Inspection on 08/08/07 for Waymead Short Term Care

This inspection was carried out on 8th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Waymead Short Term Care 10/10/06

Waymead Short Term Care 02/05/06

Waymead Short Term Care 07/12/05

Waymead Short Term Care 02/05/05

Waymead Short Term Care 15/12/04

Waymead Short Term Care 27/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 Waymead Short Term Care St Anthonys Close Off Binfield Road Bracknell Berkshire RG42 2EB Lead Inspector Steve Webb Unannounced Inspection 8th August 2007 09:45 Waymead Short Term Care DS0000031646.V343746.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 Waymead Short Term Care DS0000031646.V343746.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. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waymead Short Term Care Address St Anthonys Close Off Binfield Road Bracknell Berkshire RG42 2EB 01344 451285 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) derek.mccarthy@bracknell-forest.gov.uk www.bracknell-forest.gov.uk Bracknell Forest Borough Council Derek McCarthy Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: 2. Learning Disabilities (LD) The maximum number of service users to be accommodated is 10. Date of last inspection 10th October 2006 Brief Description of the Service: Waymead Short Term Care Unit provides respite care for adults with a learning disability. The home can accommodate up to 10 service users per night, and was providing a service to 39 service users overall, at the time of inspection. The home is registered to take service users who are male or female between the ages of 18-65 years. The service is owned and operated by Bracknell Forest Borough Council. Some people are funded by the PCT as their needs are such that they have 100 continuing health care funding, others pay a basic cost of: aged 18-24-£7.20 per night; aged 25—59--£8.90 per night and aged 60 and over--£9.25 per night. After 28 overnight stays in one year service users receive a financial assessment and their contributions are re-assessed. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 9.45am until 7.00pm on the 8th of August 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, some of the staff members on duty during the day, and with two service users, plus some time was also spent observing the interactions between service users and staff at various points during the latter part of the inspection. The two service users the inspector spoke to were happy with the service and on in particular, enjoys the activities and outings, and was looking forward to the planned adventure weekend. Both also said that they liked the staff. The inspector also examined the premises. It was evident that the service is well managed on a day-to-day basis by an effective management team, who had made considerable improvements and developments to the service since the last inspection, though a number of issues remain to be addressed and the future configuration of the service is under review. What the service does well: The service obtains the necessary information regarding a prospective service user’s needs and wishes in order to decide whether they can be met. The needs, wishes and goals of service users are increasingly reflected within their care plan. The service recognises the rights of service users to make decisions for themselves wherever possible. Service users are supported to take risks within a risk assessment framework. Service users have opportunities to take part in a range of activities and events, both in the unit and in the wider community. The service now very much seeks to place the wishes of the adult service user at the centre of decision-making. The service respects the rights of service users and increasingly encourages them to take responsibility for aspects of their own care and decision making, with any necessary support provided. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 6 An appropriate and varied diet is provided, taking into account the known likes and dislikes of service users, who are supported to be involved in shopping for and preparing meals, where possible. The health needs of individuals are also addressed effectively, where they impact on them during periods of respite care. The unit manages the medication on behalf of service users, very well and appropriate records are maintained. Service users have access to an adapted version of the complaints procedure, which is more accessible for some individuals. The service has systems in place to protect vulnerable adults, and staff have either received or are booked to attend “safeguarding” training. The home provides each service user with a single bedroom and some adaptations have been provided to address the needs of residents with disabilities. The unit was found to be clean and hygienic and safe. The unit has a core of longer term, permanent staff who are experienced and familiar with service users. The views of service users on aspects of the service have been sought via a survey on the activities provided. What has improved since the last inspection? What they could do better: All of the care plans need to be completed within the existing format, pending the introduction of a Person-Centred Planning approach in the future. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 7 There was a need for improvement in the complaints records in the unit. A policy on physical intervention needs to be produced. The environment could be improved in a number of areas, though this is likely to be considered in the context of current discussions regarding the reconfiguration of the service. The unit has a high proportion of vacancies made worse by the current deployment of three staff members to another service. NVQ attainment levels have also suffered as the result of the current situation. Additional permanent staff need to be recruited to the team. No records of the required recruitment and vetting of new staff were available for inspection. This situation needs to be rectified. Not all staff have received all of the required core training according to available records, and no overall current record of staff training was available in the unit. Some staff still need Makaton training to be provided. There is a need to broaden the quality assurance system to better obtain the views of various stakeholders. The provider must undertake the required monthly monitoring visits and report on these to the manager. A more regular cycle of fire drills needs to be carried out to ensure that all service users experience these. Copies of completed accident forms need to be filed within the individual case records. 