Inspection on 03/04/07 for The Windbound

This inspection was carried out on 3rd April 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Windbound 27/07/09

The Windbound 03/09/08

The Windbound 25/09/07

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 09/07/2008.

CARE HOME ADULTS 18-65 The Windbound Shepperdine Nr Thornbury South Glos BS35 1RW Lead Inspector Paula Cordell Unannounced Inspection 3 and 4th April 2007 09:30 rd The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 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.V334459.R01.S.doc Version 5.2 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.V334459.R01.S.doc Version 5.2 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 To be Appointed Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate one named person aged over 65 years. The registration will revert to previous when that person leaves. 6th September 2006 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. Residents 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. Ms Lesley Richings is the manager and as yet has to be registered with the Commission for Social Care Inspection. The fees for the home at the time of publishing this report range from £1,092 to £2,779 per week. The home is in the process of setting up an Email address. This was not available during this inspection visit. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The purpose was to follow up the outstanding requirements and recommendations from the inspection in September 2006 and monitor the quality of the care provided to the twelve adults that live at the Windbound. The manager was present during the inspection. In addition the inspector had an opportunity to speak with the operations manager and three members of staff. The focus of the inspection was on the general care of a sample group of residents and the environment, including an extensive tour of the premises. This provided a good opportunity to observe residents in the different flats as well as allowing for informal conversations with individuals and the staff supporting them. The provider has been sending reports of the monthly regulation 26 visits and these were used to plan the inspection along with the pre-inspection questionnaire. The inspection was conducted over a period of two days for a total of twelve hours. During the period between the last inspection and this the home has made a referral to the Adult Protection Team and this is still being investigated and as yet an outcome has not been reached. In addition, the manager and the operations manager met with the lead inspector at the local office for the Commission for Social Care Inspection to discuss the lack of registered manager for the home, since June 2006. What the service does well: The home supports individuals with complex care needs, which include behaviours that challenge. It is encouraging that the environment is homely and furnished with ordinary domestic furnishings. Residents are encouraged to make full use of the local community and daily outings are organised. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are three outstanding requirements from the last inspection which include cleanliness of the home and formal support to the staff to include supervisions and staff meetings. The manager must ensure that there are systems in place to support and manage the staff ensuring a consistent approach. Residents must benefit from guidelines for staff to follow in response to behaviour that challenge ensuring a consistent approach. Residents would benefit from having a more structured plan of social activities which links to their goals and aspirations. Residents would benefit from having more involvement in the running of the home and the planning of their care. Residents should benefit from care planning documentation being archived where no longer relevant to enable information to be more accessible. Residents must be assured that the home is of sound construction. With an appropriate professional investigating the damp in two of the bedrooms and into the cracks that are appearing on the ground floor. In addition the guttering and the facia boards are in a poor state of repair. Where restraint is used, this must be with the consent of the resident and or their representative. Terminology should be reflective of the service provision and in relation to the restraint method used. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 7 Residents would benefit from having toilet roll, soap and towels available in bathrooms. The manager must attend training relevant to their role including protection of vulnerable adults and a suitable management course, which would have benefits to both the staff and the residents. Residents must benefit from a trained workforce which links to their specific care needs to include mental health. Staff would benefit from formal supervision and regular staff meetings, which will give, staff a forum to air their views and offer clear direction and guidance. 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 summary of this inspection report can be made available in other formats on request. The Windbound DS0000043699.V334459.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.V334459.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have sufficient information to make a decision on whether to move to the home. However it would be beneficial if this was available in different formats ensuring it is accessible to a wider audience. Residents assessed care needs are being met. EVIDENCE: The statement of purpose and service user guide had been read on previous visits to the home and was found to contain all the information as required by the National Minimum Standards and the Care Home’s Regulations. This has been reviewed by Voyage to ensure that this is specific to the care needs of the individuals living at the Windbound. Information was available in plain English. However, consideration should be taken to make it more accessible to the residents. The statement of purpose clearly describes the admission process and the criteria for potential individuals that the home could support. The home has an established group of residents with