Inspection on 08/03/06 for Walnut House

This inspection was carried out on 8th March 2006.

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 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walnut House 24/05/06

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 Clive Lucas Unannounced Inspection 8 March 2006 10:00 th Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 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.V279948.R01.S.doc Version 5.1 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.V279948.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Walnut House Address 49a Norwich Road Dereham Norfolk NR20 3AS 01362 683581 01362 683581 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.V279948.R01.S.doc Version 5.1 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 18th April 2006. 7th December 2005 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. There is also a staff sleeping in room on the first floor. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. No service users were present during the day, although a service user will often return to the home for lunch. The inspector spoke with the manager and two members of staff, looked at some records and looked at some areas of the house. What the service does well: What has improved since the last inspection? What they could do better: 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.V279948.R01.S.doc Version 5.1 Page 6 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.V279948.R01.S.doc Version 5.1 Page 7 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): EVIDENCE: These standards were not inspected on this occasion. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 8 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): EVIDENCE: These standards were not inspected on this occasion. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 9 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): 16 and 17 Service users are able to exercise choice in their daily lives. They are offered a healthy diet and are encouraged to be as involved in preparing meals as they are able to. EVIDENCE: Service users are able to exercise choice in their daily lives, as far as their ability and available staffing allows (see comments for “Staffing”). Examples were given by staff of times when service users were able to choose to listen to music or watch videos in their rooms, spend time talking with staff, or in the communal living room. Records evidenced that service users have choice about rising and bedtimes. There are two male and two female service users. The home has a bathroom and a shower room. The men bath or shower in the evening and the women in the morning. As there is a time pressure on week-day mornings, the women have to alternate, showering one morning and bathing the next. Staff said that as change can be difficult for people with autistic spectrum disorders, the alternating of bathing and showering is something that has become accepted and service users feel comfortable with. The manager feels that there would Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 10 be time in the mornings for both female service users to shower should they so wish, or should there be a change of service users in the future. Service users take part in the daily chores around the house. Staff may lead this, but service users are able to choose what they do. For example one service user does not like ironing, so he does not do it. Service users plan meals and they help in the preparation of them. If a service user does not want what is planned an alternative will be provided. Some service users have to watch their weight, so staff will remind and guide them in their diet. Service users take turns to do the food shopping with a member of staff. Some staff require training in food handling and hygiene; see comments for “Staffing”. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 11 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 and 20 Service users are supported in undertaking their own personal care. Their health needs are met, but the limited staffing is a problem that has to be overcome to do so. EVIDENCE: Intimate personal care is not provided for any of the service users living at Walnut House. Shopping for clothes is done individually. Service users can exercise choice over clothing, toiletries and hairstyle, although staff may give guidance on suitability and cost. There are currently no service users who manage their own healthcare. Staff said that service users are able to tell staff when they are not feeling well. Staff will arrange for medical help or consultation as required, but this may be dependent upon a member of staff from Whitstone House or an on call manager coming in to allow the service user to be taken to the GP’s. A member of staff who will act as an advocate accompanies service users to the GP. This will always be a female member of staff with a female service user, and attempts are made to ensure that a male member of staff would accompany a male service user. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 12 The previous inspection report noted that the key for the medicine cupboard was kept in an unlocked drawer in the dining room, and required that this practice change. The key is now kept in a locked key cabinet in an unlocked cupboard. This is an improvement, but the registered manager must ensure that the key cabinet be secured to the wall. When the planned building work is complete it will be possible to locate the key cabinet in the staff room. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 13 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 and 23 There is a culture of listening to concerns, but training in adult protection is needed for those staff who have not yet received it. There is additional work required to the complaints information for families. EVIDENCE: Training in the protection of vulnerable adults has been provided for some staff, but not all. The manager said that future training is planned for the remaining staff. The registered manager must ensure that all staff have access to this training. This is a repeated requirement. In order to ensure that service users and their relatives or representatives are able to raise any complaints it is recommended that a complaints leaflet be developed, which would be more user friendly than the whole complaints procedure. Complaints information for service users is provided in widget format. The manager said that there have not been any complaints made and that there is not a format for recording any complaints that are made. The registered manager must ensure that a format is provided to record any complaints that are made. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 14 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 and 30 The home continues to provide a homely and comfortable environment for the registered use for three service users. The admission of a fourth service user has not been appropriate for the building. EVIDENCE: At the time of the previous inspection there were four service users living in the home, which meant that the member of staff had to sleep in the living room. The previous inspection report stated that it was not appropriate for a member of staff to sleep in a service user’s communal area and the admission of a fourth service user had been outside of the home’s registration. The fourth service user moved into the home in late July 2005 and the application for a change of registration was not made until October 2005. An application for a variation was made and granted. This allowed a fourth named service user (name held at CSCI Norwich office) to be accommodated until 18th April 2006, in order to allow time for necessary building work to be undertaken, so that the home would be suitable for four service users. However the building work has not yet started. The home cannot operate outside of its conditions of registration; the registered manager must ensure Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 15 that action be taken to either apply for a further variation, or to arrange for a return to three service users. Since the previous inspection, net curtains have been provided for a service user’s bedroom on the ground floor. This has increased her privacy. Although the whole of the building was not looked at on this occasion, the areas seen were homely and comfortable. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 16 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, 33, 34 and 35 All staff working at Walnut House are experienced. Attention needs to be given to training, staffing levels and team meetings. Improvements in the recruitment process protect service users. EVIDENCE: Staff who work in Walnut House are taken from the staff group at Whitstone House and are all senior care staff. There is a low turnover of staff. Staff meetings are held for Whitstone House and matters relating to Walnut House may be discussed there. There are not specific staff meetings for Walnut House. It was recommended in the previous report that regular staff meetings take place for Walnut House. To date this has not happened, but there has been a significant change to the staff rotas, which has reduced the length of the shifts that staff work, especially at week-ends. This has resulted in the two previous staff teams being divided into three teams. These teams do meet regularly. However, it is still recommended that regular staff meetings take place for specifically for Walnut House staff, so they can discuss matters relating to that home. The previous report required that the registered manager ensure that the staffing levels were reviewed to make sure that service users had their needs fully met and that shifts were not overly long for staff to be able to work Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 17 effectively. The change to the staff rotas has shortened staff shifts; but the staffing level for the home has not changed. Staff reported that there were times when service users may not be able to go shopping for clothes, or to the GP, without extra staff coming in. Furthermore, the service users’ ability to choose what they do at week-ends can be limited as there will only be one member of staff on duty and a trip out may require an additional member of staff. The service users’ care plans, examined at the previous inspection indicated that the level of supervision and support needed would not be met with one member of staff. The registered manager must ensure that there are sufficient staff on duty at appropriate times. This is a repeated requirement. An additional visit to the home on 7 December 2005 found that the recruitment checks not previously sought had been obtained. There is an ongoing programme for staff to undertake NVQs. Staff training records indicate that several staff require key training, such as food handling and first aid. In discussion with the manager, it was suggested that the training records might not be accurate. The registered manager must ensure that all staff receive appropriate training. It was not possible to check staff supervision records on this occasion, as only one team manager was present to provide his records. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 18 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 and 42 Health and Safety is promoted, but some areas of training are required. Monitoring by the manager should include a review of the quality of care, to improve the care of service users. EVIDENCE: The registered manager is currently undertaking her NVQ 4 in care, and hopes to be finished by Autumn 2006. She still has to undertake her NVQ 4, or equivalent, in management. It is recommended that the registered manager complete these NVQs. Staff comments and records indicate that the views of service users are obtained and taken seriously. Residents meetings have been introduced on a weekly basis; records are kept of these meetings. However, the registered manager must ensure that more structured reviews of the quality of care are undertaken at appropriate intervals and that these reviews are consistent with regulation 24 of The Care Homes Regulations 2001. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 19 Health and Safety matters are dealt with across both Walnut House and Whitstone House. A Health and Safety file is kept in the staff office at Whitstone House. This file contains information on issues such as the health and safety policy, the COSHH policy, product information safety data, medication and control of infection. As all staff at Walnut House come from the Whitstone House staff team, they have access to this file. Fire evacuations take place regularly and include both Walnut House and Whitstone House. Fire equipment checks take place roughly every week (but not when the Health and Safety Officer is on leave). See comments in section on staffing regarding training in Food Handling and Health and Safety. An accident record book is kept, but contains no entries. A member of staff said that there have not been any accidents. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 3 X Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 21 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. 2. Standard YA20 YA23 Regulation 13 18 Requirement The registered manager must ensure that the key cabinet be secured to the wall. The registered manager must ensure that all staff have access to training on the protection of vulnerable adults. (Previous timescale of 28 February 2006 not met) Repeated Requirement The registered manager must ensure that a format is provided to record any complaints that are made. The registered manager must ensure that action be taken to either apply for a further variation to conditions of registration, or to arrange for a return to three service users. The registered manager must ensure that there are sufficient staff on duty at appropriate times. (Previous timescale of 9 December 2005 not met) Repeated Requirement The registered manager must ensure that all staff receive appropriate training. DS0000027591.V279948.R01.S.doc Timescale for action 30/04/06 30/09/06 3. YA22 22 30/04/06 4. YA24 23 18/04/06 5. YA33 18 30/04/06 6. YA35 18 30/06/06 Walnut House Version 5.1 Page 22 7. YA39 24 The registered manager must ensure that more structured reviews of the quality of care are undertaken at appropriate intervals and that these reviews are consistent with regulation 24 of The Care Homes Regulations 2001. 30/06/06 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. 2. 3. Refer to Standard YA22 YA33 YA37 Good Practice Recommendations It is recommended that a complaints leaflet be developed, which would be more user friendly than the whole complaints procedure. It is recommended that regular staff meetings take place for Walnut House. It is recommended that the registered manager complete NVQs in care and management. Walnut House DS0000027591.V279948.R01.S.doc Version 5.1 Page 23 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.V279948.R01.S.doc Version 5.1 Page 24 - 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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