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. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 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 Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has systems in place to identify the needs, wishes and aspirations of prospective service users, in order to establish whether these can be met. Identified needs, wishes and preferences are transferred to the care plan so that they can be addressed on an ongoing basis. EVIDENCE: The original assessments for longer standing service users were not readily available, having been archived. However the pre-admission and transition planning records for a prospective service user were examined to establish the current process. A pre-admission assessment/initial care plan had been completed, and the transition plan included relevant risk assessments. The service uses the Care Management Assessment and asks any necessary supplementary questions to establish that the person’s needs can be met. The current care plans of five service users were examined and these contained a range of relevant information about the individual needs, wishes and aspirations of service users, and indications of how these were to be met. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 10 One service user, whose needs could no longer be met by the service, had recently been supported positively to transfer to supported living, and for the interim, was receiving ongoing support from some of the team members from Waymead. This is an appropriate arrangement for the service user in question, as it provides consistency and continuity of support, during the period of transition and settling into the new living situation, but the implications for staffing levels within Waymead are discussed within the staffing section of this report. The level of respite offered is decided by the CTPLD, and at present the service user’s carers then decide how they would like this respite provided, via completion of a three-monthly booking form, which goes to the service. This can present issues in terms of the balance and spread of the service across the year, with weekends and other peak times evident, and does not necessarily reflect how the service user themselves would like to use the time or with whom they might wish to share it. The provision of the service is currently under review, to decide how best to provide an effective respite service to take greater account of the wishes of the service users themselves, with regard to how and where they would like to spend their time with the service. A consultation process is about to commence with carers and service users, which will include presentations from other successful respite services across the country, operating alternative models of respite care, and both the configuration and possible location of the service are under review. Developments in this regard are discussed further under the Lifestyle section of this report. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 11 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): Standards 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. The needs, wishes and goals of service users are increasingly reflected within their care plan, though there is a need to ensure that all are completed within the existing format, pending the introduction of a Person-Centred Planning approach in the future. The service recognises the rights of service users to make decisions for themselves wherever possible, and has already begun to address the implications of the Mental Capacity Act. Service users are supported to take risks within a risk assessment framework. EVIDENCE: There is still a plan to introduce a system of Person-Centred Planning, and work is ongoing with the Authority’s Support Planning and Brokerage Team as part of the “In Control” initiative, to develop these. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 12 In the interim, improvements have been made in the care plan format since the last inspection, with more details evident in terms of the individual wishes, preferences, likes and dislikes of the service user, and better records of healthrelated issues such as allergies and special dietary needs. It was noted, however, that some of the care plans have yet to be fully completed, and this needs to be addressed as a priority. All care plans should be signed and dated to enable effective review. The care plans identify any cultural or spiritual needs and how service users/their carers wish these to be addressed. In some cases, conflicts may arise between the routines and care desired by the carers and the evident wishes of the service user themselves. The service has already begun to develop its ability to advocate appropriately for the rights of the adult service users to make decisions for themselves, wherever possible, in such situations, in line with the Mental Capacity Act. The manager and senior staff spoken to during the inspection expressed a clear understanding of the rights of service users in this regard and the proposed plans for the service are intended to further these aims. Service users or their carers are currently asked to sign a consent form regarding whether the service user handles their own money during respite stays, or whether the service does this on their behalf. This is good practice, though the implications of the new Mental Capacity Act will need to be taken into account, with regard to the focus on the service users’ own “capacity” to decide this for themselves, and who is able to make such decisions where “capacity” does not exist on the part of the service user. Where consent has been given for the service to manage a service user’s funds during their stay, these are signed in on an individual records sheet, which includes amounts in and out and a running balance, as well as recording the reason for any amounts spent, confirmed via double signatory. Receipts are also retained, and these, together with the completed financial record for the visit, are currently offered to the carer at the end of the stay. A copy is also filed within the individual’s case record. Individual risk assessments are now in place for each service user, and in some cases have since been reviewed, whilst the review of some others is not yet due. It is suggested that a schedule of review dates for risk assessments is added to the existing schedule for care plan reviews to enable the completion of both to be monitored effectively. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 15, 16 and 17: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of activities and events, both in the unit and in the wider community. Considerable development has taken place to increase the level of community access and broaden the range of experiences of service users, and this is ongoing. Within the remit of a respite service, relationships between service users and their carers are supported, though the service now very much seeks to place the wishes of the adult service user at the centre of decision making. The service respects the rights of service users and increasingly encourages them to take responsibility for aspects of their own care and decision making, with any necessary support provided. An appropriate and varied diet is provided, taking into account the known likes and dislikes of service users, who are supported to be involved in shopping for and preparing meals, where possible. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 14 EVIDENCE: Some of the existing activities enjoyed by individual service users are identified within their care plans and associated documents, though these may be limited by existing experience. More recently the service has begun to expand the level of respite provided elsewhere than within the unit itself, including camping at a music and dance festival and plans for an adventure activities weekend, in line with the possible future model of respite delivery. Such a model would positively expand the life experiences and provide opportunities for service users to take part in new and challenging experiences, outside of the limitations of unit-based respite care. The service maintains a good record of the various activities and outings offered and which service users took part, which enables monitoring of the individual levels of service user involvement. Carers are asked, in advance of respite sessions to provide funds for attendance at various planned activities and events, (usually from their Attendance or Disability Living Allowance funding), and the funds are brought in when the service user arrives. As already noted, carers/service users can choose either to manage their own money or ask the service to manage it on their behalf, and appropriate records of expenditure are maintained. Service users attend the day centre as their individual needs require, where they take part in a range of organised activities including art and craft, and games. From Waymead, service users go to the sports centre, the cinema, the pub and various community events, such as boot sales; and some attend a “get-together” group for local people with a learning disability. The unit has an unlabelled people carrier to enable people to access activities about and some staff are insured to use their own cars. Within the unit, a TV and a collection of video films, a games console, and a pool table are provided. Some weekends the service provides exclusively for either male or female clients to enable a focus on specific identified types of activity, and increasingly, outings are suggested spontaneously. Questionnaires have been provided to service users/carers asking about preferred activities, and a new three-monthly newsletter is planned to keep carers informed of developments and upcoming events. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 15 None of the current service users has an identified need for spiritual support within their respite service at present, though this would be facilitated if it were an identified need. The care plan format includes a section for recording spiritual and cultural needs. Given the respite nature of the service it may be that the majority of spiritual needs, where present, are addressed by their carers when service users are at home, but the service would address these where necessary. The two service users who were able to respond verbally to questions from the inspector clearly indicated they enjoyed coming to Waymead, enjoyed the activities and outings and got on well with the staff. One commented that he was hoping to be invited to the upcoming adventure activities weekend and liked the fact that they were now able to go out from the unit much more than they used to. He said he liked to bring in his own CDs to listen to. He said he enjoyed going to the shop within the local garage, where he was now going alone, following a gradual preparation for this, and had also been on a recent group trip to the seaside and been to the bowling alley recently. Given that Waymead is a respite service, contact with carers tends to be focused at the beginning and end of respite stays, but contact and visiting is not prevented during respite stays, where appropriate, and service users could phone home if necessary. The provision of a cordless phone would improve the opportunity for some service users to be able to make phone calls with a degree of privacy. There is now greater emphasis on encouraging service users to take more responsibility for involvement in meal preparation table laying and clearing and other day-to-day household tasks, such as making their beds and doing their own laundry, with support where necessary. More time is needed to develop service user involvement in these areas more fully, as the practice of encouraging this is still relatively new. The care plans now clearly identify any individual dietary needs, including such issues as allergies and specialist dietary requirements such as soft diets and fluid thickeners. The service now buys food on a weekly and more frequent basis to enable greater involvement in food shopping and choice by some service users, rather than bulk purchasing as previously. Menus tend to be planned flexibly according to the known likes and dislikes of the service users who are due to come in. Some pictures are used to support meal choices, though this area could possibly be developed further. Both of the service users spoken with said they liked the meals very much. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 16 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): Standards 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. Service users receive individual support reflecting their needs and increasingly based on their individual preferences and choices as adults. Their health needs are also addressed effectively. The service has a thorough system in place to manage the medication on behalf of service users, and appropriate records are maintained. EVIDENCE: As already noted, the care plans have been improved and include more detail about the individual needs and preferences of service users regarding how they are supported. This is likely to be further developed as part of the PCP programme, which is still under development, and the ongoing developments of the service as a whole. The service is increasingly focused on the wishes of its adult service users and supporting of their right to self-determination wherever possible as part of their ongoing growth and development. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 17 The staff rotas have been shifted forward by an hour to enable greater choice with regard to the time individuals wish to retire to bed at night. The planning of some single gender weekends of respite enables a focus on different styles of respite and experiences to suit the individual groups and what they enjoy. The staff were observed supporting and encouraging choice, decision making and involvement by service users at various points during the inspection, and the feedback from two of the service users was very positive regarding the approach and support of the staff. Individual communication passports were said to be present in a few care plans where these had been prepared following input from a speech and language therapist, though it was acknowledged that additional service users might benefit from this support. The manager should consider the potential advocacy role of the service in terms of additional speech and language therapist support, where it is felt this might be of benefit. At present apart from some Makaton and the use of pictures to assist some service users to make choices, no other specialist communication methods are in use. Some service users are able to express their choices and preferences verbally, while some can make their preference known via nodding or eye movements or otherwise indicating their wishes when offered concrete choices. Some but not all of the staff had received Makaton training, and others were to be booked on upcoming courses. This is a priority while the service has users utilizing this form of communication. The service also made appropriate plans for and supported the move of one service user to her own flat and is supported by her own team of people, once it became clear that their needs could no longer be met at Waymead. This enabled the move to be a positive one, which continues to be supported by staff from the unit for the time being, providing continuity and consistency of support for the transition. Although there has been a downside to this in terms of the staffing implications for the service, it would appear to have been a positive decision from the perspective of this individual’s needs. The premises, whilst not ideal in some ways, do have various adaptations to provide for the needs of service users, including a bathroom equipped with a parker bath, with overhead tracking and hoist, a level entry shower facility, and during the inspection, a new changing table was delivered. The majority of the routine healthcare issues and appointments would be addressed while service users reside with their carers, but the service has the Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 18 necessary contact details of individual GP’s and specialists on file should the need arise. Where health-related issues are essential to the care provided, the service has detailed information as part of the care plan. For example in the case of one service user who experiences swallowing difficulties and needs a specific soft diet and the use of thickener in all fluids, the relevant details and information are on file, including detailed “Swallowing Guidance”. Details regarding any known allergies are now also recorded prominently. Given the potential complications of managing medication within a respite service, Waymead has an excellent system in place. Medication is only accepted in original containers, with pharmacy labels giving the dosage and details, and all medication is counted in and recorded on arrival. Two staff initial the individual service user’s medication administration record, (MAR) sheet, to record each dosage given, and returns to carers at the end of each stay are also logged, providing an appropriate audit trail. A new MAR sheet is completed for each respite stay and filed on the service user’s case record once completed. The service also has a controlled drugs log in place, but is not currently handling any controlled drugs. All staff have received relevant medication training, and have also received appropriate training to undertake necessary blood testing and administer insulin, for a service user with diabetes. Individual written GP authorisation is also obtained for the administration of any PRN (as required) medication, such as headache tablets, or any homely remedies, to ensure no contraindications with prescribed medication, and these are also entered on the MAR sheet. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 19 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): Standards 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to an appropriate complaints procedure, which is available in a more accessible version. However, it was not possible from the available complaints records to follow the process of investigation, or establish the outcome, from the log in some cases, and this information must be filed appropriately in the unit, in order to demonstrate the operation of the system. The service has systems in place to protect vulnerable adults, and appropriately referred one concern, not related to the care provided by the service, to the relevant authorities, in accordance with the protocol. The staff have either received or are booked to attend “safeguarding” training, but the service needs to produce a policy on physical intervention, in line with the training provided to protect service users and staff. EVIDENCE: The service has a complaints procedure including a leaflet and form in an accessible format for some individuals, which is available in the entrance hall. The complaints log indicated six complaints since the previous inspection, four if which related to invasions of service user privacy by an ex service user who has since moved to another service. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 20 One of the complaints related to the greater emphasis being placed on the rights and preferences of service users, and demonstrated how the service was developing in terms of recognising these. It was noted that in several cases there was no information in the complaints log to indicate how the matter had been addressed, nor any cross-reference to where this information might be found. The log should include brief details of the action taken and resolution, or refer the reader to where this information can be found, if it is confidential in nature. Any confidential papers relating to complaints investigations should be filed confidentially in the unit together with related correspondence etc. and a cross reference be included in the complaints log to enable effective tracking. Following discussion, the manager was able to satisfy the inspector that the matters in the log had been addressed appropriately on this occasion. Formal complaints are referred to the Authority, for investigation by the designated complaints officer. One of the service users confirmed that he would tell the manager or one of the staff if he had any complaints, and that they would sort it out. No complaints have been received by the Commission and referred to the service for investigation since the last inspection, but one issue was raised by a parent, who was advised to raise the matter with the service. The service has a policy on safeguarding vulnerable adults and also works within the local multi-agency protocol. Some staff have received recent “safeguarding” training and others were booked on an upcoming course in September, during the inspection. Staff should also receive regular updates of this training. All staff have received some training on the new Mental Capacity Act. One “safeguarding” issue relating to a service user, had arisen since the last inspection, which did not relate to care provided by the service, but was appropriately referred by the manager to be addressed by the proper agency. As already described, the service has appropriate systems in place for the safekeeping and management of service users’ funds during their stay, where they decide not to look after these for themselves. The service still does not have a physical intervention policy in place though most of the staff have been trained in Strategies For Crisis Intervention and Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 21 Prevention, (SCIP) techniques, and the manager is undergoing the training to become an accredited SCIP instructor. It is strongly advised that an appropriate physical intervention policy is produced to address this complex area of support and care and protect the interests of service users and staff. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 22 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): Standards 24 and 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the environment is safe and provides to some extent for the needs of service users, provision could be improved in a number of areas, though it is understood that this is likely to be considered in the context of current discussions regarding the reconfiguration of the service. The unit was found to be clean and hygienic. EVIDENCE: The service currently operates in premises which were not purpose-built for this client group, being an ex children’s home. As a result facilities for some of the service users with addition physical disabilities do not fully meet current standards, though some adaptations have been provided, and some of the bedrooms are rather small. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 23 Two of the bedrooms are impractical since the wardrobe cannot be accessed with the door open and anyone trying to do so could be injured were the door to be opened. In bedroom ten, the ceiling had been damaged by a water leak, which has since been addressed, but the ceiling remains in need of repainting. None of the bedrooms are currently fitted with ceiling hoist tracking, though the largest bathroom has been provided with this equipment, a specialist bath and a changing table, which was delivered during the inspection. In order to make the most effective use of such equipment an integrated system of ceiling hoist tracking should be considered between at least one bedroom and the adapted bathroom. It is understood that the future configuration of the respite service, including its location within the existing building are under review as the service develops and any potential changes to the existing building are likely to be considered in this context. At present the unit can provide for up to ten service users overnight, within single bedrooms of varying size, with three bedrooms on the ground floor and seven on the first floor. The building has no lift. Standards of décor have been improved since the last inspection but the home tends towards functional rather than homely in some areas. The nature of a respite service contributes to this, since the residents are constantly changing and individuals tend to bring in only what they need for their short stay. Staff have worked hard to make the environment welcoming and as attractive as possible, though and the entrance hall is bright and welcoming. A large notice board located there details the various planned events over the current week, including notices, text and pictures. There is a small lounge, redecorated and re-carpeted since the last inspection, which is equipped with leather sofas and a TV/video and the unit’s collection of video movies, from which service users can select freely. In addition there is a larger dining/activities/games room, which includes tables for dining and crafts and a new pool table and a computer with internet access provided. There is also an adjacent conservatory, equipped with blinds to control the temperature, provided with armchairs and another smaller TV. A number of new hospital style beds, additional new mattresses, pillows and bedding have been purchased since the last inspection, and one service user said his bed was now comfortable. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 24 The unit’s kitchen is set up more for staff to produce meals than to facilitate service user involvement, and the lack of lowered facilities for service users who are wheelchair users is a notable omission, which should be considered as part of the service reconfiguration planning. The laundry facilities are provided via commercial machines and the washing machine has a sluice cycle to address the risk of cross infection. However, consideration should be given to the provision of a domestic washing machine as well, to enable skills development work where necessary. Observed standards of hygiene in the home were good, with no evidence of unpleasant odour. The service is on the same site as other council services, and shares some communal garden areas, but does have its own secure garden. Though this area had good potential for service users to use, this was not being maximised as the area was overgrown and in need of repairs in some areas. The manager is in discussions with day service regarding the possibility of protected work placements being developed for day services attendees, to maintain the garden. Within the building all of the fire doors have been fitted with electromagnetic holdbacks, integrated with the fire alarm, which allow the doors to close via their self-closers in the event that the fire alarm is triggered. Waymead Short Term Care DS0000031646.V343746.