Inspection on 31/10/05 for Wallfield

This inspection was carried out on 31st October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 25/01/07

Wallfield 01/03/06

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 31st October 2005 13:50 DS0000032029.V264380.R01.S.doc Version 5.0 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 DS0000032029.V264380.R01.S.doc Version 5.0 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. DS0000032029.V264380.R01.S.doc Version 5.0 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 Zuhal Halet Septekin Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (3) of places DS0000032029.V264380.R01.S.doc Version 5.0 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. 18th January 2005 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 additional facilities to care for two service users with physical disabilities. Wallfield is managed on behalf of Bournemouth Borough Council by Mrs Z Septekin. Wallfield is a detached building located in the Southbourne area of Bournemouth. It is within easy reach 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. The communal facilities include two welldecorated and furnished lounges, a dining room and a training / activity room. There is also a large garden outside that can be used for recreational purposes. DS0000032029.V264380.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of 4.25 hours on a weekday afternoon. The lead inspector was accompanied by Mark Goodman, Regulation Manager. The inspection was part of the normal routine of inspecting every service twice a year. The inspectors were assisted by the Registered Manager throughout the duration of the visit. There are fourteen residents accommodated at Wallfield at the present time. All residents are currently under 65 years of age although the manager reported that two are approaching 65. At the start of the inspection the majority of residents were attending day services although a few residents who do not currently attend day services were present in the home. However, during the visit, the inspectors had the opportunity to meet a number of residents on their return to the home following day service. The manager reported that the number of service users living in the home with medium to high level needs has increased which means that it has become more difficult to obtain verbal feedback from residents during the inspection process. Therefore during this inspection, information was obtained mainly from the Registered Manager, two Assistant Manager, care staff attending a staff meeting, observation of staff interaction with service users, inspection of a sample of service user files and a guided tour of the premises. At the time of the inspection, no comment cards had been sent out to residents, relatives, health care professionals or Care Managers but this information will be obtained prior to the next inspection of Wallfield and incorporated in the next report. The Registered Manager has ensured that a requirement made at the last inspection has been met and the home is now compliant with its conditions of registration. What the service does well: There are effective systems in place to promote good communication within the staff team including regular, structured staff meetings and a daily ‘report exchange’ which involves all staff on duty. DS0000032029.V264380.R01.S.doc Version 5.0 Page 6 The Registered Manager appears to be very much involved with the life of the home and there are clear lines of accountability in the staff structure. It is evident that the service has liaised with the multi-agency team in supporting previous residents to move into supported living accommodation. They continue to liaise with the multi-agency team in supporting new residents in their transition to Wallfield. What has improved since the last inspection? What they could do better: Specific risk assessments and management strategies should be put in place relating to risks identified at initial assessment. For example, where a risk has been identified around maintaining road safety for an individual service user, a clear action plan needs to be produced which details proposed interventions by staff to minimise risks and how, when and by whom the strategies will be evaluated. The home is supporting a service user whose needs are complex and challenging. The manager should establish a clear action plan which will enable the service user’s needs to be met to include regular formal multiagency reviews. A system of structured monitoring should be put in place to support behaviour programmes, for example use of ABC charts, to enable effective analysis of data and patterns of behaviour to be identified. DS0000032029.V264380.R01.S.doc Version 5.0 Page 7 Service users should be able to access their bedrooms as and when they choose, without the need for them to seek assistance from staff, in order for their rights and independence to be promoted. Service user involvement, or the involvement of their advocates or representatives, should be promoted during the assessment process and their views clearly reflected in the assessment documentation. Contributors to individual Plans should be encouraged to ‘sign up’ to the Plan and the Plan made available in a language and format that the service user can understand. Staffing levels should be reviewed on a regular basis to reflect the changing needs of service users. 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. DS0000032029.V264380.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000032029.V264380.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Service users’ needs are assessed prior to admission to Wallfield but the process appears to have limited service user involvement. EVIDENCE: The file of a service user recently admitted to the home was examined by the inspector. This demonstrated that a Care Management assessment had been undertaken prior to the service user moving to Wallfield. The assessment included background information on the service user’s personal history, health needs and ability to participate in activities of daily living. Consideration should be given to cultural and religious needs, however, as these areas of the assessment had not been completed. There was no evidence that the service user or their advocate / representative had actively contributed to the assessment process in terms of identifying their needs and aspirations. The section titled ‘service user’s view of own needs’ stated ‘unable to comment’, and the section titled ‘carer’s views’ had not been completed. DS0000032029.V264380.