Inspection on 27/07/09 for The Windbound

This inspection was carried out on 27th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Windbound 03/09/08

The Windbound 25/09/07

The Windbound 03/04/07

The Windbound 26/04/06

The Windbound 17/10/05

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 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 The Windbound Shepperdine Thornbury Sth Gloucestershire BS35 1RW Lead Inspector Paula Cordell Key Unannounced Inspection 27 and 28th July 2009 09:50 th The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Windbound Address Shepperdine Thornbury Sth Gloucestershire BS35 1RW 01454 418274 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) Voyagecare.com Voyage Limited Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 12 3rd September 2008 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. People who use the service 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 individuals to access community facilities. The Windbound was once a public house, which has been converted into three individual flats separated by keypad systems. The home does not have a registered manager. The fees for the home at the time of publishing this report range from £1,092 to £2,444 per week. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the requirements and recommendations from the visit in September 2008. In addition to monitoring the quality of the care provided to the eleven individuals living in the home. There have been no additional visits to the home. However, three monthly meetings have been organised by the local authority to discuss ongoing concerns about the home, including care of the individuals, the environment and the general management of the home. There have been two safeguarding referrals made since the last visit. One related to the care of the individuals and the other, financial management. These will be discussed further in this report. The inspection methods used included record checks, case tracking, a tour of the home and discussion with staff, people who use the service and the operations manager. The home has been sending information in respect of regulation 37 notifications of event events affecting the well being of the individuals living in the home. The visit was conducted over two days for a total of eleven hours with structured feedback being given to the deputy manager and the operations manager at the end of the second day of the visit. What the service does well: What has improved since the last inspection? The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 6 Individuals can be confident that the information in the statement of purpose reflects the service being provided. Individual contracts clearly specify what is and is not included in the fees. This includes contributions made towards the cost of the transport. Some works have commenced on the environment including making the individual flat entrances more clear and the three gardens have been in part fenced off. The kitchen worktops have been replaced in Sabrina View. What they could do better: Individuals must be assured that their plans of care and risk assessments are kept under review and reflect their changing needs. Individuals must be assured that complaints are responded to promptly with clear records maintained of the outcome. Individuals must be assured that competent staff support them and that training is provided relevant to the needs of the people that live at the Windbound. Including supporting individuals that challenge, mental health and autism. Support mechanisms for staff must be in place to reduce anxieties, to give a forum for them to voice their views and improve morale. The individuals must benefit from an effective management structure being in place where concerns and issues are addressed promptly. Individuals must be assured that the Windbound is a safe place to live and repairs are responded to promptly. Individuals must be assured their safety in the event of a fire and are supported by competent staff. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 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 Windbound DS0000043699.V376004.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to individuals and their representatives about the service provided at the Windbound. Contracts have been updated and are reflective of the fees and the contributions made by the individual. EVIDENCE: The home has a statement of purpose that has been updated since the last visit in response to a requirement made. This now clearly describes the reconfiguration of the home into three separate areas/flats. The flats are called Severnside, Sabrina View and River Cottage. This change came about last September. Each area has a nominated staff team who work with the individuals. The home has an established group of individuals that have lived in the home for a number of years. There is one vacancy. This vacancy is not going to be filled as the bedroom is now being used as an office as this is more central to the home than where the office was previously sited. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 10 Each person receiving a service had an assessment of need and a care plan based on the assessment and care plan drawn up by the placing authority. There are policies and procedures to guide the staff through the admission process and information is contained in the statement of purpose to guide the individuals and their representatives. The contracts have been updated to reflect the changes in fees and any other contributions made in respect of their care. The organisation is still in discussion with South Gloucestershire Council in respect of charges made towards the use of transport. The local council state that this is part of the fees paid to the home and no further charge should be made to the individuals. Presently all individuals contribute towards transport. This is based on whether the individual is paid the higher or the lower rate. The home is completing an audit on transport and the costs to ensure that it is equitable. This will be followed up at the next visit to the home as this was a recommendation from the visit in September 2008. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of detail in care documentation could put individuals at risk and mean that a consistent approach is not being implemented. There is a lack of review for some of the care documentation to demonstrate that the home is meeting the changing needs of the individuals. EVIDENCE: Four people’s care plans were viewed to determine how the home was supporting the individuals. Care plans were in the process of being updated and changed to the corporate documentation. This covered all aspects of daily living including how individuals are involved and the capacity to make decisions. This was work in process and approximately half of the individuals had been transferred to the new system. The deputy manager has been allocated the task to sit with key workers and team leaders to complete the documentation. It was not clear how the The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 12 individual was involved or how the information was going to be made more accessible to the individuals. Care plans made broad statements in relation to goal planning which would have made them difficult to implement as it was not specific or measurable. One person’s plan said “to encourage independence”, but failed to break the statement into smaller achievable and measurable steps. Where care plans are too broad staff could overlook them. From talking with staff it was evident that they were aware of the support needs of the individuals both in the home and the community. There was slight confusion in respect of one person’s support in that staff said they required two staff when in the community but the care plan drawn up by the home stated two staff when on holiday and one staff when going swimming. The placing authority’s initial plan of care stated one to one support when out in the community. It is advisable for this to be discussed further with the placing authority ensuring that contractual arrangements are being met. A concern recently raised by a member of public highlighted that two individuals had gone out with one member of staff when in fact they should have been supported by one member of staff each. This raises serious concerns about the support that individuals are offered and will be discussed further under concerns and complaints. Due to the above the staff in the home are working alongside a behaviour specialist employed by Voyage to review all the risks relating to accessing the community and the support offered to them. The plan is for these to be all updated to reflect the current risks. It was noted that some of the care plans had not been reviewed since August 2008 along with the risk assessments. It was evident that the person’s care had changed considerably during this time due to behaviours that challenge. Whilst some information had been updated in respect of risk assessments around behaviour other care plans had not. From reviewing one person’s plan of care it states that they should be supported by familiar staff and preferably male staff. There were no male staff working on the second day and on the first day there was an agency nurse new to the home supporting the individuals in the flat. This demonstrated a lack of planning around the staffing and an understanding of the care plan that was in place. When discussed with the staff it was evident that due to sickness and gender of most of the staff this was not always possible. At the last visit the staff were starting to develop a booklet called “My Life” a person centred approach to planning care. The operations manager was not aware of the documentation but said that there is an expectation that the home will use the corporate documentation. As already mentioned this was not accessible and did not involve the individual. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 13 Support plans included information on how the individual should be supported with their challenging behaviour including the triggers. The home was implementing a new challenging behaviour training package for staff and it was noted that this was reflected in the plans of care on supporting individuals that challenge the service. Individuals are supported by the organisation’s behaviour specialist and the local community learning disability team (intensive support team) in drawing up care plans for individuals that challenge. The home maintains a record of restraint. Staff said that this is only used as a last result. Where restraint is used it has evidently been discussed with the placing authority and agreed within the care plan. This was confirmed in a recent review completed by a social worker. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels could be restricting individuals from taking part in their planned activities. Good contact is being maintained with family. The individuals will benefit from the review of the menu where it is planned that there will be more choice. EVIDENCE: As noted at the last visit individuals now have structured activity plans that they complete on a daily basis. However, on both days little activities were taking place in the mornings as staff were busy with personal care and household chores. Staff indicated that there was insufficient staff to complete some of the activities. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 15 Care documentation included how the person likes to be supported both in the home and the community including risk assessments. Staff were knowledgeable about the staffing levels to support individuals in the community. There has been a recent incident where two individuals were only supported by one member of staff when in fact there should have been two. It was evident from talking with staff this was being discussed more openly to ensure the safety of the individuals and the staff. Individuals were seen being supported in a positive manner with staff having a good understanding of the needs of the people they support. One member of staff said that a more individualised care package is being provided now that the separate flats have been developed. It was evident from conversations and observations that the individuals living in Severnside are being encouraged to have more independence in preparing food and involvement in the running of their home. One person said that they did not like living in the home as it was too noisy. When this was discussed with staff they said that the individual changes their mind on a regular basis and has unrealistic ideas