Inspection on 09/06/08 for Welbeck House

This inspection was carried out on 9th June 2008.

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

Other inspections for this house

Welbeck House 10/06/09

Welbeck House 17/12/07

Welbeck House 25/09/06

Welbeck House 14/11/05

Welbeck House 20/10/04

Welbeck House 25/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Welbeck House 42 Welbeck Avenue Bushbury Wolverhampton West Midlands WV10 9LS Lead Inspector Rebecca Harrison Key Unannounced Inspection 9th June 2008 10:15 Welbeck House DS0000030055.V365882.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 Welbeck House DS0000030055.V365882.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. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welbeck House Address 42 Welbeck Avenue Bushbury Wolverhampton West Midlands WV10 9LS 01902 681909 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) Arcare (West Midlands) Ltd Manager post vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: No conditions apply Date of last inspection: 17th December 2007 (KEY inspection) 12th May 2008 (Random Inspection) Brief Description of the Service: Welbeck House is registered with the Commission for Social Care Inspection to provide accommodation and personal care for a maximum of three adults with a learning disability. Arcare (West Midlands) Limited is the registered provider and the responsible individual is Dr Raj Sharma. The post of registered manager is currently vacant however an acting manager has recently been appointed and is in the process of applying for registration. The property is a traditional semi-detached house and is situated in an urban area of Bushbury, providing access to local amenities and transport and the premises are in keeping with the local community. Accommodation is provided over two floors comprising: Two single bedrooms with a bathroom on the first floor and one single bedroom with en-suite facility on the ground floor. Communal areas include a lounge, dining room and kitchen. A small enclosed garden is provided to the rear. The homes stated philosophy is to Maintain a high standard of care, respecting individuality, privacy, residents dignity and independence at all times. First and foremost a happy and secure environment within the home. People who use the service and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide, which are currently in the process of being updated. Inspection reports produced by CSCI can be obtained direct from the provider or are available on our website at www.csci.org.uk The provider is in the process of including the fees charged in the Service User Guide as required; therefore the reader may wish to obtain this information direct from the service provider. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The inspection was unannounced and took place on 9th June 2008 by one inspector over seven hours. A range of evidence was used to make judgements about this service to include discussions with all three people who use the service, the acting manager and area manager and a tour of the home. We also looked at a number of records to include care records held on behalf of two people, complaints and protection, staff training, recruitment, quality assurance and health and safety records. Given the concerns raised at the last key inspection six months ago, we returned to the home in May to look at staff files and what the home does when they take on new staff and some of our findings have been included in this report. The purpose of the inspection was to assess all ‘Key’ National Minimum Standards for Younger Adults and any additional Standards considered necessary. We also reviewed the requirements that we made as a result of the previous inspection undertaken on 12th December 2007 and the random inspection on 12th May 2008. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. What the service does well: What has improved since the last inspection? Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 6 Since the last inspection, a number of rooms have been redecorated involving the people who use the service. New bedroom furniture has been purchased for one person and the bathroom on the first floor has been refurbished. This provides people who live at the home with a more comfortable place to live. Since the last inspection each person has been provided with a Personal Health Record, which details all health appointments and outcomes. This makes health information about individuals much more readily accessible to staff. Managers reported that all staff hold a recognised care award known as a National Vocational Qualification, which exceeds the National Minimum Standards. Staff are working hard to improve records held in the home and to make information more easily accessible to people using the service. What they could do better: Support plans should be more detailed and describe how individuals’ needs in respect of their health and welfare are to be met. This will help staff to provide support in such a way as to ensure all service users needs are met. Although staff files are now better presented and information readily available, managers must ensure recruitment practices are robust so that people living at Welbeck House are not placed at risk. New staff must not start work until all the necessary documentation has been obtained and the necessary checks completed. Behavioural support guidelines should be developed for the person whose behaviours can challenge the service. This will ensure that the individual is treated appropriately and safely when they need additional support to manage their behaviour and ensure staff that work alone are consistent in their approach. The home has a copy of the local policy for safeguarding adults however discussions held evidence there is a lack of understanding of local safeguarding procedures and how they work and not all staff have received training in adult protection. The home has been without a registered manager since November 2007 therefore an application to register an experienced and competent manager with CSCI should be undertaken at the earliest opportunity. Staff should receive first aid training as soon as possible and all other aspects of how the home manages health and safety should be reviewed to fully promote the health, safety and welfare of people using the service and staff. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 7 Managers fully acknowledged that more could be done to involve people with daily living tasks, promoting rights and independence and enabling people rather than caring. The findings of this inspection indicated that some improvements have been made over the last six months. Managers must strive to provide better outcomes for the people using the service. 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. Welbeck House DS0000030055.V365882.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 Welbeck House DS0000030055.V365882.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): 1 and 2 Quality in this outcome area is adequate Information about the service is being updated to ensure people have the necessary information to help them choose a home that will meet their needs. The service has assessment and admission processes in place to enable the successful admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Managers are currently updating the Statement of Purpose and Service User Guide to reflect the change in manager, the new organisational structure and staff qualifications and to ensure that fees charged are included in the guide as required. There have been no new admissions to the home since the last key inspection however the homes assessment processes have previously been assessed as satisfactory. The last person to be admitted to the home told us that he was originally only going to stay at the home for a short time but has since decided to remain living there as he likes it and gets on with the two other people he shares with. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate Support plans, although improved, need further development to ensure they provide staff with detailed information to meet people’s individual needs and achieve their personal goals. People are supported to make decisions about their lives and to take some risks but identified risks must be assessed and regularly reviewed to ensure people are not placed at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People have been able to make decisions and choices about their lives through their involvement in reviews and being consulted about their care and support plans. Although improved it would be better if people’ support plans were more detailed to ensure their individual needs are identified, this would help staff to meet their needs more effectively. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 11 Records evidence that one person’s behaviour has challenged the service as highlighted in the previous inspection report and although behaviours are much improved the person’s support plan does not contain sufficient detail to ensure lone working staff are consistent in their approach. It is strongly recommended that all management guidelines to support identified behaviours are developed by people who are qualified to do so. This was raised with the area manager following the inspection who stated that the placing authority is to provide input into the development of a behaviour management plan very shortly. The support plan for a further person stated that the person ‘gets agitated and restless if he has to wait’ however no guidance was available to inform staff how to support the person with this. People are now being involved with choice and making decisions for example meetings have been held to discuss changes to the layout of the home, redecoration and replacing the bath with a shower in the first floor bathroom. People living at Welbeck House are supported to take risks for example travelling independently and crossing the road but the guidance for staff on how to manage some of the risks needs to be more detailed for example a risk assessment for one person, who has previously had a fall resulting in injury, does not take into account the environmental issues that may place him at risk of further falls. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate People living at Welbeck House are provided with some opportunities to develop and maintain their social and recreational interests and are enabled to keep in contact with family and friends. Rights could be better promoted and responsibilities recognised and although people receive a diet that is varied their individual preferences and dietary needs are not always reflected in menus created. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival to the home all three people were out at day services and returned mid-afternoon. One person told us that he travels on his own to the day centre using public transport and enjoys doing this. One person is being reintroduced to his day service following a period of ill health and is being encouraged to Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 13 attend in his best interests although staff have supported him to remain at home when he has declined to do so. Discussions held with people who use the service and records seen indicate that people access the community and partake in some activity and can choose not to go out if they want to. Comments include ‘I used to go to college but don’t want to go back again’ ‘I like staying at home of an evening and watching TV and listening to the news’ ‘I enjoy going to the disco, seeing my girlfriend and I also go to the shop to buy milk and bread for us all’. People told us that they keep in touch with their family and friends and get on well with the people they share their home with, which was evident in observations made. The manager reported that good working relationships have been developed with families and staff at day services. Two people told us that they like helping out with keeping their home tidy but would like to do more things like shopping and cooking, the other person said he does not like to do this therefore staff do this for him. Managers fully acknowledged that more could be done to involve people with daily living tasks and promoting their rights and independence. The three people living at the home said that a new menu has been developed and although they thought this was a good idea they would like more involvement in choosing the menus as they don’t take into account one person’s special dietary needs or his preferences and that ingredients are not always readily available to cook to the menu. Two people said that would like to go with staff to buy the food instead of staff doing this for them when they are out at day services. One person said ‘The food is alright, staff do the cooking as I don’t want to do it’. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate The personal and health care needs of people are met with good evidence of multi agency working in the best interests of the people living at the home. People would be greater protected if all staff responsible for administering medication have received the necessary training and have their competency to administer medication regularly assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three people said they were happy with the level of support they receive. One person has received professional help as he was showing signs and symptoms of a health condition. His health has been closely monitored and all outcomes clearly recorded. Everyone living at Welbeck House now has a Personal Health Record, which details all their health appointments and outcomes. A referral has been made in relation to one person following a recent visit to his doctor about his health. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 15 Two people are currently receiving prescribed medication and procedures were discussed with the manager who reported the home uses the monitored dosage system. The area manager reported that new medication files are in the process of being developed and a sample of one was seen. These will provide staff with useful information regarding medication prescribed and possible side effects. Records for medication administered were found satisfactory with no errors. Staff Training records seen and discussions held evidence that all but one member of staff has received training in the safe handling and administration of medications. Discussions held with the area manager post inspection, indicate that the necessary training has now been sought for the staff member concerned who is a lone worker. The area manager committed to ensuring staff are assessed for their ongoing competence in administering medication as highlighted at the previous inspection. The area manager is in the process of updating the medication policy therefore this was not reviewed on this occasion. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate The home has a complaints procedure in place that ensures people’s views are listened to and acted upon. People living at Welbeck House would be better protected if all staff were provided with the necessary training in adult protection to ensure they have the knowledge and an awareness of the referral process to safeguard the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us that they knew who to speak to if they were not happy. The home has a formal complaints procedure, which has been improved but not yet developed in a format appropriate to the people living at the home. We have not received any concerns or complaints in relation to this service since the last inspection. No complaints were found recorded in the complaints log and the manager confirmed that no complaints have been received by the home. Following the findings identified at the last key inspection around the home’s poor recruitment practices the local authority who place people at the home have undertaken an investigation under the inter-agency adult safeguarding policy. A meeting has been held to discuss the shortfalls and a further meeting has been arranged to take place shortly. The home has a copy of the local policy however discussions held evidence there is a lack of understanding of local safeguarding procedures and how they work and not all staff have received training in adult protection. The area manager stated that training has Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 17 been sourced and the company allocated a limited number of places. She committed to ensuring that staff in need of this training receive this at the earliest opportunity and to ensure that all staff are familiar with the process of recognising and reporting under the local policy. All three people told us that staff help them to look after their money and are happy with this. One person said that he is only allowed his money ‘a bit at a time’ as he would spend it all. Managers told us that his money is restricted in his best interests and told us why. A protocol should be developed in conjunction with the service user and others for this. The area manager reported that a policy for the management of service users’ finances has been developed as highlighted at the previous inspection however this was not reviewed on this occasion. The area manager was advised to audit financial records as part of Regulation 26 monthly visits to ensure systems used protect people living at the home and the staff. Training records evidence that the majority of staff have received training in dealing with violent incidents provided by the local authority. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Quality in this outcome area is adequate The environment has improved to provide people living at Welbeck House with a clean and comfortable home to live. Staff have received training in infection control procedures however procedures to prevent the spread of infection must be further developed to ensure people are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us about the improvements that have been made to their home to include the redecoration of a number of rooms and one person told us he has some new bedroom furniture. A new washer/dryer has been purchased and new blinds fitted throughout. The layout of the home has been changed and new garden furniture is on order for a forthcoming barbeque. The bathroom has been refurbished although still requires attention to ensure the safety of people using it and to ensure privacy as discussed with the area manager. A record of work undertaken is now maintained. All three people said that they like living at the home and are encouraged to personalise their rooms. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 19 The home was generally found clean on the day of this unannounced inspecton and staff have received training in infection control procedures however liquid soap and paper towels were not readily available in all areas requiring them. Substances hazardous to health are appropriately stored but not all of the necessary assessments are in place. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate People who use the service are supported by a trained and committed staff team who have a good understanding of their needs. Although improving, managers must ensure all pre-recruitment checks are undertaken to ensure that people who use the service are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three people spoken with told us that they like the staff that support them. One person said ‘I like the staff here, they are nice and I get on well with them’. Observations made clearly evidence that the manager has a good understanding of the needs of the people living at Welbeck House and has developed positive working relationships with individuals. Managers reported all staff have now gained a recognised care award known as a National Vocational Qualification at level 2 or above and two are awaiting certificates. The team at Welbeck House consist of a manager and three support workers. The usual staffing ratio is one member of staff to support three people. The manager stated that additional staff are available to support evening activities Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 21 if required. It was reported that the home are fully staffed. One person said ‘We have enough staff here to help us’. The manager stated ‘There are no problems with the staff, we work together as a team and the morale is pleasant and upbeat’ Recruitment processes were judged as poor at the previous key inspection in December 2007. We sent a letter of serious concern to the provider about the shortfalls in recruitment practices that have potentially placed people at risk. The provider told us that they had improved all areas to ensure people are not placed at risk. We therefore returned to the home in May 2008 to review this. Both the area manager and manager reported that no new staff had been recruited since the last inspection therefore we were unable to assess how new staff had been recruited to this service. Although we found personnel files more readily available and better presented we still found some shortfalls in practices such as incomplete application forms, little employment history and references although available had not been obtained from the previous employer, as required. We also found evidence that the staff member sent home in December while waiting to obtain checks had been reinstated three days prior to obtaining a second reference. Managers were unable to locate the home’s staff rota at the random inspection to evidence the hours worked however the manager stated that the staff member was supervised until both references had been obtained. References were available on other files sampled; some were not dated and were addressed as ‘To whom it may concern’ and there was no evidence that gaps in employment history had been explored and application forms were found incomplete. Shortfalls were fully acknowledged by managers and we made it very clear what documentation is required. We also discussed what action we may take if the home continues to place people at risk due to poor recruitment procedures. The area manager shared some new documentation with us that she intends to use for new applicants and agreed to forward a copy of their revised recruitment policy and procedure in addition to an improvement plan. No new staff have been employed since our random inspection although staff from one of the provider’s other homes have worked at Welbeck House and their files were examined and overall satisfactory although minor shortfalls were discussed at the inspection. We intend to closely monitor the provider’s recruitment practices across all services however managers have committed to ensuring no future shortfalls. An overall staff training matrix was not available therefore it was difficult to ascertain the exact training staff at the home have undertaken. The area manager said that staff are in need of first aid which was evidenced on staff files seen. Staff files seen contained certificates of training undertaken. The manager reported that staff have completed training in equality and diversity, health and safety and food hygiene since the last inspection. Training certificates available indicate that staff continue to be provided with good Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 22 training opportunities. It was reported that the home has tried sourcing training in the Mental Capacity Act provided through the local authority but have been unsuccessful at present. Although evidence of in-house induction was available the provider must ensure that new staff receive structured induction training to Sector Skills Council specification as required. Staff records examined evidence that staff are in receipt of formal supervision with a line manager but not at the required frequency as highlighted at the previous key inspection. The manager fully acknowledged this and said that dates are now scheduled. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate The manager has an understanding of the areas in which the service needs to improve in the best interests of people living at Welbeck House. Quality assurance processes require further development as outcomes for people using the service are not evaluated to bring about improvements. Current health and safety practices do not fully safeguard people potentially placing them at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Welbeck House has been without a registered manager since November 2007. Since the last key inspection a new acting manager has been appointed in April Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 24 2008 as the previous acting manager declined to apply for registration. The new acting manager has worked at the home for eight years and has recently completed NVQ level 2 and demonstrates a good understanding of the needs of the people in her care. All three people told us that they like the manager and that she works hard. The manager said that she has an application for registration and is fully aware of the need to apply to us for registration as soon as possible. The acting manger has some management experience but must ensure she has knowledge of the National Minimum Standards and regulatory framework within which she must operate. Surveys to gain the views of people using the service and their relatives have been distributed and completed surveys were examined. Views indicate that people are quite satisfied to very satisfied with the service provided. One relative stated ‘I am totally happy the way staff look after X and see to his needs’. Another relative indicated that she was very satisfied with meals, the environment, management and support her relative receives. The manager stated that the home works closely with relatives, staff at day services and social services and was therefore advised to sent out surveys to day services and health and social care professionals and collate the overall findings. The area manager intends develop a detailed annual development plan for the service linked to outcomes for people. Visits and reports required under Regulation 26 are now being undertaken but not at the required frequency. Reports seen could be more detailed and focus on outcomes for people and how the service could be best developed in the best interests of people living at Welbeck house. Overall records required by Regulation have improved and are better presented and evidence service user involvement for example support plans. Managers acknowledged that further work is required to ensure staff have access to up to date and detailed policies and procedures and risk assessments. All three people who live at Welbeck House considered they are safe and well cared for. Records examined evidence that health and safety checks are carried out at the required frequency however there was no evidence that water temperatures are tested and recorded as highlighted at the previous inspection. Assessments to support risk taking and for safe working practices require further development. The fire officer has visited the home since the last inspection and a number of deficiencies were identified in relation to locks fitted on emergency routes and exits. Suitable locks have since been installed to the front and rear doors however new locks fitted to bedroom doors must be replaced as they potentially place people at risk in the event of an emergency. It was reported that Environmental Health Officer has not visited the home since the last key inspection. Records indicate that staff have attended training in safe working practices however some require first aid training as identified at the previous key inspection six months ago. Monthly safety checks have been introduced but this must be carried out at the stated frequency and Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 25 detailed. Managers were advised to follow up work identified on the service certificate for electrical installation, dated February 2006, which states that it is unsatisfactory which was highlighted as an issue at the previous inspection. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 26 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 2 2 2 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 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 2 x 2 x Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 27 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 YA34 Timescale for action 19(1)Schedule2 All pre-recruitment checks as 09/06/08 required under Schedule 2 must be obtained before new staff commence direct work in order to protect people from possible harm. Unable to assess as no new staff recruited Regulation Requirement 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 YA6 Good Practice Recommendations Support plans should be more detailed and describe how all service users needs in respect of health and welfare are to be met. This will support staff to provide care in such a way as to ensure all service users needs are met. Behavioural support guidelines should be developed by people who are qualified to do so. This will ensure that people are treated appropriately and safely when they need additional support to manage their behaviour. All identified risks must be assessed and regularly reviewed to ensure service users are not placed at risk of harm or neglect. DS0000030055.V365882.R01.S.doc Version 5.2 Page 28 2. YA6 3. YA9 Welbeck House 4. 5. YA20 YA23 6. YA35 7. 8. YA37 YA36 9. 10. 11. YA40 YA42 YA42 All staff responsible for the administration of medication should receive medication training and have their competency assessed on a regular basis. Staff should be provided with training in safeguarding adults at the earliest opportunity to ensure they are familiar with the process of recognising potential abuse and the formal referral process. New staff should receive structured induction training in line with Sector Skills Council specification this will enable care workers to give high quality care and support, provide recognition for their work, and prepare them for entry onto NVQ health and social care programmes. An application to register an experienced and competent manager with CSCI should be undertaken at the earliest opportunity. Arrangements should be made to ensure that all staff receive formal supervision at the required frequency to ensure they are provided with the necessary support they need to carry out their jobs. The homes policies and procedures should be reviewed in conjunction with the manager to ensure they comply with current legislation and good practice. Staff should receive first aid training as soon as possible supporting the safety of people who use the service. Locks on bedroom doors should be replaced to ensure staff are able to access people quickly in the event of an emergency. Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Welbeck House DS0000030055.V365882.R01.S.doc Version 5.2 Page 30 - 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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