CARE HOME ADULTS 18-65
The Willows Halvarras Park, Halvarras Road Playing Place Truro Cornwall TR3 6HE Lead Inspector
Lowenna Harty Unannounced Inspection 24th January 2006 09:30 The Willows DS0000009122.V280122.R01.S.doc Version 5.1 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 Willows DS0000009122.V280122.R01.S.doc Version 5.1 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 Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Willows Address Halvarras Park, Halvarras Road Playing Place Truro Cornwall TR3 6HE 01872 865588 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) Spectrum Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 3 adults with a learning disability (LD) Total number of service users not to exceed a maximum of 3 Date of last inspection 12th July 2005 Brief Description of the Service: The Willows is a home providing personal care and accommodation for up to three adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist care in small units for people with autism. The aim is to provide them with specialist support in a domestic style environment. There is a manager in charge of the home on a day-to-day basis. A team of care staff assists them. Senior managers from within the organisation are available to provide specialist support and assistance where necessary. The home is located in the village of Playing Place, close to the city of Truro. There is reasonable access to public transport and the home has its own vehicles to assist service users to access the local community. The home is a single storey building, set in its own grounds and is set off the main road. There are three single bedrooms for use by the service users. The home has a combined lounge and dining room, a kitchen, separate laundry room and two bathrooms. There is a lockable office, which also functions as a sleeping in room for staff at night. The home has a large garden and some offstreet parking space. There have been some adaptations, with the provision of grab rails to assist people with specific physical disabilities to access the building. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 24 January 2006 and lasted for approximately five and a half hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The principle method of inspection was case tracking, whereby a small number of service users are selected and their care notes are reviewed. This is followed through with interviews and/or observation of them and staff working with them. At this inspection the three service users currently resident in the home were all case tracked and interviewed. In addition to this the inspection focused on an inspection of the premises, examination of care, safety and employment records and discussion with staff. A manager from one of Spectrum’s other homes assisted during the inspection as the home’s manager was on leave. There were opportunities to observe the daily life of the home and staff interaction with the service users. The home provides a good standard of care to the service users placed there, which they confirmed, very enthusiastically, during the interviews and there was an observably good rapport between them and the care staff working with them. What the service does well:
Service users are assessed before they are admitted to the home to ensure that it will be suitable to meet their needs. They appeared to be well placed at the home and comfortable with their surroundings and each other. They all have individual care plans, which address their personal; health and social care needs, including needs relating to their backgrounds, culture, religion and ethnicity. Their care plans consider their abilities to make decisions for themselves and staff are constantly available to assist them with this. Service users have good information about the terms and conditions of their placements in the home, including information written in translated formats, which they can access directly. This includes information on how they can make complaints about aspects of their placements they are not happy with. They all indicated that they are satisfied with the food provided to them. Service users’ healthcare needs are well met and they regularly access a range of local healthcare providers, depending on their individual needs. The home
The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 6 has written policies and procedures that encourage the safe management of their medication. These allow for service users to manage their own medication if they are able to do so safely. Service users indicated that they feel safe and well cared for and they appeared to have a good rapport with the staff working with them. Staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting. The home’s environment is mainly comfortable and homely for service users it appeared mainly clean and tidy at the time of the unannounced inspection. The home’s staff are recruited fairly and on the basis that they are suitable and safe to work with vulnerable adults in a care setting so that service users and their representatives can have confidence in the people looking after them. The home is generally well managed, for the benefit of service users. The home’s manager is experienced in working for Spectrum and has recently completed her application to be registered as manager with the Commission for Social Care Inspection, which was awaiting final approval at the time of the inspection. What has improved since the last inspection? What they could do better:
Service users would benefit from being able to be more directly involved in developing their care plans, which should be translated into meaningful formats for them. They should also have clearer and more specific goals to work towards, so that they are encouraged to maximise their skills and independence. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 7 At the time of the unannounced inspection there was a box full of confidential information about service users in the main hallway of the home. This was awaiting transportation to Spectrum’s head office to be archived, but should have been securely stored in the interim, to reduce the risk of breaches of confidentiality. Staff assisting service users with their medication should undergo training in the safe handling of medicines so that service users are better protected from medication errors. Formal systems to protect service users from abuse, including the home’s internal written procedures and information given to staff should be reviewed and updated and the home’s manager should undergo multi-agency training so that they are better informed on how to protect vulnerable adults from harm and abuse. Specific improvements are needed to make the home more comfortable and safer for service users, including formal risk assessments and action plans, cleaning or replacement of the living room carpet, replacement of broken furniture in a service users’ bedroom and provision of suitable window covering in all the bedrooms. A paper towel dispenser in one of the bathrooms should be firmly affixed to the wall and kept supplied with paper towels to encourage good hand washing. The shower trays need to be thoroughly cleaned to remove what appears to be mould from around the edges. Currently less than half of the homes care staff are qualified to NVQ level 2 or above. Whilst they are all in the process of undertaking or are due to undertake training, they should be supported to complete it and gain qualifications so that service users and their representatives can be confident of their competency to work in a care setting. Service users’ night time care records show that they can be quite active at night and on occasions disturb each other at times when there is a single staff member sleeping in. Spectrum should review the home’s night staffing cover to ensure that service users are safe and undisturbed by each other at night. 