Inspection on 17/10/05 for The Windbound

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Windbound 27/07/09

The Windbound 03/09/08

The Windbound 25/09/07

The Windbound 03/04/07

The Windbound 26/04/06

The Windbound 15/03/05

The Windbound 26/01/05

The Windbound 30/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Windbound Shepperdine Nr Thornbury South Glos BS35 1RW Lead Inspector Wilfried Maxfield Unannounced Inspection 17th October 2005 09:30 The Windbound DS0000043699.V255178.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 Windbound DS0000043699.V255178.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 Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Windbound Address Shepperdine Nr Thornbury South Glos BS35 1RW 01454 414888 01454 416724 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) Voyage Limited Mrs Vicky-Sue Hewer Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. It is a condition of registration that the Home is registered for 13 adults with learning disabilities with effect from 23rd July 2004 until the temporary resident leaves, when the occupancy of the Home will revert to 12 persons. 15th March 2005 Date of last inspection Brief Description of the Service: The Windbound is a care home operated by the Voyage Group. It is registered by the Commission to provide accommodation and personal care for up to 12 men and women aged 18 – 65 years who have a learning difficulty. Service Users have a diverse range of needs. The home particularly aims to cater for people who may challenge other services and who may display verbally and physically challenging behaviours. The home itself is situated on the bank of the River Severn. It is in a secluded spot, which would best suit those who prefer a calm and quiet environment. The home has three vehicles, which are used to support Service Users to access community facilities. The Windbound was once a public house, which has been converted into three individual flats separated by keypad systems. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The purpose of the visit was to monitor the progress to the requirements from the last inspection in March 2005 and review the standard of the care provided to the residents at The Windbound. The inspection was conducted over two days 17th and 26th October 2005. The Lead Inspector carried out the first visit and was accompanied by a Regulation Manager on the additional second day. On the first day only a limited number of resident’s and staff were present at the home due to a day trip having been organised. The total number of hours for the two visits was 18 hours. Outside of the customary parameters of an unannounced inspection, a large proportion of time during this visit focused on the conditions of the care specific to one particular resident. This became necessary after it was noticed that the imposed restrictions on the resident’s freedom of movement were outside of the legally acceptable standards. As a result a POVA (Protection of Vulnerable Adults) strategy meeting was called by the Commission and conducted within the regional South Gloucestershire POVA practices and procedures. The Registered Manager was present throughout the inspection process. The Voyage organisations Operations Manager responsible for The Windbound assisted the inspection during part of the second day. Both managers attended the Strategy Meeting. The Registered Manager helped to focus the inspection on the general care of a small sample of the other service users and the environment, including an extensive tour of the premises. This provided good opportunities to observe residents in the different flats as well as allowing for informal conversations with some of the residents. Four members of staff were interviewed and a comprehensive assessment of the home staffing situation and employment strategy was undertaken. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The needs of prospective resident’s newly admitted to the home could be better and more realistically met if the home re-assessed its current capability to meet the needs of individuals with extreme conditions and behaviours as outlined in its ‘Range of Needs’ assertions in the Statement of Purpose. Resident’s individual freedom and choice would be better respected and observed if the home regularly reviewed its system of keypad locking to exclude any possibility of misuse by using locks to control and contain The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 7 behaviours Resident’s with clearer guidance on how to avoid and combat the current culture of ‘locking’ at the home. Current restrictions to the freedom of movement of one service user and access to communal areas must be lifted. Any restrictions imposed upon residents must be fully consulted on, documented and recorded in the plan of care, discussed during the statutory reviewing process and agreed with the resident’s guardian and/or the Local Authority Social Worker. Risk assessments must be put in place limiting the extent of restrictions imposed on the freedom of movement of any resident and the home’s supervisory regime must include adequate and constantly present numbers of staff. The home must regularly consult and inform the Commission using agreed protocols as outlined in Regulation 37 (Notification of Events) of the Care Homes Regulations in respect of any of the above. Staff would be in a better position to ensure that resident’s freedom is better protected and respected if the home’s