Inspection on 31/05/06 for The Wheel House

This inspection was carried out on 31st May 2006.

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

The inspector 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 26/03/08

The Wheel House 29/10/07

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 Key Unannounced Inspection 31st May 2006 09:30 The Wheel House DS0000063400.V295416.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.V295416.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.V295416.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 6 Category(ies) of Learning disability (6) registration, with number of places The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2005 Brief Description of the Service: The Wheel House is situated on the outskirts of Wellington but has close access to all local amenities and facilities. The home is currently registered to provide a service for six service users with a Learning Disability. It is expected that this will rise to a total of ten service users once building work is completed. The home currently has one lounge, a large kitchen/dining room, six single bedrooms, four of which have full en-suite facilities. The other two bedrooms have a toilet and wash basin and share one bathroom that is on the same landing. 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. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 5.5hour period. The inspector was able to meet with all three service users, talk with the three staff on duty and the registered manager/provider. The inspector was able to observe care practices and was given access to all records requested. Two care managers completed comment cards prior to the inspection. What the service does well: What has improved since the last inspection? All staff stated that the main thing that has improved since the last inspection is the communication between staff members. This they say has resulted in all carers working as a team and created a more pleasant environment for service users to live in. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 6 A requirement was made at the last inspection to improve the information in staff recruitment files. All the recruitment files have now been up dated and re organised. The inspector viewed two and found them to contain all items required. Torches and hot water outlets are now being regularly tested in line with a requirement and recommendation of 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 Wheel House DS0000063400.V295416.R01.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.V295416.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Overall quality in this outcome group is good. The home sees and assesses all prospective service to ensure that they are able to meet their needs. Prospective service users are able to visit The Wheelhouse before making a decision to make it their home. EVIDENCE: The home has updated the statement of purpose to reflect changes that have occurred in the home in the last 6 months. Their local authority financially supports all service users currently living at the home. All service users have a financial agreement with the appropriate authority and the inspector viewed copies of these. The weekly fee does not include personal toiletries and services such as hairdressing and chiropody. Each service user receives a service user guide when they move to the home. No new service users have been admitted to the home since the last inspection, however staff spoken to stated that more than one person has been assessed with a view to admission. It was apparent when talking with staff, and the manager, that the home not only consider the needs of the The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 9 prospective service user but also the needs of the current service user group when assessing. The home is currently in the process of admitting a fourth service user. This person has visited the home to familiarise themselves with the staff, environment and other service users. Staff from The Wheelhouse have been visiting and assessing this person in their current placement to ensure that the home is able to meet their needs. It was apparent that the staff had been working with the prospective service users current carers to ensure a smooth transition. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. Overall quality in this outcome group is adequate. Personal risk assessments were not dated and gave no evidence of review. Some information relating to care, behavioural support and personal goals was not in individuals’ personal files. Comprehensive records are kept in respect of personal finance. EVIDENCE: The inspector viewed the personal files of two of the three service users. One person had recently had a full review of their needs and the plan of care was not in their file. The other plan of care seen was detailed and very personal to the individual. This service user stated that they were fully aware of their care plan and had been involved in its review. How service users like to be assisted with personal care and any significant behavioural traits is outlined in the bathrooms of individuals. These guidelines did not appear to be in personal files. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 11 There was no evidence in care plans of individuals’ personal goals or wishes for the future. Personal risk assessments had been drawn up in respect of individuals and the activities that they undertake. These risk assessments were not dated and showed no evidence of review. It was apparent when observing care practices in the home that service users are encouraged to make choices about their day-to-day lives. There are regular service user meetings and the home is actively looking at ways to further involve service users in the running of the home. No service users are able to manage their own personal finance. The registered manager is the appointee for two service users. The inspector viewed records listing all transactions. All correspondence from the Department of Work and Pensions is stored with these records. The third service user has a financial appointee outside the home. All staff in the home are aware of the need for confidentiality and it was noted that this had been discussed at a staff meeting. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Overall quality in this outcome group is good. All service users have opportunities to take part in fulfilling activities in the home and in the community. Service users were happy with the quality of the food. EVIDENCE: There no strict routines in the home with service users choosing when they get up and when they go to bed. Meal times are flexible dependant on the activities being undertaken by service users. It was noted that there was continued interaction between staff and service users, which created a warm and friendly atmosphere. All service users are encouraged to participate in household chores to learn and develop independent living skills. Service users are responsible for their personal shopping such as toiletries and clothing. On the morning of the inspection two of the service users were The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 13 assisted to go shopping. One service user stated that they also assisted with the weekly food shop for the home. The home has two vehicles to enable service users to access facilities and services away from the home. There is a weekly timetable for activities. This shows that service users are able to take part in meaningful activities both at home and in the wider community. Activities undertaken include; walking, swimming, horse riding and skittles. There are extensive grounds around the property where service users can relax and take part in gardening activities. One service user stated that they had been involved in planting the vegetable garden. There is a woodwork and art workshop where service users can pursue art and craft hobbies with staff support. No one currently living at the home takes part in any work activities outside the home. One person attends college and another has been given the opportunity to visit a local college and take part in some taster sessions. The minutes of service user meetings showed that they had been able to make suggestions about day trips that they would like to take during the summer months. All service users are going on holiday over the summer with the home and some people also have holidays planned with family members. The main meal of the day is in the evening when all service users are at home. A lighter meal is provided at lunchtime. The inspector observed that lunch was a relaxed occasion with service users choosing where they wished to eat. Staff currently eat with service users which made it a sociable and pleasant occasion. Due to the size of the dining area this may not be possible when there are six people living at the home. The weeks menu is displayed and all food in the home is prepared and cooked by the care staff team with assistance from service users. All service users stated that the food was very nice. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Overall quality in this outcome group is good. Service users have access to appropriate healthcare professionals. There are guidelines in place to enable staff to assist service users with personal care. EVIDENCE: Service users personal files show that they are accessing an appropriate range of healthcare professionals such as GP’s, dentists and dieticians. Records are kept of all appointments. The two care managers who completed questionnaires prior to the inspection both answered YES to the question “Does the home communicate clearly and work in partnership with you?” As previously stated there are guidelines in individual bathrooms giving details of how service users like to be assisted with personal care. One male carer is employed which offers some choice to service users about the gender of the person who assists with personal care. All service users have a designated keyworker. All service users currently living at the home have their own en suite facilities where personal care is carried out in private. The inspector noted that staff The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 15 knocked on doors before entering bedrooms and respected peoples wishes to spend time alone if they chose to. No service user currently living at the home self-administers their medication. Staff who administer medication have received training from the dispensing pharmacist and some have also completed more comprehensive distance learning courses in the subject. There is appropriate storage for medication. The inspector viewed the Medication Administration Records, all had been signed when administered to service users. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Overall quality in this outcome group is good. The home have taken reasonable steps to minimise the risk of abuse to service users. EVIDENCE: The home has policies in respect of recognising and reporting abuse, whistle blowing and making a complaint. The complaints procedure is displayed in written form and in total communication signs. The inspector viewed the complaints log; there have been no complaints since the last inspection. All staff read the whistle lowing policy when they commence work at the home and sign to state that they have understood its contents. The policy has a contact number for the Public Concern at Work office but not for the local Commission for Social Care Inspection office. All staff spoken to were aware of the ability to take serious concerns outside the home but were not clear of the best way to do this. Discussion with the manager gave evidence that he is very aware of the vulnerability of some of the people living at the home and takes appropriate steps to minimise risk and share information with relevant professionals. At the previous inspection a requirement was made for all staff to receive training in physical intervention/breakaway techniques. Since that inspection the service user group has changed and the home no longer use any physical The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 17 intervention. Therefore staff have no received this training as it has not been considered a priority. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. Overall quality in this outcome group is good. The Wheelhouse provides a comfortable, homely environment for service users. EVIDENCE: The home is set on the outskirts of Wellington, within walking distance of some shops and other amenities such as the swimming pool and sports centre. The Wheelhouse provides comfortable accommodation for up to six people. Bedrooms are arranged over two floors, all are for single occupancy. Each bedroom has en suite facilities, four have toilet, wash hand basin and shower/bath. The other two each have a toilet and wash hand basin and share a bathroom. The provider has plans to install a further shower into an en-suite, which will mean that everyone living at the home has access to their own private facilities. All bedrooms are above 12 square meters in size. The inspector was able to view the three rooms currently occupied. All had been personalised to reflect the personality and choices of the individual. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 19 The home has adequate laundry and hand washing facilities. On the day of the inspection all areas seen were clean and fresh. Communal areas are located on the ground floor and are accessible to all service users, there is a kitchen/diner and a lounge. Outside there are large secluded gardens. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Overall quality in this outcome group is good. Staff were confident in their roles, appearing enthusiastic and well motivated. EVIDENCE: The home is adequately staffed to meet the needs of the service users. Staffing is in line with the needs of the service users. On the day of the inspection there was 3 members of the care staff team on duty and the manager. There is always a senior member of staff on duty who offers guidance and support to other staff. All carers observed during the inspection appeared very well motivated and enthusiastic. Staff spoken to were knowledgeable about the service users living at the home. All staff spoke of the good communication in the home and the high level of team support. The manager works alongside care staff to ensure a high quality of care is offered. All staff also have formal supervision sessions with the manager. The inspector viewed two carers’ supervision records and found them to cover a wide range of subjects. It was pleasant to note that supervision offered the chance for staff to discuss issues and also to receive positive feedback about the work that they carried out. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 21 The home employs 7 care staff, 5 have a National Vocational Qualification in care at level 2 or above, 62 . (Figures taken from pre inspection questionnaire.) Staff stated that they had also received training in statutory subjects such as food hygiene, first aid and health and safety. In addition to this staff talked enthusiastically about a training session on autism that they had attended. Both care managers who completed comment cards prior to the inspection answered YES to the questions “Do staff demonstrate a clear understanding of the care needs of service users?” and “Is there always a senior member of staff to confer with?” There have been no staff recruited since the last inspection. Since the last inspection the manager has up dated and re organised staff files. Two recruitment files for existing staff were sampled and found to contain all items required. The Wheel House DS0000063400.V295416.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. Overall quality in this outcome group is good. The manager of the home creates a positive and inclusive atmosphere. The safety of the gas installation and portable electrical appliances now needs to be tested. EVIDENCE: The registered manager/provider is Bill Gillespie. He works at the home every day and is accessible to staff and service users. The manager was available throughout the inspection and demonstrated a good knowledge of service users and staff. All staff described the manager as open and approachable. He gives a clear sense of direction to the home and respects the views of staff and service users. All records are appropriately stored. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 23 There are regular staff and service user meetings in the home giving everyone an opportunity to discuss issues and express their opinions. Other ways of seeking the views of those at the home and other interested stakeholders were discussed during the inspection. The manager is in the process of up dating the policies and procedures in the home and these will be viewed at the next inspection. Steps have been taken to ensure the health and safety of service users whilst enabling people to maintain a degree of independence. A fire log is maintained that gives evidence that alarms, torches and emergency lighting is tested on a weekly basis. Staff have received training in fire safety and there are regular fire drills involving staff and service users. Staff have received training in basic first aid, food hygiene and other health and safety issues. An accident/incident book is maintained. Hot water temperatures are recorded weekly to ensure that safe temperature limits are maintained. A number of environmental risk assessments have been completed. The ‘Landlords Gas Safety’ is dated the 24/05/05 so is now due for renewal. As the home is now a year old all portable appliances should be tested. Up to date certificates of registration and insurance are on display. The Wheel House DS0000063400.V295416.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 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 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 2 X X 2 X The Wheel House DS0000063400.V295416.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 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. The gas installation in the home must be checked by an appropriately qualified person and certificate of safety forwarded to the CSCI. Timescale for action 31/07/06 2. YA42 13 (4) 31/07/06 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 YA6 Good Practice Recommendations The personal files of service users should contain copies of all current information about the person to ensure that it presents a holistic picture of the persons’ abilities and needs. The registered person should ensure that the whistle blowing policy contains contact details of the Commission for Social Care Inspection. DS0000063400.V295416.R01.S.doc Version 5.2 Page 26 2. YA23 The Wheel House 3 YA39 4 YA40 5 YA42 The home should develop an annual development plan and quality assurance and quality monitoring systems. This should include seeking the views of interested parties outside the home. It is strongly recommended that the Registered Manager ensures that there are polices and procedures at the home as listed in Appendix 2 of the National Minimum Standards Care Homes for Adults (18-65) (Recommendation made at previous inspection.) All electrical portable appliances should be tested annually. The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Wheel House DS0000063400.V295416.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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