CARE HOME ADULTS 18-65
The Whinnies Gateshead Road Sunnyside Newcastle upon Tyne NE16 5LG Lead Inspector
Mrs Elsie Allnutt Announced Inspection 14th September 2005 10:00 The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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 Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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 Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Whinnies Address Gateshead Road Sunnyside Newcastle upon Tyne NE16 5LG 0191 496 0418 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) Community Integrated Care Brenda Cawton Care Home 3 Category(ies) of Learning disability over 65 years of age (3) registration, with number of places The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12/04/05 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. 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 DS0000046256.V250036.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took 6.5 hours over one day in September 2005. The views of the three service users and six members of staff were sought. All were complementary about the service and the care and support given by staff. However the concerns raised at the previous inspection in relation to the compatibility of the three service users to live together remains. As part of the inspection process the service users’ care files and a sample of the homes records were examined and a tour of the building was made. This is the second of two inspections carried out this year at this home, therefore not all of the standards were inspected. However, the core standards not assessed at the last inspection were addressed, as well as the standards related to the Requirements and Recommendations of the last report. What the service does well:
The Whinnies provides a safe and comfortable environment that is well maintained, attractive and reflects the 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 the vegetable plot has proved to be very productive this year in producing many different vegetables and fruit that the home has used in their menus. Meals are nutritious and attractively served and service users are involved in the menu planning. 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 planned holiday breaks and trips out in their car. Although each service user is supported to maintain contact with family members, an independent advocate is also involved in their lives, who regularly supports them and has an active part in the development of their individual plans of care The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The home could improve its quality monitoring system by compiling the individual systems, currently in use, into one file where they can be easily accessed. This would provide one Quality Assurance System that could play a major part in the development of the service. So that staff are consistent in the way they respond to challenging behaviour when administering medication and mistakes are avoided as a result of the distraction, guidelines must be put in place for staff to follow. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 7 To further protect service users from the possibility of abuse, training in relation to the local authority’s Protection of Vulnerable Adults (POVA) must be made available to all staff and to demonstrate that positive police checks have been received in relation to newly recruited staff, the CRB documents must be kept safely in the home until the inspecting officer has examined them. 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 Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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 Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 A range of information is available which enables service users to make a fully informed choice about where they would like to live and the service contract gives details of the terms and conditions of their stay including the cost of the fees and how these will be paid. EVIDENCE: The home has provided a comprehensive Statement of Purpose and Service User Guide. Both documents provide detailed information about the service at The Whinnies and the Service User Guide provides access to the information in picture format. Both documents are equally professionally presented. A signed Service Contract including the Terms and Conditions of the stay was evident in each service user’s care file, this now includes the full cost of the service delivered and who is responsible for the payment. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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, 9 Service users are actively supported to take control of their own lives. Further effort has been made to support and protect service users from the behaviour at times of a service user that 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. Records showed that risk assessments, that are an integral part of the plan of care, have been further developed to address individuals’ safety and rights when challenging behaviour arises. The risk management plan provides clear guidelines for staff to follow in relation to minimising the risk. 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 Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 11 The advocates have been involved in service reviews and are able to give independent views in relation to how they feel individual needs are being met. The manager stated that such views, expressed by the advocates, while generally complimentary about the service delivered, also identify concerns in relation to the effect of the challenging behaviour on the health of all service users. Records demonstrate that one service user’s needs are in the process of being reassessed. The Social Worker and the home have carried out their own assessments and the Occupational Therapist from the Resettlement Team is to visit in the near future. The home has carried out a person centred review for one service user that is recorded in picture format so that the service user has an account of the outcome they can relate to. This process has proved positive in relation to how the service user was able to communicate their personal aims and aspirations and is an important tool for planning their future. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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): 15, 16, 17 Service users rights are respected, and routines in the home are flexible. This can help to promote a flexible service that encourages and promotes service users’ choices and preferences while also providing service users with a healthy and nutritious diet. EVIDENCE: Individual service users’ daily routines are recorded in picture format with the use of photographs in a book called “All About Me.” Staff confirmed that the key workers support service users to collate this information and to present it effectively. Two of the service users discussed the contents of the books, including their likes and dislikes, for example in relation to food and activities and preferred time for going to, and getting up from bed, with understanding and interest. Records and some of the photographs in the book and decorated on the lounge walls in the home, confirmed that service users have regular contact with family and friends and staff support them with this. A sample of menus and discussions with the manager, confirmed that the home’s aim is to promote a healthy lifestyle by delivering nutritious and