about moving back with parents. Good practice would be for the individual to be supported by an advocate independent of the home to ensure that the individual continues to be happy with the care support. It was acknowledged that the home at times can be noisy and behaviours that challenge are having an impact on the individuals. Staff were also concerned about the impact of the behaviour of two of the individuals living in Severnside and how this was affecting the atmosphere and voiced concerns for the safety of all the individuals. The home is liaising with the placing authority and is working closely with the Community Learning Disability Team on minimising the risks. From reading the records of one individual it was evident that they were being supported to participate in activities but in the main this is around the local area. This included bike rides, feeding the birds, watching television, cooking and going for walks. Staff said that due to the staffing levels and the person needing 3 staff to support them in the community activities further a field are restricted. Staff said that family supports the individual on regular trips out on a weekly basis. Staff said that activities are organised and recent trips have included a visit to the helicopter museum, a picnic on the beach and trips to Weston Super Mare. It was evident that individuals were supported with their interests but due to behaviours that challenge and the staffing levels this is not always possible. Care plans were in place detailing the support individuals need in relation to cultural and spiritual beliefs. Where individuals request to go to church it was evident from talking with staff that this was supported. The home has sought advice and support for individuals in respect of sexuality where required. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 16 Care plans include information about capacity and best interest meetings have been arranged for those individuals that have lacked capacity. It was evident that the organisation was reviewing the service in respect of the new Deprivation of Liberty legislation and discussing this with the individuals’ placing authority. Each flat area is entered via a key pad system which restricts the individuals from leaving the home of their own accord. However, individuals do have access to a secure garden space overlooking the river Severn. This is clearly documented in the statement of purpose but the operations manager said that they were ensuring that all placing authorities were aware and, in the best interest of the individual, ensuring their safety. It was evident from reading care documentation and speaking with both staff and individuals that people are supported to maintain contact with relatives and friends. A small area on the ground floor is being developed into a place where relatives can meet up in private away from the main hub of the home. A record of visitors is maintained. Menu planning was discussed. It was noted that there was a limited choice of food on offer. The deputy manager said two staff have been allocated the responsibility to review the menu. The main meal is being swapped to the evening and two choices will be offered to individuals with a snack provided at lunch time. Individuals were observed having their lunch which appeared unhurried and support was given sensitively. One individual spoken with said that the food was alright. Individuals in Severnside were observed assisting in the lunch time preparation including laying the table. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual’s personal and health care needs are being met. Poor records relating to prescribed medication could put people at risk. EVIDENCE: Records demonstrated that individual’s health and personal care needs were being met. The home has developed links with the community learning disability team and individuals are referred as their needs change. Individuals have access to a GP, dentist and optician. The home’s statement of purpose clarifies which therapeutic techniques are on offer at the Windbound. These include access to the Community Learning Disability Team, consultant psychiatrist and psychology. Voyage employs a behaviour specialist who can support the staff. In addition there is a counselling service, chiropody, hairdressing and aromatherapy. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 18 Health Action plans were in the process of being developed for individuals. Each person had a file with individual records of visits to professionals. Good practice would be for previous information relating to health care appointments to be transferred to the new files along with care plans relating to health and personal care. The deputy manager said that she was in the process of developing further health care plans which are in a more accessible format. This will be followed up at the next visit. Medication was reviewed on this occasion. Medication was held securely with designated staff having responsibility for the administration. There was a record of medication entering the home, the administration and disposal. All prescribed medication is usually recorded on a Medication Administration Record by the pharmacist. However, it was noted that two prescribed medications were poorly recorded by the staff and this could easily have been missed. For one person this was pain relief and from the record and an audit of the stock it had not been given since mid July. When staff were asked they said that this was no longer required however this was not clear from the medication record and could have resulted in a mistake. Staff said that the pharmacy has been reluctant to send spare medication administration records. This must be resolved as poor recording can lead to errors being made. Policies and procedures were in place including evidence of training for staff who have the responsibility for administering medication. Medication audits are completed on the systems and records on a weekly basis. Each person had a medication profile and an up to date photograph. Clear protocols were in place relating to as and when medication and linked with behaviour care plans. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there have been serious shortfalls in the reporting of incidents of abuse new financial systems and safeguarding procedures should avoid mistaqkes being made in the future. EVIDENCE: The home has complaint procedure and record. A new record has been introduced to the home. Staff were unable to find the previous record. It was noted that the home should have a complaint record where staff record the initial complaint and the outcome and a separate folder to record more personal information in respect of the investigation. The latter folder could not be found. It was noted that the complaint has not been resolved due to absence of people involved. There was no documentation relating to the strategy meeting that was held with South Gloucestershire. Information was poorly recorded relating to the outcome and any further work planned to complete the investigation. There is an expectation that the complaint would be investigated within 28 days and the outcome fed back to the complainant. The home remains within this timescale.. The complaint related to two individuals being taken to the local laundrette, but remained in the minibus whilst the staff completed the task of washing the clothes. The complaint was forwarded to the home by South Gloucestershire Council as part of a Safeguarding Adult Referral. During the course of the visit The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 20 discussions were had about activities in general and the support needs of the people living in the home. It seems that there is not a culture of individuals staying on the mini bus during outings to the community and staff were aware of the support needs of the individuals. However the two individuals who participated in the above activity should have had support from a member of staff on a one to one basis. Neither of the individuals could completely consent to the activity or when asked about the event could not recall the day in question. This is poor practice and could have been deemed as neglect even though the staff member checked the individuals regularly. In response to the complaint/safeguarding issue the organisation has requested that the organisation’s behaviour specialist assist the staff in reviewing the risk assessments and protocols for accessing the community. In addition guidance has been given to staff in relation to shift planning and improving the communication between staff. The home now completes a record of each shift detailing the staff on duty, who they supported and the activities that had taken place. A further safeguarding referral was made by the Care Quality Commission in respect of information that came to light involving the unregistered manager in respect of finances to South Gloucestershire Council. There was a delay in the organisation forwarding this information which meant that the safeguarding procedure was not implemented within a reasonable timescale. This has been discussed with the organisation and clearer guidelines have been put in place for operation and human resources staff. Finances had been withdrawn from the accounts of individuals and not entered on to their record of expenditure for a period of five months. Whilst it is clear that the individuals’ moneys has been reimbursed there were no answers as to why it took so long to enter the expenditure records. In response to the above, the service has put further safeguards in place in relation to money belonging to individuals living in the home. Two members of staff are required to sign the cheques and check the money into the individual’s purse. Signatures on the cheques are restricted to three members of staff. A new record has been devised to ensure that all money entering the home is entered on the record. Staff check finances daily and monthly by the manager with the operations manager checking a random selection on a monthly basis. It was noted that the finance file would benefit from being sorted in to a logical sequence with dividers sectioning each person’s records. It is strongly recommended that the organisation’s financial department audit the finances dating back two years ensuring that the individuals’ money has been protected. The home has safeguarding procedures which clearly detail what constitutes abuse and the role of staff. Concerns have been raised in the past about how The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 21 the service shares information with the local authority in respect of issues relating to abuse. This remains an ongoing issue as detailed above. Clearer guidance has been developed for senior management including human resources. Staff have received training on safeguarding and it is evident that this is discussed at staff meetings and during regulation 26 visits. The operation manager stated that some staff are not aware of the procedure and this must be clarified during staff meetings and supervisions during a regulation 26 monthly visit. Policies and procedures are in place to guide staff in supporting individuals that challenge. As mentioned individuals have a care plan detailing the triggers and the support that is required when exhibiting challenging behaviour. From talking with staff it was evident that restraint is only used as a last result. Regular monitoring is completed on the use of restraint with a record maintained. Information is forwarded to the operations manager on a monthly basis. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are ongoing issues relating to the environment that will continue to show signs of damage related to the behaviours of those living at the home. The organisation needs to be more speedy in dealing with repairs and identifying more robust furniture and fittings. EVIDENCE: The Windbound is a split level property with the residential provision on the upper level. Accommodation for people who use the service is provided in three flats (Severnside, Sabrina View and river Cottage). Training rooms, an activity room and a relaxation room are on the ground floor. In addition there are a number of offices, which in the past have been used by the operations and the training manager for Voyage. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 23 The three flats have access to a separate lounge and a small kitchen. There is a larger kitchen in the centre of the home which provides most of the meals for Sabrina View and River Cottage. There are separate bathroom facilities for each flat. The bathrooms in Severnside were in a poor state of repair. The door was missing from one of the bathrooms meaning that individuals could not bath in privacy. Tiles were missing from both the bathroom and the shower room. The door frame on the shower room was in a poor state of repair showing bare plaster and the lintel which looked dangerous. There was no shower head in the bathroom and the sink unit had no doors. Staff said that this had been like it for approximately four to five weeks and the door has been off for months. When discussed with the operations manager she was aware and a budget has been released to complete refurbishments to these bathrooms and a further ensuite. Concerns were raised that the works were not completed earlier and that the home should ensure that the repairs are completed using appropriate sturdy materials to prevent further damage to this area. The operations manager confirmed that the repairs would be completed and consultation will take place with a specialist service that supports individuals that challenge. Photographic evidence has been received on the 29th September 2009 demonstrating that this has been completed. A number of bedrooms were viewed in two of the flats as the occupants of Riverside were not happy with my presence. Whilst it is evident that individuals are supported to personalise their bedrooms the standard of decoration varied. Three of the five bedrooms viewed furniture was broken including missing drawers and wardrobe doors. Curtains were not available in one of the bedrooms and mixed messages were given by staff, in that some stated that the person did not want them or the staff member did not realise they were missing. There were no curtains in the lounge of Severnside. Carpets throughout the building were heavily soiled. Decoration had not been completed in one bedroom with the paint of the previously yellow room showing behind the wardrobe. It is evident from touring the building that the environment takes a lot of wear and tear. The home employs a maintenance person permanently on site with support from a further person who works across all the homes. The home maintains a maintenance record but there were no records of works being requested since the beginning of the year. This meant that it was difficult to ascertain response times for repairs or how vigilant staff are in reporting them. Three staff spoken with during this visit highlighted concerns about the environment and the lack of response from the organisation in resolving the issues. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 24 Since the last visit the organisation has responded to a requirement to replace a kitchen work surface that was worn. The home now has a call system to alert staff of an emergency and the emergency repair budget has been increased. The operations manager said that the budget has been increased although the home still needs to get expenditure authorised. It may be beneficial for the timescales for decisions to be reviewed, particular as the bathroom has been in a poor state of repair for four to five weeks. The Windbound is a building that may not continue to be suitable to the people in the home who challenge the service. The corridors are narrow and could put both individuals and the staff at risk. Furniture is domestic in quality which may be suitable for some but is not for others. Individuals in one of the flats can be noisy and one person becomes distressed when new faces invade their space. The home is receiving investment from the organisation and small gardens are being developed for each flat. The fences have been installed but they still have stone chippings. The operation manager gave reassurances that turf and top soil has been ordered and will be in place shortly. Since the visit confirmation has been received that this has been completed in the form of photographs. Work is underway in the ground floor accommodation with training kitchens and smaller work areas replacing the large room on the ground floor. A small quiet area has been developed so that individuals can entertain their relatives or hold meetings away from the noise of the residential area on the first floor. The ceiling in part of the ground floor was missing exposing pipes from a water leak. Parts of the ground floor were damp and although it has been developed as a gym, staff said they have to bring the equipment into another area on the ground floor. The ground floor also holds a sensory and relaxation room. The operations manager said that a budget has been set aside for the staff to purchase more equipment for this area. As mentioned at the last two previous visits this ground floor area was being developed as an activity centre, which will be staffed independently of the care home. Staff said that another home uses this area but it has not been fully developed as an activity centre. The home has a number of outbuildings which are being used as store rooms, workshops and the laundry. Staff said that the laundry has been out of action due to the washing machine not working for the past two months. During this time staff have taken washing to the local laundrette and now to another Voyage home in Slimbridge as a consequence of a complaint made. The Operation Manager said that although the organisation and the staff have chased this up there have been a number of unforeseeable delays. Including weighing up the cost of the repair over purchasing a new one. It is strongly The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 25 recommended that good arrangements are in place to prevent this occurring again in the future. The home was clean and free from odour. Staff are responsible for cleaning the home and it was evident from talking with them that this sometimes can be a balancing act in relation to supporting the people in the home and getting them out in the community. Individuals are supported to help if they want with household chores and for some individuals this is part of their structured activity plans. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of training, support mechanisms and leadership is having an effect on the staff morale in the home. Whilst staff are committed to providing a good standard of care to the individuals this is being compromised by the minimum staffing levels. EVIDENCE: The statement of purpose states that there should be a minimum of seven staff per shift during the day and three staff at night. Each flat has a designated staff team to support the individuals. Staff comments about the changes that have been implemented were generally positive in respect of them building better relationships with the individuals in the home. As previously commented the minimum staffing is restricting individuals in their activities in the community as staff were observed completing personal care and household chores in the morning on both days. On the second day there was only six staff working in the home which meant that Severnside was The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 27 only staffed with two staff. This is a serious concern considering the behaviours that challenge and the risk to both the staff and the individuals living in this area. From meetings that have been taken place in February, April and July 2009 with the local council, the Care Quality Commission and senior management of Voyage in respect of ongoing safeguarding issues the operations manager said that the home was being staffed with nine staff per shift. From the rota it was evident that minimum staffing was in place most days. The home has experienced a high staff turnover and sickness is particularly high which has consequently meant that shifts are being covered by agency staff and minimum staffing levels have been in place. The operations manager gave reassurances that a recruitment initiative has been completed and five new staff are waiting to commence in post subject to satisfactory references and other checks. A review of the staffing must be completed to ensure sufficient staff are working in the home to meet the needs of the individuals enabling them to access the community and complete their activity plans. Four staff records were viewed in respect of recruitment processes, training and supervision. Records relating to recruitment are held at the head office for Voyage. The home has some records and this is variable for staff, some had references and others only had an application form. The human resource department send an overview record of dates that the information was received at the head office including criminal record bureau checks and references. Managers do not see all the information and personnel staff make the decision whether the applicant is suitable. This practice should be reviewed so that the manager can be fully involved in the process. Copies of recruitment information should be kept in the home. Of the four staff, three had completed their induction and statutory training in respect of health and safety. One member of staff has been working in the home mainly at night since October 2008 and it was noted that they had not attended any training or completed the induction. As noted in July and September 2008 staff have not completed their Learning Disability Qualification as part of their induction. The previous manager said that there was an expectation that all staff would complete this. The deputy manager said all the staff have been enrolled but progress was slow. As noted at previous visits training has again slipped where by staff need updates on supporting people who challenge and some statutory training. The acting manager and deputy manager have completed a review of training and they were in the process of forwarding training requests to the head office. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 28 The Windbound provides a specialised service for people with a learning disability who challenge. Individuals could have autism, mental health issues, and epilepsy and communication difficulties to name a few. For a service to be specialised there would be an expectation that staff would be trained. Only seven staff have training in autism and four staff have mental health training out of a team of twenty. One member of staff said that this was a basic one day course and they would benefit from further training. Of the twenty staff only 10 staff have attended training in supporting individuals that challenge. The home uses non violent crisis intervention and one of those members of staff required an update. Eight staff have an National Vocational Award as noted during the visit in September 2008. It would appear that the area of training and support to staff has not been maintained over the last ten months. This will be discussed further in the management section of this report. The acting manager has re-established monthly meetings for senior carers and the care staff. There was a lack of supervisions for all staff files viewed. However, the deputy manager and a senior carer said that the acting manager has established a new system where senior carers will take on some of this responsibility. The operations manager said that the senior carers will be taking on more responsibility and training would be provided to enable them to fulfil their role. Three staff were spoken with during the course of the visit. From the conversations it was evident that the morale in the home has been low due to the uncertainty of the management, the high staff turnover and the sickness levels. Staff were concerned about the timescales for the repairs to the environment and felt that the organisation did not respond quickly enough. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of leadership in the home has meant that the quality has been compromised. Morale in the home is low due to the changes in management. However reassurances by the senior management have been given that an action plan is in place to address this. Individual’s safety is being compromised in the event of a fire due to the lack of training. EVIDENCE: The service has not had a registered manager since June 2006. This has been discussed with the responsible individual through correspondence. This is not acceptable and it is evident that the lack of management and leadership is having an effect on areas of the running of a care home, including care The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 30 delivery, the planning of activities through to the support of the staff and training and the environment. The organisation has commenced the recruitment process. Information received after the visit (28th September) confirmed that a manager will be taking up post by the 5th