CARE HOMES FOR OLDER PEOPLE
Wellhay Resource Centre Knole Lane Bristol BS10 6GH Lead Inspector
Sandra Garrett Unannounced 30 July 2005 09:30 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 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 Older People. 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. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Wellhay Resource Centre Address Knole Lane Bristol BSBS10 6GH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 3772591 Bristol City Council Christine Ruth Bryant PC Care home only 10 Category(ies) of DE(E) Dementia - over 65 (10) registration, with number DE Dementia (10) of places Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate 8 persons aged over 65 years of age with Dementia May accommodate 2 persons aged 50 years and over with Dementia Two un-named persons with dementia aged over 50 years may receive respite care at the Centre Date of last inspection 3-Feb-2005 Announced Brief Description of the Service: Wellhay Resource Centre is operated by Bristol City Council and registered to provide personal support and temporary accommodation for eight people who are over 65 and two people over 50 years. All service users accommodated have a diagnosis of dementia. The centre provides respite and also day care for people living in the community plus support for their carers. Wellhay is purpose built and is able to provide day care for up to 24 people with dementia. The premises are accessible for disabled older people and there are a number of vehicles available for the centres use. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out at the weekend. Eight service users were resident at the time although some were going home after a period of respite. New service users were also coming in for a stay on the same day. Day care is provided seven days a week so people came in for this also. At least five out of eight service users were spoken to, one at some length as s/he was unhappy with aspects of her/his stay. Care records were examined as well as complaints, accident records and risk assessments. What the service does well: What has improved since the last inspection?
No major issues of concern were raised at the last announced inspection that took place in February ’05. Since the last inspection all staff have had training in effective recording skills and positive evidence of better recording in respect of service users’ whole lives and from their own perspectives were seen in daily records. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 Although there is an assessment and care planning system in place, it needs to be more consistent to adequately provide staff with relevant information to satisfactorily meet service users’ needs. The identified specialist needs of service users are well met with evidence of good multi-disciplinary working taking place on a regular basis. EVIDENCE: Social workers or Community psychiatric nurses make referrals to Wellhay through their team manager. Referrals are received from all over the city. Copies of initial assessments that form the basis of care to be delivered were seen in some care records. These were completed by social workers, were comprehensive and included biographical details, social histories and information regarding service users’ daily lives. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 9 However, one service user asked to speak with the inspector as s/he was unhappy at ‘being compelled’ to stay at the centre and unable to leave. On looking at this service user’s records no pre-admission assessment was found and it was not clear if the service user had a diagnosis of dementia. The manager said the service user’s situation was complex and a second psychiatric assessment was awaited. Without an initial assessment and care plan it was not easy to see what the service user’s assessed needs were or how they could be met. Wellhay is a specialised resource that offers support and respite care to older people with dementia. It provides day care to a number of people with dementia who are still able to live in the community, supported by relatives/carers. The manager attends a weekly care review meeting that is attended by a range of healthcare professionals including social workers, occupational therapists, community psychiatric nurses and psychogeriatricians. Therefore specialist guidance is available to help the centre meet the needs of people with dementia and care given is demonstrably based on current good practice. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Service users are well looked after in respect of their health and personal care needs. Care or support plans are developed but need to be consistently applied for all service users. EVIDENCE: The service user who was unhappy with her/his care spoke at length about what s/he viewed as an enforced stay at the centre. S/he was also concerned that the manager had taken away her/his money. As above it was clear that no Wellhay care plan had been developed, that would have covered personal care, behaviours, emotional issues, money management and why s/he was placed at the centre. The manager was able to provide lots of information about the service user and after reviewing care records that were available, a meeting was held to enable the service user to fully discuss the situation. Actions that s/he consented to were agreed at this meeting although not recorded. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 11 Some service users staying at the centre for respite care had care or ‘support plans’ that covered all aspects of their assessed needs. Those seen were clear and detailed with service users preferred names recorded. The plans detailed personal and emotional support needs and were holistic and person centred. However not all service users staying at the centre had support plans. A requirement is made that all service users must have support plans if they are staying in the centre for any length of time. From care plans and records seen there were lots of references to show how service users healthcare needs were identified and met. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 14 Service users experience a stimulating and varied life in the centre with activities given high priority. EVIDENCE: Lots of photographs were seen pinned up on the wall outside the dining room. These were mainly of service users and staff doing various activities e.g. making collages and Christmas decorations, having their hair done and enjoying the garden. The manager said that service users like to spend time in the garden and try to do gardening tasks. Staff said that activities are carried out at weekends and this (Saturday) was no exception. Activities take place for everyone when the day care service users arrive. Some service users were seen finishing breakfast, wandering around the centre or chatting together in the lounge. Some said they were going home but didn’t know when. They said they liked the centre but ‘it’s not as good as being at home’. Service users have lots of choices available to them in respect of the environment, activities and meals. One service user said ‘s/he wasn’t allowed to go out or go home’ and although this was in fact not true, it wasn’t clear how her/his rights and choices could be conveyed that would reassure her/him. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints documentation meets all the elements of the regulations and service users and their relatives are made aware of how to complain. However attention needs to be given to making complaints records available for inspection at any time. EVIDENCE: On arrival at this visit the manager wasn’t on duty and staff had no access to the office where complaints and other records necessary for inspection were kept. However the manager was contacted and came in for the rest of the day. Complaints documentation must be made available for inspection at any time and a requirement is made to ensure this. No new complaints had been received since the last inspection. Service users and their relatives are given information about the complaints process and a box is ticked on their admission information to show that this has been done. Seven letters and six cards of thanks and compliments with positive comments about the home were seen at the front of the complaints and compliments file. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 24 The standard of the environment within this centre is good providing service users with an attractive and homely place to live. However attention must be given to ensuring bedrooms are kept unlocked so that service users can have full access to them. EVIDENCE: Wellhay has been thoroughly refurbished and decorated over the last two years. All bedrooms are decorated in pastel shades and well appointed with new furniture and fittings. Communal areas are decorated to a good standard and provide a pleasant and homely environment. The centre benefits from a music room, activities room and maintenance workshop that male service users like to sit in. The centre is spacious enough to accommodate a snooker table and there is a well-stocked garden with patio area that service users like to sit out in. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 15 On arrival at the centre the service users were finishing breakfast. One service user complained that he couldn’t get into his room and staff said the rooms were locked because of other service users wandering into them. One service user with limited mobility wanted to speak in private about her/his stay at the centre but the bedroom was locked. This entailed a long walk for her/him to find a staff member to come and unlock it. The manager later said that rooms are normally only locked when floors have been washed to protect service users from risk of slipping on wet surfaces. As the locking of rooms presented difficulty for residents and prevented them from entering freely a requirement is made. This is to ensure that rooms are only kept locked if absolutely necessary and for the shortest time possible or else subject to an individual risk assessment. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Wellhay staff are well trained and supported and employed in sufficient numbers to meet service users needs. EVIDENCE: Staffing levels in Wellhay are above the minimum Standard in order to meet the needs of day care users and service users receiving respite. Staff go out each day on the minibus to collect service users from their homes, escort them to the centre and escort them home again in the evenings. Appropriate numbers of staff were seen on duty at this visit. A number of staff hold NVQ at levels 3 and 4. All Staff have, in the last year, received training in effective recording skills and Protection of Vulnerable Adults as well as other mandatory training e.g. manual handling and first aid. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35,37 & 38 The home is efficiently managed on a day-to-day basis but attention needs to be given to appointing a person to act as a responsible individual and carry out internal monitoring visits at least monthly. This is to ensure service users are given the quality of service they are entitled to expect. Further, attention should be given to improving the records kept of service users’ valuables and cash to ensure that they are protected. Health and safety issues are well managed and service users are protected from harm as far as possible. EVIDENCE: The manager was off duty at the time of this visit although came to the centre immediately when asked to by a staff member. The manager demonstrated clear knowledge and understanding of service users and their needs, some of which are complex. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 18 Since the last inspection the Commission had not received an application in respect of an appointed person to act on behalf of the registered provider as responsible individual. Further no reports of monthly internal monitoring visits had been sent to the Commission since February ’05. A new requirement is therefore made to ensure that an appropriate individual is appointed. The service user who was unhappy with her/his care was also concerned that the manager had taken away her/his money. The manager said that a sum of money had been put in the safe for the service user’s protection. At a meeting with the service user s/he was offered the money to keep but agreed that it should continue to be kept in the safe. The manager was observed talking with the service user in a calm and person-centred way that reduced the service user’s fears and anxiety about the situation. However no receipt or copy of a cash sheet was given to the service user that would aid her/his memory of the situation. A good practice recommendation is therefore made. Records of fire safety tests were in good order and health and safety issues were well managed. It was noted from accident records seen that some service users had fallen whilst in the garden though none had received any injury. A comprehensive risk assessment was in place that covered use of the garden and patio areas. Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x
COMPLAINTS AND PROTECTION 3 N/A x x x 2 x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x 3 1 x 2 x 3 3 Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 20 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 OP3 Regulation Requirement Timescale for action 12/09/05 2. OP7 3. 4. OP16 OP24 14(1)(b)(c Copies of pre-admission ) assessments must be provided for each service user entering the centre for short-stay purposes 12/09/05 15(1) Care plans must be developed for each service user entering the home for short-stay purposes. Care plans must demonstrate and record: Factors affecting service users assessed needs and how assessed needs are to be met; That service users or their relative/representative are consulted and able to sign to say they have been consulted (Timescale not met from 3 February inspection) 22(8) The centres record of complaints 12/09/05 must be made available for inspection at any time 12(4)(a) Service users bedrooms must be 12/09/05 kept unlocked unless there is a clear and up to date risk assessment in place that provides for locking of rooms on health and safety grounds only Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 21 5. OP33 7(2)(c)(i) 26(2)(c) The registered person must appoint a named person to act as responsible individual who is fit to carry out the registered persons duties. This person must also make monthly internal monitoring visits to the home and send copies of these visits to the Commission 30/09/05 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 OP35 Good Practice Recommendations Service users should be given receipts for cash held for them in the centres safe and/or copies of the cash sheet with details of monies kept Wellhay Resource Centre D56_D05_S37063_Wellhay_V234207_300705_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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