wheel House DS0000063400.V366321.R02.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. The home is effectively managed taking account of the views of interested parties. There are formal quality assurance systems in place to ensure ongoing improvements in the home. EVIDENCE: The registered provider/manager is Bill Gillespie who has owned the home since it opened in May 2005. Mr Gillespie is currently working towards National Vocational Qualifications in management and care at level 4. In addition to the manager the home has a deputy manager. The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 23 Staff who completed questionnaires spoke very highly of the management in the home. People said that the manager was always available and extremely approachable. Quality assurance systems are in place to ensure ongoing improvements. There is a monthly health and safety check and a three monthly full quality audit. There are now regular staff meetings and staff spoken to stated that these were an opportunity to share ideas and opinions as well as pass on information. There is also a suggestion box in the main house, which can be used by people living, working or visiting the home. There is an up to date fire risk assessment in place. The fire log gives evidence that the alarms and emergency lighting are tested weekly. There are regular fire drills, which are recorded. All accidents and incidents are recorded and the Commission for Social Care Inspection is informed of significant events. Up to date certificates of registration and insurance are displayed in the home. The Wheel House DS0000063400.V366321.R02.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 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X The Wheel House DS0000063400.V366321.R02.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 YA26 Regulation 12 (4) [a] Requirement To promote the privacy and dignity of people living at the home the manager must ensure suitable window coverings are in place in personal rooms. Timescale for action 31/08/08 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 2 3 Refer to Standard YA32 YA37 YA22 Good Practice Recommendations 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 manager should ensure that the complaints procedure is clearly displayed in the home. The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 26 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. Extracts may not be used or reproduced without the express permission of CSCI The Wheel House DS0000063400.V366321.R02.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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