Inspection on 03/09/08 for The Windbound

This inspection was carried out on 3rd September 2008.

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

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 7 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 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 09/11/2008.

CARE HOME ADULTS 18-65 The Windbound Shepperdine Thornbury Sth Gloucestershire BS35 1RW Lead Inspector Paula Cordell Unannounced Inspection 3rd September 2008 09:30 The Windbound DS0000043699.V366166.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.V366166.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.V366166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Windbound Address Shepperdine Thornbury Sth Gloucestershire 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) Voyagecare.com Voyage Ltd Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Windbound DS0000043699.V366166.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 25th September 2007 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 £2,444 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.V366166.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 progress to the requirements and recommendations from the visit in September 2007. In addition to monitoring the quality of the care provided to the eleven individuals living in the home. There has been one additional visit in July 2008.This was to follow up concerns raised by the local placing authority in respect of staffing and arranging a healthcare appointment for one individual. Finding of this visit will be included in this report. The inspection methods used included record checks, case tracking, a tour of the home and discussion with the manager, three staff, and people who use the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. These were used as a focus for the site visit, along with the annual quality assurance selfassessment completed by the home and comments from people who use the service (5), relatives (4), staff (5) and visiting professionals (3). The visit was conducted over a period of six hours and ended with structured feedback. What the service does well: Individuals are supported by a dedicated team of staff who show good understanding of the needs of the individuals. 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. Individuals are encouraged to make full use of the local community and daily outings are organised. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Individuals must be assured that there is a competent manager who is registered with the Commission for Social Care Inspection. This has been a requirement from a previous visit. Individuals must be assured that the contracts specify the fees, who is responsible for paying them and any additional costs to the placement. Individuals and their relatives would benefit from having clear information in the statement of purpose describing the changes to the service which would clearly describe what is being offered. This must include the staffing arrangements for each area of the home. This would ensure that the service is open and transparent. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 7 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.V366166.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.V366166.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): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals and their representatives would benefit from clear information in respect of the changes to the service. Contracts are misleading, as these do not detail information about the current fees and money the individuals are entitled to. In addition the service is not being open and transparent about the contributions that are being made towards the transport costs. EVIDENCE: The home has a statement of purpose and a service user guide. This has recently been updated to include the changes in the provider’s address and registered individual. A requirement was made during the visit in July 2008 for the home to develop a more in-depth statement of purpose in respect of the recent changes to the service where by the home has introduced clear defined flats with nominated staff supporting the individuals. The plan to clearly define the flats has been implemented from the 1st September 2008 but this has been discussed at previous visits from as early as the April 2007. This change has been seen as a positive move to provide a more individual and focused service to the individuals with dedicated staff to support them. There The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 10 are four flats and these have all been given names since the visit in July 2008. The flats are called Severnside, Sabrina View and River Cottage. This has meant little change to where the individuals live. The flats have always been in place but not so clearly defined in that all staff have worked across the home. The main change is that each area will have a dedicated team who are trained to support the individuals for example Severnside support individuals who have mental health and have a diagnosis of autistic spectrum disorder and epilepsy whilst one of the other flats support individuals with non-verbal communication. This is seen as a positive step in providing a more person centred and individualised package of care. However, these changes must be reflected in the statement of purpose including staffing, specific staff skills and the needs of the people that each flat can support. The latter will assist in the admission process for prospective individuals moving to the home. The Windbound is a service that supports individuals with complex and challenging care needs. During the last visit there were concerns raised about the training that was in place for staff to support the individuals in relation to challenging behaviour, mental health and autism. Staff stated that this training is now being put in place. The majority of the staff have attended training in relation to autism and supporting one particular person with their challenging behaviour. Further training is planned throughout October 2008 to ensure that all staff attend training in challenging behaviour. This was confirmed in the records. Training will be discussed further later in this report. The home has an established group of individuals that have lived in the home for a number of years. There is one vacancy. The manager stated that this is not going to be filled, as the vacant room is now the manager’s office. This previously was on the ground floor. Again this was seen as good practice as it means the manager is more