Inspection on 24/05/06 for Walnut House

This inspection was carried out on 24th May 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walnut House 08/03/06

Walnut House 13/10/05

Walnut House 03/03/05

Walnut House 08/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Walnut House 49a Norwich Road Dereham Norfolk NR20 3AS Lead Inspector Mr Roger Andrews Unannounced Inspection 24th May 2006 01:00 Walnut House DS0000027591.V297266.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 Walnut House DS0000027591.V297266.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. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walnut House Address 49a Norwich Road Dereham Norfolk NR20 3AS 01362 683581 01362 683581 whitstone@nacha.org.uk 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) Norfolk Autistic Community Housing Association Ltd Mrs Marie Ann Large Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to three (3) adults of either sex, with Learning Disability, not falling within any other category, may be accommodated. A fourth named service user (name held at CSCI Norwich office) may be accommodated until 1st August 2006. 8th March 2006 Date of last inspection Brief Description of the Service: Walnut House provides accommodation and care for up to three people with a learning disability; the registration has been temporarily amended to allow a named fourth service user to live at the home. Walnut House is managed by the Norfolk Autistic Community Housing Association and is situated in the grounds of Whitstone House, which is also managed by the organisation. Access to the Home is through the shared garden or through the larger Home. There is parking to the front of Whitstone House. The Home is situated on a main road into the market town of Dereham. The service users have single bedrooms and share the communal facilities. Building work is currently taking place to add a ground floor extension which will contain a staff sleep-in room and a small office. This will allow the registration to be formally extended to four residents on a permanent basis. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. It involved looking at records and care plans, looking at the state of the building and talking to the residents and staff. The residents also completed a questionnaire before the inspection took place and the manager of Walnut House also provided other information, e.g. about complaints, staffing and training, before the inspection took place. Walnut House offers the opportunity for residents to enjoy greater levels of independence and make a lot of choices about their day to day lives. The overall quality judgement for the service is good. What the service does well: What has improved since the last inspection? What they could do better: A quality assurance process needs to be developed to make sure good standards of care are being maintained. Walnut House staff could also benefit from staff meetings. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 6 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. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 7 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 Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 8 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 Assessment processes are in place for prospective new admissions. The quality judgement for this outcome area is good. EVIDENCE: The most recent resident came to live at Walnut house in July 2005. Information was on file from his previous placement including risk assessment records and a detailed report on the level of support required. Norfolk Autistic Community Housing Association Ltd, (NACHA), have also developed their own assessment form in line with a requirement made in a previous inspection report. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 9 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, 7 & 9 Care plans reflect a detailed picture of each resident and are reviewed regularly. Risk assessments are in place. Residents’ privacy is respected. The quality judgement for this outcome area is good. EVIDENCE: All four care plans were examined. They contained information on personal details, communication issues, areas of independence and areas where encouragement and support was focused. Preferences and weekly activities were included as well as healthcare issues, personal hobbies and nutrition. Support programmes gave examples of staff encouraging self-esteem and family contact. When communicating with residents, one example encouraged staff to use “simple and direct sentencing when talking to xxxx”. The care plans are reviewed monthly, (a new written monthly review is produced each month). Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 10 In addition to the detailed care plans a larger file contained information on contact with various health professionals, college courses, property inventories and other information. Daily care notes are also maintained and these give a good insight into the day to lifestyle of each resident. Risk assessments are in place and cover a variety of areas. Examples seen included using the kitchen facilities, holding a key to the bedroom, ironing, visiting pubs and shops and washing & bathing. There were good examples of residents being able to make choices and have these respected. One example relates to a resident who likes to spend periods of time in his room. He has a ‘do not disturb’ sign and instructions to staff instruct them to “respect his ‘do not disturb’ sign” unless it is an urgent matter and to ensure staff also knock on residents’ doors so that privacy is respected. All of the residents are able to communicate verbally and do not require any specialist communication aids. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 & 17 The residents are encouraged to be independent and enjoy a flexible routine within which they can make choices. The residents are fully involved in decision making, such as food choices. Residents can maintain contact with family members. The quality judgement for this outcome area is good. EVIDENCE: The residents are involved in many aspects of the domestic routine including doing their own laundry, cleaning their rooms, changing their bed linen and ironing. One of the residents was observed ironing a top after returning from her day centre activity. They are able to use the kitchen facilities and make, for example, hot drinks and will help lay the table for meals and wash up. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 12 All of the residents are able to make their own choices about when to go to bed and are generally quite capable about getting up at appropriate times for work. Residents decide on a daily basis what they are going to have for their evening meal. On the day of inspection one of the residents had cooked a hot meal at her day centre for lunch and informed the member of staff that she only wanted sandwiches for her teatime meal. The residents can make their own packed lunches and they take turns in doing the shopping with a member of staff on a one to one basis. One resident’s care plan notes that the resident “is able to produce a variety of main courses and desserts”. There are also risk assessments in place in respect of using knives and other kitchen facilities. Residents can make their own breakfasts and one resident likes to take her breakfast to her room and have breakfast in bed. During weekdays the residents attend local day centres or colleges and records note that one resident is working towards an NVQ qualification in food preparation. Leisure activities include swimming, (some of the residents were going swimming that evening after tea), horse riding, visiting local pubs and ten pin bowling. In their questionnaires the residents indicated that they had lots of things to do, though one said, “I would like to go out more to places like the seaside and walks”. Residents also have their own personal hobbies and interests which are documented in their care plans. One resident has a Play Station computer console. Another resident likes watching soaps and listening to music in her room. Weekends are more relaxed and often involve a lie in. Activities at weekends are flexible and are decided upon by the staff and residents. Walnut House has its own dedicated vehicle for trips out. Where they wish to do so residents are able to have considerable contact with their family. One resident, for example, goes home on alternate weekends and family and friends can visit Walnut House. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 13 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): 18, 19 & 20 Residents are encouraged to undertake their own personal care. The health care needs of residents are met and recorded. Medication is properly stored and handled. The quality judgement in this outcome area is good. EVIDENCE: A member of staff described how, in some cases, residents can make decisions about when to bath or shower and that they are self-caring in practically all personal care tasks and generally just need encouragement and prompting. Care plans set out each resident’s capabilities in this area and the support they require. Health care issues are documented in residents’ individual files and each resident has an ‘appointments’ book documenting all health care appointments and outcomes. Where appropriate arrangements are in place for specialist involvement such as the Consultant Psychiatrist and Speech Therapist as well as G.P., Dentist and Chiropodist. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 14 Three of the residents are on medication, though at present none of them looks after their own. Medication is stored in a locked cabinet inside a locked cupboard. Medication administration sheets were checked and were properly completed and up to date. The medication each resident is on is clearly set out and ‘information leaflets’ on each medication, including the reason it is being taken and any side effects, are on file. Any errors and remedial actions are documented in the care plans. Medication is only administered by Level 3 staff and above and staff have attended medication training. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 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): 22 & 23 Residents know who to speak to with concerns and training on adult protection is taking place. The quality judgement in this outcome area is good. EVIDENCE: All of the residents indicated in their questionnaires that they knew who to talk to if they were concerned about anything and that they were happy living at Walnut House, which was confirmed in discussion during the inspection. A simplified complaints procedure has been produced. External adult protection training sessions have been taking place recently and several staff are attending each course as they arise. The member of staff on duty during the inspection was aware of adult protection and Protection of Vulnerable Adult issues. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 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): 24, 25, 27 & 30 The residents’ accommodation offers a pleasant and safe environment to live. The quality judgement for this outcome area is good. EVIDENCE: Walnut House is a domestic size property with four bedrooms, (one on the ground floor), a lounge with comfy seating, television, video and DVD equipment, a dining room, kitchen and utility room. There are also several storage cupboards. At the present time an extension is being completed which will provide a small office and staff sleeping-in room and shower which will allow the registration to be formally increased to four residents. The house is pleasantly decorated and has good natural lighting throughout. Each of the residents allowed access to their bedrooms which were pleasantly personalised and to which they hold a key, (though one resident said she didn’t use hers and kept it in a drawer). The bedrooms are of a reasonable size and residents have a variety of equipment such as their own televisions and music players. There is a bathroom on the first floor and a shower room on the ground floor. The hot water temperature is regulated. The hot water on the bath was tested Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 17 by hand. It was not excessively hot. There are also toilet facilities on both ground and first floors. Toilets and bathrooms have locks on the doors. All areas of the home were clean and there was no trace of any unpleasant odours. No obvious hazards were identified. The area where the new extension is being built is fenced off and not accessible to the residents. The residents have access to the large garden, most of which is lawn and they have some garden tables and chairs on a small patio area. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 18 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): 32, 34, 35 & 36 Staff receive appropriate training and supervision and are properly recruited. Adult protection training The quality judgement in this outcome area is good. EVIDENCE: Walnut House has at least one member of staff on duty when any of the four residents are at home. Given the degree of independence exhibited by the residents this is an adequate staffing level and additional staff can be called from Whitstone House, (located in the same grounds), if needed, e.g. in an emergency. However, the member of staff reported that this could decrease choice at weekends if residents want to do different things and a certain amount of negotiation may be needed. This needs to be monitored to ensure residents are not unduly restricted in activities they wish to participate in. The member of staff sleeps in during the night. Walnut House does not have waking night staff. The staff have opportunities to undertake a variety of training including autism specific courses. Examples of training over the past six months include first aid, team leader training, autism and diet theory & practice, best autism practice, fire prevention, management & leadership, food hygiene and an NVQ induction day. These examples are not exhaustive. A number of staff have been undertaking NVQ training and are waiting for their final verification. A Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 19 record of training undertaken by individual members of staff is maintained. The member of staff on duty confirmed that he had completed NVQ 3 training. The staff files and recruitment processes were not inspected on this occasion as they were inspected two weeks prior to this inspection when Whitstone House, (the larger care home located in the same grounds), received its inspection. On that occasion the files were in order and showed safe recruitment practices were being observed. The member of staff on duty confirmed that he receives formal supervision on a one to one basis approximately every six to eight weeks. Staff meetings relating solely to Walnut House are not currently held, though the staff do join in with staff meetings for Whitstone House and, in some cases, staff work shifts at both houses. See recommendation. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 39 & 42 The manager is undertaking appropriate training. A quality assurance process needs to be developed. The servicing of fire equipment and records kept for the protection of residents, (e.g. financial records), are in place. The overall quality judgement for these standards is Adequate EVIDENCE: The manager is currently undertaking training at NVQ level 4. The manager has worked at Walnut House, (and Whitstone House), for some years prior to being appointed as the registered manager. A formal quality assurance process needs to be developed looking at ways in which the service is meeting the needs of residents and consulting with them. The manager reported that she will be doing this in concert with the manager Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 21 of Lambert House, the ‘sister’ residential resource for people with autism. However, Walnut House is accredited annually by an external assessor and receives an Autism Accreditation Report. This looks at selected core standards in relation to the care of people with autistic spectrum disorders. See requirement. The fire alarm system was serviced in January 2006. Extinguishers and other fire fighting equipment was serviced in April 2006. The record of weekly checks of fire points was up to date. The accident record was examined. There have been no recordable accidents at Walnut House. Minor accidents such as small cuts and abrasions are recorded in the back of the appointments book. All four residents’ financial records were examined. These were up to date and recorded income and expenditure. Receipts are kept and a random check was made on some of these. A current liability insurance certificate is displayed in the kitchen. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 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 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA39 Regulation 24 Requirement The registered manager must ensure that a review of the quality of care be undertaken as specified in regulation 24 of the Care Homes Regulations 2001. Repeated Requirement: Timescale extended Timescale for action 31/10/06 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 YA33 Good Practice Recommendations It is recommended that regular staff meetings take place for Walnut House. Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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 Walnut House DS0000027591.V297266.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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