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Individual Plans are not currently in a format that makes them accessible to service users. There was a lack of clear risk management strategies in place to demonstrate how some service users are supported to take risks. EVIDENCE: Examination of service user records demonstrated that Essential Lifestyle Plans were in place. These Plans identified things that are important to the service user, their likes and dislikes and information regarding how the service user likes to be treated by those supporting them. It was reported by staff that in the past three months one service user had started to smear faeces. There was no reference to this in the service user’s Essential Lifestyle Plan. A behaviour programme had been drawn up between staff and a Clinical Psychologist, although this had not been signed or dated by the contributors. There was no evidence of any structured monitoring in place to collect information regarding the behaviour, its antecedents or consequences that could be analysed. The manager reported that she had DS0000032029.V264380.R01.S.doc Version 5.0 Page 11 been liaising with Social Services regarding the behaviour but there was no evidence of a formal review since May 2005. Review of another service user’s file demonstrated that risks had been identified for the service user in the Care Management assessment but there were no clear risk assessments or risk management strategies to follow on from the initial indication of risk. For example, it was identified during the initial assessment process that a service user is at risk of choking due to eating too quickly and that there was a ‘need to monitor’ this. The manager reported that since admission there had been no incidences of this service user choking and therefore a risk assessment had not been undertaken as the behaviour ‘had not happened’. There was no detailed care plan around how staff would act to minimise or monitor the risk. In addition, it was noted that the service user had no road safety awareness. The initial assessment indicated that the service user should link arms or hold the hand of a staff member. An update of the assessment stated that the service user is ‘also happy to walk on her own’. It was discussed with the manager that this contradictory information was potentially confusing for staff. Staff confirmed that in busy areas and near roads they link arms with the service user but in open spaces the service user is allowed more freedom to walk independently with supervision from staff. There was no specific care plan in place with this information. The manager reported that communication within the team is good and that staff do not go out with a service user without having had a verbal briefing about support that is required beforehand. Following the inspection the Registered Manager reported that care plans are in place in relation to the risks of choking and road safety for the service user concerned. These are kept in a separate folder and were not pointed out on the day of the inspection. DS0000032029.V264380.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 16 The home offers service users opportunities to engage in leisure activities according to their needs and preferences. Although the rights of service users are generally respected within the home, the practice of locking service users’ bedrooms is detrimental to their rights. EVIDENCE: Appropriate leisure activities for individual service users were discussed in the staff meeting to which the inspectors were invited. Particular attention was paid to identifying leisure activities suitable for residents who do not currently attend a day service and a resident who is a wheelchair user. It was also evident that staff are liaising with Social Services to identify an appropriate day service for one particular service user. Arrangements for the Christmas party were discussed – service users are going to a local hotel where they had been welcomed in previous years. DS0000032029.V264380.R01.S.doc Version 5.0 Page 13 It was noted during a guided tour of the premises that staff were locking doors to service users’ bedrooms prior to their return from day services. A member of staff informed the inspectors that this course of action had been adopted a few months ago in response to a service user going into other residents’ bedrooms uninvited and smearing their property. The member of staff expressed concern about the practice of locking doors. The member of staff informed the inspectors that all residents had been issued with keys but not all were able to use them and therefore most would need to approach a member of staff for help should they wish to have access to their bedroom. DS0000032029.V264380.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Service users’ physical and emotional health needs are generally met. EVIDENCE: Each service user has a Personal Health Record in which appointments with various healthcare professionals can be documented. It was clear from discussion within the staff meeting that the home has developed links with the Community Learning Disability Team in the provision of specialist health care support for individual service users including Clinical Psychology and Occupational Therapy. It was discussed with the manager the steps being taken to support a service user whose challenging behaviour was impacting on the daily life of other residents. The manager reported that she had been in contact with Social Services regarding the issue but it was evident from the service user’s records that there had been no formal multi-agency review since the onset of the behaviour. DS0000032029.V264380.