staff team followed its own Protection of Vulnerable Adults Policy and was therefore re-trained in its spirit and general principles. Residents self esteem and dignity would be enhanced if the home employed more successful strategies to guide and support residents with their own clothes, hairstyle and appearance. Resident’s health and welfare would be better protected if the home followed the advice and recommendations of the ‘Premises Inspection’ conducted by South Gloucestershire Environmental Services (Dated 28/8/05 and including a variety of recommendations regarding the safe preparation of food). In addition the home should operate a regular ‘deep cleaning’ regime and improve the way it manages intrusive odours around a number of areas across all flats. There should be better measures to ensure all areas are kept homely and there should be a strategy for updating and re-decorating the environment. To avoid the possible spread of infection and improve the state of general hygiene and cleanliness in the home there should be soap available in bathrooms and the plugs from wash hand basins should be replaced. Resident’s would be better protected from people unsuitable for working in the home if procedures were in place to regularly re-check staff with a significant record of convictions with the Criminal Records Bureau after a period of three years. The staff team would feel better supported and residents would benefit from this if a suitable staffing strategy to avoid long periods of being understaffed were put in place and the team kept updated about developments in this area. Residents would benefit from a staff group receiving regular and frequent supervisions. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 8 . 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 Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 9 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 Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 10 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, 5. While the Statement of Purpose is of a very high quality, assertions about the home’s intended target population and the use of a keypad system in the Statement need reviewing. Written policies and procedures around admissions are sound but there is a possibility that the home overestimates its skills and experience to deal with the most challenging behaviours. Equally, while needs assessments are well written and planned the home struggles to meet assessed needs. EVIDENCE: An updated copy of the Statement of Purpose was in place for inspection. This document was found to be of a very informative and comprehensive nature far exceeding the general standards expected from such a paper. There was also a service user guide available that detailed a range of useful information about the Home. Contracts outlining the terms and conditions applicable to the home and the service user were available for inspection on individual residents files. Admissions procedures of the Voyage organisation were studied as part of the inspection. The Windbound has full occupancy and many of the residents have been living in the home for a number of years. In spite of this the home has all the necessary procedures in place to accommodate possible future admissions. The Statement of Purpose includes details on the process and that visits would be tailored to suit the individual to enable them to make a decision on whether to move to the home. Needs assessment (also prior to admission) of residents The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 11 was scrutinised and the information was discussed with the Registered Manager. The home takes care in ensuring that it only offered a place after a thorough evaluation of what it could offer to prospective residents. The home’s admission process as discussed with the Manager was well reflected in these specific procedures. However, page three of the Statement of Purpose clearly describes the very challenging spectrum of needs prospective residents of the home might have when admitted. The chapter clearly defines individuals with the widest possible range of challenging behaviours being within the home’s admission criteria. The next announced inspection would have to focus on the question whether this extraordinary range of extreme behaviours is within the home’s capabilities. The home is advised to weigh up the current residents needs against the home’s capacity and the staff group’s skills and experience to deliver the service and care which the home offers. In order to avoid that the home offers a place to someone whose needs it cannot meet, this should include a review of its Statement of Purpose in the light of NMS 2 and 3. Equally, the Statement of Purpose seeks to clarify the use of a keypad locking system defining the system as “a way of designating the separate accommodation areas for service users, and affording them some privacy and protection”. While this might have been the original intention for which the system was accepted and sanctioned by the Commission it is important that the intended use is constantly monitored and reviewed so that the keypad system is not used as a means of controlling challenging behaviour or unduly and excessively restricting the freedom of movement of residents. Evidence from staffing rotas undoubtedly pointed to the home being very short staffed on occasions increasing the likelihood of staff using the system as a form of containment and control. Questions will need to be asked, whether the homes reliance on keypad locking has not also ‘lowered the threshold’ leading staff to use illegal locking systems to contain and control one specific resident’s freedom of movement. Further details of this are discussed in the relevant sections of this report. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 12 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. In spite of some very good examples of individual resident’s plans of care the service fails to deliver a protective, yet open, transparent and participative level of service to one of its residents. Grave concerns remain that nobody inside or outside the home realised that procedures amounted to an illegal infringement on the resident’s human rights and individual needs and choices. EVIDENCE: There is an outstanding requirement to make certain that “the registered manager must ensure the care plan identified at the time of the inspection is regularly reviewed and evaluated”. From the sample seen at this inspection actions to meet the residents’ care needs and their outcomes were fully documented and there was good evidence that all resident’s care plans are reviewed six monthly. However, the Registered Manager openly confessed that she was not fully compliant with her own high standards and subsequently still in the process of fine-tuning a number of plans of care. The examples seen were already of a very high quality. All of the plans seen described individual procedures for residents likely to be aggressive and described restrictions on choice and freedom. Plans scrutinized clearly state that residents will not be able to leave the building or access other flats because all entrance doors have a keypad system. Reasons such as “has The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 13 little awareness of his own personal safety” and “limit noise levels from the other flats and in turn reduces the self injurious behaviours he exhibits” are given to justify the restrictions on the freedom of movement. From the plans it could not be clearly enough established whether the home had discussed or consulted any of these reasons with other agencies, had obtained the consent of the resident or an advocate acting on his behalf, or involved significant professionals in discussing alternative measures. The plan of care and reviewing process of one resident was case tracked after the inspection of his flat found him to be locked in, unable to have any access to the home or grounds. The resident had been instructed to attract attention by knocking on the locked door and, assuming staff were near by to hear him, state his needs. There is good evidence in care panning and review papers that the home highlighted the extraordinary extent of difficulties it was experiencing around the resident. These included the total and regular destruction of his flat by destroying and stripping it of all items. Danger to his personal safety included the risk of electrocution and flooding eventually resulting in the home stopping to replace any items of furniture “accepting that X chooses to live in this way”. A list was seen listing the damage done to the environment including a detailed estimate of cost, which amounted to several thousand pounds. Regular and intense physical attacks on staff were well documented using the stringent recording principles of the C.A.L.M (Crisis and Aggression Limitation and Management) policies and procedures. Also the fact that the resident started to refuse all medication (Christmas 2004) was well recorded. It is likely, that as a result of this the resident’s behaviours started to become ‘totally unmanageable’ far exceeding the potential of the environment or the skills of the staff group. While there is some evidence that the service was clearly communicating these difficulties with other stakeholders it was also apparent, that this was not done transparently enough. Professionals involved in the following POVA (Protection of Vulnerable Adults) process were all stressing that they had been left under the impression that “the service was managing”. None of the professionals, including the resident’s Social Worker was aware that the resident was in effect suffering from “false imprisonment” by having been locked into his room. From interviewing staff, the Registered Manager and the Operations Manager it could be established, that this practice had been customary since the beginning of July 2005. It was evident that the service failed to inform any professional stakeholder of the measures it was taking. It is of the greatest concern that none of the managers, staff or other stakeholders felt it necessary to ‘whistleblow’, alert the Commission or initiate The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 14 a POVA strategy meeting. Only on one occasion did the home alert the Commission about an incident relating to the resident in question using the Regulation 37 ‘Notification of Incidents’ procedure. From this notification none of the significant facts above could have been deduced. At the last inspection the Inspector noted that the risk assessments seen covered a range of areas including a safe environment, day-to-day activities and particular challenging behaviours. These were of a high standard. This remains the case. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 15 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): 11, 13, 14, 16. In most cases residents are given good opportunity to attend a varied range of social and therapeutic leisure activities, have opportunities for personal development and are supported to maintain appropriate and fulfilling lifestyles. This is well recorded and documented. EVIDENCE: The Windbound Care Plans studied during this inspection detailed opportunities for ‘personal development’, ‘education and occupation’, ‘social inclusion’ and ‘leisure’ issues under the heading ‘Identified Needs’. Documentation of this is good with plenty of useful detail provided and additional headings for the specific ‘aims and objectives’, ‘actions to be taken’ and ‘desired timescales’. Likes and dislikes are recorded on a ‘Thumb Print’ condensing essential information on one or two pages for each of the residents. Daily records that were examined also showed residents attended a variety of activities. There was information recorded in resident’s daily records that confirmed they regularly go out on a range of trips to the local community. The The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 16 home has vehicles for resident’s use. At the time of inspection these were being used for a day trip. Information seen in resident’s records confirmed that a number have regular contact with their families. There was evidence from discussions with staff and residents to demonstrate that opportunities were provided to enable residents to maintain and develop practical and personal skills. Also well evidenced was documentation to demonstrate how the home monitors each resident’s progress in terms of communication, social and independent living skills. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 17 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. While residents receive personal support their appearance and clothing does not always show the best possible care and standards. If and when needed residents benefit from a range of therapeutic services. Healthcare needs of residents are assessed and recognised. EVIDENCE: A key worker system provides each resident with, personal and flexible support. Time arrangements for routine events are kept flexible if residents require. All of the current residents were met during this inspection, however briefly. Outer appearance, their clothes and hairstyles were of no more than a reasonable standard. While this is partly a reflection of the complexities of their needs and behaviours more successful strategies to guide and support residents with their own clothes, hairstyle and appearance need to be in place. There is a good range of support services available for residents. The Statement of Purpose clarifies which therapeutic techniques are on offer at the Windbound. These include the local C.L.D.T. (Community Learning Disability Team) that offers Consultant Psychiatry and Psychology. In addition there is a Counselling Service, Chiropody and Hairdressing and Therapeutic Massage. From records it was clear that these services had been usually available for the resident’s if needed. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 18 The service makes good use of local healthcare facilities. A health check proforma tracks whether residents have been able to access general health checks or health screening services. Standards relating to the administration of medication were not assessed at this inspection. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 19 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. In spite of clear policies and procedures the home’s complaints, POVA and whistle blowing policies failed to highlight, record or notify a case of ‘false imprisonment’. The home is now fully co-operating in the current POVA strategy process. EVIDENCE: No log to record comments of complaints could be identified at the home. This contravenes the home’s own complaints procedure, which can be found as a separate policy as well as a part of the Statement of Purpose. However, the home uses a system of electronic ‘notification forms’ which are completed by the Operations Manager and forwarded to the Regional Director and the Director of Quality Assurance. The home is reminded that complaints need to be filed appropriately to be more readily available during the inspection process Members of staff stated that abuse is discussed as part of the induction. Records confirmed that the induction covers issues of abuse. Staff assured that they would have no hesitation to report abuse. There was good evidence that most of the team members had attended training with the Local Council on Protection of Vulnerable Adults. Staff interviewed were clear about the organisation’s procedures and well informed about the role of CSCI in the complaints and whistle blowing process. The home has a policy on abuse and local joint policies and guidance between South Gloucestershire Council and the local authority was available. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 20 As mentioned above the home has a policy on restraint and aggression by residents is generally well understood and dealt with appropriately. However, as evident from previous comments it is apparent that the home has developed a culture of ‘locking’ and ‘locking up’ (Kitchen doors, kitchen cupboards, key pads between flats, etc.) In the case of one resident this amounted to ‘false imprisonment’ with the use of padlocks and a large bolt to secure his door. A thorough analysis by the provider will have to establish how this fact could have gone unnoticed for a period of at least 3 months. Abuse is generally defined as any form of degrading treatment whether deliberate or through ignorance. Internal procedures to ensure robust responses to suspicions of abuse or neglect have failed on this occasion. However, the homes management is fully co-operative and participative in the current POVA process. An additional meeting is planned at the Commission to establish and discuss management issues relating to the highlighted case. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 21 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, 26, 27, 30. Residents would benefit from a refurbishment plan and continual maintenance of the Windbound. Residents would also profit from routine cleaning being completed on a regular basis including far improved odour management. Some areas of the home fail to look and feel homely. EVIDENCE: The accommodation is ‘split level’ with the residential provision on the upper level. Accommodation for residents is provided in three ‘flats on the upper level. The manager’s office and recreation area are on the ground floor. There are outbuildings that house the laundry, food store and potting shed, that are used by residents and visitors from the organisation’s other homes. On the upper level there is a patio area that is accessed from each of the flats and on the ground level work has been carried out to create gardens for the residents’ use. This includes raised ‘beds’ that were used during the summer for residents to grow vegetables and salad. There are plans to extend the gardens by using part of the car park at the front of the building. In flat one a resident’s room has been refurbished including the installation of new flooring and purchase of a new bed, wardrobe and desk. The resident The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 22 stated that he was happy with everything in his room and in particular the new double bed. There is a bathroom and shower room in flat one and it was noted, as in other areas of the home, that there was no soap available and the plugs from wash hand basins had been removed. There must always be soap available for hand washing and it is recommended that washbasins be fitted with plugs. There is a peep-hole set in the door in the bathroom of flat two and these needs blocking to protect residents’ dignity and afford privacy. In this bathroom a toilet seat is needed. The WC in one of the residents rooms was noted to be badly stained and in need of thorough cleaning. There was a smell of urine in some areas. One of the residents in flat one causes environmental damage and there was evidence that progress was being made to remedy this. There is a small kitchen where residents are able to make snacks and drinks. The majority of catering is carried out in the kitchen in flat two. It was noted that in flat one the fridge and freezer seals were in need of cleaning and the microwave was splattered with food on the inside. The home was visited by the Environmental Health Department of the local Council earlier in the year and received a less than favourable report. There needs to be an emphasis on food safety and to maintain a safe environment for the preparation of meals. The lounges in all three flats lacked a homely feel. There are plans to redecorate the lounge in flat one and the lounge in flat three was in the process of being refurbished for the use of the occupant of that flat. Corridor flooring is due to be replaced. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 23 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, 36. A clear recruitment strategy is in place in order to tackle significant staff shortages. Recent progress is encouraging. Supervision and support protocols need to be in place in order to ensure compliance with NMS (National Minimum Standard) 36. EVIDENCE: In addition to the manager and operations manager, four staff were consulted as part of the inspection. Each spoke enthusiastically about their work and relationships with residents. One person commented on how staff support each other and there was positive reference made regarding the appointment of a temporary deputy manager. This appointment should enable the manager to delegate more effectively and address all relevant issues within the home. There have been staff shortages that have had an impact on the home and comment was made about how staff feel some pressure to work additional shifts to meet shortfalls. In spite of this there has been many occurrences when shifts have been short staffed and it was suggested that this leads to the residents getting a reduced service. The manager is positive about recruitment of new staff and hopes to include a housekeeper and maintenance person in future appointments. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 24 Part of a staff meeting was observed during which staff discussed recent inspection findings and the outcome for one particular resident, forthcoming events and the management of the key worker system. It was evident, that the staff group is currently not receiving enough support in the form of regular and frequent supervisions. The manager is aware of this fact and in the process to realise a strategy that helps to create the necessary timeslots in a very busy schedule and workload. However, judging by the considerable amount of weekly hours currently being afforded by the manager pertinent questions remain over the organisational support available to her. The recent appointment of a deputy will come as welcome assistance but might in itself not be enough to tackle the workload generated by a home of this size. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 25 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, 40, 41, 42. An experienced and competent manager manages the home. However, ethos and current management style need to be questioned considering the extent of the criticisms contained in this report. EVIDENCE: The Registered Manager of the Windbound has recently taken over this position from the Operations Manager who now has become her line manager. She gained most of her previous management experience by managing a daycentre for adults with learning difficulties before joining the Voyage, then Headwind, organisation in 1999. She is currently working towards her NVQ (National Vocational Qualification) level 4 and the Registered Manager’s Award with South Gloucestershire Social Services. She has a Certificate in Childcare and Education (1997) and achieved a F.A.E.T.C. stage 1(Further Adult Teaching Certificate) in 1997. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 26 Altogether the manager has six years experience of working in similar residential settings and has other significant experience working with people with learning difficulties and challenging behaviour. Since joining Voyage she has undertaken periodic training and development opportunities, maintaining and updating relevant skills and competencies. Overall, there was good evidence, that the Operations Manager and the Registered Manager form a strong team in order to manage the home. However, the staff group opinions on direction and leadership at the home seemed divided with comments ranging from ‘very strong’ to ‘no clear aims and little leadership’. In spite if this all staff agreed that she adopted an open and transparent leadership style allowing staff to voice concerns. Surprisingly however, in the case of the specific concerns highlighted in this report, no specific concerns were raised by staff. Having said this, while interviewing a significant sample no attempt was made by inspectors to raise specific and related issues with staff. There was evidence seen that the Home had been carrying out a quality review of the care, and the Home generally. The quality assessment system being used to measure the overall quality of the service has been commented on favourably during previous inspections. However, questions remain over the efficiency of this process. Significant shortfalls are identified as a part of this report and have been identified – but not remedied – in previous audits undertaken by the Manager. The home has up to date policies and procedures relating to the promotion of the health, safety and welfare of its residents. Clearer guidance on how to avoid and combat the current culture of ‘locking’ at the home needs to be urgently issued. The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 27 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 2 2 2 X 3 Standard No 22 23 Score 2 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 1 1 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 2 2 X X 1 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 X 16 1 17 Standard No 31 32 33 34 35 36 Score X 3 1 2 X 1 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Windbound Score 2 3 X X Standard No 37 38 39 40 41 42 43 Score 3 2 2 2 3 2 X DS0000043699.V255178.R01.S.doc Version 5.0 Page 28 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 3 4 Standard 1 1 3 3 Regulation 4 4 12 14 Timescale for action Review the Statement of Purpose 01/01/06 and the homes fitness to cater for the intended target group. Review the Statement of Purpose 01/01/06 and the homes use of a keypad locking system. The current restriction to the 17/10/05 freedom of movement of one resident to be lifted. All restrictions on residents need 01/12/05 to be clearly documented in the plan of care and discussed with all stakeholders. Individual risk assessments need 01/12/05 to be in place for all restrictions and these clearly communicated. The home needs to keep to the 01/01/06 agreed staffing levels as negotiated with individual local authorities. The home to give notice to the 17/10/05 Commission about any event specified by this Regulation. Policies and guidance to be 01/01/06 developed that combats the current culture of restricting resident’s freedom of movement. The staff group to be re-trained 01/12/05 in the Protection of Vulnerable Adults Policy. DS0000043699.V255178.R01.S.doc Version 5.0 Page 29 Requirement 5 6 9 33 12 18 7 8 30 23 37 13 9 23 18 The Windbound 10 11 18 42 12 23 12 13 14 15 16 17 24 24 24 34 33 36 13 13 23 19 18 18 To ensure that appropriate strategies are in place improving resident’s outer appearance. The home to follow the advice and recommendations of the latest inspection by Environmental Services. The home needs to develop a more frequent and rigorous deep cleaning regime. The home needs to find more efficient ways to manage offensive odours. All parts of the home to be well decorated and kept homely. Staff with significant previous convictions to be re – checked by the Criminal Records Bureau. The home to develop a suitable staffing strategy. The staff team to receive regular support and supervision. 01/12/05 01/01/06 01/12/05 01/12/05 01/01/06 01/01/06 01/01/06 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Windbound DS0000043699.V255178.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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