no vacancies. Although one resident was keen to share a recent experience of visiting another home that was felt more The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 10 appropriate to their needs. It was evident that the resident and the placing authority were involved in the process. The operations manager was keen to share new plans for the Windbound, which would mean that there were clearer boundaries to the three flats and that residents with similar needs would live together. Each flat would have a designated team of staff with the appropriate skills to support the individuals. Each flat would be self-contained with separate facilities including a kitchen and lounge area. The operations manager stated that this would include a complete refurbishment of the home and minor building works being undertaken. The operations manager has agreed to forward the plans to the Commission for Social Care Inspection once finalised. Training will be discussed later in this report. However there was a lack of training linked to the assessed needs of the residents, for example mental health, epilepsy and autism to name a few. Training focused on mandatory health and safety training and techniques for supporting individuals that challenge. Training must link with the assessed care needs of the residents. Each service user had an assessment of need and a personalised contract of care that informed the plan of care. These were commendable. Where residents care needs had changed the home was seeking the support of the local community learning disability team to reassess residents and support them with behaviour care plans. The Windbound DS0000043699.V334459.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a service that identifies their care needs, however the service fails to involve them in this process and fails to protect them from others. EVIDENCE: Care planning records were viewed for three residents. There was evidence of three monthly care reviews completed by the staff and an annual review involving the placing authority. It was less apparent how residents were involved in the planning or the review of their care from the home’s documentation. The manager stated that the placing authorities review all residents annually and residents are asked if they would like to attend. Resident’s views should actively be sought during the review process, which is conducted by the home. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 12 Discussions with staff demonstrated that they had a good understanding of person centred care, user participation and the rights of the individuals living in the home. Records further evidenced how individuals are supported to make choices and communicate their care needs. A number of staff have attended a course on sign language specific to individuals with a learning disability. This was observed in use during the inspection. However, a member of staff stated that more staff would benefit from this training. Three residents spoken with stated that they liked living at the Windbound. Residents were observed moving freely around their individual flats and accessing the secure garden over looking the river Severn. An opportunity was taken to view the records for three residents. Risk assessments were being routinely reviewed and updated. However, there was a lack of soap and toilet roll in a bathroom and the inspector was told this was because of risk of flooding. There was no risk assessment for the individuals supporting the decision process and ensuring this is kept under review. Risk assessments included information on restrictions imposed on individuals and the reasons. For one individual it was clear that this had been discussed with the placing authority, relatives and other professionals. It was evident that the manager and the staff were committed to the care of the residents and were substantially reviewing strategies and approaches to the individual ensuring they remained appropriate. It was evident from conversations with staff and the manager and care documentation that the home seeks assistance both from the organisational behaviour specialist and the local community learning disability behaviour team. A resident confirmed that they had a meeting planned, which involved a number of professionals including a social worker and the psychiatrist. Behaviour strategies were in place detailing the triggers, de-escalating strategies and the interventions. These were personalised to the individual. There were clear records of incidents of behaviour and the strategies used. Staff confirmed the home’s policy that restraint was only used as a last result and that the home uses techniques that cause no physical discomfort. However, records seen for one individual indicated that they had been restrained (a technique in this case, which was to move the individual to another area) on 26 occasions since January 2007. One member of staff stated that they were concerned about the high amount of times that restraint had been used for this particular individual. From conversations with staff the individual has been hitting out at other residents. The manager must make a referral to the Adult Protection Team ensuring the protection of the other individuals living in the home. As individuals should not be subjected to attacks (assaults) on a regular basis. During the course of the inspection the individual hit out at three members of staff, and it was noted that staff ignored the behaviour. Guidelines must be put in place to ensure a consistent approach. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 13 The manager stated that a referral has been made to the local community learning disability team for assistance in the management of the individual’s behaviour. In addition the terminology used for this particular resident makes reference to a “child restraint” which could be perceived as inappropriate in that the individual is an adult. Staff records confirmed challenging behaviour training is annual, however the home’s policy states that this should be six monthly. The manager stated that there have been some issues delivering the training for supporting individuals that challenge, as the instructor is no longer based at the home. The manager confirmed that dates have been arranged for those it is no longer current over the next month. This will be followed up at the next inspection. As seen at the last site visit consultation with residents whilst not formal was evident on a day-to-day basis in the planning of their care and more formally at the key worker meetings. However, the key worker reviews remain adhoc. One resident had two key worker reviews, whilst another had only had one and the third none. The documentation should evidence who took part in the review. A recommendation would be to formalise this to ensure that they consistently take place to ensure that there is a regular forum for residents to air their views. The Windbound DS0000043699.V334459.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): 12,13,15,16,17, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are supported to go out and about in the local community. There is a lack of structure to the activities of which some residents may benefit from. Residents have a good variety of food available to them. EVIDENCE: Whilst it was evident that most residents were getting out on a daily basis there was minimal structure to the activities completed and they did not link to individual’s needs or aspirations. The manager stated that some of the residents attend swimming at a local swimming pool and a hydro pool twice each week, two residents attend college and residents have the opportunity to attend church on Sunday. Other than that there is no structure to the weekly timetable of events. Whilst it is acknowledged that some residents prefer minimal structure, others may prefer activities to take place at more familiar times which link to the their goals and aspirations. Staff confirmed that there The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 15 was little structure and activities depended on the staff on duty however, it was felt that the trips out were a benefit to the residents. From conversations with staff activities were not just limited to outside the home but arts and crafts and cooking and home skills are completed. A resident confirmed that staff have recently supported them in the kitchen to make some cakes and that they had recently attended college. These activities were not recorded in the daily records so it was difficult to determine the frequency or for the home to formally review the activities that were taking place. A member of staff stated that one resident becomes upset and will hit out at residents and staff if they are unable to go out on the minibus. From talking with staff it was evident that there was not a consistent approach to supporting the individual with the aggression. Some staff increase the trips out linking it to boredom whilst others, seeing the behaviour as inappropriate, stop the trips out until later in the day. Clear guidelines must be developed to offer the individual a consistent approach. Two residents confirmed that they have regular contact with family; one individual stated that they telephone their relative weekly, whilst another stated that family come and visit on a regular basis. This was confirmed in conversations with staff and in care records. Residents have available to them a nutritious and varied diet. In addition to the planned menu there is a list of alternatives. Three residents commented positively on the food provided and that there was a choice available to them if they did not like what was on offer. Residents were observed having a wholesome meal at lunchtime, which consisted of pasta with vegetables and garlic bread with a side salad. One resident had a sandwich preferring to eat a cooked meal in the evening and three residents were out for lunch. Food cupboards were well stocked with a combination of fresh and convenience food. Concerns raised during the last inspection had been addressed in that food, which had been opened in the fridge, was labelled and dated. There were policies and procedures available to staff guiding them on the safe handling of food. Records for fridge/freezer and food temperatures were consistently being completed. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s personal and health care needs are being met and they are protected by the home’s medication systems. EVIDENCE: Records were informative about the personal care needs of individuals giving clear direction to staff. This included individual preferences on how they wanted to be supported. Residents are supported to attend appointments with the GP, opticians, dentist and hospital. Residents had very distinctive style in clothes and haircuts. Residents seen on the day of the inspection had the appearance of being well cared for. Evidence was provided that other professionals are consulted on the care provision complimenting the skills and the knowledge of staff. The home operates the key worker system as confirmed in records and conversations with staff and residents. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 17 As seen at the last inspection 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 and consultant psychiatry and psychology. In addition there is a counselling service, chiropody, hairdressing and therapeutic massage. Records relating to stock administration were found to be satisfactory. All medication was stored appropriately. The home has clear individual procedures for the use of as and when required medication and the use of non-prescription medication (homely remedies). This is good practice. The information was informative and detailed to enable new staff to support individuals. The home has designated staff members who have been assessed as competent that are solely responsible for the administration of medication. Records demonstrated that these staff had attended appropriate training. Since the last inspection senior care staff have completed a distance learning pack on medication to further enhance their skills and competence. This was confirmed in conversations with staff and the manager but the home was awaiting the certificates. Quality initiatives were taking place to ensure the administration of medication was appropriate and in accordance with the local procedures. This is good practice. