CARE HOME ADULTS 18-65 The Whinnies Gateshead Road Sunnyside Newcastle Upon Tyne NE16 5LG
Lead Inspector Elsie Allnutt Unannounced 12 April 2005 10:00am 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 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 Stationary 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 Whinnies Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Whinnies Address Gateshead Road, Sunnyside, Newcastle upon Tyne NE16 5LG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 496 0418 Community Integrated Care, 2 Old Market Court, Widnes, Cheshire WA8 7SP Ms Brenda Cawton PC Care home only 3 Category(ies) of LD(E) Learning Disability - over 65 (3) registration, with number of places The Whinnies Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17 August 2004 Brief Description of the Service: The Whinnies is a care home owned and run by Community Integrated Care, a registered charity that provides care services for people with learning disabilities. The Whinnies is registered to provide 24 hour care for three people with moderate to severe learning disabilities all of who are over 65 years and who were discharged from long stay hospital. The Whinnies is pleasantly situated in a quiet part of Sunniside with close proximity to health care facilities, local shops, pubs and surrounding countryside. There are frequent bus services to Gateshead and Newcastle and the Metro Centre. Service users are able to access facilities of their choice within the community with support from a trained staff team. The service users also have use of the home’s car.The Whinnies is one of several bungalows in the area, which has been extended and adapted to provide accommodation for the service users in a safe and homely environment. The bungalow consists of a lounge, dining room, bathroom with a toilet and a separate shower. Each service user has an individual bedroom with en suite facilities that includes a bath or shower. The room doors have appropriately designed locks fitted and with an additional locked facility inside the room where valuables can be stored. There are special aids and adaptations throughout the home to address the physical needs of the service users.The building is surrounded by extensive well kept gardens. The Whinnies Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took 7 hours over one day in April 2005. The views of the three service users and six members of staff were sought, as were the views of the service users’ independent advocates. All were complementary about the service and the care and support given by staff. However there were some concerns raised in relation to the compatibility of the three service users to live together. As part of the inspection process the service users’ care files and a sample of the homes records were examined. What the service does well:
The Whinnies provides a safe and comfortable environment that is well maintained, attractive and reflects the likes and preferences of the service users. The extensive gardens and land that belongs to the home are well maintained and well stocked and provide a beautiful location and outlook for the service users. Staff are now encouraging service users to use this facility by developing outdoor projects in the garden areas, for example service users are currently being supported to develop a vegetable plot. Staff actively support service users to become involved in activities both in the home and in the local community. Service users confirmed their involvement in such activities and discussed with enthusiasm recent holiday breaks taken and trips out in their car. Meals are nutritious and attractively served and service users are involved in the menu planning. Service users were observed assisting in the kitchen and carrying out domestic tasks. Although each service user is supported to maintain contact with their family they also have an independent advocate involved in their lives who regularly supports them and has an active part in the development of their individual plans of care. The Whinnies Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Whinnies Version 1.10 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 Standards Statutory Requirements Identified During the Inspection The Whinnies Version 1.10 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 standard(s) 1,2,&5, Effective information sharing processes promoting choice for service users as to where to live, and that there care needs will be met, are available. EVIDENCE: Examination of documents within the home confirmed that pre admission assessments from a multi disciplinary team were in place, as was an up to date care plan for each service user. A signed document related to the Terms and Conditions was evident in each service user’s care file. However this did not include the full cost of the service delivered. To fully meet the Care Homes Regulations 2001 this information must be included in the Terms and Conditions and the Service User Guide. The Whinnies Version 1.10 Page 9 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 standard(s) 6,7,&9 Service users are actively supported to take control of their own lives. However the risk involved in some behaviour at times of one service user exceeds an accepted level and potentially undermines the choices and decisions of the other service users. EVIDENCE: The home has developed comprehensive care plans for each service user that cover all aspects of the individual’s personal, social and healthcare needs. Within these are clear guidelines for staff to follow in relation to individual needs and in relation to one particular service user’s behavioural problems. Although risk assessments are in place and are an integral part of the plan of care, the need for further identified risk assessments was discussed with and agreed by the manager. These were in relation to individuals’ safety when challenging behaviour arises. Each service user has an independent advocate who in addition to staff, are actively involved in supporting their needs and achieving their personal goals. The advocates were involved in recent service reviews and were able to give independent views in relation to how they felt individual needs were being met. Such views, expressed by the advocates, while generally complimentary about the service delivered, also identified concerns in relation to the effect of the challenging behaviour on the health of the other service users.
