Inspection on 25/01/07 for Wallfield

This inspection was carried out on 25th January 2007.

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

The inspector 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

Wallfield 01/03/06

Wallfield 31/10/05

Wallfield 18/01/05

Wallfield 25/08/04

Wallfield 25/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Wallfield 29 Castlemain Avenue Southbourne Bournemouth Dorset BH6 5ES Lead Inspector Heidi Banks Unannounced Inspection 25th & 30th January 2007 11:55 Wallfield DS0000032029.V328876.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 Wallfield DS0000032029.V328876.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. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wallfield Address 29 Castlemain Avenue Southbourne Bournemouth Dorset BH6 5ES 01202 428048 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) Bournemouth Borough Council Vacant Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (3) of places Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to be admitted to the first floor must be ambulant and able to manage stairs. Two service users (names to the CSCI) in the category PD may be accommodated to receive care. Service users in the category of LD(E) can be accommodated in the home up to a maximum of three places at any one time. 1st March 2006 Date of last inspection Brief Description of the Service: Wallfield is a Local Authority retained home with accommodation for fourteen residents. The home predominantly provides care and support for adults with learning disabilities although it has facilities to care for two service users with physical disabilities. Wallfield is a detached building located in the Southbourne area of Bournemouth. It is within walking distance of local shops and community facilities. Some on-street parking is available outside the home and bus routes to Bournemouth and Christchurch are easily accessed. Accommodation is provided in single bedrooms, two being on the ground floor and the rest on the first floor. There are toilet and bathroom facilities on both floors for shared use by residents. The communal facilities include two lounges, a dining room and a training / activity room. There is also a large garden at the rear of the home that can be used for recreational purposes and is accessible to wheelchair users. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection which took place over approximately ten hours on two weekdays; 25th and 30th January 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards and assess the provider’s progress in meeting requirements and recommendations made at the last inspection of the service. At the time of the inspection there were thirteen permanent residents living at Wallfield. One bedroom is used on separate occasions by two service users who have regular respite stays at the home. The first day of the inspection was carried out with the assistance of Hayley Hughes who is known as an ‘expert by experience’ and her supporter, Rose Martin, from Bristol and South Gloucestershire People First advocacy organisation. They took a guided tour of the building to look at the environment in which residents were living, spoke with two residents and the acting manager of the home, looked at information provided to residents on admission and following service user meetings and spent some time observing care practices and interactions between staff and service users. On the second day of the inspection, the inspector was able to meet and talk with residents, the acting manager of the home, four members of care staff and attend a staff meeting. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. A total of three completed surveys were received from relatives and visitors to the home and comment cards were received from one general medical practitioner and one Care Manager. The current residential fees at Wallfield are £735 per week. A total of twenty-four standards were assessed at this inspection. What the service does well: The home has admitted two new service users to the home since December 2006. There was evidence of liaison between staff at the home and Social Work teams to ensure that the home could meet the needs of the service users. Information had been obtained from the service users’ previous placements so that staff had some information about their routines, likes and dislikes. Visits by the service users to the home had taken place as part of the assessment process. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 6 Service users have Essential Lifestyle Plans that contain information; staff should know about them to meet their needs. Meetings are held for residents about once a month and minutes of the meetings showed that service users had been given opportunities to discuss activities and holidays they wanted. Risk assessments are in place and there was evidence to show that risk assessments for new residents were in the process of being written to ensure that their independence is promoted and risks to their safety minimised. The majority of residents access local day services on a regular basis. A programme of daily activities was on display in the home which included art and craft, music, gardening and a weekly outing for service users who are not attending day services. The expert by experience was shown two folders of photographs of holidays, outings and activities that had been enjoyed by service users in previous years. The expert by experience thought this was good as the photographs showed people doing things, going places and having a good time. She also noted that the files could help people to choose what they wanted to do. Service users are able to maintain contact with their families so that they have a circle of support outside the home. On the first day of inspection, the visit coincided with lunch-time in the home. The expert by experience noted that several of the residents had help from staff to eat. She thought they did this well. People