Inspection on 13/04/05 for Wellpark

This inspection was carried out on 13th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wellpark 10/05/07

Wellpark 08/06/06

Wellpark 29/11/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Wellpark Alphington Road St Thomas Exeter EX2 8AU Lead Inspector Bel Heginworth Announced 13th April 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Wellpark Version 1.00 Page 3 SERVICE INFORMATION Name of service Wellpark Address 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) Alphington Road St Thomas Exeter EX2 8AU 01392 217387 Networking Care Partnerships [SW] Ltd. CRH PC Care Home providing Personal Care 8 Category(ies) of LD Learning Disability [8] registration, with number of places Conditions of registration Date of last inspection YES 30th March 2004. This home was closed and has recently re-opened under new ownership Brief Description of the Service: Wellpark provides support and personal care for people with a learning disability and complex needs. The home is a detached house situated on a busy road in Exeter. The house is on three levels. There is a large lounge, dining room, laundry room, kitchen and en-suite bedroom on the ground floor. The upper levels house the remaining bedrooms, an additional communal room, an office and bathrooms.There is a large secure garden to the rear of the property. Wellpark Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. The current residents living at Wellpark have limited verbal communication skills and were therefore were unable to contribute fully to the inspection process. A short time was spent observing residents. Due to their complex needs the time spent had to be short on this occasion. Seven staff were spoken with including the “acting” deputy manager. This announced inspection took place over 7 hours with the provider, Mrs Ann Balchin present throughout the day. The inspector looked around parts of the building and a number of records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Improvements are needed in care plans to ensure that the information provided relates to the residents’ current living arrangements. Restrictions on choice or freedom should be discussed, agreed and recorded with other professionals. For example a Good Practice Committee. Medication systems need to be improved to ensure the safety of residents. Wellpark Version 1.00 Page 5 Recruitment practices must be improved immediately to protect residents. Training on Adult Protection needs to be improved. Hand-washing and drying facilities must be made available in the laundry room to help with infection control. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wellpark Version 1.00 Page 6 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 Standards Statutory Requirements Identified During the Inspection Wellpark Version 1.00 Page 7 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 standard(s) 2 There is good information about residents prior to admission that ensures the home can meet their needs. EVIDENCE: The two residents living in the home were unable to discuss their involvement in the admission process due to limited communication skills. The home has an admission form and receives detailed information from previous placements. Prior to admission staff worked with the residents and visits to the home were arranged. Staff said that the assessments provided them with clear information and guidelines that ensures residents needs can be met. Wellpark Version 1.00 Page 8 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 standard(s) 6, 7 & 9 Risk assessments provide staff with the information they require to meet residents’ needs safely. Improvements are needed in care plans and the decision making process. This is particularly important given that residents have limited capacity to contribute to plans and decisions. EVIDENCE: Residents have limited communication skills and have a limited understanding of care plans and are therefore unable to contribute to their formulation or reviews. The information in the care plans has come from previous placements. Although this provides a good history and information of need, not all of it relates to the current living arrangement. It was agreed with the provider that care plans should be reviewed to ensure that the information and the assessed needs are relevant to home. Residents have complex needs that often challenge the staff and services. To ensure the residents’ safety, the kitchen door, a bathroom and doors leading to the outside of the home and all garden gates are locked. The decision to impose these restrictions is carried out with good intention and with the safety of residents in mind. However, restrictions, which might impact upon a resident’s freedom of choice and movement, should always be discussed and agreed with families and community professionals. Wellpark Version 1.00 Page 9 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 standard(s) 0 Not inspected on this occasion. EVIDENCE: Wellpark Version 1.00 Page 10 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 standard(s) 20 Medicines are stored securely but are not being dispensed correctly. Improvements are needed for staff training. Policies, procedures and information in residents’ risk assessments and guidelines need to be improved. EVIDENCE: Medication is supplied in a monitored dosage system. It is currently stored in a secure cabinet in a temporary office on the ground floor. When residents go out for the day or stay with families for a weekend, medication is re-dispensed into containers from medication wallets. Medication was found in a container with no label describing what and whom the medication was for. This is an unsafe practice and must stop. When medication needs to be re-dispensed advice must be sought from a pharmacist about the correct and safe method of doing this. Un-prescribed pain relief medication was found in the medication cabinet. No Homely Remedy policy was in place and there was no advice on how and when it can be used. Some staff that administer medication have attended a 2-hour training session from a pharmacist. The training should include training on medication policies and procedures. A competent trained person then needs carry out an initial Wellpark Version 1.00 Page 11 assessment of competence to ensure members of staff are following policies and procedures and putting into practice their training. The assessment of competence will need to be reviewed on a regular basis. Some medication is used on an “as necessary” basis (PRN), for residents who become