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their concerns would be listened to. However, the lack of staff training in adult protection could potentially put residents at risk of harm. EVIDENCE: Systems for individuals to raise concerns and complaints were reviewed, the home was able to demonstrate that the home would respond to a complaint. Staff interviewed were well informed about the complaint process. The home has not had a complaint since the last site visit, as evidenced through the pre-inspection questionnaire and the home’s records of complaints. The home has copies of the local authority’s policy on the protection of vulnerable adults and a copy of “No Secrets” to compliment the home’s policy on the procedure to follow in the event of an allegation of abuse. These were seen during the site visit in April 2006. The home has instigated the adult protection policy and a member of staff has been suspended and referred to the Department of Health’s POVA List. The Commission for Social Care Inspection and the local Authority have been kept informed of proceedings. There was an initial delay in both the reporting both to the manager and to the local authority and the manager was reminded of The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 19 the need to inform the local authority. The investigation has yet to be finalised and the manager has agreed to keep the Commission informed of the outcome. Staff attend a combination of in-house and external courses on abuse. The training manager provides this training and it was suggested that they attend a “train the trainer course in abuse” organised by the local authority. This was not followed up at this inspection. It was noted that six staff had not attended training on abuse including the manager. Staff spoken with during this site visit had a good understanding of what constitutes abuse and the need to report to the manager. Less apparent was the role of Social Services in the proceedings. Staff stated that they felt confident that the manager would take the appropriate action. Finances were not checked on this occasion. The operation manager completes random checks on the finances on a monthly basis and reports have noted that there were no inaccuracies. Care plans included information on the support needs for residents in relation to their finances and the contract clearly described what was included in the fees. This is good practice and in accordance with the National Minimum Standards. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents live in a homely environment. However, concerns are raised about the general condition of the external building and the cleanliness, which could put residents at potential risk. EVIDENCE: Windbound is a split-level property with the residential provision on the upper level. Accommodation for residents is provided in four flats. The manager’s office and training rooms and a café bar is on the ground floor. In addition the there are a number of offices in an annex, which is separate to the residential care home. In the past these have been used by the operations manager and the training facilitator for Voyage but are now empty and used only occasionally. The four flats have access to a lounge and three of the flats share a communal kitchen, which is domestic in scale and there are separate bathroom facilities. As discussed earlier in the report there are plans to make some changes to the The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 21 building to have three flats. The plans have not been finalised and it is evident that the home will keep the Commission for Social Care Inspection updated once the plans are finalised. Discussions were had that the home must ensure that residents have the same amount of communal space that they have now and in accordance with the National Minimum Standards. Three of the flats were homely and comfortably furnished. Residents’ bedrooms were personalised and contained appropriate furnishings. Flat four in contrast was bare. This was clearly documented in the plan of care and professionals had been consulted and the views of the resident sought. There are outbuildings that house the laundry, food store and potting shed. There are a number of outdoor spaces including an enclosed patio area, which can be reached by three of the four flats taking in the views of the river Severn. In addition there is an area that has a large enclosed fishpond and raised beds. There was an ongoing programme of general maintenance and refurbishment of the home. A number of areas had been redecorated and new furniture had been purchased. Areas seen were homely with ordinary domestic furnishings. Response to repairs was good with a general maintenance person visiting the home regularly. Minor repairs were being responded to on the day of the inspection. However, concerns were raised that in a number of rooms, large cracks have appeared and the stairs to the middle flat in part are spongy. A full investigation must be undertaken to ensure that the building is safe. The manager stated that a surveyor is visiting the property in the week following the inspection. The manager has agreed to forward a copy of the report and has offered reassurance that the organisation will undertake the appropriate works. There was damp in two of the bedrooms. A down pipe was missing, guttering had large clumps of grass growing and the general woodwork including windows and facia boards was in a poor state of repair. Whilst staff were observed to be completing the day-to-day cleaning of the home there were stains on skirting boards and walls. The manager stated there were no cleaning schedules in place to guide staff on the deep cleaning of the home. The manager stated that a recruitment drive was being undertaken to employ a domestic to free up care staff to support residents. Cleanliness of the home remains an outstanding requirement since September 2006. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Processes regarding support, supervision and guidance are lacking in the home and could be to the detriment of the provision of care provided to the residents, failing to ensure a consistent approach. EVIDENCE: Evidence was provided that the home was adequately staffed in accordance with the assessed care needs and the statement of purpose. The duty rota for the home provided evidence that the home had at least seven staff working in the home during the day and evening and three staff working in the home at night. One of the night staff sleeps in. Staff spoken with during this inspection described a good cohesive team and good support mechanisms in place. However, there was a lack of evidence of regular meetings and formal supervisions for staff. Recruitment records were not viewed on this occasion as these are held centrally. The Commission for Social Care Inspection has recently agreed this. The nearest office of the Commission for Social Care Inspection will inspect The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 23 these. The manager was aware of her legal responsibilities to ensure that a thorough recruitment process was undertaken. The organisation has procedures on equal opportunities and recruitment processes. These were viewed at the last key inspection in April 2006. All staff spoken with had a good awareness of their roles. Contracts and job descriptions were in place as seen at the last inspection. Inductions were seen for new staff and staff confirmed that they had completed a thorough induction and staff were supportive in guiding them during their induction period. New staff in post confirmed that they had completed the crisis and aggression limitation management training (CALM). Existing staff confirmed that this was undertaken annually and that some staff had exceeded the twelve months. However, the home’s policy states that this should be updated at least every six months. Training was in place and whilst it was noted that at the last key inspection in April 2006 that this had regularly been reviewed to ensure that staff have the skills to enable them to complete their roles, this was less apparent on this occasion. The home had good systems in place to audit the training ensuring that staff attend regular updates in health and safety, first aid, COSHH and annual fire training however less apparent was training relevant to the needs of the residents this had not been updated. The home’s overview chart did not correspond with individual staff training records and there was a lack of certificates supporting the attendance at the training. Staff and the manager stated that in the past a variety of training was offered however this is now limited to statutory health and safety training. There was no organisational prospectus of training available or training offered by the local placing authority. It was noted that only two staff had achieved a National Vocational Qualification at level 2 at the last inspection. Since the last inspection the manager stated that 2 staff are presently undertaking their NVQ 3 in care, and a further 15 staff have enrolled to do an NVQ 2. The staff are assessed externally. Two assessors were supporting staff on the day of the inspection. This was in response to a recommendation from the last inspection. The home is now actively working towards meeting the government target of 50 of the workforce to have an NVQ. As noted at the last inspection none of the staff have completed the Learning Disability Award Framework. In spite of a requirement at the last three inspections regular staff supervision is still not available for staff. Voyage has a formal supervision policy and this is not being followed in the home. Six staff records were observed and the amount of formal supervision varied from some staff only having one in the last twelve months to some staff having two. The manager stated that all staff that will be expected to have a supervisory role have undertaken training but as yet senior staff have not been assigned specific staff. The manager stated that there is an expectation that staff will have some choice. Consideration The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 24 should be that the manager gives more direction and guidance to staff as this has not been undertaken and is an outstanding requirement. There was a mixed message from staff on the communication systems within the home as noted at the last inspection; all stated that the manager was supportive however there has been many changes with the senior management level including change three changes of operational manager in the last twelve months. Again as noted at the last inspection there was a lack of staff meetings these were being held three monthly with the focus being on senior carers. Due to the nature of the challenges in the home staff should be supported through the supervision process on an individual level and in team meetings which would offer staff not only the support but give the home more purpose and clearer guidance to staff. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management of the home is reactive rather than proactive and there is a lack of direction and formal support systems to guide and direct staff. This impacts on the consistency of practice that could put residents and staff at risk. EVIDENCE: Staff stated that the newly appointed manager was supportive and dedicated to her role as manager and ensuring that the residents lead very active lifestyles. Staff stated that the manager responds to concerns raised. From observations, and the conversations it would appear that the management is reactive to issues rather than proactive. There lacks clear The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 26 guidance for staff in the lack of evidence of staff meetings, supervisions and the lack of planning of activities for residents and resident involvement. The manager has been in post since September 2006, there has been a lack of registered manager in the home since May 2006. The Commission for Social Care Inspection has recently received an application for Mrs Richings and the Central Registration Team are processing this application. This was in response to a letter being sent to the director of operations for Voyage. It was evident from conversations that the manager was respected by her team and has built good relationships