were given choices and were treated as individuals. Support plans contain information about service users’ personal care needs so that staff know how service users want to be supported. There is also good liaison between the home and health care professionals to ensure that service users’ health care needs are met. The home has a complaints procedure which means that service users and their representatives can access information about how to raise concerns. The home follows the Local Authority’s adult protection policy and all staff are given training in abuse awareness as part of their induction training so that they know what action to take to protect residents from harm. The expert by experience commented that, for a big building, she thought the home was nice and comfortable. At the time of the inspection, two service users’ rooms were being redecorated and the manager described the work that should be done in the next year to ensure the home remains well-maintained. Systems are in place to ensure the home is clean and hygienic so that service users are protected from infection. The expert by experience noticed that the home was clean and tidy and there were no unpleasant smells. Robust recruitment procedures are in place to ensure that care workers who work with service users are safe to do so. All new staff to the home undertake a comprehensive induction programme and have access to ongoing training so that they have the necessary knowledge and skills to work safely with service users and meet their needs. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 7 Wallfield has had an acting manager since 1st June 2006 who plans to submit an application for registration with the Commission in the near future. The manager is supported by a team that includes a Deputy Manager, three Assistant Managers, a team of Support Workers, two part-time cooks and a domestic worker. The management structure of the home ensures that there are clear lines of accountability within the staff team and that systems are in place to ensure staff are well-supported in their work with service users. The home has a quality assurance process which seeks to obtain the views of residents, their families and care staff. The manager is looking to review the process to ensure that information obtained from the process is used effectively to improve the service. What has improved since the last inspection? What they could do better: As a result of this inspection, one requirement and five recommendations have been made. The home’s medication policy is under review. This must be finalised and fully implemented for service users to be fully protected by practices in the home. The expert by experience looked at information that is provided to service users about the home. The home is clearly making an effort to make information more accessible to service users by using symbols and pictures. However, the expert by experience felt that more work could be done by the home for the documents to be fully accessible to residents including the use of Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 8 larger font and photographs and pictures that are recognisable to service users. This was identified by the expert by experience as a potential area for development in which service users could be involved. It was noted that contributors to an Essential Lifestyle Plan for one resident were mainly staff at the home. Some of the service users at Wallfield do not have relatives or friends outside of the home and it was suggested to the acting manager that the home continues to look at ways in which service users can establish friendships and links outside of the home. Discussion with the acting manager indicated that she plans to implement a goal-setting process for individual service users as part of their support plan so that their decisionmaking and goals can be clearly documented. On both days of the inspection it was evident that there were extended periods of time when some service users were not engaged in meaningful activity. At these times staff were seen to be occupied with other tasks around the home. This was noted by the expert by experience who felt that staff should have been spending more time interacting and engaging with service users. The programme of activities was seen to be group-centred rather than personcentred and home-based rather then community-based. It is therefore recommended that activities are reviewed so that they meet service users’ personal needs and preferences and offer more one-to-one time for service users who might benefit from this. The manager is liaising with appropriate authorities to ensure that a system is in place by which staff are assessed as competent to perform certain tasks such as checking the blood sugar levels of residents. This should be confirmed and implemented so that service users are fully protected by practices in the home. The manager has identified a number of areas of the home environment that would benefit from refurbishment. This should be implemented to ensure the home is fit for purpose and provides greater comfort for residents. 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. Wallfield DS0000032029.V328876.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 Wallfield DS0000032029.V328876.