distressed. There are guidelines and risk assessments in place for its use but the guidelines do not include other factors that might be contributing to their distress. For example, are they in pain, thirsty, hungry, cold, hot and so on. This is particularly important given the medication used is a “chemical restraint” and residents have limited capacity to express their feelings. There should also be guidelines on monitoring and recording the outcome after it is administered. Prescribed medication is recorded on pre-printed sheets (MARS). Staff handwrite changes that have been prescribed by a GP. This is not being recorded correctly. Staff have been scoring out or altering the original instruction and writing in the new. Any changes must be recorded on a new part of the MARS sheet with the date of the change and signatures of the person writing the change and the person checking the entry. Wellpark Version 1.00 Page 12 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 standard(s) 23 The home has some good systems in place that protect residents from abuse. Improvements are needed for staff training on Adult Protection and recruitment practices. A review of the current shift pattern is needed. EVIDENCE: Staff demonstrated a good awareness of Adult Protection and knew what to do if they suspected abuse. A senior member of staff has talked through Adult Protection issues with staff as part of their induction training. No staff, including the senior staff has received in-depth training on this subject. Advice was given on whom to contact for advice on this training and it was suggested that the home obtains the “No Secrets” video. The home’s shift system does not take into account the social needs of residents in the evening. Staff work a 12-hour day shift pattern that end at 9pm when the night carers come on duty. While the staff team prefer this arrangement it prevents ad hoc evening activities. The rota is therefore not completed according to the needs or wishes of service users. Recruitment practices are not satisfactory and do not protect service users. (See section 31 – 34) Wellpark Version 1.00 Page 13 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 standard(s) 24, 26 & 30 The standard of décor, furniture and fittings throughout the home is good. Improvements are needed in relation to infection control and when bedroom doors are locked. EVIDENCE: The home has been opened since January and is bright, airy and furnished in a homely manner. The dining room is still to have pictures hung. Part of the approval of registration was that a small room on the ground level and a room on the third level were to be used and made available as extra communal space for residents. The room on the third level is not yet equipped and the room on the ground level is being used as a second office. The provider explained that this is a temporary measure while there are only two residents currently living in the home. A resident’s bedroom is currently locked to prevent another resident from entering. The locks are operated by use of a key which the resident is unable to use. The provider should research into alternative locking mechanisms that suit the needs of residents and prevent residents from being restricted on entering their bedroom when they choose. Wellpark Version 1.00 Page 14 The home has a separate laundry room with washing machines, dryers and a sink. There are no hand-washing facilities in this room for staff and residents to ensure that good infection control measures are in place. Wellpark Version 1.00 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 Some of the recruitment practices do not protect residents. EVIDENCE: Three staff files were looked at. Appropriate references and identification was obtained. CRB checks were looked at. Applications for CRB checks for all staff have been completed but only 3 were returned. Staff without CRB checks are working in the home, with residents, as part of the numbers needed in the shift system, before CRB of POVA checks have been completed. Until satisfactory CRB or POVA first checks are completed, staff must not work with residents in the home. Wellpark Version 1.00 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 Not inspected on this occasion. EVIDENCE: Wellpark Version 1.00 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 x x x 2 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x 1 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x Wellpark Version 1.00 Page 18 N/A 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 Regulation 19 (1-7) Requirement Timescale for action 15/05/05 2. YA20 13 (2) 3. YA30 13 (3) The registered person shall not employ a person to work in the care home unless the employer has obtained in respect of that person the information and documents specified in paragraphs 1-7 of Schedule 2 of the Care Home Regulations. (This refers to CRB and POVA checks being completed for all staff BEFORE working with residents) The registered person shall make 15/05/05 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicinces received into the care home. The registered person shall make 15/05/05 suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home. (This relates to having hand-washing and drying facilities in the laundry room) Wellpark Version 1.00 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA7 YA20 Good Practice Recommendations Information in care plans should relate to the environment the resident is living in. Practices of freedom of choice or movement should be discussed and agreed with families and other professionals with records kept. Medication training should be accredited and must include - 1. Basic knowledge of how medicines are used and how to recognise and deal with problems. - 2. The principles behind all aspects of the homes policy on medicine handling and records. Residents risk assessments and guidelines should include information about alternative methods or medicines to be used before medication with a sadating effect are used. The home should ensure that appropriate Adult Protection training is implemented for all staff. Residents bedrooms should have locks that are suitable to the needs of that person and allow access whenever they choose. 4. 5. YA23 YA26 Wellpark Version 1.00 Page 20 Commission for Social Care Inspection Suite 1 Renslade House Bonhay Road Exeter, EX4 3AY National Enquiry Line: 0845 015 0120 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 Wellpark Version 1.00 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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