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): Standards 32, 33, 34 and 35: in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The existing core team of permanent staff are appropriately experienced and competent, but the unit has a high proportion of vacancies made worse by the current deployment of three staff members to another service. NVQ attainment levels have also suffered as the result of the current situation. It was not possible to verify, on site that appropriate recruitment checks are undertaken on prospective staff prior to their appointment, in order to protect service users. This situation needs to be rectified. The comparable records of agency staff who have worked in the service were thorough. The needs of service users are met by staff who have received a varied level of training. Not all staff have received all of the required core training according to available records, and no overall current record of staff training was available in the unit. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 26 EVIDENCE: At present the service is running with a vacancy level of around 50 , made worse due to the temporary provision of three of its staff to support the transition of one service user to a supported living environment. The manager indicated that the unit had in fact successfully recruited a number of new staff over the past year, but some had not taken up the posts offered, and some had since left. One new recruit was due to commence work in September. The unit still has four full time equivalent vacancies, and one senior staff member was about to go on maternity leave. The manager indicated that ongoing attempts were being made to recruit to vacant posts, in order to continue to develop the provision beyond the confines of the current building based service. The level of vacancies had led to some variation from the expected rotas, and levels of agency staff, though reduced, were still high at weekends. The service tries to use known agency staff, wherever possible to maximise consistency. Due to the current demand the unit is operating at around 40 capacity and recruitment is taking place to fill the vacant post in order to maintain the quality of the service provided. Progress with NVQ is mixed, with four staff having attained at least NVQ level 2 and two others currently working towards their level 2. The service accesses training from Bracknell Forest and some external providers. Though progress has been made with core training, staff were booked on one upcoming course during the inspection, and some other shortfalls were identified. It appears that the Authority have not maintained the necessary overview of training needs in the unit and were not aware that some staff were present in the unit’s team. Given the importance of maintaining an overview of training across the staff team, it is suggested that the manager devise a spreadsheet to indicate where core training or updates are required. There have also been issues with the conflict between training and unit staffing priorities, especially given the level of vacancies, and the fact that a number of staff previously commenced work at the same time, and some contingency planning might be beneficial in this area, where perhaps the service is closed on particular days to facilitate training of larger numbers of the team. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 27 Training in specialist areas such as diabetes, has been provided, and the manager is undertaking training to become an accredited SCIP trainer to enable this to be provided in-house. It was stated that staff had all attended a recent fire safety training update and that these are provided regularly. Feedback from two of the service users about the staff was very positive, and the relationships observed during the inspection were also positive and respectful. It was not possible to examine a sample of staff recruitment records since it is the Authority’s policy to retain these within the HR department at head office. It is necessary to be able to verify on site, that the recruitment and vetting process is sufficiently rigorous, and the Authority must either make copies of the required evidence available within the unit or provide a sufficiently detailed recruitment checklist to confirm the checks undertaken. The recruitment records available on site for the agency staff used by the service, met the required criteria, giving the requisite details, confirming that relevant documents were in place, and that photographic evidence of identity had been seen. The Authority must take steps to ensure that the required evidence of recruitment checks is available on site. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 28 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): Standards 37, 39, 42 and 43: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from a unit that is well run by a manager who is clearly focused on the rights and wishes of service users. The views of service users on aspects of the service have been sought but there is a need to broaden the quality assurance system to better obtain the views of various stakeholders. The provider must undertake the required monthly monitoring visits and report on these to the manager. The health and safety of service users are promoted by the service and systems are in place to protect their safety. However, more regular fire drills should be undertaken. The proposals for development of the service present opportunities to benefit service users by improving the range of their life experiences and skills through a more imaginative respite provision, based more in the community as a whole and less bound to the physical premises. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 29 EVIDENCE: The unit manager is appropriately trained and experienced to manage the service and provides a very positive lead on the rights of service users to be consulted on their wishes and needs regarding the service. The manager has over twenty-seven years experience and has attained his NVW level 4 in management and the Registered Manager’s Award. He attends various ongoing training to maintain current knowledge. Service users/their carers were consulted about their preferred activities etc. via a pictorial questionnaire in October and November 2006. Previously the service has tried to obtain quality assurance feedback via questionnaires at the end of each respite stay, but these were increasingly unsuccessful and there is now a plan to send out a questionnaire quarterly, together with the new quarterly newsletter to service users, which will advertise upcoming events and provide details about service developments. There are no specific questionnaires to carers as yet, nor are the views of other stakeholders systematically sought as yet. These are areas that should be developed to provide the broadest quality assurance feedback about the service. Coffee mornings for carers have been tried previously but were poorly supported, but there is a planned open evening in September regarding the future development of the service, so this would be another opportunity. Examination of Regulation 26 monitoring visit reports available in the unit indicated that only reports for visits in September and December 2006 and February and June 2007 were present – these visits have been carried out and the paperwork will be sent. It was not possible to verify that these visits had taken place monthly as required. The provider must undertake monthly regulation 26 visits and a copy of the resulting report must be provided to the manager to action any issues raised therein, and for filing for subsequent inspection. Examination of a selection of health and safety-related service certification indicated that most of the required checks had been carried out within required timescales. There was no evidence of the recent testing of portable electrical appliances, but the manager confirmed this had taken place around January. A copy of the certification should be obtained for the unit’s records. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 30 Accidents to service users are recorded on an Accident/Incident /Near Miss form and copied to the Health and Safety section of the Authority. The copies retained in the unit were held collectively in a file to enable monitoring. However, completed forms also need to be copied to the relevant service user’s case record as part of their care history. Also some of the forms were not dated and staff should be reminded to fully complete these statutory records. The unit has a fire risk assessment in place, undertaken in October 2006, and the manager indicated that the matters arising had been actioned. However, the most recent fire drill was dated September 2006. The manager should ensure that regular fire drills are undertaken, especially given the respite nature of the service and the resulting changing population of the unit. From discussions with the senior staff it was evident that this is a service in transition. Changes have already been made towards a greater focus on the views and wishes of the service users, and towards increasing opportunities for accessing events and experiences within the community, rather than focused mainly within the limitations of the unit. The future configuration of the service as a whole is under review, presenting an opportunity to develop new ways of working to support and enable service users via respite provision. Successful alternative models of respite care provision elsewhere are being explored and invited to present to staff, service users and carers. Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 31 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 2 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 2 33 2 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 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 4 X 3 X 2 X X 2 3 Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 32 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. 2. Standard YA6 YA22 Regulation 15 22 Requirement The manager must ensure that all current care plans are fully completed, signed and dated. The manager must ensure that the complaints system enables the tracking of relevant documents regarding investigations and outcomes, to demonstrate that the system is fit for purpose. The shortfalls of the current building must be taken into consideration in the current planning for the reconfiguration of the service. The provider/manager must take steps to increase the proportion of permanent staff within the service to maximise the consistency and continuity of support provided to service users. The provider must ensure that a record of the recruitment and vetting checks undertaken on prospective staff is available, at all times for inspection within the unit The provider/manager must review the training needs of all permanent staff and ensure that steps are taken to address any gaps in their core training. DS0000031646.V343746.R01.S.doc Version 5.2 Timescale for action 08/10/07 08/09/07 3. YA24 23 08/02/08 4. YA33 18 08/12/07 5. YA34 17(2) & Schedule 4.6 18 08/09/07 6. YA35 08/09/07 Waymead Short Term Care Page 33 7. YA39 26 The provider must undertake monthly Regulation 26 monitoring visits and copy the resulting reports to the manager. 08/09/07 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. 2. 3. 4. Refer to Standard YA18 YA23 YA32 YA35 Good Practice Recommendations The manager should ensure that all staff receive appropriate training in specialist communication skills such as Makaton, with regular updates also provided. A physical intervention and restraint policy should be produced. Ongoing steps need to be taken to increase the levels of NVQ attainment. The manager should establish a collective record of staff training across the team to readily enable monitoring of the need for training, including regular updates where required. The manager should consider undertaking more regular fire drills to ensure that all service users experience these. Copies of completed accident forms should be placed within the relevant service user’s case record in addition to being held collectively to enable monitoring. 5. 6. YA42 YA42 Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Waymead Short Term Care DS0000031646.V343746.R01.S.doc Version 5.2 Page 35 - 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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