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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to prospective service users about Wallfield to help them decide whether it is a place they would like to live. The home has ensured that they have sufficient information about new service users to ensure that placements are only offered to service users whose needs can be met. EVIDENCE: The home has produced a Service User Guide entitled ‘Welcome to Wallfield’ which gives prospective service users information about the home. It is written in simple text with some pictures and symbols to make it more accessible to adults with learning disabilities. This was reviewed by the expert by experience who consulted with one resident to see whether she was able to recognise the symbols and pictures in the document. It was clear, that the resident could identify some pictures but not others. Therefore, although the standard is met overall, it is suggested that the home looks at ways to develop their information for service users to promote full accessibility, for example, by Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 11 using larger font for text and pictures / photographs that are recognisable to service users. There have been two admissions of service users to Wallfield in the past two months. The record for one service user was seen. A care management assessment had been undertaken of the service user’s needs at his previous placement in July 2006. This contained information about his communication, health, mobility, self-care, relationships and preferred activities. There was evidence of senior staff from the home having visited the service user in his previous residential home in October 2006 and a series of visits taking place to Wallfield by the service user prior to admission. During this process there was evidence of information about the service user’s needs and preferences being gathered in daily records. A six-week review had been held just prior to the inspection to ensure that his needs are being met by the home. Wallfield DS0000032029.V328876.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Essential Lifestyle Plans provide information about service users’ needs and preferences. Implementation of goal-setting processes as part of their plan will help ensure that service users’ needs and choices are met. Systems are in place to support service users in making decisions about their lives but further development of individuals’ circles of support will be beneficial in ensuring that their aspirations are fully considered and met. Risk assessments are in place to ensure that there is a balance between promoting service users’ safety and independence in their home and community. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 13 EVIDENCE: An Essential Lifestyle Plan was seen. The Plan contained information about how the service user communicates including, for example, facial expressions and changes in behaviour, and how care workers should communicate with him; ‘always talk directly to me…I like interacting with people’. The Plan also contained information about the service user’s support needs for example, the assistance he needs at meal-times and how staff should promote his independence. The people involved in the compilation of the Plan were listed as the service user himself and a number of care workers from Wallfield. The Plan is kept in the office. Discussion with the acting manager of the home indicated her awareness that work needs to be done with service users to establish personal goal plans. It was clear from records seen that information about service users who are new to the service is being collated. Staff were able to talk about service users’ likes and dislikes, preferred routines and individual abilities. Where a person-centred plan was in place for one service user from her previous placement it is suggested that this is updated to correspond with her new home. A key worker system is in place to enable service users to work closely with a member of staff in making decisions about their lives. On the second day of the inspection, a service user had been supported to go shopping with her key worker to purchase a foot spa bath for herself. It was clear from her reaction that she was very pleased with her purchase and that this was something important for her. Records for service users indicated an awareness that service users communicate their decisions and preferences in different ways; for example, a service user was offered an alternative meal when he only ate a few mouthfuls of food from his original plate of food. There is a residents’ meeting held approximately once a month that is run by a senior staff member. The expert by experience felt that residents should have external advocacy support to help with this so that residents are empowered to make decisions as independently as possible. Risk assessments are in place for service users and there was evidence that the risk assessments for new residents were in the process of being drawn up. There was some discussion in the staff meeting about the numbers of staff needed to accompany one service user on trips out in the community to maintain her safety. The acting manager of the home is keen to promote the independence of service users and this was demonstrated by her plans to undertake a risk assessment to enable one service user to administer her own medication. It was evident from discussion that this process may need to comprise several stages so that the service user has adequate support to be able to do this safely. Wallfield DS0000032029.V328876.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s activity programme does not currently demonstrate how the leisure and occupational needs and preferences of individual service users are met. Further development of the home’s activity programme to be communitybased rather than home-based will help promote service users’ participation in their local community. The home recognises that service users benefit from contact with their families and promotes service users’ rights to invite their relatives into the home at any time. Service users are treated with respect and are given appropriate support to make some choices about aspects of their everyday lives. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 15 Service users are offered a varied range of meals which respect their individual preferences. EVIDENCE: The majority of service users at Wallfield attend local day services on a parttime basis. For service users who do not attend day services in the community a programme of activities facilitated by Support Workers is in place. This was seen to include music sessions, a weekly outing, gardening, fitness and arts and crafts. These activities are organised on a group rather than on an individual basis and are home-based rather than community-based. On the morning of the second day of the inspection three service users were sat in the lounge in front of the television but did not appear to be watching it. Two other service users were wandering in and out of the office seeking staff company. Other staff were observed to be busy undertaking tasks around the home at the time. However, when a jigsaw puzzle was taken to one service user he was seen to respond positively, and when another service user was offered one-to-one time to look at books and magazines, again she responded positively and welcomed the engagement. Discussion with staff and observation of service users within the home indicated that there is a diverse range of needs to be met within the service user group. It is therefore recommended that the home reviews its provision of activities to promote a more individualised, person-centred approach. At the time of the inspection, the home’s mini-bus was being serviced. The replacement vehicle did not have wheelchair access. Although systems were in place for the home to order wheelchair-accessible taxis as necessary, discussion with staff indicated that in practice, these were difficult to obtain. Discussion with the acting manager evidenced that service users have regular opportunities to go to shows at local theatres and consideration had been given to service users’ individual likes and needs when choosing these events. The acting manager reported that staff are flexible with the times of their shifts so they can take people out to events in the evening. A Christmas party had been organised at a local hotel for the majority of service users who had wanted to attend. Activity records indicated that two service users who did not wish to attend were able to enjoy a take-away meal at home. A file of colourful photographs was available showing activities that had been undertaken by service users in the past. The expert by experience thought this was good as the pictures showed service users enjoying themselves and having a good time. The home maintains a record of activities which indicate which service users have participated in activities and what they did. Entries indicate the initials of service users involved, the date on which the activity took place and a description of the activity. Descriptions were not sufficiently Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 16 detailed to give a meaningful account of the activity; for example, ‘walk and drink’; ‘walk’; ‘out for a short drive’. The minutes of the service user meeting held on 21st November 2006 were seen. These included suggestions by service users about things they wanted to do including having their nails and hair done, keep fit, ‘music and more cookery’. It is recommended that the home develops a system by which actions arising from their suggestions is tracked to evidence that they are followed through. Records showed that several service users at the home benefited from regular contact with their families. Service users’ relatives are welcomed in the home at any time and there is a pay-phone available for use by service users in the small lounge of the home. There are few service users who have friendships outside of the home however, and therefore, it is suggested that the home continues to look at ways of increasing opportunities for service users to build friendships and circles of support. Service users have free access to all communal areas of the building and during the inspection were seen to use both lounges, the dining room and office. There was evidence to indicate that where a service user wishes to have greater independence, this is facilitated by means of risk assessments being in place to enable her to go to local shops by herself. In addition, the home is planning to implement a key-pad system at the entrance to the home so that this service user can get in and out easily. Discussion with this service user showed that she had her own key to her bedroom and was receiving support to do her own laundry. Service users are offered choices and Essential Lifestyle Plans detail their preferences in aspects of their support. The home employs a cook who has responsibility for preparing main meals for service users. Discussion with the cook indicated that she is aware of service users’ personal likes and dislikes and takes these into account when planning menus. On the first day of the inspection, a group of service users were observed having scrambled eggs on toast for lunch. One service user reported that she had wanted baked beans on toast but staff had explained that they only had very large tins of beans in stock and they did not want to open one for just one person. However, she was offered an alternative of soup which she was happy with. The expert by experience felt that it was important for the home to have smaller tins of food available so that individual choices could be accommodated. The manager confirmed that this is usually the case. Inspection of one service user’s file indicated that his needs in relation to eating and drinking had been detailed; ‘I need to be assisted at meal times but not fed by staff. I will feed myself if staff assist me by holding the spoon.’ Service users were seen to be receiving support from staff during lunch and the expert by experience felt that they did this well acknowledging their individual needs and treating them with respect. Service users are supported Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 17 to make choices about what they eat, this process supported by the use of pictures and photographs. Groceries are delivered to the home from a central source. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide personal support that offers service users choice and promotes their dignity. The home liaises appropriately with generic and specialist health care professionals to ensure service users’ needs are met. The home’s policy on medication administration needs to be finalised and fully implemented for service users to be fully protected by practices. EVIDENCE: Service users’ preferences in relation to their personal care are clearly detailed in their support plans. Senior staff spoke of plans to purchase a new bath; this was seen as particularly positive for one service user who was reported to prefer this to a shower. One service user encountered during the inspection clearly enjoyed taking pride in her appearance and had been supported by staff to choose clothes, jewellery and nail polish that was colour co-ordinated. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 19 For new residents it was evident that their individual abilities with regards to their personal care had formed part of the assessment process. One service user spoken with reported that care workers ‘are doing a good job. They look after me well. I like the staff.’ This was echoed in responses to surveys from relatives of service users who commented that staff are ‘very supportive to the residents’ and ‘know the likes and dislikes of each resident’. One comment card was received from a Care Manager who also indicated that staff at the home demonstrate a clear understanding of the needs of residents. Senior staff spoken with during the inspection talked of the home having a good relationship with service users’ general medical practitioners. One comment card from a GP was received, this indicating that the home communicates clearly and works in partnership with him and that staff demonstrate a clear understanding of the care needs of service users. The home’s visitors book indicated that visits to service users from various specialist health care professionals are a common occurrence in the home and that the home consults with Community Learning Disability Nurses, Occupational Therapists and Psychology as required to ensure that service users’ health care needs are met. Records of a new service user to the home indicated that he had been registered with a local GP, had a dental appointment scheduled and was awaiting an audiology appointment for assessment of his hearing. Discussion taking place in the staff meeting indicated concerns around various service users’ weight and nutrition. It is suggested that the home requests the support of a dietician in assessing this and planning meals that meet their individual nutritional requirements. The home’s medication policy is currently under review. The acting manager at Wallfield is part of the working party involved in developing this policy and ensuring that it meets the needs of service users at the home. An inspection of the home’s medication procedures was undertaken by Christine Main, Pharmacist Inspector, in October 2006. One requirement was made at this inspection for the provider to undertake a review of the systems in place for administering medication to individuals accessing respite at Wallfield. This was to ensure that medication is not re-dispensed by care workers from the original packet supplied by the pharmacy. Discussion with an Assistant Manager indicated that this requirement has been met with one service user now attending the home with her own monitored dosage system and another preferring to have medication dispensed directly from the original pack. A series of recommendations were also made. Discussion with the Manager and examination of records indicated that work is in progress to meet all recommendations. An audit trail has been implemented by the Manager who now performs regular checks to ensure that medication is being given as prescribed. The Manager also reported that she is liaising with the Primary Care Trust regarding the training and assessment of staff who perform checks on one service user’s blood sugar levels. Appropriate training in medication Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 20 administration is being delivered by Bournemouth Borough Council in conjunction with the Primary Care Trust. This involves attendance at three two-hour sessions and an assessment. Although only senior staff take responsibility for administering medication to service users training is being provided to all at in the home to promote awareness of medicines, their uses, side-effects and good practice issues. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to give service users and their families opportunities to air their views and gain positive outcomes. Safeguards are in place to ensure service users are protected from harm and abuse. EVIDENCE: The home has a complaints procedure which gives information to the reader on how the Borough Council responds to complaints and the contact details for the Commission for Social Care Inspection. Although the home has a complaints procedure in symbols format it was noted that these may not be recognisable to service users. The expert by experience has suggested that work is done with service users to produce a complaints procedure that they can understand and that is meaningful to them. Key worker systems and regular service user meetings are in place to offer service users opportunities to raise issues that are important to them. All three surveys received from relatives and visitors to the home indicated that they were aware how to make a complaint about the care provided by the home if they needed to. They also indicated that the home had responded appropriately to their concerns when raised. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 22 Inspection of the home’s complaints record showed that no complaints have been received by the service since the last inspection in March 2006. Discussion with the manager indicated that at the present time there is no formal way of recording concerns that may be raised about the service and their outcomes. The home follows the local multi-agency procedures with regards to adult protection. Training is offered to staff as part of their induction programme. There have been no adult protection issues arising at the home since the last inspection of the service. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Plans are in place to improve the home so that it meets service users’ needs more effectively and provides a smart and comfortable living environment. The home is kept clean and systems are in place to maintain good hygiene and minimise the risk of cross-infection for service users. EVIDENCE: At the time of the inspection there was evidence that two service users’ bedrooms were in the process of being redecorated. The expert by experience took a guided tour of the building and noted that it appeared ‘nice and comfortable’. She was informed that the home had removed the dark wallpaper on the upstairs landing and had it redecorated and plans were in place to choose some pictures for the walls. A new bath had been ordered for Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 24 the downstairs bathroom to meet the needs of service users with mobility difficulties. The acting manager has compiled a list of work that should be undertaken in the home to ensure the home remains in good order and fit for purpose. These have been allocated an ‘order of priority’ and includes a ramp to provide a second exit for wheelchair users and replacement furnishings, fittings and carpets in various areas of the home. The Manager plans to submit a Capital Bid for funding to the Council so that these issues can be addressed. The Manager also discussed that she would like to increase access to the first floor of the home by installing a lift. The home’s garden is situated to the rear of the building. It had been made accessible from the home and was secure. There is a barbeque area for use by residents during the summer months. The expert by experience observed that the home presented as clean and tidy with no unpleasant smells. Domestic staff are employed to maintain the home’s cleanliness. Paper towels are available at every wash-hand basin in the bathrooms and there are ‘yellow bins’ for disposal of clinical waste. The Manager has identified that the existing laundry facilities in the home are inadequate to fully meet service users’ requirements and is advocating that an extension and refurbishment takes place. Infection control training is offered to staff at induction but it was not clear whether regular updates take place as part of the Borough’s training schedule. It was suggested to the Manager that this is investigated and staff are given opportunities to update their knowledge in this area as appropriate to their role. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 25 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, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are encouraged to work towards nationally recognised qualifications to equip them with the underpinning knowledge they need to work with adults with learning disabilities. A stable staff team and consistent staffing levels ensure service users’ needs can be met and they benefit from continuity of care. The home’s recruitment procedures ensure that service users are protected from harm by the people employed to work with them. The home’s programme of training enables staff to meet service users’ needs with confidence and competence. EVIDENCE: Discussion with the acting manager and two Assistant Managers indicated that three members of staff are currently working towards their Learning Disability Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 26 Award Framework qualification. A total of seven Support Workers have either achieved an National Vocational Qualification (NVQ) to Level 2 standard (or equivalent) or are working towards this. The three Assistant Managers are being supported to undertake qualifications to NVQ Level 3 standard in Care or Management to give them the skills they need to undertake their roles and supervise staff effectively. The acting manager reported that there have been no new staff recruited since the last inspection of the home. The home is reported to be fully staffed apart from approximately six hours each week which are filled by existing staff. As sleep-in duties are due to cease at the home by 1st April 2007, plans are in place to employ additional waking night staff to cover these hours. On the morning of the second day of inspection there were two Assistant Managers and three Support Workers on duty in the home. The afternoon shift was due to be staffed by one Assistant Manager and three Support Workers. The Manager agreed that, with the two new admissions to the home, staffing levels would be reviewed on an ongoing basis as the needs of the service users become more evident. Although no new staff have been recruited since the last inspection of the home, examination of one staff file indicated that all essential information about the individual had been collected including a completed application form and evidence of a structured interview process, written references, proof of identity and evidence that a satisfactory enhanced disclosure with the Criminal records Bureau had been obtained. There was evidence to indicate that staff are asked to renew their disclosures every three years as good practice. A copy of ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ published by the Commission has been forwarded to the acting manager of the service for her information. Training records seen indicated that staff have access to various training courses to help them perform their role safely and effectively. An induction training programme is mandatory for all staff during which all aspects of health and safety are covered. Records showed that all staff have received updates in moving and handling and emergency aid. Basic Food Hygiene training has been arranged for all staff in February and March 2007. Two staff have been nominated as link workers in total communication and have attended a fiveday course in this subject. They are now taking responsibility for cascading this information down to all staff in staff meetings. Other courses available to staff include dementia, sensory impairment and person centred planning. One Support Worker spoken with at inspection reported that he was up-to-date in his mandatory training and that information about training courses is put in a file in the office which staff can look at and apply for as they come up; ‘We usually get what we request’. It is suggested that the home continues to promote the uptake of specialist courses to increase the skills of the staff group. The acting manager confirmed that she was liaising with the Borough’s Training Department to establish future training needs for the staff team. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management structure at Wallfield offers clear lines of accountability and adequate leadership to ensure the service is run in service users’ best interests. Quality assurance systems and audits are in place to monitor the service provided to service users and make improvements to the support they receive. Service users are protected from harm by the home’s health and safety policies and procedures. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 28 EVIDENCE: The home has been without a Registered Manager since June 2006. However, interim arrangements for managing the service have been in place since this time with an acting manager in post who is well supported by senior management within the Local Authority. The Commission was informed of these arrangements in May 2006. The acting manager has suitable experience to equip her for her role. She reported that she has a NVQ Level 4 in Management and plans to supplement this with a NVQ in Care. Discussion with the acting manager at inspection evidenced that she intends to apply for the permanent post and has submitted an application for an enhanced check with the Criminal Records’ Bureau via the Commission as the first stage of applying for registration. Discussion with the acting manager indicated that she has a clear vision for the home including promoting service users’ autonomy as appropriate and supporting staff in adapting to change and development within the service. Staff spoken with at inspection were positive about the change in management and appear to have adapted well to this. The home has a quality assurance process in place which involves obtaining the views of service users, their relatives and care staff through surveys. The expert by experience examined a sample service user survey and felt it would benefit from review to encourage residents’ understanding and participation. The acting manager has noted ways in which the quality assurance process could be improved so that feedback obtained is utilised more fully. There was evidence to show that the home’s annual development plan links with the Council’s Business Plan. Requirements and recommendations made at inspection are also incorporated into the development plan and progress tracked on a regular basis at monitoring visits by the provider. A sample of fire safety records were inspected. Weekly checks are made of different alarm points within the home and monthly checks of emergency lighting and fire extinguishers are also undertaken. Records showed that the most recent fire drill taking place in the home was in December 2006. The names of service users and staff involved in the drill were recorded. The acting manager reported that, in terms of fire safety training, the minimum training provided to day staff is an annual session held by the Borough’s Fire Officer. Regular internal training is also provided to staff which comprises simulation exercises, scenarios and questionnaires on fire safety. The acting manager reported that night staff are provided with quarterly training in fire safety. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 29 Health and safety training is provided to staff at induction and through regular updates although it is suggested that the home implements a system to ensure that updates always take place prior to expiry of the previous certification. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 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 3 X X 3 X Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13 Requirement The registered provider shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered provider must ensure that the home’s medication policy is finalised and procedures and training are fully implemented. Timescale for action 31/05/07 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 YA7 Good Practice Recommendations The home should plan and implement goal-setting processes for service users to evidence how decisions they make are followed through. Service users should be supported in building their own circles of support outside of the home. DS0000032029.V328876.R01.S.doc Version 5.2 Page 32 Wallfield 2. YA12 The home should demonstrate how they provide activities that meet service users’ individual needs, choices and personal goals and offer them meaningful engagement. The home should promote community presence and participation for service users within the provision of daily activities. Individual plans should include information relating to service users’ medication. There should be evidence that staff who carry out invasive tasks have been trained and assessed as competent. These recommendations are repeated from the last inspection of the service. 3. YA13 4. YA20 5. YA24 The registered provider should ensure that continued refurbishment takes place in the home to ensure that it provides a comfortable home for service users that continues to meet their needs. Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. Extracts may not be used or reproduced without the express permission of CSCI Wallfield DS0000032029.V328876.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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