The Whinnies Version 1.10 Page 10 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 standard(s) 12,13, Work has progressed in developing a range of activities for all service users within the home and in the local community consequently service users are developing valued and fulfilled lifestyles. EVIDENCE: During the inspection service users were observed visiting the local shops and hairdressers. Service users spoken to confirmed that such activities were part of their daily activities. One service user explained that they needed their paper from the local shop so that they could follow the horse racing on the TV. This was observed during the day. However the behaviour of another service user indicated that they did not approve of this. Service users also confirmed that they used other community activities. These were recorded in the care files. Such activities included attendance at local Men’s Clubs, a Tea Dance at the local church hall and visits to local places of interest. All service users were enthusiastic to discuss recent short breaks away and for one person in particular this was a very positive development. The Whinnies Version 1.10 Page 11 Records examined and discussions with staff confirmed that one service user has progressed to assisting with light domestic tasks around the home. During the inspection this was observed when they assisted with clearing the table after lunch. The Whinnies Version 1.10 Page 12 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 standard(s) 18,19,20 Although the home makes every effort to assist service users to maintain good quality healthcare there are aspects of practices in relation to the administration of medication, that puts all service users at risk. EVIDENCE: Issues have been raised in the past two inspection reports in relation to errors made in the administration of medication. Reports forwarded by the home to the CSCI prior to this inspection, and discussions with the manager on the day of the inspection, confirmed that errors continue to take place. The manager confirmed that the home is now addressing this issue. She explained that additional formal training in relation to the administration of medication has been provided and the assistance of the pharmacist in an advisory capacity has been requested. Although one of the home’s aims is to offer service users choice, the personal preferences of some service users is often impeded by the behaviour of one service user. During discussions with staff it was explained that this is often the case in relation to the preferences made by service users in relation to what time they wish to rise in the morning and what time they wish to go to bed. Records showed that this is often dictated by the behaviour of one service user who at times wishes to rise at unsocial hours, and wishes to retire very
The Whinnies Version 1.10 Page 13 late and during these times disturbs others when demonstrating loud behaviour. The manager and staff explained that health professionals have also voiced concerns in relation to the health of one service user. Staff and others involved in the care of the service users feel that the impact of one service users’ challenging behaviour may be having an adverse effect. In response to the concerns a reassessment of need is currently being carried out. The Whinnies Version 1.10 Page 14 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 standard(s) 22,23 The home has a satisfactory complaints system in place the aim of which is to protect service users from abuse. However further work is required to ensure that day to day concerns from service users are dealt with appropriately, within the complaints procedure. EVIDENCE: There were no recorded complaints, however staff confirmed that when they feel a service user is concerned about something they deal with it there and then. Such incidences are not recorded. A discussion took place with the manager in relation to how the home might recognise when service users are demonstrating a concern or complaint and record them as such and also how the home might assist the service users to develop their skills to make known their concerns. One service user continues to demonstrate aggressive behaviour that can be abusive towards other service users and staff. This is appropriately recorded. The home records this in the care file and reports it, in response to Regulation 37 of the Care Homes Regulations 2001, to the CSCI. Since the last inspection most staff have received training on how to handle aggressive behaviour and how to follow the local authority’s Protection of Vulnerable Adults procedures (POVA). This has enabled staff to approach aggressive behaviour in a more consistent way following guidelines and using the same techniques. Although this practice reduces the risk of abuse taking place, the risk remains and is a concern of all involved in the care of the service users. Plans are in place for the remaining staff to attend POVA training in the near future. Staff confirmed this and discussed with confidence the home’s Whistle Blowing procedure. The Whinnies Version 1.10 Page 15 