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 Willows DS0000009122.V280122.R01.S.doc Version 5.1 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 Willows DS0000009122.V280122.R01.S.doc Version 5.1 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): 2 Prospective service users’ needs are assessed before they move into the home to ensure it will be a suitable placement for them. EVIDENCE: Service user’s files contain detailed assessment information covering all of their personal, health and social care needs, including needs relating to their culture, religion and ethnicity. There is evidence that they have participated in the assessment/ admission procedures in ways that are meaningful to them, by pre-admission visits to the home, for example. There is evidence of consultation with their placing authority representatives and their relatives. Service users currently living in the home appear to be well matched and relate well with each other, based on observation of them at the time of the inspection. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 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 & 10 Service users have written care plans on the basis of their assessed needs, but more attention should be paid to setting achievable, but meaningful goals for them to help them develop their skills and independence. Service users are able to make decisions about aspects of their lives that are important to them. Improvements are needed to ensure that confidential information about service users is properly stored at all times. EVIDENCE: Service users have detailed written care plans, which are reviewed every six months and shared with their representatives. Their care plans consider all of their personal; health and social care needs, including needs relating to their backgrounds, culture, religion and ethnicity. Service users will communication difficulties should be provided with information relating to key aspects of their care plans in translated formats, so that they can directly access them and participate in their development. Whilst there is some consideration to setting goals for them, these are not very specific. Service users should be clear about the aims of their placements in the home and have clear goals to maximise their skills and independence. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 11 Service users’ care plans consider their abilities to make decision for themselves. Where necessary, they have been referred to specialist services to assess and develop their speech and language skills, to enable them to communicate their needs and wishes to the maximum of their ability. The home has a lockable office and lockable filing cabinets to store confidential information about service users. Information relating to staff is securely held on the home’s computer system. There was a box containing confidential material awaiting transport to Spectrum’s head office for archiving in the main entrance hall of the home. All information containing personal information about service users should be securely stored at all times. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 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): 16 & 17 Service users’ rights and responsibilities are clearly communicated to them so that they are aware of their duties and obligations in respect of their placements in the home. They are well fed so that mealtimes contribute to their health and quality of life. EVIDENCE: Service users’ guides have been provided to them in translated formats. These set out their rights and responsibilities in relation to their placements in the home, including expectations that they will participate in household tasks to develop their skills and independence. They have all been provided with copies of the home’s complaints procedure, which includes information on how they can access the Commission directly, should they wish to do so. Any restrictions, necessary for their welfare, are included in detailed written risk assessments, which their representatives have signed. Service users’ dietary needs are considered in the care planning process. There are records of their dietary preferences, likes and dislikes. Records of menus and food served provide evidence that they have healthy, mainly home prepared meals, with occasional meals out. Service users are encouraged to
The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 13 help with shopping, menu planning and food preparation. They all indicated that they are satisfied with the food provided to them at the home. Service users’ healthcare needs are well catered for and they have regular appointments with a range of local healthcare professionals, based on their individual needs. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 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’ healthcare needs are met so that they have a good quality of life. Systems in place to support service users’ medicines management are mainly safe and sound but staff training should be improved so that service users are better protected from medication errors. EVIDENCE: Service users currently placed in the home are young and in good physical health. Their physical and emotional healthcare needs are considered in their care plans. There are separate medical records, which provide evidence of their access to a range of NHS healthcare providers, according to their individual needs. The home has written procedures to guide and support staff in the safe management of service users’ medicines. These provide the option of service users retaining and controlling their own medicines, depending on their individual risk assessments. Staff have some training, but should be provided with full training in the safe handling of medicines to protect service users from medication errors. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 15 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): 23 There are systems in place to protect service users from abuse, neglect and self-harm, but they need to be updated so that staff are better informed. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults from abuse and staff have ready access to the local multi-agency procedures. They undergo training in the protection of vulnerable adults as part of their induction on commencing employment with Spectrum. There is evidence that staff are recruited on the basis of their suitability to work with vulnerable adults in a care setting. The home’s internal procedures for the protection of vulnerable adults should be reviewed and amended to ensure staff have up-to-date information and copies of service users’ placing authorities’ procedures should be available in the home. The home’s manager and/or senior staff should undergo multi-agency training on the protection of vulnerable adults from abuse and cascade this to staff working in the home so that they are fully informed of the action they should take if they suspect a service is at risk of abuse. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 16 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 & 30 Service users live in a homely and comfortable environment but specific improvements are needed to improve it and make it safer for them. The home was clean and tidy at the time of the inspection but specific improvements are needed to improve hygiene. EVIDENCE: The home is spacious, comfortable and homely. It was mainly well furnished and well decorated but one service user needs satisfactory covering for their bedroom window. Bedroom and bathroom doors are lockable so that service users are able to choose the level of privacy they wish to enjoy and staff have facilities to over-ride locks in an emergency. The living room carpet is stained in parts and needs to be cleaned or replaced. Broken furniture in a service users’ bedroom should be replaced. Staff have or are due to undertake essential training to maintain a safe environment for service users, including basic health and safety, safe moving and handling, fire safety and the provision of emergency aid. The home’s fire safety risk assessment has been completed and records of tests and checks of equipment were up-to-date. The home’s environmental risk assessment needs to be updated, including manual handling risk assessments, with action plans to control hazards to people in the home, as far as is reasonably practicable. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 17 The home appeared to be mainly clean and tidy at the time of the unannounced inspection. Staff have or are due to undertake training in basic food hygiene and infection control and have access to equipment they need to assist them in maintain hygiene. A paper towel dispenser in one of the bathrooms should be firmly affixed to the wall and kept topped up with paper towels, to encourage good hand washing. Shower trays still need proper cleaning to remove what appears to be mould from the edges. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 18 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): 32, 33 & 34 There are insufficient qualified staff working in the home to assure service users and their representatives that the people looking after them are competent in care work. The registered provider should review night staffing cover to ensure the peace and security of service users. The home’s recruitment policies and procedures are fair, safe and effective for the welfare and protection of service users. EVIDENCE: Less than the recommended 50 of care staff are qualified to NVQ level 2 or above although they are all undertaking or are due to undertake training to obtain formal qualifications. Staff do undergo structured induction training prior to commencing work in the home and have access to essential training support them in their work. The home’s night care records indicate that service users are sometimes quite active at night and on recent occasions they have disturbed each other. Their risk assessments indicate that during waking hours they require at least two to three care staff to work with them. A single staff member sleeping in over night currently covers the home. This needs to be reviewed to ensure the welfare and safety of service users. Records are available to confirm that care staff are recruited in accordance with good equal opportunities practices, on the basis of their suitability to work
The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 19 with vulnerable adults in a care setting. This includes copies of their applications, interview records, references and checks with the CRB. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 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 The home is well run, for the benefit of the service users. EVIDENCE: The home’s manager is experienced and competent. Her application to be registered with the Commission was in the final stages of approval at the time of the inspection. The home was generally well run in her absence and staff on duty were well informed in terms of providing necessary information to conduct the inspection. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 21 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 3 X X X X X X The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 22 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. 2. Standard YA10 YA30 Regulation 12(4)(a) 13(4) Requirement Timescale for action 01/03/06 3. YA33 12, 13 & 18 Confidential information relating to service users must be securely stored at all times. Up-to-date environmental risk 01/03/06 assessment and manual handling risk assessments must be available in the home. The registered provider must 01/03/06 review night time staffing cover to ensure that service users are safe and do not disturb each other at night. 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. 4. Refer to Standard YA6 YA6 YA20 YA23 Good Practice Recommendations Service users’ care plans should be provided to them in translated formats. Service users’ care plans should contain clear and specific goals. Staff handling service users’ medication should undergo training in the safe handling of medicines. The home’s internal procedures for the protection of
DS0000009122.V280122.R01.S.doc Version 5.1 Page 23 The Willows 5. 6. YA23 YA24 7. 8. 9. YA30 YA30 YA32 vulnerable adults from abuse should be reviewed and updated. Copies of service users’ placing authorities’ procedures for the protection of vulnerable adults from abuse should be available in the home. The home’s manager should undergo multi-agency training on the protection of vulnerable adults from abuse and cascade this to staff working in the home. The home’s environment should be improved, including provision of a clean carpet in the living area, replacement of broken furniture in a service user’s bedroom and window covering in all bedrooms. The paper towel holder one of the bathrooms should be firmly affixed to the wall and kept supplied with paper towels. Shower trays should be thoroughly cleaned. At least 50 of the care staff team should have qualifications to NVQ level 2 or above. The Willows DS0000009122.V280122.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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