The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 13 healthy food. Service users and staff were proud to show a variety of fresh vegetables and fruit that are used in meals and that service users and staff grow in the homes vegetable garden. Records showed that the weight of individual service users is monitored and a dietician is involved so that individual’s physical health is not compromised by their diet. A tasty and nicely presented light lunch was taken with service users and staff. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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): 19, 20 Service users receive good support from staff to ensure that their personal, physical and emotional health needs are met. This is supported by good systems being used for the storing and administering of service users medication, ensuring that they receive the individual treatment that they have been prescribed. EVIDENCE: The manager and records confirmed that the previous errors made when administering medication have now ceased and medication is administered in relation to good practice as directed in the Royal Pharmaceutical Society’s Guidelines for The Administration of Medicines in Care Homes. All but one new member of staff have received training in relation to these and the Pharmacist has visited the home to advise on different medications and their storage needs. The manager was advised to carry out a risk assessment and to put into place clear guidelines for staff to follow in relation to the risk involved when medication is being administered and the attention of staff is diverted due to the demonstration of challenging behaviour within the home. The manager was receptive to this idea. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 15 Although staff have worked hard to support and promote service users’ healthcare needs, as well as their rights and personal choices and in many ways have been effective in doing this, the problem of some challenging behaviours demonstrated in the home continue to have a negative effect on individual service users both in relation to their health and general well being. This continues to be addressed by the home. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 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): 22, 23 The home has a satisfactory complaints system in place the aim of which is to protect service users from abuse as well as a policy to follow the local authority’s Adult Protection Procedures that further protects service users from harm. EVIDENCE: A recent recorded complaint in relation to an incident that took place on the homes property but with no relation to the people who live there or the service delivered, demonstrated that complaints are taken seriously and addressed appropriately. Records demonstrate that staff have worked hard to support service users in expressing their concerns about issues that might affect them in relation to life at The Whinnies. The outcome of this is that service users are less accepting of abusive situations within the home that may be a result of challenging behaviour and will express their feelings appropriately. Records proved that staff support service users in such situations. All but the recently recruited staff have received training on how to handle aggressive behaviour and how to follow the local authority’s procedures in relation to the Protection of Vulnerable Adults (POVA). This has enabled staff to approach aggressive behaviour in a consistent way following guidelines and using the same techniques. Although this practice reduces the risk of abuse taking place, the risk in relation to the challenging behaviours being demonstrated 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 DS0000046256.V250036.R01.S.doc Version 5.0 Page 17 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, 28 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: The home is well maintained, clean and tidy. The individual tastes and personalities of the service users are demonstrated throughout the home with colours and small furnishings reflecting their preferences. One service user’s bedroom has recently been decorated and they explained that a member of staff had painted their favourite football teams loco on one of the walls. This had delighted the service user. The home accommodates service users with individual bedrooms with en-suite facilities as well as a lounge/dining room and a small conservatory, kitchen and bathrooms. Although when demonstrating challenging behaviour one service user is encouraged by staff to go to their bedroom or to the small conservatory at the
The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 18 back of the dining area, this does not provide the needed facility where loud behaviour is unobtrusive to other service users. The outcome of many discussions between staff and other professionals involved in the service user’s care has concluded that this home does not provide the accommodation that meets the needs of all service users in a congenial way. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 19 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): 34, 35 The home employs a competent and qualified staff complement via robust recruitment and selection processes, which means that service users are effectively supported and protected by staff. EVIDENCE: The examination of staff files provided evidence that good recruitment procedures are in place. The file of the most recently recruited member of staff was included in the sample examined. The necessary documents were in place, these included, an application form, 2 references and a satisfactory CRB document, however this did not include the whole document and the manager was advised that the full CRB document must be kept on file until examined by an inspector from the CSCI at the nearest inspection. Staff discussed the needs of the service users with respect and understanding. When observing staffs’ social interaction with service users, their response, and the way they addressed service users’ needs, it was evident that positive relationships have developed. A training matrix demonstrates that staff are up to date with mandatory training and the NVQ training is on target. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 20 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, 41, 42 The manager, who is well supported by the staff team, provides good leadership and runs a service that has effective monitoring systems and is focussed on the best interests of the service users. EVIDENCE: The Registered Manager is now fully qualified having achieved the Registered Managers Award and NVQ 4 in Care. The manager confirmed that she has enough time to carry out her managerial duties by not always being included in the duty rota. An examination of the staff rotas confirmed this. She was however, observed working with the staff team when necessary and guiding them discreetly and competently. Staff and service users were observed responding effectively and showing respect towards their manager. Service users receive an effective service as a result of effective policies and procedures being in place. Records proved that they are regularly monitored and reviewed. A discussion took place with the manager in relation to the monitoring systems. Although the home has good monitoring systems in place
The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 21 these are all recorded in different files. It was suggested to the manager that the quality monitoring of systems might be more effective and easier to access if they are kept in one file that was referred to as the Quality Assurance File. The manager was receptive to this and suggested she shares this idea with the other Company managers. Staff were aware of health and safety issues and carried out their roles accordingly. The fire log and accident book were examined and were satisfactory. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x 3 x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score x x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Whinnies Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x x x DS0000046256.V250036.R01.S.doc Version 5.0 Page 23 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 YA20 & YA9 Regulation 13(4)(c ) Requirement Timescale for action 31/10/05 2 3 YA23 YA24 4 YA34 A risk assessment must be put in place, with strategies for staff to follow, in relation to the administration of medication and any challenging behaviour that may divert the attention of staff away from the task. 13(6) All staff must attend training in relation to the local authoritys POVA procedures. 23(2)(a)(e) The suitability of the environment, in relation to the compatibility of the three service users, must continue to be addressed and a positive outcome found. 19(1)(b) The CRB document of any newly recruited member of staff must be available for examination at the nearest inspection. 31/12/05 31/12/05 31/12/05 The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 24 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 YA39 Good Practice Recommendations The current quality monitoring systems should be compiled together to develop one Quality Assurance System that protects service users and provides a system that regularly monitors and effectively helps to develop the service. The Whinnies DS0000046256.V250036.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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