accessible to both the staff the individuals living in the home. Each person receiving a service had an assessment of need and a personalised contract of care that informed the plan of care. These were commendable. However, the section relating to finances needs reviewing to ensure it reflects the new fees and personal allowances that the individual is entitled to. This remains an outstanding requirement. The manager said she has recently obtained this information and is planning to update the financial section in the contract of care. From this information it was noted that all the individuals contribute towards the cost of the transport at variable rates depending on the level of Disability Living Allowance in respect of mobility. Those on higher rate contribute more. The manager said the organisation’s finance department prior to the individuals receiving their finances does this. Concerns were raised with the manager whether this was equitable. It was noted that one person paying a higher rate quite often refused to go out using the home’s transport. There were no agreements in place consenting to this expenditure either from the individual or their The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 11 representative including the placing authority. It was not clear whether the funding authorities pay a contribution to the transport costs as part of the agreed fees. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that their assessed care needs are being met. Individuals are supported to be as independent as possible and are protected by a risk assessment framework. EVIDENCE: Three persons care plans were viewed to determine how the home was supporting the individuals. Care plans gave sufficient detail to enable a clear path of how staff support the individuals. These had been kept under review. It was evident that these were person centred and reflected the preferences of the individual. The home’s care plan linked with the assessment and care plan drawn up by the placing authorities. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 13 Reviews were held at regular intervals involving the individual, their relatives, care staff and the placing authority. Key workers complete three monthly reviews, with formal care reviews being organised annually. However, one person had not had a formal annual review since February 2005. The manager stated that this was because the placing authority has been unable to attend. Irrespective of whether the placing authority can attend it is important that the home has an annual (or more frequent where needs are complex) review involving the individual, their relatives and any professionals that are involved in the person’s care. No requirement was made during this visit but will be followed up during the next visit to the home. The home has responded to a requirement for one individual to be reassessed due to concerns raised by the home that they were not meeting the person’s needs. The home has demonstrated compliance and has put safeguards in place. This has included a more structured activity plan, a move to another part of the home and staff consistently following the plan of care for the person. From reviewing care records and speaking with staff and the manager it was evident that this has had a positive impact on the person’s life and other people that live in the home. During this period of time the home has accessed support from other professionals, which has had a positive impact on the care planning processes and ensuring a consistent approach. Risk assessments were in place and covered a wide spectrum of activities both in the home and the community. These had been kept under review. The home had started to introduce a new person centred care plan called “My life” as noted during the visit in July 2008. Mrs Richings said that this has been completed for one person, with the plan that this will be cascaded to staff to complete at the next staff meeting. However, from talking with Mrs Richings it was evident that the progress has been slow with little work having taking place in the last six weeks. This will be followed up during the next visit. There was a requirement from the last visit to ensure that individual’s communication needs are clearly documented in the plan of the care. Support Plans seen did include information about how the individual communicates. The manager said this was work in progress. The home has demonstrated compliance but this will continue to be a focus for future visits. In light of the levels of challenging behaviour and the communication needs of the people living in the Windbound. Relative’s comments from surveys were positive about how the home keeps them informed of changes to the plan of care for the individual. One comment included “Staff are always helpful in updating me on X’s progress”, another comment included “X gets lots of support from staff and I greatly admire their patience and understanding”. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 14 One relative stated “I cannot speak highly enough of the huge efforts of the staff and the manager at the Windbound to get to the bottom of why X was behaving so aggressively. During this time additional staff were employed to ensure everyone’s safety”. Support plans included information on how the individual should be supported with their challenging behaviour including the triggers. The home is implementing a new training package for staff, which will mean that these will need to be updated to include the new guidance. The manager stated that these couldn’t be changed until all staff have had this training. The manager has agreed to commence this change by rewriting the plans and for this to be fully up and running by October 2008 when the last member of staff will have received the training. No requirement has been made but this will be followed up during the next visit. Records were being maintained in the event that staff have to use restraint. Staff confirmed that this is used as a last result. From reviewing these records it was evident that there has been a reduction in the amount of restraint used over the last twelve months. This is good practice. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals have opportunities to participate in activities both in the home and the local community. Good contact is maintained with friends and relatives. Individuals have a health and varied diet. EVIDENCE: This is an area where the home has considerably improved. Everyone has a structured day activity. Evidence was provided that these were being followed. It was evident that the activities are tailored to suit the individual’s preferences. Staff stated that this has improved with the recruitment of new staff and increasing the staffing from seven to nine. Various activities were taking place during this visit both in the home and the local community. Some of the individuals had been supported to go swimming and then out for lunch, whilst others were going out for a bike ride or doing The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 16 arts and crafts in the home. Some of the individuals were seen using the relaxation/sensory area on the ground floor. Daily records provided evidence that there has been a commitment to ensure that the activities are taking place. The manager said that they were in the process of recruiting an activity coordinator, which would further improve this area. This will be followed up during the next visit. Staff were seen spending time with the individuals. It was evident that the recent change in relation to the flats was seen as positive. One member of staff stated, “now we are assigned to specific areas in the home we can get to know the individuals better and offer a consistent approach”. Individuals are supported to attend college, swimming, arts and crafts, trips out, relaxation and visits to church. Annual holidays are arranged for those individuals that benefit. For some of the individuals a holiday would not be beneficial due to the way the individuals react to change however from conversations with staff and the deputy manager this is constantly kept under review. A detailed plan was in place to demonstrate that holidays were being planned including trips to Butlins, Cornwall, Devon and other places of interest. It was evident from conversations that the holidays were tailored to the individual and staffed according to the assessed needs of the individual. Individuals living in the home confirmed that they have contact with relatives. Staff stated that individuals are supported to visit relatives in their home. Some of the individuals use the telephone to maintain contact. This is commended, as some relatives are not local. This was further evidenced in care records. Individuals have available to them a nutritious and varied diet. In addition to the planned menu there is a list of alternatives. A record of meals is recorded for each individual in the daily diaries. This is good practice. Staff described how the individuals in Severnside are encouraged to take more of an active role in the preparation of food including shopping. Individuals confirmed in conversations that the food was good. There were policies and procedures available to staff guiding them on the safe handling of food. Records for fridge/freezer temperatures were consistently being completed. Cupboards were well stocked with a combination of fresh and convenience food. An opportunity was taking to have a meal with the individuals in Sabrina View. The meal was tasty and well presented. Support given to one individual was sensitive and it was evident that independence was promoted. The Windbound DS0000043699.V366166.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal and health care needs are being met. However, conflicting advice from different professionals involved could be putting individuals at risk and lead to inconsistencies in the delivery of care. Individuals are protected by the home’s medication systems and practices. 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 an 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 psychiatry and psychology. In addition there is a counselling service, chiropody, hairdressing and therapeutic massage. One person has been supported with a recent bereavement and was accessing a specialist counselling service. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 18 Feedback from two visiting professionals raised the concern that the organisation has their own behaviour therapist and at times this can conflict with the advice given by the local Community Learning Disability Team. In addition there was a concern that the home only contacted the Community Learning Disability Team when an individual was in crisis and there was a lack of involvement prior to this. This was discussed with the manager at a recent joint meeting with the Local Placing Authority and the Commission for Social Care Inspection. It was agreed that regular meetings would take place with the Community Learning Disability Team involving Voyage’s behaviour specialist from Voyage ensuring that there is a consistent approach and advice given. From reading care records it was evident that the consultant psychiatrist was regularly reviewing the individuals. The manager said that all individuals were being encouraged and supported to attend well being clinics at the local surgery. This has been completed for two of the individuals and further appointments were being made for the other nine individuals. It is recommended that the home develop health action plans. In accordance with the government’s white paper Valuing people in that all people with a Learning Disability have a health action plan. It was suggested to the manager that she contact the local Community Learning Disability Team for advice. Medication was reviewed on this occasion. Robust systems are in place for medication entering and leaving the home and the administration. A visiting professional stated that “advice on medication is followed through and changes made”. One visiting professional was concerned that staff had a lack of knowledge in relation to one individual’s prescribed medication for diabetes. This was clarified during this visit and staff were aware of when and why this was prescribed. Policies and procedures were in place including evidence of training for staff who have the responsibility for administering the medication. The manager stated that only senior and night staff administer the medication. The pharmacist has recently audited the home’s medication systems and all was satisfactory. Medication audits are completed on the systems and records on a weekly basis. A senior care worker said the home is exploring how the medication can be kept in the individual flats. It was evident that this included purchasing new storage. The Windbound DS0000043699.V366166.