Inspection on 23/06/08 for Walc House

This inspection was carried out on 23rd June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walc House 20/08/09

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 13/03/2009.

CARE HOME ADULTS 18-65 Walc House 8 Argyle Road Swanage Dorset BH19 1HZ Lead Inspector Heidi Banks Unannounced Inspection 23rd June 2008 12:15 Walc House DS0000070429.V364215.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 Walc House DS0000070429.V364215.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. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walc House Address 8 Argyle Road Swanage Dorset BH19 1HZ 01929 422200 01929 422200 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) www.walc.uk.com Walc Ltd Ms Deborah Kate Tutin Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Walc House DS0000070429.V364215.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 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 3. Date of last inspection Not applicable Brief Description of the Service: Walc House is owned by Walc Ltd. The abbreviation ‘Walc’ stands for ‘Wood Autistic Living and Care’. It is currently the only registered care service owned by the company. Mr Nick Wood is the Responsible Individual for the service. Mrs Deborah Kate Tutin is the Registered Manager. The service was registered with the Commission in January 2008 to provide accommodation and personal care for up to three people with learning disabilities. The service aims to provide a care service specifically tailored to meet the needs of adults with autistic spectrum disorders. The home is a large terraced property situated along a residential street approximately half-a-mile from the centre of Swanage. Accommodation is provided in three single bedrooms on the first and second floors of the home, all of which have en-suite facilities. A communal kitchen and communal lounge are situated on the lower ground and ground floors. There is a landscaped garden to the rear of the property which is accessible from the kitchen. Local amenities are within close reach. Car parking is available along the street. The home is staffed 24 hours a day with waking night staff. The Service User Guide supplied to us by the home in August 2008 states that the basic fee for the service is £2168 per week. This is inclusive of sensory programmes, basic toiletries, use of laundry facilities and all activities as outlined in the home’s Statement of Purpose. The Guide states that any additional costs will be calculated in accordance with the company’s pricing policy. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 5 General information about fees and fair terms of contracts may be obtained from the Office of Fair Trading at www.oft.gov.uk. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 6 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 the first key inspection of the service. The Commission inspects all services within six months of initial registration to assess how they are meeting the Regulations and key National Minimum Standards. The inspection took place over approximately 5.5 hours on 23rd June. At the time of the inspection there was one person using the service who was out for the day with their family although we were able to meet them very briefly on their return. We were able to take a tour of the premises, meet the Registered Manager and some of the staff who work in the home and look at a sample of records. This included information about the person who lives in the home, medication records, staff recruitment and training records, health and safety records and a sample of policies and procedures. Before the inspection we sent out surveys to the home for distribution to people who use the service, their relatives, care professionals who have contact with them and care workers employed to work in the home. A total of nine surveys were returned to us. Comments and views from the surveys are reflected throughout this report. Following the inspection we received a completed Annual Quality Assurance Assessment (AQAA) from the home. This is a self-assessment document that focuses on how well outcomes are being met for people who use the service. It also gives us some numerical information about the service. Twenty-three standards were assessed at this inspection. What the service does well: The home ensures that people’s needs are assessed before they come to live there and that the service user and their family have the opportunity to visit the service. This helps ensure that the home is the right place for the person to live in and promotes a smooth transition. For the person using the service there was a clear, written care plan which tells staff what they need to know to ensure the individual’s needs and wishes are met. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 7 The home clearly aims to provide a service that gives people the right to an ordinary life. The person using the service is able to make choices about things they want to do and their independence is promoted in their home and community. The person is enabled to take part in a range of work, leisure and social activities and maintain contact with family and friends. The person using the service receives personal and health care that meets their needs. There home has developed a system to enable people to raise concerns and ensure these are recorded. Staff are receiving induction training which covers information on safeguarding vulnerable adults to ensure they know what to do to keep people who use the service safe. The home is situated along an ordinary street and is in-keeping with other properties along the road. The home is clean and well-decorated which means it provides a comfortable environment for people to live in. There are sound systems in place to ensure that safety checks are carried out in the home on a regular basis to promote the welfare of people who live there and ensure that it is a safe environment for them to live in. Feedback we received from people who have contact with the service indicated to us that the home is well-run and they have confidence in the home to provide a good standard of care to people. What has improved since the last inspection? What they could do better: The main weakness identified at this inspection was in relation to staff recruitment procedures. These were not robust enough to ensure that all necessary checks had been completed before people started work in the home. A requirement has been made for the registered provider to ensure this is addressed. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 8 We have made some recommendations around medication policy and procedures to ensure that the home is following best practice in this area and that care workers have the right level of training to be able to administer medication safely. We have also recommended that the provider amends the home’s whistle-blowing policy to ensure that care workers know that they are protected by law if they raise concerns about malpractice within the service and that they are aware they can contact the Commission if they have concerns. At the time of the inspection the home was developing a staff training programme. This will need to be fully implemented to ensure that people who work in the service have a National Vocational Qualification (NVQ) that is relevant to the care of adults and that they have specialist training to meet individuals’ diverse needs. Being a new service the home had not fully implemented a quality assurance process at the time of the inspection. This is important as the home needs to show evidence that they are monitoring themselves with regards to the service they provide and so that they can be confident they are running a service centred on the needs and wishes of the people who live there. The manager has told us that this will be fully implemented in the near future. 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. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 9 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 Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 10 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): 2 and 4 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Admissions to the service are well-planned and assessment arrangements are in place to promote a smooth, person-centred transition. EVIDENCE: The home has told us in their Annual Quality Assurance Assessment (AQAA) that they ‘undertake a full assessment of prospective residents and attend transition meetings’ as part of the admissions process. The AQAA also indicates that at present the home does not have a referral and admissions policy. This is recommended so the home’s admissions process is clearly set out in writing and can be made available to any enquirer. We looked at records for the person who moved into the home three months before the inspection. Assessment documentation was in place and there was information about the person from their previous placement. The assessment was in a ‘tick-box’ format with additional space to add information. A care manager responding to the survey indicated that the service’s assessment arrangements ensured that accurate information was gathered so that the right service could be planned and given to individuals. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 11 The care plan indicated that transition visits took place over a four-week period ending with an overnight stay. Some documentation was seen on file to evidence this including written notes from a transition meeting in January 2008. The care plan indicated that the service user, their parents and sister and their key worker from their previous placement had assisted with the move to Walc House. There was also evidence on file of a review taking place after six weeks attended by the service user, their relatives, care manager and representatives of the home to look at how they were settling in to their new home. The person using the service indicated in a survey that they had been asked if they had wanted to move to the home. They told us that they had received enough information before moving in to help make the decision whether it was the right place for them. The home has told us in their AQAA that they have implemented a new communication package to assist people who use the service to give feedback during the transition period. The manager told us that they were expecting a second person to move into the home in the near future. She reported that there was ongoing consultation with the service user, local authority and the family with regards to the admission to ensure that the home was able to meet their needs and wishes. Walc House DS0000070429.V364215.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 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s individual needs and choices are identified and followed through to maximise their independence and control over their lives. EVIDENCE: We looked at the care plan in place for the person who lives in the home. This contained some good detail about the person’s routines, skills, needs, likes and dislikes. For example, there was information about how care workers should communicate with the person; ‘Short, clear instructions alongside gestures indicating what he is being asked to do…firmly voiced instruction’. There was also a good account of what the person can do for themselves in relation to preparing breakfast and helping with household tasks and where they needed support. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 13 A care manager responding to the survey told us ‘I have observed them providing a very individualised and user-led service. They have taken into consideration the service user’s needs, likes and dislikes and also those of the family’. The person using the service at the time of the inspection was reported to communicate non-verbally. The care plan we looked at showed evidence that the person had been consulted about activities on offer and asked whether his needs were being met. The home had devised a ‘smiley face chart’ to help the person communicate their responses. The home’s Annual Quality Assurance Assessment tells us that people who use the service are invited to attend staff meetings and are able to participate fully if they choose so that they have a say in the running of the home. Records showed that the person living in the home had participated in their transition and review meetings. The person told us in a survey that they were able to make choices about what they wanted to do during the day, in the evenings and at weekends. We noted that the person’s bedroom was very personalised and discussion with the manager indicated that they had chosen the colour scheme and positioning of the furniture themselves so that it was how they wanted it. Some risks with regards to personal care had been highlighted in red in the person’s care plan, for example ‘Do not leave X alone with wet-shave razor’ but there were also full risk assessments on file for various activities at home and in the community including using the minibus, bowling, cooking, gardening and swimming. These assessments identified the risks involved in activities, the likelihood of it happening, possible outcomes and how the risk can be reduced. It was clear from discussion with the manager and staff that the individual’s independence is promoted and inspection of daily records indicated that the person is empowered to engage in a wide range of activities as part of an ordinary lifestyle. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service lead ordinary lives in their home and community with opportunities for personal development and social contact. EVIDENCE: The care plan in place for the service user contains an ‘activity rota’ showing activities undertaken by the person. This was seen to include visits to amenities in the area including parks, the cinema, leisure centre, library, pub, shops and trips to the forest, beach and local markets. Records indicated that the service user is being supported to do work experience at a local café on one day a week, attend a local club for people with learning disabilities and maintain contact with friends from school. There were a number of photographs in the plan showing the person enjoying a range of activities. The manager told us that the home has a minibus to provide transport for residents but that they also promote the use of public transport as well. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 15 Discussion with staff indicated that the person enjoys using the computer and playing on a game station. Records showed how staff were supporting him in managing his time to ensure that, while he has regular amounts of time to enjoy these activities, it is not excessive and he has ample opportunities to engage in other activities as well. A relative indicated in the survey that the home always supports people to live the life they choose, this also echoed by the person’s care manager. The home has told us in their Annual Quality Assurance Assessment that they are looking into gym membership for people who use the service and are installing a sunken trampoline in the garden at the request of one individual. A health care professional who has contact with the home indicated that ‘clients are encouraged to access activities but are respected if they choose not to’. The person’s contact with their family had been detailed on the activity rota and at the time of the inspection members of their family were visiting. The manager told us that families and friends of people who use the service are welcome to visit at any time. She told us that a prospective service user’s parents lived a long distance from the home and discussions had already taken place about how contact could be promoted to maximise the time the family could spend with him. The relative of one service user told us ‘X writes to me weekly. He sends e-mails to his sister, brother and myself’. We looked at the menu for the week which was on display in the home. This showed a range of meals on offer to the person who uses the service. Discussion with staff indicated that the person is given choices about what he eats including opportunities to go out to eat and to have take-away meals. There was evidence in records that the service user is enabled to help with grocery shopping and meal preparation. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service receive personal and health care that meets their needs and promotes their well-being. EVIDENCE: The care plan we looked at showed some good information about what the individual can do for themselves and what aspects of personal care they need support with. Both the care manager and health care professional who responded to the surveys indicated that they felt the home respected the person’s privacy and dignity in providing care. A relative told us that they were always informed about plans and changes in relation to their family member’s care; ‘X’s needs are always taken care of. X is very happy’. A health care professional told us that staff had sought the advice of people who had been involved in the care of the person prior to their move to Walc House and had listened to the person’s family about the individual’s needs, likes and dislikes in relation to their care to ensure there had been a smooth transition. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 17 A health appointments record was in place for the person using the service indicating that they had visited the doctor and dentist since being admitted to the home. We noted that entries on the record had been typed but not signed by the person making the entry. It is suggested that the home reviews this system to ensure entries are signed by the care worker making the record. A care manager who has contact with the person said that they felt the person’s health care needs were always properly monitored and attended to by the care service and another care professional indicated that staff were ‘very vigilant’ in this area. The home has told us in their Annual Quality Assurance Assessment that they plan to employ a part-time nurse who will be available for residents if they wish to discuss specific personal health issues. We observed that charts were in place to monitor the individual’s behaviour. Staff told us in surveys that they were always given enough information to be able to meet people’s health and personal care needs and that information in care plans was continually being updated to ensure people’s needs were met. We looked at current medication practices in the home. A medication policy is in place in the home which covers storage, administration, record-keeping, use of over-the-counter remedies, training, ordering and disposal of medicines. We observed that the policy did not cover the action that needed to be taken by care workers in the event of a medication error. Medication is supplied by a local pharmacy which also produces the Medication Administration Record (MAR) chart for use in the home. Medication is stored in a lockable metal cabinet fixed to the wall of the office. We noted that the MAR chart had some handwritten instructions on it which had not been double-signed by staff to confirm their accuracy. A list of homely remedies that can be administered to the person was on file. We looked at the records for two care workers which indicated that both had completed a basic medication handling course offered by the pharmacy. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure that complaints are responded to effectively and that people who use the service are protected from harm. EVIDENCE: The home’s complaints procedure was noted to be on display in the hallway of the home. The manager has told us in their Annual Quality Assurance Assessment that they have recently adapted the complaints procedure so that it is in a more accessible format for people who use the service. The person who lives in the home indicated in a survey that they knew who to speak to if they were not happy and they were aware of how to make a complaint. A relative also told us that they knew how to complain if they needed to but added ‘I have never had to raise concerns as X’s needs are met to the highest standard’. The home’s complaints record indicated that there had been one complaint made from an external source since the home opened. Correspondence relating to this complaint was on file. There have been no complaints or concerns raised with the Commission about the service to date. The manager has told us in the Annual Quality Assurance Assessment that they plan to introduce a ‘Niggles Book’ as a way of recording any day-to-day issues that may be voiced by people who use the service. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 19 The home’s Annual Quality Assurance Assessment told us that the home has a policy on safeguarding adults and the prevention of abuse. We looked at this at the inspection. The policy gives guidance to staff on how to respond to a disclosure of abuse and make a referral. Information on safeguarding vulnerable adults is covered by the home’s induction training programme. At the time of the inspection the manager told us that they were in contact with an external training provider to organise specific training in abuse awareness for all staff. The manager has told us in the Annual Quality Assurance Assessment that there have been no safeguarding referrals or investigations in the home since it opened. A whistle-blowing policy is in place in the home. We discussed with the manager that the policy could be re-worded so that it encourages care workers to raise legitimate concerns and ensures that staff are aware that they can contact the Commission with concerns about malpractice while being protected by law in doing so. The home has told us in their Annual Quality Assurance Assessment that they do not currently have a policy on the management of service users’ money, valuables and financial affairs. It is recommended that this is put in place so that procedures in the home are clearly documented and individual arrangements are specified in people’s support plans. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a homely, comfortable and clean environment for people to live in. EVIDENCE: Walc House is a large terraced property along a residential street in Swanage. The property is in-keeping with other houses in the road. Car parking is available on the street outside the house. There is an enclosed landscaped garden to the rear of the house. Accommodation is on four floors. On the lower ground floor there is a large kitchen and adjacent WC. The lounge and office space is on the ground floor. There are two bedrooms on the first floor and one on the second floor of the home. All three bedrooms have an en-suite shower and toilet facility. A communal bathroom is situated on the first floor for use by residents. There is a spare room on the second floor of the house that, at the time of the inspection, was being used for storage purposes. The home has a laundry area with a washing machine and tumble dryer for people Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 21 to use. There is adequate lockable storage in the home for utility items and cleaning fluids. The home is accessed up a short flight of external steps. There is no toilet facility at ground floor level. The manager has told us in the Annual Quality Assurance Assessment that work is underway to adapt the garden to meet the needs of residents. They have also told us that they are planning to create a sensory / activity room in the house as this has been requested by a representative of a resident. We looked at the bedroom that is currently occupied. The person who uses the home had been able to choose the colour scheme and personalise the room to their taste. A tour of the premises showed the home to be clean and decorated to a high standard. The manager told us that glass in windows had been changed to safety glass to meet the needs of people who use the service and the bedroom walls for one person had been reinforced in a discreet and decorative manner to promote their welfare. Cleaning checklists are kept by staff to ensure that all tasks are completed. The manager has told us in the Annual Quality Assurance Assessment that the home intends to employ a cleaner as more people come to live in the home to enable care staff to focus on providing personal and social care for people. The manager has told us in the Annual Quality Assurance Assessment that the home has an infection control policy and that all staff have received instruction on the prevention of infection. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment processes are not currently robust enough to ensure people who use the service are fully protected. Work is underway to develop a training programme to ensure that care workers have the necessary knowledge and skills to meet the needs of individual residents. EVIDENCE: We looked at the records for two care workers who are employed to work in the home for evidence that the home has safe recruitment procedures. Each person’s file showed evidence of an application form, two written references and an enhanced disclosure from the Criminal Records’ Bureau. However, the following gaps were noted. One person’s application form did not show dates relating to their previous employment and therefore it was not clear that a full employment history had been obtained. The same file indicated that the person had commenced working in the home approximately three weeks before their full disclosure had been received from the Criminal Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 23 Records Bureau. There was no evidence on file that a PoVAFirst check had been carried out by the home prior to them starting in post to determine their suitability to work with vulnerable adults. Although the second file we looked at contained two written references, a reference had not been taken up from a recent employer in the care field. There was also no photograph or proof of identity on this file. We discussed these shortfalls with the manager who has advised us in the home’s Annual Quality Assurance Assessment that since the inspection they have improved recruitment processes to ensure that these gaps are addressed. An induction workbook for new staff is in place in the home which follows the Common Induction Standards. People who are employed to work in the home commented that the induction package is comprehensive and useful. The manager has told us in the Annual Quality Assurance Assessment that the majority of their staff have a National Vocational Qualification at Level 3 standard and all staff are qualified to Level 2 standard. However, it was not clear how many staff have an NVQ in the Care of Adults rather than for ‘Children and Young People’. The manager was advised to ensure that staff with the latter qualification undertake the additional modules necessary so that they have the knowledge and value base to work with adults. We looked at training undertaken so far by a sample of care workers. These showed evidence of both care workers completing training in First Aid and Food Hygiene. The manager has told us that care workers have been selected for employment on the basis of their previous experience of working with people with autism. The manager reported that they are investigating specialist training for care workers including appropriate physical intervention training before the admission of any people who may require this. All care workers responding to the survey indicated that they were being given training relevant to their role. A relative and care manager who responded to the survey indicated that they felt care staff always had the right skills and experience to look after people properly; ‘Management and staff have a lot of experience of people with autistic spectrum disorder’; (Relative) ‘I have been greatly impressed by the enthusiasm and dedication shown by the staff team’. (Care Manager) Care workers also told us in a survey; ‘The company is keen to give training and offers lots of choice. I have been booked in for two more training courses relevant to my position and there have been offers continually so that I can progress within my field’; Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 24 ‘The company…is very new and in its early stages, but it has been very easy to join the company and follow their philosophy for care’; ‘I am really glad to be given the opportunity to work within this new venture. I feel I can put my skills to good use and I feel very much part of the team. I feel valued!’ Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is developing appropriate systems to ensure that the right support is given to people who use the service. People who have contact with the service have confidence that the home is well-run. EVIDENCE: The home was registered with the Commission for Social Care Inspection in January 2008. The Responsible Individual for the service is Mr Nick Wood. Mr Wood’s background is as a qualified teacher with experience in special needs education. The Registered Manager of the home is Ms Deborah Kate Tutin who has a background in working with children and young people with autism and a Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 26 degree in Health and Community Studies. At her registration interview in December 2007 Ms Tutin stated that she intended to undertake her Registered Managers’ Award and follow this with a National Vocational Qualification in Care to Level 4 standard. Ms Tutin told us at the inspection that she has commenced the Registered Managers’ Award. She queried her need to undertake a National Vocational Qualification in Care to Level 4 standard and was sent the Commission’s guidance on this by e-mail following the inspection. Discussion with the manager during the inspection