with the residents. She was committed and dedicated to her role. Mrs Richings has been the acting manager for the Windbound since May 2006. Previously she was working as the deputy. In this period she has had three changes of senior management. There has evidently been a lack of training in place to assist with the transition from deputy to registered manager. The manager stated that they were in the process of applying for an internal course on leadership and management, which is completed over a three-month period. With the long-term plan to complete an NVQ 4 in care and management. Presently Mrs Richings has an NVQ 2 in care. Whilst she has had the practical experience of management she must attend appropriate training to her role and receive appropriate support from the organisation. The Commission for Social Care Inspection has received regular reports of monitoring visits in respect of regulation 26 conducted by the operations manager. In addition comprehensive monitoring “Monthly Service Review Programmes” are carried out following the Voyage organisations, own selfmonitoring, quality assurance system. Records were held securely and generally found to be in a logical and accessible format. Voyage has a number of policies and procedures, which have been developed and reviewed over time. They cover all aspects of running a care home and are relevant to the individuals that the home supports. Policies and procedures were kept in the main office and in the small office situated on the second floor. These were accessible to staff. Staff confirmed that these were covered during the induction and periodically with them as new policies are introduced. There were good systems in place to ensure the safety of residents and staff. Information was accessible to staff and included policies, procedures and risk assessments. Routine checks on the premises were being completed including the testing of the gas and electrical appliances. These systems also included checks on wheelchairs and the home’s vehicles. Logs were maintained of the checks. This is good practice. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 27 An opportunity was taken to view the fire logbook. It was noted that this was up to date until February but checks had not been undertaken during March 2007. However, the manager addressed this during the inspection. It was noted that not all staff have undertaken a fire drill in the last six months. However the manager stated that she had got confused and felt it was the premises and not the individual staff that should undertake the drill in a six month period. The manager has agreed to rectify this to ensure each member of staff attends a fire drill once in a six-month period. This will be followed up at the next inspection. The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 28 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 1 X X X 3 X The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 29 yes 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. Standard YA6 YA6 YA14 Regulation 15 (2) (c) (d) 15 (1) (a) 16 (2) (m) Requirement Service users to be more active in the planning of their care and participating in their reviews. For the home to develop clear guidelines when a resident hits out at staff and other residents. Service users to have care plans that identify their leisure activities, which offer individuals, structure enabling the home to review fully the individuals plan of care in relation to social occupation. The home must provide adequate toilet rolls, towels, and soap for the use of residents within a risk assessment framework. For the home to replace and ensure guttering, facia boards are of sound quality. For the home to investigate the damp in the two bedrooms in flat 1 and flat 4 and the flooring to the stairs leading to flat 2 and complete appropriate works. To ensure all parts of the home are clean. (Outstanding since 07/10/06) For the provider to submit a DS0000043699.V334459.R01.S.doc Timescale for action 04/06/07 04/05/07 04/06/07 4. YA9 13 (4) 04/04/07 5. 6. YA24 YA24 23 (2) (b) 23 (2) (b) 04/08/07 04/06/07 7. 8. YA30 YA24 23 (2) (d) 23 (2) (b) 11/04/07 04/05/07 Page 30 The Windbound Version 5.2 9. YA36 18 (2) refurbishment plan which includes timescales for redecoration of the home. (Outstanding since 07/11/06) The staff team to receive regular support and supervision at least 6 times per year (Outstanding from 1/5/06, 26/6/06). 04/05/07 10. 11. YA23 YA35 13 (6) 18 (1) (c) For the manager and staff to 04/08/07 attend training in adult protection. For the home to develop training 04/08/07 plan for the team collectively and for individual members of staff. For staff to attend training in mental health. The registered manager shall undertake from time to time such training as is appropriate to ensure that she has the experience and skills necessary for managing the care home. The manager must attend appropriate management training and a course for managers on responding to allegations of abuse. 04/08/07 04/06/07 12. 13. YA35 YA37 18 (1) (c) 10 (3) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA23 YA6 Good Practice Recommendations For the home to make a referral in respect of one individual that is hitting out at other residents to the adult protection team. For the home to review the term child restraint and develop a plan that all staff should follow when this DS0000043699.V334459.R01.S.doc Version 5.2 Page 31 The Windbound 3. 4. 5. YA6 YA36 YA36 individual hits out at both staff and residents. For the home to archive information in care files if no longer relevant. Staff to receive at least six supervision sessions per year. (Outstanding since 26/0406). Staff meeting to be held regularly at least monthly or as determined by the staff team and the needs of the care home. (Outstanding since 26/05/06). For new staff to complete the Learning Disability Award Framework as per standard 35 For the home to develop cleaning schedules for ensuring that all parts of the home are clean including deep cleaning. (Outstanding) 6. 7. YA35 YA30 The Windbound DS0000043699.V334459.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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