October 2009. The home has had an acting manager since April 2009 when the last manager left the home. The acting manager has instigated some changes in respect of ensuring that Voyage documentation including policies and procedures are in place developing support mechanisms for staff and reviewing the care documentation. A deputy manager has been redeployed from another home to assist with this process until October 2009. The acting manager who is a registered manager for another Voyage home is returning to their substantive post at the end of August 2009. Reassurances were given that another registered manager would be redeployed until a manager has been appointed. This process according to the operations manager is underway. Concerns are raised in the management of the home and slowness of the organisation to responding to some of the environmental issues in the home including replacement of the washing machine and the repairs to the bathroom. In addition there are concerns about how the senior management have responded to safeguarding issues. All these have been discussed previously in this report However, a meeting has been held with the senior management of the organisation to address some of these concerns and reassurances have been given that an action plan is in place to address these with invest being made to the environment. The organisation is completing monthly visits in respect of regulation 26 visits. There were no copies of the reports from May onwards, so it was difficult to determine what the operations manager felt about the environment and the laundry facilities. It was evident from the operations manager that she did not feel that the situation was acceptable and was assisting the home in chasing up some of the areas. In addition to the monthly visits the home completes audits on medication, the environment, care planning processes, staff training to name a few. It was evident that more guidance should be given to staff in relation to what is expected and the standards that should be in place. An opportunity was taken to review health and safety in the home. Good procedures are in place relating to food hygiene, storage of chemicals hazardous to health and routine checks on the fire and electrical equipment. Less apparent was fire training and staff participation in fire drills. The last record of a fire drill was December 2008. Staff must participate in a fire drill once in a six month period and fire training six monthly for day staff and three monthly for those staff that work nights. One member of staff has worked in The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 31 the home for 9 months and has not participated in a fire drill or fire training and is working nights. General risk assessments require a review as these have not been updated since the home has implemented the individual flats and some individual’s behaviour has changed and escalated over the two year period. Policies and procedures were being updated by the acting manager to ensure that there were all current and in accordance with the corporate policies. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x x 2 2 x x 2 x Version 5.2 Page 33 The Windbound DS0000043699.V376004.R01.S.doc 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 YA6 Regulation 12 (2), 15 Requirement To ensure that care plans and risk assessments are kept under review at least once in a six month period. Ensuring that individual’s needs are being met consistently. Ensure that medication is recorded clearly on the Medication Administration Record. Ensuring individuals are protected and reduce errors. Where there are medication changes ensure that this is clear on the Medication Administration Record. Ensuring individuals are protected and reduce errors. Ensure all staff attend training in safeguarding as part of their induction. To increase staff awareness and better protect the individuals. Ensure individual’s privacy is not being compromised within a risk assessment framework. Provide curtains in bedrooms and communal areas. Ensure that the individuals in Severnside have privacy when DS0000043699.V376004.R01.S.doc Timescale for action 28/12/09 2. YA20 13 (2) 08/08/09 3. YA20 13 (2) 08/08/09 4. YA23 13 (6) 28/09/09 5. YA24 12 (4) (a) 28/08/09 6. YA24 12 (4) (a) 29/07/09 The Windbound Version 5.2 Page 34 7. YA27 23 (2) (b) 8. 9. YA24 YA33 23 (2) (b) 18 (1) (a) 10. YA32 18 (1) (c) (i) 11. YA36 18 (2) (a) bathing until the door can be replaced. For the bathroom and shower room in Severnside to be refurbished. Improving the quality of the environment. Replace broken furniture in bedrooms and communal areas. Ensure the home is adequately staffed to ensure the safety of the people living in the home and enable them to access the community. Ensure staff complete an induction in accordance to the guidance given by Skills for Care. Ensuring staff have the skills and the competence to support the individuals. Ensure staff receive regular supervision and support. Improving the effectiveness of the team and communication. Ensure that staff participate in fire training and drills as advised by the local fire officer. Ensuring that the individuals are protected in the event of a fire. For staff to attend training in mental health and autism. This will ensure that the staff have the skills and expertise to support the individuals. 28/10/09 28/12/09 28/08/09 28/08/09 28/08/09 12. YA42 18 (1) 28/08/09 13. YA35 18 28/12/09 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 YA17 Good Practice Recommendations For the individuals to have more choice in relation to what DS0000043699.V376004.R01.S.doc Version 5.2 Page 35 The Windbound 2. 3. 4. 32. YA32 YA26 YA24 YA23 they eat. For the staff to complete the Learning Disability Qualification as part of their induction. For staff to receive supervision at least six times per year. For the home to review the purchases in respect of furniture to ensure fit for purpose and take specialist advice in respect of fixings and fittings. For the organisation to complete a financial audit for each person living in the home on all expenditure for the last two years. The Windbound DS0000043699.V376004.R01.S.doc Version 5.2 Page 36 Care Quality Commission National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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