Inspection on 29/11/05 for Wellpark

This inspection was carried out on 29th November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 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 13/04/05

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 Wellpark Alphington Road St Thomas Exeter Devon EX2 8AU Lead Inspector Belinda Heginworth Unannounced Inspection 29th November 2005 09.20 Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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 Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wellpark Address 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) Wellpark Alphington Road St Thomas Exeter Devon EX2 8AU 01392 217387 Networking Care Partnerships (SW) Ltd Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th April 2005 Brief Description of the Service: Wellpark provides support and personal care for up to eight 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 DS0000062704.V265433.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over fours hours and twenty minutes. Many of the residents living at Wellpark have limited verbal communication skills and were therefore unable to contribute fully to the inspection process. However time was spent with residents and observations of staff and residents interacting were made. One resident was consulted and there views on the home discussed. The inspector spoke with six members of staff. The inspector look around parts of the building and some records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be read and used by the staff to ensure residents’ needs are being met and are monitored. Restrictions on choice or freedom of movement must be discussed, agreed and recorded with other professionals. For example a Good Practice Committee. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 6 This is particularly important where residents lack capacity to contribute to care plans and decisions. This relates to the many areas of the home being inaccessible to residents. For example, the kitchen, most bedrooms and some bathrooms. The complaint’s procedure should be in a format that can be easily understood by residents with communication difficulties. For example, using pictures or symbols. Training on Adult Protection issues and other training that will help staff to meet residents’ needs safely, must improve. This help to better protect residents’ welfare and safety. There should be very clear systems that monitor the quality of care delivered in the home, with information about what needs to be completed and when. This would ensure that all staff are aware. As part of the home’s quality monitoring the provider should seek the views of residents, relatives, staff and other parties to find out their views on how well the home is run. There should be clear risk assessments related to fire safety and prevention. 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. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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 Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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): 0 Not inspected on this occasion. EVIDENCE: Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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 Staff are provided with information to help meet residents’ needs. Improvements are needed to create care plans that are used. The decision making process needs to improve. This is particularly important given that residents have limited capacity to contribute to plans and decisions. EVIDENCE: During the last inspection it was highlighted that residents had limited communication skills and had a limited understanding of care plans and were therefore unable to contribute to their formulation or reviews. The information in the care plans had come from previous placements. Although these provided a good history not all of it related 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 were relevant to home. Care plans have been reviewed. They provide new staff with information about resident’s likes and dislikes, with guidelines and risk assessments to manage a variety of behaviours. These plans are kept in an office upstairs. Staff said they read them when they started working at the home but have not read them since. The plans are not used on daily basis, as a working tool. There is no information about what residents hope to achieve to progress towards more independent living skills. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 10 Residents have complex needs that often challenge the staff and services. The staff feel that to ensure residents’ safety, the kitchen door, bathrooms 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, during the last inspection it was highlighted that restrictions, which might impact upon a resident’s freedom of choice and movement, should always be discussed and agreed with families and community professionals. There was no evidence that this work had been completed. Some care plans stated the reason the locks were needed but there was no evidence that it was discussed with other community professionals, such as a Good Practice Committee. (See sections 10 - 17 & 24 – 30) Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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 & 17 Resident’s benefit from some activities in and out of the home. Improvements are needed in this area. Resident’s benefit from a healthy and varied diet. Improvements are needed to residents’ to the access of the kitchen. EVIDENCE: One resident attended a variety of activities within the local community. An activity chart was displayed there bedroom. The resident said they liked knowing the routine and what to expect each day. Other residents went swimming regularly, went for walks and used pubs and cafes for leisure pursuits. Some activities are carried out in the home but this is done on an add hoc basis. Staff said they were looking into finding more activities for residents, particularly therapeutic activities that would benefit residents. No activities take place out of the home in the evening. (See section 30-36) Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 12 A resident said the food was good but said that choices were not offered. Staff said this was not true, choices were always offered. Daily records did not reflect foods eaten or that choices were offered. Most of the time, the records said “ all meals eaten”. The kitchen door is kept locked; staff said this was to keep residents safe. Drinks, snacks and meals are provided at times decided by staff. Some residents will indicate when they want a drink but most rely on the staff. The home provides a high ratio of staff to residents to ensure residents complex needs are met. Some residents could use the kitchen under supervision but because of how the kitchen is set up, it is more dangerous. For example, dried / tinned foods are kept on open shelves, hot water for drinks is kept in an urn rather than using a kettle. A better design of the kitchen would make it safer for residents to use. Care plans should include how staff intend to promote independent living skills, such as using the kitchen and preparing foods and drinks. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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 Residents’ personal care and health needs are met. EVIDENCE: One resident was happy with how personal care was given. Staff had a good knowledge of how residents preferred to receive personal care. Daily records also reflected how personal care was given. There were good records of residents’ health care needs and how they are monitored. Medication is supplied in a monitored dosage system. All medicines are now prescribed, including pain relief medicine. When residents go home medication packs are sent with residents. The inspector contacted the CSCI Pharmacy Inspector to ensure this is a suitable practice. He has said this is a safe practice. However the home must record the total amount of medication / tablets sent out and record how much came back. This is to ensure there is a clear audit trail of medicines leaving and returning to the home. The inspector was told that all staff that are responsible for giving medication to residents, have received appropriate training. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 14 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 Residents and staff benefit from a system that enables complaints and concerns are acted upon. Improvements are needed to ensure the policy is understood by residents. The home has some good systems in place that protect residents from abuse. Improvements are needed for staff training on Adult Protection. EVIDENCE: A resident said that staff listened to any concerns they raised and acted upon them. However, the complaint’s procedure is not in a format that is suitable to the communication needs of residents. For example, pictorial photographs and so on. This would help all residents be able to express concerns if necessary. Staff were aware of what to do if they were unhappy or concerned about any issues at the home. The home is currently investigating a complaint raised through the CSCI. Staff demonstrated a good awareness of Adult Protection and knew what to do if they suspected abuse. During the last inspection it was highlighted that a senior member of staff had talked through Adult Protection issues with staff as part of their induction training. However, no staff, including the senior staff had received in-depth training on this subject. Advice was given at the time, on whom to contact for advice on this training and it was suggested that the home obtains the “No Secrets” video. This remains the same. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 15 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): 26 & 30 Resident’s benefit from a clean and comfortable home. Significant improvements are needed to enable residents to have better access to their bedrooms, some bathrooms and the kitchen. EVIDENCE: The home is bright, airy and furnished in a homely manner. It was highlighted during the last inspection that the home has a separate laundry room with washing machines, dryers and a sink. There were no hand-washing facilities in this room for staff and residents to ensure that good infection control measures are in place. Soap and paper towels are now available. During the last inspection it was found a resident’s bedroom was locked to prevent another resident from entering. The locks are operated by use of a key, which the resident was unable to use. It was recommended that 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. During this inspection all bedroom doors and bathrooms on the upper levels were found to be locked. The doors had been locked by the staff. The inspector was told this was normal practice. This is an addition to the all entrances to the home being locked with only staff having keys. The atmosphere created by all of these locks is more in line with a Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 16 secure unit rather than a residential home. The decision to have rooms inaccessible to residents has been made with the providers and staff team. There was no evidence that this was discussed and agreed with relatives, care managers or community professionals, such as a Good Practice Committee. This is particularly important when residents have limited capacity and restrictions are infringing on their freedom of movement and sometimes choice. The Statement of Purpose does not inform potential residents and relatives that the home uses locks in this way. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 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, 33, 34 & 35 Residents benefit from a high level of staff numbers to help meet their needs. Recruitment practices protect residents. Improvements are needed to staff training. EVIDENCE: The home currently provides five staff for six residents to enable staff to meet the residents’ complex needs. During the last inspection it was highlighted that the home’s shift system did not take into account the social needs of residents in the evening. Staff worked a 12-hour day shift pattern that ended at 9pm when the night carers came on duty. While the staff team preferred this arrangement it prevented ad hoc evening activities. The rota was therefore not completed according to the needs or wishes of residents. The rota system has now been changed to include 3 x 10 hour shifts and 1 x 7.5 hour shift. The times of starting are staggered to enable more staff to be on in the evenings up until 9.30pm. Despite this residents have not gone out in the evenings. (A recommendation has been made relating to this under section 10-17) It was highlighted during the last inspection that the home’s recruitment practices did not fully protect residents. The Human Resources manager said that the policy has changed to ensure that no staff are employed to work with residents until all necessary checks are obtained, including CRB / POVA checks. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 18 The majority of staff are relatively new to the home. Staff appeared very competent and had a good knowledge of residents’ needs. Staff said that the manager provided an in depth induction, but many have not received any health & safety training, such as Food & Hygiene, Manual Handling, Fire Safety and First Aid. This means that residents’ safety and welfare is not fully protected. Training to help meet the needs of residents has been limited some staff have attended “safe holding” and “conflict resolution” training but not all. Priority must be given to provide staff training to help meet residents’ needs safely. For example, total communication, gentle teaching, autism, person centred planning and so on. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 19 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, 39 & 42 On the whole residents benefit from a well run and safe home with methods that monitor the care given. Some improvements are needed in this area. EVIDENCE: The manager was not present during the inspection. Staff spoke highly of her skills and experience. The home has varies systems that monitor the quality of services. For example, care plan reviews, health & safety checks, staff training and much more. However, there is no plan that sets out what should be done and when. This would ensure that all staff are aware of what needs to be completed and when. The home should also find a way to seek the views of residents, staff, relatives and other interested parties on how well the home is run. The fire logbook was found to include regular fire alarm and safety checks. Staff training was up to date. However, the fire risk assessment was not completed. Residents’ safety is therefore not fully protected. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 20 Staff were aware of the home’s policies on issues relating to health & safety. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X 2 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wellpark Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 1 X DS0000062704.V265433.R01.S.doc Version 5.0 Page 22 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. 1 Standard YA6 Regulation 12 (1) (a) Requirement The registered person shall ensure that the care home is conducted so as – (a) to promote and make proper provision for the health & welfare of service users. (This relates to care plans not being read and used by the staff on a regular basis) The registered person shall ensure that the care home is conducted so as – (a) to promote and make proper provision for the health & welfare of service users. (2) The registered person shall as far as practicable enable service users to make decisions with respect to the care they are to receive and their health & welfare. (3) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health & welfare, so far as practicable Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 23 Timescale for action 30/01/06 2 YA17 12 (1) (a) (2) (3) 30/01/06 ascertain and take into account their wishes and feelings. (This relates to residents’ lack of access to the kitchen and the decision making process to keep it locked) The registered person shall ensure that the care home is conducted so as – (b) to promote and make proper provision for the health & welfare of service users. (2) The registered person shall as far as practicable enable service users to make decisions with respect to the care they are to receive and their health & welfare. (3) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health & welfare, so far as practicable ascertain and take into account their wishes and feelings. (This relates to the majority of bedroom doors and some bathrooms being kept locked and the decision making process to keep them locked) The registered person shall, 28/02/06 having regard to the size of the care home, the statement of purpose and the number of service user – (c) ensure that the persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perform; and (ii) suitable assistance, DS0000062704.V265433.R01.S.doc Version 5.0 Page 24 3 YA26 12 (1) (a) (2) (3) 30/01/06 4 YA35 18 (1) (c) Wellpark including time off, for the purpose of obtaining qualifications appropriate to such work. (This relates to the lack of mandatory health & safety training and training specific to help meet the needs of residents) The registered person shall after consultation with the fire authoritya) take adequate precautions against the risk of fire, including the provision of suitable fire equipment. (This relates to fire risk assessments) 5 YA42 23 (4) 30/12/05 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 YA7 Good Practice Recommendations Practices of freedom of choice or movement should be discussed and agreed with families and other professionals with records kept. For example a Good Practice Committee. Staff should consider evening activities for residents in and out of the home. A great variety of activities, leisure pursuits and therapeutic activities should be explored for residents. The complaint’s procedure should be clearly displayed and in a format suitable to the communication needs of residents. The home should ensure that appropriate Adult Protection training is implemented for all staff. DS0000062704.V265433.R01.S.doc Version 5.0 Page 25 2 YA14 3 4 YA22 YA23 Wellpark 5 YA39 There should be a quality assurance plan that provides clear guidance on what needs to be done and when. The home should seek the views of residents, staff, relatives and other professionals on how well the home is run. Wellpark DS0000062704.V265433.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Exeter Suites 1 & 7 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 DS0000062704.V265433.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!