Inspection on 12/11/08 for Wall Street

This inspection was carried out on 12th November 2008.

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

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

Wall Street 14/08/07

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wall Street Wall Street Hereford Herefordshire HR4 9HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Debra Lewis     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Wall Street Wall Street Hereford Herefordshire HR4 9HP 01432342683 01432340609 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Stephen Macdonald Nicolson Type of registration: Number of places registered: Livability care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: 4 Residents may have a learning disability associated with their physical disability. Residents may also have a mental disorder associated with their physical disability. Date of last inspection Brief description of the care home The home is provided by Livability, a national Christian society with charitable status. In June 2007 the homes previous provider, the Shaftesbury Society, merged with another charitable organisation to form Grooms-Shaftesbury, now renamed Livability. The service provided at 14 Wall Street is primarily for adults with physical disabilities or acquired head injuries. [The scheme also provides emergency cover for the adjacent independent flats, however these are not subject to registration under the Care Standards Act.] The home was purpose built in 1993 and is in Hereford city centre, giving good access to the local community. The homes registered manager is Stephen Nicolson, who was registered with CSCI in February 2007. The homes registered provider is Livability. The responsible individual for Livability is Kim Haldenby. Information about the home is available in the form of a service users guide, and the Care Homes for Adults (18-65 years) Page 4 of 28 10 Over 65 0 Brief description of the care home home gives copies of the inspection reports to tenants. The places in the home are block purchased by Herefordshire Council. Items not covered by the fees, which tenants will have to pay extra for, are holidays, entertainments, transport, clothing and social activities / outings. People living in the home are known as tenants (rather than service users) and will be referred to as tenants in this report. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a Key Inspection. This means that we (the Commission for Social Care Inspection) checked all of the standards that have most impact on tenants. It was unannounced, which means that the home manager and staff did not know we were coming. This report includes what we found during the visit to the home, as well as any relevant information that we have received about the home since the last inspection. This included a report from the manager and surveys from tenants, staff and visiting professionals. We were in the home from mid morning until early evening. We met and talked with some of the tenants and with several staff on duty. The Care Homes for Adults (18-65 years) Page 6 of 28 registered manager was not in the home. We spoke with the deputy manager. We looked at the building and whether it is well kept and safe. We checked records that staff keep, for example about what care they are giving to the tenants. We looked at what had changed since the last inspection. The last Key Inspection of Wall Street was on 14th August 2007, when we found a lot of improvements being made. This inspection found that the service was continuing to get better, which was good for the tenants. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 8 of 28 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to move into the home can visit and can usually get the information they need. They can involve their family or an advocate if they wish, when they are deciding whether to move in. Staff make sure they know what support people need, and whether the home can offer that support, before new tenants move in. Evidence: The home does have written information available for prospective tenants, but this is not always offered to them. Sufficient information is given verbally. People visit the home before they move in, and other tenants have the opportunity to comment on whether they feel it is a suitable placement. The home ensures they have a full assessment of peoples needs before they move in, then staff do a further assessment. Sometimes prospective tenants complete their own application form detailing their needs and wishes, which is good practice. Family and advocates are involved in the admission process, if this is what the person wants. Care Homes for Adults (18-65 years) Page 11 of 28 Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home keeps clear records, so staff know what support each tenant needs. Tenants make their own choices and are as independent as possible, while staff take care to reduce unnecessary risks. Evidence: We looked at care plans and risk assessments, and talked with tenants and staff. Care plans and risk assessments were detailed and up to date, so tenants knew staff were aware of their support needs. Plans were mostly kept in tenants rooms, and they had as much involvement with writing them as they wanted. Tenants described making choices in everyday life. Staff supported tenants independence as much as possible, reducing risks without unnecessarily restricting anyones freedom. For example, one tenant had gone on holiday without staff. He and staff had discussed potential difficulties and made contingency plans. He had been able Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: to enjoy an independent holiday. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tenants like living at Wall Street and say they have a good life there. Their social lives are good and they have a good choice of food. Evidence: We talked to tenants and staff, and looked at records. Tenants have the freedom to do what they like, in and out of the home. The only limitation is staff availability for those who need staff support. This has been a concern in the past. Tenants now mostly say it has improved, despite a difficult period with some staff on long term sick leave, and they are almost always able to go out when they want. One person did comment that going out for the day, or the evening, depended on staff levels. It appears that staff rotas can be arranged in advance to allow sufficient staffing for a pre-planned activity, but in general staff levels are not Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: high enough for tenants (who need staff support outside the home) to routinely feel confident that they can go out of the home when they want, without planning it in advance, as non-disabled people are able to do. The manager continues to try to improve this situation by increased funding and recruitment of volunteers. Family and friends are welcomed in the home and visit regularly. Tenants take part in a variety of activities, hobbies and social outings, according to their interests. Tenants choose their own food, with a good variety of fresh meals. Some people cook their own, some have staff help and staff do all the preparation when needed. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tenants know that the personal and health care they need is recorded, so staff provide the care that people want. Staff manage medication in a way that keeps tenants safe. Evidence: We talked to tenants and staff, and looked at care records and medication storage and records. Tenants say staff provide personal care in a respectful way, and as they want it. Plans give good details of what is needed by each person. Staffing arrangements sometimes affect tenants choices about when they go to bed. Health care needs are also recorded well, and records are kept of any medical treatments , appointments etc, so staff know exactly what health care has been given. Professionals surveyed about the home were complimentary, one said Support for (health issues), including supporting self care and attendance for appointments, is excellent. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: Medication is usually managed well. An error had occurred, which the home had reported appropriately (which is good practice) and had investigated. It appeared that it was not a result of general poor practice but was due to an unfortunate combination of factors; the registered manager had put safeguards in place since then, to try to ensure that tenants always get the right medication. Records and storage seen on the day were satisfactory, although there were still some medications where the labels provided by the pharmacy were not as clear as they could be - in some cases this was because of changing doses. It would be safer for tenants if these were always as clear as possible. When possible, staff give tenants any support needed with looking after their own medication. One tenant showed us their secure storage and described the help and training staff had given; we also saw the assessment of any risk associated with them managing their own medication. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tenants feel free to raise any concerns with staff, and they know how to do so. Staff know how to respond professionally if they suspect any mis treatment of tenants. Evidence: The home had a suitable complaints policy, which tenants know about and said they feel free to use. There were no complaints recorded, but there were some concerns raised. In these cases the home had not always recorded what action they had taken. No-one has complained to the Commission for Social Care Inspection about the service. Staff at the home knew what to do if there were any concerns about possible abuse. They had mostly had recent training on this matter, and discussions with the manager on other occasions had shown that the home followed good practice guidelines and were very alert to any potential mistreatment of tenants. There had been a concern about an event in the home, which staff and managers had reported openly and promptly, following the best procedures for ensuring problems are properly investigated. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and well maintained. It has the adaptations needed by tenants. Evidence: The home was warm, clean and well maintained at the time of the inspection. It had the adaptations needed by the tenants, such as suitable baths, hoists and kitchen furniture. Tenants rooms were furnished according to their tastes. Some refurbishment was needed, such as carpets, but this was in hand. Tenants said carpets were about to be replaced. The home is kept clean and hygienic. Almost all staff have now been trained in food hygiene and infection control. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tenants have good relationships with staff in the home. Staff are well qualified and trained for the support they provide to tenants. Most staff have done Disability Awareness training. New staff are checked to reduce the risk of employing people who could be unsuitable for working with the tenants. Evidence: Staff were well qualified, with 90 of permanent staff and 1/3 of bank staff having achieved NVQs (National Vocational Qualifications). This should ensure they have basic skills and knowledge for their role. Tenants were positive about staff; 4 of the 8 tenants surveyed said that staff usually listened to them and the other 4 said they always did. Several made positive comments about the staff., such as The staff are excellent... they always understand problems. The service had staffing difficulties over the past year, due to a combination of factors outside their direct control, such as sickness absence and funding levels. The manager has continued to pursue matters where he could in order to try to improve the situation. He also used regular agency / bank staff wherever possible so they were familiar to the tenants. He had also begun again to recruit volunteers, to provide additional social support to tenants. Tenants said the staffing situation had improved, Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: but there were still some potential improvements if staffing levels could be improved (see previous sections on Lifestyle and on Personal/Healthcare Support). The use of agency or bank staff had been very frustrating for some tenants; one person described how they had to explain the way they needed to be supported over and over again, and how frustrating this was. Staff said agency workers would read support plans, but would not immediately be able to remember all the details for each person. New staff went through a safe recruitment procedure, including interviews, references and a CRB (Criminal Records Bureau) check. Evidence of these checks was on staff files, showing that the home was careful to guard against employing staff who were unsuitable. In one case we saw an incomplete employment history, which did not account for a gap in employment; this should have been checked and recorded on the file. Tenants were starting to take part in the recruitment process. A lot of updated staff training had been done, which should help to improve staff skills and knowledge, contributing to improving the service for tenants. 7 staff had done moving and handling training. This should be done by all staff; the home was aware of this and was attempting to resolve the suitability of their trainer. Other training included Disability Awareness training, recently done by 11 staff. This was a very positive development as the home provides a service to tenants with disabilities. Staff meetings were held regularly and staff said they had regular supervision. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and tenants like the manager. Improvements are being made to the service and tenants opinions are taken into account. The home is kept safe for tenants. Evidence: The registered manager is qualified, experienced and competent. Tenants and staff like him. He has achieved a lot of positive improvements in the service since becoming its manager. One tenant commented We have effective management now. He liaises professionally and effectively with external professionals, including with the Commission for Social Care Inspection. He has established regular staff meetings and tenant meetings, and all who spoke with us said they felt able to discuss difficulties or ideas with the manager. A process of Quality Assurance by Livability has started and was seen by us during the inspection. Tenants, relatives and professionals had been asked for their feedback about the service in order to contribute to Livabilitys development report which would Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: identify how to improve the service for tenants. The manager completed his Annual Quality Assurance Assessment, which tells us about all aspects of the home. It was sent to us promptly and was found to be a thorough and accurate assessment of how the service is functioning, including ways in which it could be improved. Records in the home were up to date and kept in an organised and accessible way. The home was maintained in a safe way. Written assessments of risks to tenants had been reviewed and updated; this was now being done 6-monthly and should help to ensure the home and any activities are kept safe for tenants. The format could be improved to be clearer and more consistent; this had been identified by the manager in his report. Most safety checks and tests were being done as required. Records of staff training in fire safety, and fire drills, were not as clear as they could be; it was difficult to ascertain whether night staff had taken part in drills, or how often other staff had been trained during the past year. Training had been done by all staff and fire drills were being done monthly. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The home should always give information in suitable written form to prospective tenants, so they can consider the details in their own time. The home should keep staffing levels under review, and continue trying to raise them, to ensure that tenants are able to take part in activities outside the home as they wish. The service should consider how to meet the needs of tenants who may prefer later bed times. The home should liaise with the pharmacy to ensure that, wherever and whenever possible, labels on medication state the exact directions for their use. The service should record the action they take in response to any concern or complaint. The manager should aim to achieve 100 staff trained in food hygiene and infection control, including bank staff. Recruitment procedures and records should be checked to ensure they are always thorough and complete. Training in safe moving and handling should now be prioritised for all staff including bank / relief staff, as well as training in disability awareness. 2 14 3 4 18 20 5 6 7 8 22 30 32 35 Care Homes for Adults (18-65 years) Page 26 of 28 9 42 All records and procedures related to health and safety should be reviewed to ensure they are clear and consistent, and show all relevant information. Further training (e.g. in risk assessment) could be beneficial. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. 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