Inspection on 11/08/05 for The Woodmill

This inspection was carried out on 11th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Woodmill 09/07/09

The Woodmill 15/06/07

The Woodmill 15/02/06

The Woodmill 31/12/04

The Woodmill 03/06/04

The Woodmill 09/03/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 The Woodmill Exeter Road Cullompton Devon EX15 1EA Lead Inspector Louise Delacroix Announced 11 August 2005 10:00hrs 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 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 Stationary 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 Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Woodmill Address Exeter Road Cullompton Devon EX15 1EA 01884 836220 01884 836229 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brain Injuries Rehabilitation Trust Mrs Penny Jean Blackmore Care Home 19 Category(ies) of MD Mental Disorder (19) registration, with number PD Physical disability (19) of places The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 31 December 2004 Brief Description of the Service: The Woodmill is a single storey building, which was specially adapted in 1993, for the Brain Injury Rehabilitation Trust. It operates in conjunction with other residential services and community services, to provide a continuum of services operated by the Brain Injury Rehabilitation Trust. There are currently 18 single bedrooms all with en-suite facilities. The home’s application to increase their occupancy to 19 is complete. There is a conservatory lounge and an activity /TV Lounge, with another activity area with pool table and seats. There is also an art room. A physiotherapy room is available. There is a training kitchen with a high/low sink and a work skills area. Outside there is a landscaped patio area and a BBQ area. There is a gardening area complete with a Polytunnel. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a day and was announced. Time was spent talking to people living at the home, who shared their thoughts on the service and their aspirations for the future. People living at the home were seen enjoying a pottery class, nurturing plants they had grown and using the home’s facilities i.e. pool table. Staff were also spoken to on an individual basis and observed in their practice. Records were inspected which included care assessments and plans, staff training and recruitment files, and safety records. What the service does well: What has improved since the last inspection? What they could do better: No requirements were made on this inspection. A recommendation of a sevenday annual holiday for long-term placements remains outstanding. From this inspection, a recommendation was made for the results of service user surveys to be published and made available to people living at the home, their representatives and other interested parties i.e. CSCI. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 6 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 Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4,5 Prospective residents are actively involved in moving to the home and have detailed information and involvement in reviews to help enable them to make a decision about whether the service can meet their individual needs. EVIDENCE: The statement of purpose contains the information required by this standard. The service users’ guide is available to each service user and kept in their rooms. Full assessments are carried out prior to admission to the home. The Woodmill team completes these. The assessments are detailed, and cover all issues in a holistic manner as well as recognising the individuality of the people living at the home. Care plans are then generated from these assessments. Rehabilitation and therapeutic needs are assessed by registered professionals within The Woodmill and are incorporated into the plan of care. Records evidence that relatives and service users are involved in the process. Three service users were case tracked as part of the inspection. Good evidence was seen of visits to prospective service users in their current settings and of the service users visits to the home. A service user confirmed that they had visited and looked around prior to moving. Reviews take place after a ‘settling in’ period, which include the service user, their representatives, the multi-disciplinary team at The Woodmill and external professionals. Reviews generally state if service users do not wish to be involved. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 9 The home rarely undertakes emergency admissions. This service is only offered to other BIRT units/services. A copy of the service user contract was seen, which is formatted in a clear manner, with the room number included. On a previous inspection, the manager advised how the fees charged are not stated on the service user contract due to previous issues of client confidentiality being broken by family members. The contract clearly states that service users have the right to know the charges and that staff can be approached to find out this information. The manager said that the home was always striving to work in an open way with service users. This was demonstrated during the inspection, as service users spoke about their funding and were clearly kept up to date and well informed. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,10 Residents feel included in the running of the home and are involved in setting the goals in their care plans, while staff meet their care needs and aspirations in a manner which respects confidentiality. EVIDENCE: The detail and information in the care plans is to be commended. They include, rehabilitation and therapeutic programmes, personal care, behavioural, occupational and physiotherapy guidelines, and risk assessments. This information is then summarised onto the service user plan used by the care staff. Three people living at the home were case tracked and evidence was seen of their views and those of their families included in their care plans. The source of information was clearly evidenced. Three people spoken to at the home were clear about the goals within their care plan and felt involved. Regular reviews generally detail if service users are involved or have chosen not to attend, and address the aims of the care plans. During individual discussion several people living at the home spoke about their plans to live more independently and how they had been involved in the decisions surrounding these plans. One person explained how they are supported with their finances and recognised why this had been put in place. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 11 A number of service users described how they feel very much part of the home and the way it is run. The weekly client forum is used as a time for service users to comment on new policies or changes to policies. For example, changing the times of meals to enable a more flexible routine with a trial period. Discussion with individual staff members demonstrated an understanding of service users’ communication needs, and the inspector observed during the inspection and noted through this discussion the commitment to ensure that service users are able to participate in the life of the home to the best of their individual ability. The manager also confirmed that clear guidance is in place to ensure that there is continuity in staff approach. Service users’ individual records are secure and confidential. Staff shared no inappropriate information about service users, and people living at the home were spoken about in a respectful manner. Information concerning service users was shared in an appropriate setting to maintain confidentiality. The inspector was told that induction training covered the issue of confidentiality and records confirmed this. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,14, 15,17 The service offers people living at the home scope to develop a range of life skills, which includes linking with the local community and maintaining contact with friends and family. Meals are served in an attractive setting with service users choosing what and where they eat. However, the option of an annual holiday for service users to broaden their leisure opportunities has not been addressed. EVIDENCE: Several people living at the home shared their thoughts on their future and how they were building on their life skills to live more independently. For example, through cooking, budgeting and being aware of safety issues as part of the Moving On programme. Some felt that this had been a slow process but showed insight into the reason for delays. For example, finding appropriate housing or increasing their life skills. This recognition of the reason for the delays helps illustrates the staffing group’s commitment to keeping service users informed. Staff recognised the importance of information to help address frustrations experienced by people living at the home. In contrast, another person felt that they were not ready for the next step of independence and said that staff had reacted in a supportive manner. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 13 Five people spoke about their links with the local community. For example using shops, restaurants, the gym and going for walks. Recognition was shown in notes and discussion with staff of how to ensure people with challenging behaviour could be supported to be included into events outside of the home. Three service users said the service enabled them to create their own routines, which they appreciated. The conservatory can be used to entertain visitors or individual people’s rooms can be used if more privacy is wanted. People living at the home explained that that they can choose where to entertain visitors. Service users are supported to maintain links with families or friends, through telephone conversations, letters and visits as recorded in care plans and evidenced in discussion with people living at the home. There is open visiting except during therapy times. This is documented in the information booklet for clients and families. A keyworker confirmed that they saw linking with families as an important part of their role. For example, one person has been supported to arrange a holiday with a relative. However, the service does not yet offer a seven-day annual holiday as part of the basic contract price. The manager said this is being discussed at a national level. Specialist guidance is recorded in service user’s files where matters of sexuality occur, which recognise vulnerability to exploitation as well as choice. The atmosphere in the dining room was relaxed and friendly. People living at the home chose where to sit, with others or alone, and were seen chatting with staff working in the kitchen about the choices of food on offer and giving positive feedback about the meal. The layout of the serving area of the dining room has been altered to make it more accessible. People can now also see the options available and influence the amounts given to them. Service users were informed verbally of the type of meal and this is also written on a board. Appropriate eating aids were seen in place. Visitors are able to stay for meals for a nominal charge. For privacy, meals with visitors can be served in the conservatory or the courtyard, which has a barbeque. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21, The service provides support and care, which reflects the individual needs of the service users and promotes good access to health care services. EVIDENCE: All clients are registered with the same G.P. The GP visits The Woodmill on a weekly basis as part of the Rehabilitation team and staff said that he had a good understanding of the individual service users and the overarching needs of people with brain injuries. The GP visited on the day of the inspection. Service users have previously confirmed to the inspector that they were happy with this arrangement and there is evidence in individual files that this has been discussed with service users and that they are happy with this arrangement. On a previous inspection, the manager said that the Exeter Well Woman service is also offered. She also discussed the importance of promoting male health checks. Health screening is organised by the G.P. Local dentists, opticians and chiropodist are used in Cullompton. Clients are supported to facilitate their own healthcare as appropriate. A service user described how they managed their illness with support and monitoring from staff and health professionals, and how they still felt in control of their day-to-day life. The arrangements for self medication were well recorded and reviewed, with lockable storage space provided. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 15 Care plans for service users evidenced flexible times for going to bed and getting up, and service users confirmed this. Clear instructions are given in care plans about the level of support that service users require for personal care. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Protection of vulnerable adult training and the home’s financial system promote the safety and protection of residents. EVIDENCE: The home has a comprehensive complaints procedure that includes a 28-day response time to the complainant. Records showed that the outcome was recorded as being explained to the service user in writing and verbally by a senior member of staff. Training on the protection of vulnerable adults is part of staff induction, which is a course run internally. The assistant manager also confirmed that staff have to sign to say that they have read the whistle-blowing and vulnerable adult policy, which was seen in their staff files. Discussion with staff about these issues demonstrated their awareness of poor/abusive practice and their duty to report it. Arrangements within the rotas ensure that that the on call manager covers night duty if a permanent member of staff is off sick so that the practice of new or agency staff can be overseen. Three service users were case tracked through their records. Their care plans recorded their vulnerability to abuse, whether financially, sexually or physically, and /or their capacity to abuse. Action plans are in place to reduce these risks. Service users spoke about who they would go to if they had a problem and who they felt comfortable with to share concerns. Money is stored securely in the home’s safe, which is bolted to the floor, and information about a service user’s financial is discussed on a ‘need to know’ basis. Monies and records seen were well managed with entries double signed. Records are kept of the balance in individual service users’ accounts, and amounts deposited and withdrawn in respect of each of these individuals. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 17 Two were inspected. Administration staff have worked hard to ensure that the account provides individual interest for service users. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The maintenance and décor of the home is well maintained, and provides a clean and attractive atmosphere for residents living there. EVIDENCE: The Woodmill has been specifically adapted for the service user group. There is a good range of adaptations and equipment available. The premises are accessible to wheelchair users, and on-going alterations are made to reflect the changing needs of the client group. For example, a sliding door has been fitted on the telephone cubicle after consultation with the Fire Brigade. There is a rolling maintenance programme and service users explained how they had been consulted on the colour schemes, and the manager discussed how the multi-disciplinary team contributed with advice regarding suitable furniture and equipment. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The promotion of training and the support offered to workers at the home creates a skilled and motivated team, which benefits the client group. EVIDENCE: Three care staff files were looked at, which contained job descriptions and terms and conditions of employment. Discussion with three members of staff demonstrated the values and ethos of the home. They all conveyed a clear sense of what their role was, the responsibilities within that and when it was appropriate to involve another member of the team. One person described their job as ‘fun’ and ‘interesting’ and another said there was ‘always something going on’ for service users. Staff praised the atmosphere of the home, such as team members being treated as ‘equals’, and feeling ‘valued’ by the unit within which they worked. They spoke positively about the client group and information was provided in a respectful manner. Training is clearly audited and all three staff spoken to had a broad range of training, both mandatory and specific to the service. They talked about a culture where training is promoted. The assistant manager oversees the induction programme and has made changes to ensure that night staff can still access him even if their shift patterns are different. BIRT provides different levels of training, with the induction including administration and kitchen staff. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 20 Then there are three levels, which includes a mandatory basic level and two optional levels of intermediate and advanced. Most training is in-house, although the trainers may be external to the home. Care staffing levels are appropriate with generally 1 senior staff and 3 care staff per shift, plus one to one care for some service users, which has been reviewed and adapted to prevent isolation for the staff member and service user. There are two awake night staff. The Woodmill has an effective support team, which includes a consultant clinical psychologist and clinical psychologist, occupational therapists, a physiotherapist, enablers, a vocational assistant, kitchen and domestic staff and administration team. A deputy and an assistant manager support the manager. There is a regular clinical meeting, which has minutes and is displayed for staff to read and sign. Staff spoken to said they felt well supported by supervision, annual appraisals and meetings, plus shift handovers. They praised the approachability of their team leaders. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,40,42 The home’s policies, regular safety checks and training promote the health, safety and welfare of the people living at the home. The home provides a survey for service users to influence the service but the quality assurance system does not give feedback to the service users about the outcome of their contribution. EVIDENCE: The home’s quality assurance system was discussed. This is collated centrally and currently the outcome of the service user survey is not fed back to those who have completed it. Three local policies were read and contained clear and appropriate guidance. The manager explained how they are discussed in a multi-disciplinary meeting and those with a direct impact on service users i.e. the no smoking policy was raised within the client forum. A tour of the building and records, plus discussion with staff about training i.e. moving and handling, fire training, all evidenced that safe working practices The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 22 are promoted in the home. Safety records were up to date and stored in an accessible room and sited away from the home’s electrics. The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 3 x 3 2 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Woodmill Score x 3 x 3 Standard No 37 38 39 40 41 42 43 Score x x 2 3 x 3 x D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 24 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement No requirements made. Timescale for action 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 14 Good Practice Recommendations People with long-term placements should have as part of their basic contract price the option of a minimum sevenday annual holiday outside of the home, which they help choose and plan. The results of service user surveys should be published and made available to people living at the home, their representatives and other interested parties i.e. CSCI. 2. 39 The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Woodmill D54 D06_s22068_woodmill_v235143_110805 stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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