CARE HOME ADULTS 18-65
Welham House Hundleby Road Spilsby Lincs PE23 5LP Lead Inspector
Mr Ken Hague Unannounced Inspection 1st September 2005 09:00 Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Welham House Address Hundleby Road Spilsby Lincs PE23 5LP 01790 752989 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) Boulevard Care Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25/07/05 Brief Description of the Service: Welham House care home is owned by Boulivard Care Ltd. It is situated in the town of Spilsby. The two-storey detached house has been adapted and extended to provide accommodation for 14 residents. The home caters for residents with a learning disability who require permanent or respite care. Bedroom accommodation is in single rooms. The home has a large through lounge and a separate dining area. Access to the first floor is obtained by a flight of stairs. The home has good access to the local community. A car park for visitors is provided at the rear of a care home or on road parking is also available. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and two visits were made to the care home. The inspection commenced on 1 September 2005 and a second visit to complete the inspection was made on 3 of January 2006. A tour of the building took place and care records were inspected. The main method of inspection used is called ‘case-tracking’; this involved selecting three residents and tracking the care they received through the checking of their records, discussion with the residents, care staff and observation of practices. A sample of care records and policies and procedures were examined. The Acting Manager was present throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The acting manager and the company intend to build on the progress made since July 2005. Initial assessments are completed prior to the residents being admitted but it is recommended that the initial care records should be placed at the front of individual residents file enabling them to be used as working documents.
Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 6 This would allow staff to complete the detailed care records over a period of time after the admission as the ongoing assessment of need is continued. At the present time staff have to filter through large documents to determine the care needs of residents until the assessment has been fully completed. It is important to ensure that training is provided to staff to meet the needs of all residents staying at the care home. In the case of one resident staff had not been provided with training to understand the medical condition of this individual. 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. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 &5 There are thorough procedures for the introduction and assessment of people to the service, ensuring that their care needs are met. EVIDENCE: The home has a statement of purpose and service users guide which enables new residents to identify the resources of the care home and established whether the home can meet their individual care needs. The acting manager stated this document has been reviewed in 2005 and a new updated statement of purpose and service users guide has been published. She confirmed all new residents are given the opportunity to visit the home prior to them making any long-term decision. The discussions with staff residents and the inspection of care records provided evidence that initial assessments are carried out for all new residents prior to them being admitted. The individual files of residents who were being case tracked all contained details of the terms and conditions for their stay at the care home. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 10 Care plans identify all areas of need and provide detailed care instructions for staff; this enables staff to provide appropriate care. Residents’ health needs were being met. EVIDENCE: There has been a great improvement since the last inspection in the quality of care records particularly care plans and risk assessments. Three individual files were inspected and they all contained initial assessments, care plans and risk assessments which included the management of any identified risk. The company has detailed care plans, risk assessments and care records which it uses in all of its homes. They require a great deal of time to complete due to the detail required in these records. This can result in gaps being left in records. The records seen at this inspection had been fully completed and there were no gaps in assessment documents. All sections had been completed in detail and were easy to read and to follow. Two of the three residents care records exceeded the National Minimum Standards. The third resident had only been admitted to the home in the last 10 days. His records met the National Minimum Standards but were not completed to the same standard as the other two inspected.
Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 10 It is recommended that the home reviews the minimum information it requires on file at the time of the initial assessment and admission to the care home. These documents could be filed at the front of the individual residents file to be used as a working document while a full detailed ongoing assessment is completed. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 & 16 Residents are encouraged to take part in activities of their choice and many activities are taken within the local community. The home makes all friends and family welcome. Residents are actively involved in the decision making process of the home. Staff ensure that residents rights are protected and that they are treated with dignity and respect. EVIDENCE: All people using the service at the time of the inspection said that they were provided with activities some at the Orby Day Centre. They stated their satisfaction with the type of activities being organised by the care home. Staff confirmed residents not in the home on the second day of the inspection were taking part in activities at the Orby Day Centre. Each resident’s file contains a list of activities undertaken. Staff stated all residents are encouraged to take part in small tasks around the house. Residents take personal responsibility for their individual bedrooms to be tidied and cleaned, they are supervised and assisted by staff. A list was seen in the kitchen of tasks for individual residents to carry out during the week of the second inspection visit. Residents stated that they helped around the house, for example with cleaning and meals.
Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 12 The individual bedrooms seen during this visit were all provided with equipment and facilities which met the National Minimum Standards. Eight individual rooms have been decorated since the last inspection. Residents stated that they had enjoyed a holiday organised at Center Parcs in the summer of 2005. There were photographs displayed in the care home of social activities. The acting manager stated that one resident had with the assistance of staff obtained his own mobility car. The company provides transport facilities in the form of a minibus. Residents confirmed that they are enabled to maintain contact with relatives by a telephone provided in the care home. The home holds residents meetings. Staff were observed to listen to residents requests for help and to talk to them in a calm and patient manner. The acting manager stated residents dignity and privacy is respected. During her formal interview she requested that the discussion was carried out in a different room to ensure that a resident being discussed would not overhear the conversation. The managers office was situated next to her bedroom. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 The health needs of residents are met with good liaison with healthcare services. Medication, storage and administration systems are satisfactory, ensuring that prescribed medication is administered safely. EVIDENCE: The acting manager stated that no resident self-medicates. Medication is managed and administrated by staff who have received formal training. There is a policy and procedure in place within the home for the administration and management of medication, which meets the National Minimum Standards. The care plan records contain details of the medication for each resident and includes their medical history. Staff confirmed that the company has provided formal training in the administration of medication. Service users stated that they were happy with their medication being provided to them by staff. Residents files contained a consent form signed by individual residents confirming that they were happy for the medication to be administered by care staff. The three residents files inspected all contained the choices and wishes of the residents and described the manner in which they wished support and care to be provided. This included the support and supervision of personal care, including bathing and the organisation of their social lifestyle.
Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 14 Residents signed a consent form if supervised bathing was required after a risk assessment had been completed. There were records demonstrating that appropriate community health services were being obtained for residents. The visits of chiropodists, opticians, dental appointments and hospital appointments were recorded on individual files. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 There are robust procedures for handling complaints and allegations of adult abuse and staff were clear on the action to take in the event of this occurring, ensuring that service users are safe. EVIDENCE: The home has a complaints procedure which tells residents and relatives how to make a complaint and how it will be handled. A copy is given to each resident on admission and forms part of the Service Users Guide. The care home holds residents meeting where they can express opinions and concerns regarding the service. There are policies and procedures in place which instruct staff in the actions to be taken if there are any suspicions of abuse. Staff have been provided with training in the identification and management of abuse. Staff interviewed were able to describe the reporting process set out in the companys abuse procedure. The home and the Commission for Social Care Inspection has received no formal complaints since July 2005. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The home provides a comfortable, clean and homely environment and has an on going maintenance programme. There were no health and safety issues identified at the care home. All areas of the home smelt fresh. EVIDENCE: There was evidence of ongoing maintenance being carried out at the care home. Eight rooms have been decorated. One window has been replaced on the landing area. Additional rooms are presently being redecorated. No health and safety issues were identified in the care home. The staff interviewed stated that it was a safe environment in which to work. One resident expressed satisfaction that his room which had been redecorated. All areas of the care home were clean and smelt fresh. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 ,35 &36 The acting manager is following the company’s recruitment policy, which meets the Care Home Regulations. All staff have received appraisals and supervision in accordance with the National Minimum Standards. Staff training has been provided but excluded training in one area which was essential to meet that need of one resident in the care home. EVIDENCE: Staffing rotas demonstrated that the home was meeting the minimum staffing levels with an adequate mix of care staff on duty 24 hours a day. The individual files for members of staff recruited since the last inspection was seen. The Care Home Regulations sets out a list of information, which must be obtained before the new members staff are offered employment. All of the files seen contained this information. The dates and signatures on the documentation provided evidence that employment had only been offered after the appropriate checks had been carried out. The formal interviews with staff and the inspection of records provided evidence that supervisions and appraisals are being provided at the recommended frequently set out in the National Minimum Standards. The company organises staff training in a yearly training plan, which covers all the companies homes. One resident had a health need identified on their care records. The company has failed to provide appropriate training to enable staff to understand this persons needs. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38 & 42 The home is well run, with good leadership and guidance for staff. Record keeping is of a high standard, and the health, safety and welfare of residents is promoted. EVIDENCE: The care home has a supported acting manager who has worked hard supported by the company to improve care records and staff morale. The care records are greatly improved since the last inspection in July 2005. Individual residents files are well organised, information is filed consistently and they are being used as working documents. Staff stated that staff morale has improved and that they feel very supported by the present manager. Staff are now being provided with appraisals and supervision as required by the National Minimum Standards. All service users financial interests are safeguarded by the policies and procedures of the care home. Staff stated that the home is a safe home in which to live and a safe working environment. Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 19 Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 4 x x x 3 x Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 21 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 YA35 Regulation 18 1 (a) ci Requirement The registered person must provide staff with appropriate training to meet the needs of the residents staying at the home. Timescale for action 20/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Welham House DS0000002564.V276050.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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