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that they concerns would be listened to and acted upon. Staff’s increased awareness of the policies that are in place to protect individual better affords their safety. EVIDENCE: The home has a complaint procedure and record. Evidence provided from completed surveys from both relatives and people who use the service demonstrated that they were aware of how and who to complain to. It was evident that relatives found the manager and the staff approachable. The home has recently introduced a new record of complaint that details the nature of the complaint, the investigation and the outcome. There have been two concerns raised since the last key inspection. One of these complaints was from a visiting professional and was brought to the attention of the Commission for Social Care Inspection by South Gloucestershire County Council. The information was shared with the home in July 2008 over the telephone. An investigation was conducted. But as noted during the random visit in July this was not recorded in the home’s complaint book. This was rectified by the manager during this visit. The professional was concerned that one of the flats had been left with no staff, with the staff member leaving the building to assist the profession. In addition staff were unaware of a pending health care appointment. The other complaint was from a relative and from the record it was evident that this was investigated and the outcome recorded. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 20 The home has made a safeguarding referral in respect of a member of staff. This incident occurred in March 2008. As reported in the visit in July 2008 it was noted that there has been a significant delay in the organisation making a referral to the POVA register. Letters have been sent to Voyage for them to review their policy to ensure it includes when to make a referral to the register including the interim referral process when a member of staff has been suspended. This information was forwarded to the Performance Relationship Manager (Commission for Social Care Inspection) to discuss at a meeting with Voyage’s senior management. The manager said that the organisation is in the process of updating the guidance. This will be followed up at the next visit to the home. Concerns were raised during the visit in September 2008 in respect of the home liaising with the local authority in respect of safeguarding issues and subsequently a requirement was made. As noted during the visit in July 2008 it is evident that the manager is much clearer and has completed training in this area. In addition the staff have received training in protection of vulnerable adults as part of a rolling programme. Staff were aware what constitutes abuse and who to report this to. In addition staff were aware of the whistle blowing policy. Finances were not viewed on this occasion. These are checked during the regulation 26 visits that the provider completes on a monthly basis. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. 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. The Windbound would benefit from a refurbishment plan and a commitment from the organisation in achieving this. The environment could impose a risk to staff and the people living in the home in relation to the management of challenging behaviour. 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 three flats have access to a lounge and two of the flats share a communal kitchen, which is domestic in scale. There are separate bathroom facilities for each flat. As discussed earlier in this report the home has commenced in the The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 22 plans to make some changes to the building to make the flats more selfcontained. The manager stated that the organisation is exploring how the home can utilise some of the space on the ground floor. This will include an activity space for arts and crafts/day care activities and a meeting room for families and friends, which will afford the people who use the service more privacy. Whilst some work has been completed since the last visit this is not complete and some of the ground floor areas are looking tired and run down and the small meeting room has not materialised. The home was found to be clean and free from odour. Response to repairs was good with a general maintenance person visiting the home regularly. One of the lounges has recently been decorated to reflect the taste of the occupant. It is evident that staff have made a real effort to make this area more comfortable for the person. The staff have developed a relaxation/sensory area on the ground floor. It was evident that this has been to the benefit of the individuals who live at the Windbound and is being utilised on a regular basis. The home has a number of outbuildings, which house the laundry, food store and potting shed. During the inspection in September 07 the deputy stated that the gardens are being developed and the plan is for the gardens to be more useable by the people living in the Windbound. As yet no work has commenced. Concerns are raised in relation to the commitment of the organisation in providing a budget to enable the plans to go ahead in respect of the environment. An action plan was received from the provider, which outlined some of the long and short term plans for the home. This included reinforcing the identity for each flat by painting each flat a different colour and having clear external signposts to each flat. The manager said this would ensure that visitors did not walk through each flat disturbing other people living in the home. Other areas of improvement included developing individual gardens for the flats, which are secure (as already stated this was being discussed in September 2007). The area manager also stated in the action plan that the narrow corridors that currently exist could be detrimental to the management of challenging behaviour and staff safety. This could benefit from capital expenditure in order to open them up. No timescales were given for this work. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 23 In relation to the environment being detrimental to staff safety, there is no system for calling staff effectively in the event of an emergency or if a person is being particularly challenging. Staff carry personal alarms but from talking with staff it was evident that these could not be heard throughout the home. The manager stated that the organisation is planning to use the ground floor space as an activity centre, which will be staffed independently of the care home. Again this has been discussed on a number of visits in the past but nothing has transpired from these discussions. One visiting professional commented, “The Windbound is an isolated rather run down environment and appears there is a lack of investment from the organisation” The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a lack of staff planning in relation to daily staffing requirements which is having a detrimental effect on the care provided. Both the individuals living in the home and the staff have benefited from the improved systems in support and communication ensuring a consistent approach. EVIDENCE: The manager stated that a recent recruitment initiative has enabled the home to be staffed more effectively. From talking with staff and the manager it was evident that up until recently the home has been staffed with a minimum of seven staff per shift during the day and three staff at night. Staff stated that when there is sufficient staff on duty supporting each flat, there is a reduction in behaviours that challenge and people can be supported with their activities both in the home and the local community. From these conversations it was evident that this has only recently improved when there is nine staff on duty. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 25 This has recently been increased to nine staff during the day enabling the flats to be staffed individually. The home must ensure that the minimum staffing is recorded in the statement of purpose ensuring an open and transparent service is provided to the people living at The Windbound. It is not good practice to reduce staff in view there is a shortage as this should always be maintained to ensure the care needs of the individuals are being met. The home as already mentioned has had a complaint about staffing. This related to a flat being left with no staff when a member of staff went out to support a visiting professional with one of the individuals. This was discussed with the home during the visit in July 2008. It was evident that the manager had investigated this and discussed this with all staff. It was required during this visit that the manager develops a staffing analysis for each flat which details the staffing levels depending on the occupancy. The manager stated that a risk assessment has been developed but it did not detail staffing. This remains outstanding. From talking with staff and a comment in a relative survey it was evident that when a person goes into crisis the staffing is increased. This was confirmed in the staff rotas where additional staff are employed at a specific time to support one person when it is known that they become anxious. This is good practice. Comments from relatives in respect of staffing included “the senior staff are extremely motivated, experienced and caring obviously in the field of “care”. There will always be newly recruited staff who need to be trained and require time to achieve the necessary skills and experience”. Another comment included “Staff have cheerful dispositions and very caring attitudes towards the service users”. An opportunity was taking to review the recruitment information. The manager stated the majority of this is held in the Human Resources Department at Head office. It is evident that the manager interviews staff and has an opportunity to read the application, but does not see the references. Without this information the manager is unable to make a judgement on whether the person is suitable to work in the care home and is missing a crucial part of the jigsaw. Whilst the manager is clear that a person should not be employed without suitable references and a criminal record bureau check all this documentation is not seen. A record is held in the home stating that references and a criminal record bureau disclosure has been obtained which is signed by a Human Resource’s member of staff. Good practice would be for this practice to be reviewed to enable the manager to fully see the process through. The organisation has policies on equal opportunities and recruitment processes as seen at a previous inspection. A member of staff confirmed that they had completed their induction and that their mentor had been very supportive in offering them direction and guidance. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 26 Records were seen confirming that the induction process had been completed in a timely manner as per the National Minimum Standards. As part of the induction all staff complete the Learning Disability Qualification. The manager stated that in addition all existing staff are in the process of completing this. This was discussed during the visit in July 2008, it would appear that there has been little progress since then, with only four staff having forwarded their assignments to be verified. All staff had a good awareness of their roles and the care needs of the individuals living in the home. There has been an improvement in the training that is delivered to staff. Staff have attended training in health and safety, food hygiene, manual handling and first aid. It was noted that newly recruited staff have completed this within a reasonable timescale as part of their six week induction. In addition staff have attended training in autism, challenging behaviour with further training being developed specific to the individual flats and pertinent to the individuals. This will continue to be a focus of future visits to the home. The manager stated that all staff have either completed or dates have been arranged for all staff to attend the Non Confrontational Interaction training. This training has recently replaced CALM and is now being cascaded to all staff. The manager stated that this will be completed for all staff by October 2008. It was evident from documentation, talking with staff and the manager that the home was working towards the target of ensuring that 50 of the workforce have a National Vocational Award (NVQ). The home has external assessors to support staff undertaking their NVQ. Eleven staff out of twenty five have an NVQ in care with a further six in the process of completing. Evidence was provided that staff have regular meetings and one to one sessions. This was evidenced through discussion with staff, staff surveys and records viewed. It is has been noted that senior carers have attended a course in supervisory skills to enable them to support the staff. The manager said that she has recently cascaded the role of supervising care staff to senior care staff. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 27 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 adequate. This judgement has been made using available evidence including a visit to this service. There has been improvement in the management of the home; there is an open door approach with good support for the staff working in the home. However, there is no registered manager and this has been an ongoing concern and this service is being managed reactively rather than a proactive approach. Individuals can be assured their safety. EVIDENCE: This service has not had a registered manager since June 2006. Ms Richings submitted an application, which was withdrawn in August 2007. This was then resubmitted again in November 2007 but with insufficient information so therefore was returned to Ms Richings. As yet no application has been received. Ms Richings stated during this visit that she sent this to the Commission for Social Care Inspection in May 2008. There was no record this The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 28 was received. As yet the Commission for Social Care Inspection has not received an application for a registered manager. Further concerns are raised concerning the senior management supporting the home. There have been five operational managers during that time period. Letters have been written to the director of operations relating to both the senior management and the legal requirement to have a registered manager in post. Reassurances have been given and this will continue to be monitored by the Commission for Social Care Inspection. The manager has made improvements to the service. These have included improvements to the care planning processes, social activities and staff training and support. However these have been addressed due to requirements made and not from the manager being proactive in her approach. From talking with the manager it is evident that the home has been through a number of crisis involving changes to people’s behaviour. It was evident that the manager and her staff team have tried to reduce with assistance from other professionals. However, this has led to one person being moved and one other being considered for a move. The service’s statement of purpose clearly states it can support individuals that challenge but soon as a person becomes challenging their placement is reconsidered. This is a cause for concern. A visiting professional stated in a survey “more complex changes involving behaviour management, staff arrangements environment and even unsuitable placements are not acted on quickly or at all sometimes”. A member of the local authority’s behaviour team stated “as a rule the Windbound do contact the team for help and advice but they could this earlier before they are at crisis”. This type of management is reactive rather than being proactive. It was evident that there are very mixed views on how the Windbound is managed. Staff spoke very highly about the support offered by the manager of the home. It was evident that the manager offered an “open door” style of management. This was further echoed in the surveys from relatives. It was very evident from observations that both the people living in the Windbound and staff have a positive relationship with the manager. From talking with Ms Richings it is evident that she is very passionate about her role and the people living at The Windbound and does want to get it right. The manager has attended an internal management course and is in the process of completing her Registered Managers Award. 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. Questionnaires are sent to relatives, professionals and individuals receiving a care service on an annual basis. In The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 29 addition Voyage have a quality assurance team that complete audits periodically on the home. This has recently been completed and the manager was waiting for a final report. Informal feedback from the manager was that there were improvements that could be made namely to ensuring that policies and procedures are current and that relatives are given a copy of the safeguarding policy. Records were held securely and generally found to be in a logical and accessible format. Policies and procedures were not viewed on this occasion. There were good systems in place to ensure the safety of people living in the Windbound and the staff team. Information was accessible to staff and included policies and procedures and risk assessments. Routine checks on the premises were being completed including the testing of the electrical appliances, servicing of the gas appliances and routine checks on the fire equipment. These systems also included checks on wheel chairs and the home’s vehicles. Logs were maintained of the checks. This is good practice. A comprehensive folder contained all the data sheets in respect of chemicals used in the home. Staff training relating to health and safety is in place as discussed in the standards relating to staffing. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 x 3 x x 3 x The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 31 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. Standard YA5 Regulation 5A Requirement To review the licence agreements and care plans re finances to ensure reflects current fees and what the individual is entitled to in relation to personal allowances. (Outstanding since 25/11/07) For licence agreements (contracts) to include any additional costs for example contributions to car parking or day care. Review statement of purpose to include the changes to the service. This will include the recent introduction of the new flats Severnside, Sabrina View and River Cottage. This must include a breakdown of the staffing for each area. A copy to be sent to the Commission for Social Care Inspection To review the disciplinary policy to ensure it includes the Department of Health’s guidance on making interim referrals to the POVA Register. (Within the timescale) Replace kitchen worktop DS0000043699.V366166.R01.S.doc Timescale for action 03/11/08 2. YA5 5A 03/11/08 3. YA1 4 (1) 03/11/08 4. YA23 13 (6) 15/09/08 5. YA24 23 (2) (b) 03/10/08 Page 32 The Windbound Version 5.2 6. YA24 23 (2) (b) 7. YA37 Care Standards Act - A refurbishment plan to be submitted in relation to the works that have been discussed in this report – The painting of the building in relation to the identification of the flats, garden development and the work to the ground floor etc with clear timescales. So that this can be monitored by the Commission for Social Care Inspection. The manager must submit an application for registration to the Commission for Social Care Inspection. (Outstanding since 24/10/07) 03/10/08 03/10/08 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 YA34 Good Practice Recommendations For the manager to view the references prior to making a decision to appoint. The Windbound DS0000043699.V366166.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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