indicated that both she and the Responsible Individual for the service are supernumerary in their roles. She also told us that the Responsible Individual is fully involved in the running of the home and is present in the home during the working week. As a result of his involvement the necessity for the provider to produce reports under Regulation 26 was queried. It is recommended that, as the provider is fully involved in the day-to-day running of the home, another person is appointed to undertake the Regulation 26 visits so that someone can assess on a regular basis how well the home is meeting the needs of people who live there as part of their overall quality assurance process. At the time of the inspection the quality assurance system in the home had not been fully implemented due to the fact that the home had only admitted one person three months before. However, looking at the various records in the home there was evidence that the person living there had been consulted and communication between the home, the service user, their family and care manager was good. The home has recognised the need to implement a quality monitoring system and has told us in the Annual Quality Assurance Assessment that they will complete an annual development plan based on the outcomes of this. We observed at the inspection that various substances potentially hazardous to health had been locked away for the protection of people who use the service. The manager confirmed that the home has a fire risk assessment in place. We looked at a sample of records that showed that fire safety checks are carried out in the home. A sample of refrigerator and freezer temperature charts were seen, these indicating that checks are carried out twice daily. A system for checking hot water temperatures was also seen to be in place with different outlets checked on a weekly basis. Records indicated that temperatures were within a safe range. The manager told us that there have been no accidents in the home to date although an accident book is in place to record these as they occur. The home has told us in their Annual Quality Assurance Assessment that all appliances in the home are PAT tested to ensure they are safe to use. Information in the Annual Quality Assurance Assessment indicated that there is no policy in place on dealing with emergencies and crises in the home. It is suggested that the home develops a contingency plan to ensure that there is a clear process to follow in the event of an emergency occurring and people needing to be evacuated. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 27 Comments from care workers obtained from surveys indicate that they feel the home is well-run, that there is a good sense of team work and that the service is focused on the needs of people who live there; ‘As a very new company, the whole team are currently striving to ensure that we give the best service possible. When a problem is found it is rectified or modified as soon as it can be. We are constantly assessing and updating our working practices.’ (Care worker) This was echoed by a care manager who has contact with the service who told us; ‘This is a very new service and it has been driven by the enthusiasm of the owner and the manager. I have been extremely impressed by the care and planning that has gone into the setting up of this service and am sure that this will be carried through to the care of the individual that I have placed at the home’. As previously stated in the section on ‘Staffing’ we found some gaps in recruitment systems in the home which meant that not all essential checks had been carried out on care workers before they started work in the home. This is a potential risk to vulnerable adults who use the service. In the home’s Annual Quality Assurance Assessment received following the inspection the manager told us that they have reviewed their procedures. Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X 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 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 YA34 Regulation 19(1)(b) Requirement The registered provider must not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2 of the Regulations. Timescale for action 30/09/08 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 YA20 Good Practice Recommendations The home should have a procedure which informs care workers of the action they need to take in the event of a medication error. Handwritten instructions written by care workers on MAR charts should be double-signed to confirm their accuracy. The provider should identify further training for care workers on the administration of medication which covers all areas indicated in the Commission’s guidance. The home’s whistle-blowing policy should contain the advice that people employed by the home can approach DS0000070429.V364215.R01.S.doc Version 5.2 Page 30 2. YA23 Walc House the Commission with any concerns about malpractice and be protected by law in doing so. The home should develop a policy on the management of people’s money, valuables and financial affairs. Arrangements in place for individuals should be clearly documented in their support plans. The registered provider should ensure that people who are employed to work in the home obtain a National Vocational Qualification in the Care of Adults. The home should continue to investigate sources of specialist training for care workers to enable them to meet the diverse needs of people who use the service. The registered provider should appoint a person to undertake visits in accordance with Regulation 26 as part of the home’s quality assurance and audit process. The home’s quality assurance process should be fully implemented and an annual development plan produced based on outcomes for people who use the service. 3. 4. 5. YA32 YA34 YA39 Walc House DS0000070429.V364215.R01.S.doc Version 5.2 Page 31 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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