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 standard(s) 24 The standard of the environment within this home provides service users with an attractive and homely place to live. However in relation to the current behaviours exhibited in the home, there is often not a peaceful place for service users to go within the house. EVIDENCE: Since the last inspection there have been improvements to the décor providing more colour and character, reflecting the personal likes of the service users. Discussions with staff and service users confirmed that service users were supported to choose the colours and designs used. As previously mentioned during the inspection one service user was observed watching the television while checking the details of a horse race, while at the same time in the same room another service user demonstrated loud behaviour in opposition to this. Although all service uses have individual bedrooms and there is a small conservatory at the back of the dining area, this does not provide the needed facility where loud behaviour is unobtrusive to other service users. Consideration should be given to how this can be accommodated. The Whinnies Version 1.10 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The staff team is adequate in number, appropriately skilled and knowledgeable to address the service users’ needs. EVIDENCE: The examination of staff rotas confirmed that an adequate number of staff are on duty each day to address the needs of the service users. This includes three members of staff on duty during the day and two on waking night duty. The examination of staff files provided evidence that good recruitment procedures are followed. However as a result of inspecting the file of a newly recruited member of staff although the CRB check number was evident the actual certificate was not. Staff discussed the needs of the service users with respect and understanding. When observing their social interaction and when addressing service users’ needs, it was evident that positive relationships had, and continued to be developing between service users and staff. The Whinnies Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The health, safety and welfare of the service users are promoted and generally protected. However some risks remain. EVIDENCE: Training records and staff records confirm that staff are trained to ensure the health, safety and welfare of service users. Discussions with staff confirmed that they had attended mandatory training including first aid and moving handling as well as training related to the Protection of Vulnerable Adults. They were also aware of the homes fire procedures as well as other policies related to health and safety. Records inspected included the accident and fire log, both of which were satisfactory. The errors made in the administration of medication as previously discussed must cease, and the health and safety of all service users in relation to the challenging behaviour demonstrated must continue to be monitored. The Whinnies Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15
The Whinnies x 3 3 x x Standard No 31 32 33 34 35 36 Score x x 3 x x x Version 1.10 Page 19 16 17 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x The Whinnies Version 1.10 Page 20 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 1&5 Regulation 5(b) Requirement The Service User Guide must include the terms and conditions in respect of the accomodation provided and the full range of fees charged to service users. The manager must address the problem related to the mistakes recently made during the administration of medication, and ensure that the homes procedures are followed accurately, as well as addressing the advice in the Pharmaceutical Guidelines. All staff must attend training in the local authoritys POVA procedures. The effect of the challenging behaviour demonstrated in the home in relation to the health and general well being of all service users must continue to be addressed, and the concerns of advocates and other professionals must be taken into consideration. Risk assessments that were discussed with and agreed by the manager, in relation to individuals’ safety when challenging behaviour takes
Version 1.10 2. 42 & 20 13(2) Timescale for action .30.05.05( Timescale of 30.09.05 not met) 30.05.05 3. 4. 23 19 13(6) 12 30.06.05 30.09.05 5. 9 13 30.05.05 The Whinnies Page 21 place must be developed. 6. 19 14 Serious consideration must be given to the re-assessment of need currently being carried out. 30.05.05 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. Refer to Standard 37 24 Good Practice Recommendations Consideration should be given to allocating hours for the manager to address the administrative duties related to her role. Consideration should be given in relation to how loud behaviour can be accommodated within the home without disturbing other service users. The Whinnies Version 1.10 Page 22 Commission for Social Care Inspection Baltic House, Port of Tyne South Shields NE34 9PT 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 Whinnies Version 1.10 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
