CARE HOME ADULTS 18-65
Wellington House 371 Dover Road Walmer Deal Kent CT14 7NZ Lead Inspector
Lois Tozer Key Unannounced Inspection 19th April 2007 11:50 Wellington House DS0000023123.V329156.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 Wellington House DS0000023123.V329156.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. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wellington House Address 371 Dover Road Walmer Deal Kent CT14 7NZ 01304 379950 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) The Robinia Care Group Ltd Miss Sharon Anne Head Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 12 People with learning disabilities over 18 years of age. Date of last inspection 19th October 2006 Brief Description of the Service: Wellington House is a large detached house in the village of Walmer. It is registered for 12 younger adults who have a learning disability, and is situated on the main Dover to Deal road. Public transport, shops and pubs are easy to reach. There is a private car park and the home has its own vehicles. A small garden at the rear of the house is used creatively. All the service users have their own bedrooms, with bathrooms and toilets facilities in nearby. Robinia care staff provide personal care and support. The fee to live here ranges between £90,000 and 103,000 a year (average £1,855.77 per week). Previous inspection reports can be obtained from the home. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key site visit took place on 19 April 2007 between 11.50am and 5.00pm. The manager, Sharon Head, service users and staff assisted with the process. This was a follow up site visit to the 19 October 2006 visit, where some significant shortfalls to service user wellbeing were identified. Eleven people live at the home, many gave face-to-face feedback and all sent in responses to our survey. Organised and spontaneous activities were taking place throughout the visit, and observations formed part of the evidence collected. The manager and a service user gave a tour of the main parts of the home. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota and employment paperwork. What the service does well: What has improved since the last inspection?
The manager has reviewed all of the unmet standards and has succeeded in improving every service users lifestyle. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 6 The manager is helping the team to reflect on her or his own behaviour. Through doing so, people are learning that they too may be contributing to anxiety, and are now able to do something about it. Because of this, there is no painful restraint used anymore, and staff are learning new and better ways of working with anxiety. Service users have ‘Person Centred Plans’. They are having a say in who helps make decisions that effect them. They are tracking their own goals, which are based on their wishes, hopes and dreams. There are less locked doors, and people can come and go into the back garden without restriction. 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. The summary of this inspection report can be made available in other formats on request. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 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 Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be sure that their needs and aspirations will be assessed and supported. EVIDENCE: All service users now have a detailed baseline assessment, which they have had lots of say in. This has established each person’s hopes and wishes for their future, as well as support requirements. Prospective service users have a very detailed assessment that will form their basic care package. Contracts were discussed, and the manager agreed to develop ones between the home and the service user. These are important so service users are clear on their own rights and responsibilities. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person centred approaches put service users in the ‘driving seat’ for all consultation and planning, decision-making and risk taking. EVIDENCE: Service users have been fully consulted in the development of their plans. Five of the 10 long-term residents have been supported to build person centred plans. Circle of support meetings have been arranged, and outcomes very clearly documented. These have been regularly reviewed and service users are very happy, as they are now fully involved in the decision making process. Associated risks have been assessed with the individuals too, making acceptance of necessary restrictions (such as restricted time away from the home without support) much easier to understand. Risks are being reviewed regularly to be certain that only absolutely necessary restrictions are imposed. Service users are having more freedom and problematic behaviours are seen differently as a consequence of this new approach. Levels of incidence have significantly dropped in the last 6 months.
Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 10 Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have real opportunities to develop and have the lifestyle they choose. EVIDENCE: There are considerable improvements to service user lifestyle. People are making really meaningful decisions, and these are presented in a way that they truly understand. People can learn and maintain their life skills. For example, a person who was formally restricted from kitchen access now cooks at least weekly. As a consequence of reviewing approaches to lifestyles, relationships between staff and service users have improved. There is a more equality. Service users were happy with the changes, environmental restrictions have dramatically reduced and the level of aggressive incidence has dropped significantly. The home has a vibrant and happy atmosphere, and a real ‘buzz’ about it. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are being supported to take greater control of their personal healthcare and medication. EVIDENCE: People are supported in the way they want, and this is spelt out in the person centred plan. Everyone either has, or is having a health action plan. This easy read document helps service users take more control over their health. Staff support people to understand it, and make sure that people see the doctor etc when needed. During the visit, planned annual health check-ups were taking place with the individual’s GP. Medication administration records and systems are easy to use and show no errors. Staff are beginning to support service users to learn how to administer their own medication. For some, this is already taking place, giving a sense of pride and achievement. All is clearly risk and development plan assessed. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are listened to and are protected from harm. EVIDENCE: The serious issues of physical restraint have been reviewed, and the team are now safely supporting all service users without any use of pain compliant physical intervention. An attitudinal change about protecting and supporting people has come about in a very short time. The manager and team must be congratulated on coming so far and doing so well. The service users all say they feel safe and that they all know who to take their problems to. They feel less restricted and more in control of their own lives. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, homely, clean and safe. EVIDENCE: The home is in very good decorative order and has comfortable furniture throughout. Service users are driving environmental changes, and the 2nd lounge is now smoke free. Smokers say this is fine, and understand it’s now a nice room for all people to be. A smoker’s shelter is currently being developed. The old staff office will soon become a training kitchen / diner. Access to the rear garden is now unrestricted for all service users. Consequently, people are using the area more, and this has added a broader dimension to the home. All communal areas are clean and tidy throughout. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 15 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, 34, 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users can feel certain that the staff team will understand and support their needs, and that staff have had all the necessary safety checks. EVIDENCE: The manager and senior team have provided staff coaching. It has focused on the well-being and decision making opportunities provided to service users. The team have been encouraged to be critical in their analysis of incidents and look at all factors (environment, their own behaviour, known trigger situations). This has had really positive outcomes for service users as opportunities have opened up, anxiety and aggression has decreased. Changes in care planning has allowed newer staff to get to know the people better in a shorter time period – which removes stress levels for service users. The staff team can therefore meet the current service users specific needs. Staff numbers are provided to meet service users planned activities, which may mean in one morning, there could be 11 staff on duty. Recruitment processes are solid and gather all the data necessary to make sure service users are protected.
Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 16 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in service users best interests, reflecting the lifestyle they want. EVIDENCE: The manager has improved the service significantly within a very short timescale (6 months). She has embraced person centred approaches, learnt how to apply them, and is enjoying seeing how well service users are responding to this level of consultation. Service users are having meetings and bringing their own matters to the agenda. Personal plans are drawing out each person’s aspirations, which are being incorporated in the overall development plan for the service. Visits by the responsible individual from the organisation are taking place, but these must beware on focussing heavily on systems, rather than outcomes, for service users. Quality assurance systems
Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 17 are therefore improving, but will need time to embed and develop. All safety checks are confirmed as in date. Incidents and accidents are well recorded, analysed and action taken to prevent future occurrence. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 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 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 2 X X 3 X Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 19 NO 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. Standard Regulation Requirement Timescale for action 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 YA5 Good Practice Recommendations Reliable contracts should be developed with service users so people know the conditions of their stay. Wellington House DS0000023123.V329156.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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
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