CARE HOME ADULTS 18-65
Wadeville Hostel 2a – 2b Wadeville Close Upper Belvedere Kent DA17 5ND Lead Inspector
Maria Kinson Unannounced 6 September 2005 09:20 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. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Wadeville Hostel Address 2a - 2b Wadeville Close Upper Belvedere Kent DA17 5ND 01322 342998/445901/433878 01322 440663 mcch@wadeville.freeserve.co.uk MCCH Society Limited 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) Ms Georgina Waters Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (2) of places Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Nil. Date of last inspection 10 February 2005 Brief Description of the Service: In December 2002 this home varied its registration and changes were made to the configuration of the home. The home is now registered for thirteen service users with a learning disability, two of whom may be over 65 years of age. The registered provision provides 24-hour support with a sleep in arrangement and waking night support. The house is split into two flats, six in flat 2b and seven in flat 2a. Each flat has its own kitchen/dining and lounge area, bedrooms, toilet and bathing facilities. The garden is a shared area for both sets of service users and is also shared with other people in the surrounding supported living accommodation. Daytime opportunities are provided through the day services previously operated by Bexley Council but now managed by MCCH Society Ltd. The Community Learning Disability Team provide specialist health and social input. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 6th September 2005, between 09:20am and 17:45pm. A Regulation Manager accompanied the inspector. A partial tour of the home was undertaken and care, medication and staff training records were examined. The inspectors spoke with three service users, two visitors, and three members of staff. Comment cards were sent to eight relatives and health care professionals that were in regular content with the home. In the Registered Managers absence the Deputy Manager assisted the inspection team to locate records and files. Some confidential records were not accessible to staff and therefore could not be viewed during this inspection. What the service does well:
This home provides a consistently good standard of support for service users. Feedback from relatives and health care professionals was good and service users looked happy and relaxed. Relatives said that service users “every need was met with great care and understanding” and that staff were “excellent”. The procedure for admitting new service users to the home allows adequate time for prospective service users to get to know the existing service users and staff and make an informed choice about whether they want to live in the home. The skill mix and numbers of staff on each shift were satisfactory. Staff were familiar with service users individual needs and preferences and worked hard to ensure that personal needs and choices were met and followed. Access to health care services was good and staff arranged and supported service users to attend hospital and GP appointments. The home was clean and tidy and communal and personal areas were homely and welcoming. The home had an easy to follow complaints procedure. No complaints had been received in the home since the last inspection. Service users were encouraged where possible to contribute to the running of the home. This included involvement with preparing and choosing meals,
Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 6 shopping for food, keeping the home and their personal areas clean and tidy and maintaining the garden. Staff facilitated activities in the home and community when service users were not attending day centres or college. What has improved since the last inspection? What they could do better:
Service users did not receive adequate information about the service and their rights and responsibilities once they had moved into the home. The management of medication was mostly good but closer monitoring is required to ensure that all medication is stored appropriately. Staff should ensure that the instructions on the label correspond with the instructions on the medication administration chart. Some improvements were noted with the standard of record keeping but a number of documents included information that was out of date. Staff should not wait until formal care management reviews take place to update care plans. Some service users that had difficulty getting in and out of the bath did not have a moving and handling assessment. The building was maintained to a satisfactory standard overall but the carpet in the lounge in flat 2b was stained and several cracks were noted on the walls in the corridors. As some of the service users health and mobility declines, the bathing facilities were no longer able to meet some of the service users needs. The commission had not received evidence that the risk of Legionella had been assessed, or that the water tank and pipe work were chlorinated. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 7 Staff training was variable. Some staff had experienced difficulty gaining access to training as sessions were oversubscribed. It is essential that all staff working in the home receive ongoing training. 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. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5. The arrangements for admission of new service users to the home were satisfactory. The admission procedure allowed adequate time for the service users to visit the home and meet staff. The service users living in this home did not receive adequate written information about the terms and conditions of occupancy. EVIDENCE: The previous requirement to update the Service User Guide to include information about the terms and conditions of occupancy and a standard form of contract had not been addressed. See requirement 1 and recommendation1. There had been no new admissions to the home since the last inspection. Standards relating to the admission of new service users were met when assessed during previous inspections. None of the service user’s had been provided with a copy of the home’s terms and conditions, or a contract. See requirement 2. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 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 and 9. Some of the records maintained in the home were out of date and did not reflect service users current needs. This could result in service users receiving inappropriate levels of support. Service users were encouraged to play an active role in the running of the home and make decisions for themselves. Support and advice was provided where necessary. Staff encouraged service users to take risks that improved their quality of life and sense of wellbeing. EVIDENCE: Two service users file were examined. Both of the files included a personal profile that summarised some of the service users needs. Information in personal profiles and support plans was not always up to date. For instance, the records indicated that one of the service users was independent with bathing and that the service user liked to attend a weekly church service. Staff confirmed that the service user required assistance to get in and out of the bath and had not attended church since July 2005. The care plan for one of the service users outlined the support that he required in another care home and his desire to move into a smaller home. Comprehensive information was
Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 11 obtained about service users family and social history where possible. Some documents, such as pen portraits, were not signed and dated. See requirement 3. There was evidence that service users, relatives and advocates were invited to care planning meetings and were encouraged to contribute ideas and voice concerns. Staff were seen promoting service user choice though out the day. This included consultation with service users about meals and discussions about where and how services spent their free time. Service users were encouraged to play an active role in the running of the home. All of the service users were expected to assist staff with their personal laundry and to clean and tidy their bedroom. Some of the service users were responsible for specific tasks such as dusting, vacuuming, gardening and laying the table. Service users were encouraged to assist at mealtimes and some of the service users were able to prepare hot meals and drinks with minimal supervision. Staff had assessed potential hazards to service users who were known to be at risk of injury or vulnerable in specific situations. Strategies to maintain service users existing skills and independence were implemented where possible. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 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) 13, 14, 15 and 16. Service users were supported to maintain active and fulfilling lifestyles. This included maintaining contact with friends and family and undertaking activities of their choice. EVIDENCE: Service users were supported to take part in meaningful activities in the home and community. Service users records included information about social events and outings and how they spent their free time in the home. In the month prior to this inspection some of the service users had made cakes, watched videos, attended church services and shopped for personal toiletries or clothing. At the time of this inspection three of the service users were on holiday. Relatives said they were able to visit the home at any time that suited them and commented that it was never any different when they visited. Staff were always welcoming and treated them and their relatives with respect. Written comments indicated that the home provided “excellent care and that every need was met with great care and understanding”.
Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 13 Service users were free to choose how and where they spent their time once they returned home from day centres or college. During the weekends and on days off from the centre, staff supported service users to undertake the type of activities that they enjoyed most. Some service users preferred to stay at home and watch a film, whilst other service users liked to be more active. Daily routines were flexible and were adapted to meet individual needs where possible. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 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 and 20. Service users health care needs were identified and met by staff. The management of medication was good in parts. Storage facilities should be improved and clear procedures provided for staff. This will provide additional safeguards for service users. EVIDENCE: Access to local health services was good and the Community Learning Disability Team provided specialist advice and support. Staff maintained an up to date record of all GP visits, hospital appointments and home visits. Since the last inspection, some of the service users had been assessed and treated by a variety of different professionals including Dentists, Chiropodists, Psychologists and Opticians. Two health care professionals that were in regular contact with the home returned comment cards to the commission. The responses indicated that staff had a good understanding of service users needs and worked in partnership with their team. One of the respondents said that bank staff were not always aware of service users needs. Two medication charts were examined. There were no gaps on the charts and records of receipt of medication were maintained. The instructions on the label of one bottle of medicine did not correspond with the instructions on the
Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 15 medication administration record. Staff did not identify this discrepancy when the medication was checked into the home. Some medication that was subject to special storage arrangements was stored in a locked cash tin in a filing cabinet. The previous recommendations to develop a local medication procedure and to monitor the temperature in the medication storage area in the dining room had not been addressed. See recommendation 2 and 3. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 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. The home had a simple and accessible complaints procedure. EVIDENCE: The home complaints procedure included a timescale for responding to concerns and contact details for the commission. The home had not received any complaints since the last inspection. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 17 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, 25, 27 and 30. The home was clean, comfortable and welcoming. Some of the bathing facilities did not meet service users needs. EVIDENCE: The home was clean, tidy and odour free. Service users rooms reflected their individual interests and furniture was arranged to meet specific needs. Communal areas were homely and welcoming. Most of the activity took place in the kitchen, where service users shared information about the day’s events and discussed the evening meal. The home was maintained to a satisfactory standard overall but some repairs were reported several times before they were addressed. Cracks were evident on some of the walls and the shower in flat 2b was broken. The inspector was told that the shower had been assessed and a new part was on order. The carpet in the lounge in flat 2b was stained. See recommendation 4. The arrangements for one of the service users to move out of the home and into supported accommodation in the community were progressing well. This
Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 18 move will ensure that the service user has adequate space for his personal belongings and equipment. The bathing facilities provided in the home did not meet service user’s needs. Some of the service user’s were becoming frailer and less mobile. One of the service users told the inspector that he had “a near miss” in the bath the previous day. This service user was finding it increasingly difficult to get in and out of a domestic bath, and was becoming more reliant on staff assistance. Staff had attempted to use a mechanical aid that was provided for another service user but it had been unable to take the service user’s weight. The service user told the inspector that he really enjoyed having a bath, but would now have to use the shower. Staff were advised to refer all of the service users that were having difficulty getting in and out of the bath to an Occupational Therapist for assessment and advice. Subject to the Occupational Therapists advice the home may have to consider fitting an assisted bath. See recommendation 5. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 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) 33, 34 and 35. The number and skill mix of staff provided on each shift was satisfactory. Staff did not receive adequate training. This could result in poor care practices. EVIDENCE: Copies of the current off duty roster were examined. The roster indicated that three members of staff were on duty during each daytime shift. There were two waking staff during a night shift. The management and staff team appeared stable, with few changes of staff since the last inspection. This provided good continuity of care for service users. It was not possible to assess staff recruitment practices during this inspection as the manager was on leave. See requirement 4. Two staff training files were examined. The records indicated that none of the staff had attended any training during the past six months. Staff indicated that training was requested but sessions were often oversubscribed. There was no evidence of induction training on either of the files. See recommendation 6. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 20 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) 42. Staff did not assess moving and handling risks prior to bathing service users with restricted mobility. Failure to assess health and safety risks could result in illness or injuries to service users. EVIDENCE: The registered manager was on leave at the time of this inspection. One of the residents, who had difficulty getting in and out of the bath, did not have a moving and handling assessment. Failure to assess moving and handling risks could result in injuries to staff or service users. See standard 27 and requirement 6. The previous requirement to forward evidence of a risk assessment, or water chlorination certificate to the commission, had not been addressed. See requirement 5. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x 2 x x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Wadeville Hostel Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 22 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 1 Regulation 5 Requirement The Registered Person must ensure that the Service Users Guide includes the following information-: the terms and conditions of occupancy including the amount and method of payment of fees and a standard form of contract. A copy of the revised Service Users Guide must be forwarded to the Commission within 28 days of any changes being made. (The previous timescales of 01/02/05 and 01/06/05 were not met) The Registered Person must ensure that service users are supplied with a written contract. (The previous timescales of 01/01/05 and 01/06/05 were not met) The Registered Person must ensure that service users care plans and records are reviewed and updated regularly. The Registered Person must ensure that all records relating to staff employment are kept in the home. This requirement could not be fully assessed during this inspection. The Registered Person must
G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Timescale for action 01/04/06 2. 5 (1) C 5 01/04/06 3. 15 & 17 6 01/03/06 4. 17 34 01/06/05 5. 13 42 01/04/06
Page 23 Wadeville Hostel Version 1.40 6. 13 42 ensure that a copy of the water chlorination certificate or risk assessment is forwarded to the commission. The previous timescale of 15/12/04 and 01/06/05 were not met. The Registered Person must assess the risk of injury to staff from moving and handling individual service users. The Registered Person must reduce the risk of injury as far as practicable. 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1 Good Practice Recommendations The Registered Person should ensure that the Service Users Guide includes the following information -: the relevant qualifications and experience of the Registered Provider, Manager and staff, the number of places provided and the people for whom the service is intended, service users views of the home and information about how the home meets the following standards 24.2, 24.9, 27.2, 27.4 and 28.2. The Registered Person should ensure that the home develops local policies and procedures for the receipt, storage, handling, administration, disposal, self administration, homely remedies and supply of medicines to service users on leave· The temperature in the medicine cupboard in the kitchen should be monitored and eye drops should be marked with the date of opening· The Registered Person should provide appropriate storage for controlled drugs. The Registered Person should replace the carpet in the lounge in flat 2b and repair/fill the cracks on the walls. The Registered Person should ensure that adequate and suitable bathing facilities are provided for service users who are less mobile. Any recommendations made by the Occupational Therapist about aids or adaptations should be implemented. The Registered Person should ensure that staff receive
G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 24 2. 20 3. 4. 5. 20 24 27 & 29 6. 35 Wadeville Hostel induction training to TOPSS standards and five paid training days each year. Wadeville Hostel G51 G01 S37846 Wadeville Hostel V225714 06.09.05 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent, DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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