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this occasion. EVIDENCE: DS0000032029.V264380.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 and 30 The independence of some service users’ is restricted as they are unable to access their bedrooms without asking staff. The home presents as clean, hygienic and free from offensive odours. Appropriate steps are being taken to ensure that facilities meet the needs of the service user group. EVIDENCE: Bedrooms for service users were personalised according to their individual preferences and needs. Staff reported that all service users have keys to their bedrooms but not all were able to use them. As doors are locked by staff in response to the challenging behaviour presented by one service user, this means that not all residents are able to gain entry to their rooms as they wish without asking staff for assistance. The home presented as clean and hygienic. Staff have identified that, in order to meet the changing needs of service users, the home requires additional washing machine and sluicing facilities. The manager is liaising with her line manager with regards to extending the utility area of the home for the benefit of service users. DS0000032029.V264380.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 36 Staff roles and responsibilities have now been clarified to the benefit of service users. Systems are in place to promote effectiveness of the staff team but it was difficult to see how the assessed needs of all individual service users could be met by the current staffing ratio. Staff are well supported in their roles and mechanisms are in place to promote continuity of care for service users. EVIDENCE: In response to a recommendation made at previous inspections, job descriptions for Care Assistants have now been reviewed by the service to accurately reflect their role and responsibilities. The manager is assisted by a team of Assistant Managers who provide leadership on shifts and have responsibilities appropriate to their role as key workers. Communication among staff was reported to be good and systems are in place to promote opportunities for staff to communicate with each other about aspects of the home and support provided through well-structured monthly staff meetings and daily report exchange. Staff reported that use of agency staff was kept to a minimum with permanent staff often choosing to work additional shifts to fill gaps in the rota. When agency staff are used the DS0000032029.V264380.R01.S.doc Version 5.0 Page 18 same individuals attend in order to promote consistency of care for service users. It was reported that on an average shift there are three care assistants and an Assistant Manager on duty. Given the range of needs presented by service users it was difficult to see how this staffing ratio would fully meet the needs of individual service users, particularly those requiring support around challenging behaviour. Consideration should therefore be given to reviewing staffing levels according to the assessed needs of individual service users. The manager spoke positively about the staff team and one member of staff who was relatively new to Wallfield commented during a staff meeting that she had felt well supported during her induction and that there was a good sense of team work within the home. Staff have annual Personal Achievement Development Reviews with their line manager. It was reported that goals identified in this process are linked to Wallfield’s Business Plan. DS0000032029.V264380.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The Manager is experienced and well-qualified in her role to the benefit of service users. EVIDENCE: The Registered Manager is experienced and well-qualified to NVQ 4 Level and clearly maintains involvement with the daily life of the home, attending staff meetings and report exchange as appropriate. Whilst retaining overall responsibility for the running of the home, the manager has effectively delegated responsibility for various tasks to the Assistant Managers. A Deputy Manager is due to commence in post in the near future. DS0000032029.V264380.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score Standard No 22 23 Score x 2 x x x x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x 2 x x x 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 x 16 2 17 Standard No 31 32 33 34 35 36 Score 3 x 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x DS0000032029.V264380.R01.S.doc Version 5.0 Page 21 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 YA19 Regulation 12 Requirement The Registered Person needs to take appropriate steps to coordinate a multi-agency review for an individual service user whose needs are currently unmet. A clear action plan must be formulated to show how the service plans to meet the individual’s needs. Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations The prospective service user and/or his advocate or representative should be involved in the assessment process. Their involvement should be reflected in the assessment documentation. Individual Plans should be reviewed and updated to reflect changing needs. Contributors should ‘sign up’ to the Plan. The Plan should be made available in a language and format the service user can understand. Risk management strategies should be agreed, recorded in the individual Plan and reviewed. DS0000032029.V264380.R01.S.doc Version 5.0 Page 22 2 YA6 3 YA9 4 5 6 YA16 YA26 YA33 Service users’ rights should be recognised so that they are able to access their own bedrooms as and when they choose without the need to seek assistance from staff. Service users’ independence should be promoted so that they are able to access their bedrooms as and when they choose without the need to seek assistance from staff. Staffing levels should be regularly reviewed to reflect the changing needs of individual service users. 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