CARE HOME ADULTS 18-65
Westend Pearcroft Road Stonehouse Gloucestershire GL10 2JY Lead Inspector
Ms Tanya Harding Unannounced Inspection 15th January 2006 09:10 Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Westend Address Pearcroft Road Stonehouse Gloucestershire GL10 2JY 01453 758618 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) Stroud Care Homes Limited Ms Judi Lorentz Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (2) of places Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Home may accommodate 2 named service users requiring the MD category. 16th June 2005 Date of last inspection Brief Description of the Service: Westend is a detached home in the quiet residential area of Stonehouse, close to Stroud. It is one of two homes owned by Stroud Care Homes Limited within the Stroud District that provide accommodation to adults with a learning disability who may present with behaviours which challenge. Each service user has a single room, with en suite facilities, including either a bath or a shower. Service users have been encouraged to decorate their rooms. There is ample communal space, including two large lounges fitted out with good quality fixtures and fittings; one is designated as a quiet room. There is also a domestic size kitchen with an adjoining conservatory for dining. There is a landscaped garden at the back of the house with a path leading to the sister home. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit was carried out on Sunday and lasted three hours. Most of the service users were met and some were spoken with. One person showed the inspector around the home. The newly appointed deputy manager supported the inspection and the registered manager came in for part of the visit. A number of records were examined including care files, records of expenditure and medication administration records. Since the last inspection an additional visit has been carried out to assess compliance with the requirements around staff recruitment. This report should be read in conjunction with the previous report for the inspection carried out in June 2005 to get a more comprehensive overview of the service provided in Westend. What the service does well: What has improved since the last inspection? What they could do better:
Medication administration records must be completed correctly and updated where necessary. Some practices in the home have been developed in order to manage behaviour and conflict, but may actually have a detrimental impact on the
Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 6 relationships between the service users and staff. Examples of this are given in the text under standards 22-23 and a review of one particular practice has been requested. There are no thermostatic valves in the home to regulate water temperatures. This may pose significant risks to service users who may not be able to judge the temperature of the water and could scald themselves. The home should take further steps to remove the potential risk to the service users. Window restrictors and door locks need to be checked to make sure these are in place and function appropriately. Previously there have been safety concerns about incidents in vehicles when transporting service users who may not get along with each other. The Registered Providers continue to express their commitment to review the transport arrangements in the future. Prompt notification must be made to the Commission of any incidents which may adversely affect the wellbeing of the service users. Close monitoring of staff mix on each shift is important to ensure the right support is provided to the service users. 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. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: The standards in this section were not assessed during this visit. However, it was noted that the Statement of Purpose refers to a different name for the home and this needs to be amended with the correct details. There have been no new admissions since the last inspection. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Service users assessed and changing needs are recorded comprehensively and people are consulted about the support they receive. Systems for monitoring service users finances appear to offer suitable protection to service users from any potential mismanagement of their moneys. EVIDENCE: Files for two service users were examined. A range of information is kept including details about preferred activities, care guidance, information about liaison with other professionals and information about incidents. A number of records were seen which provided evidence of consultation with the service users about risks, actions and support they receive. The home keeps records of all expenditure. There are a number of books where this is recorded under different headings. For example there is a record of expenditure for social skills and activities; savings and Christmas fund as well as individual records for each service user. All receipts are kept.
Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 10 There was evidence that balances are checked daily. The deputy manager is looking at improving the system further by asking staff to complete a slip which states how much has been taken out of each tin or purse. The suitability of the placement for one service user is being re-assessed with view of offering the person an option of more independent living. The manager has concerns about this which she has put in writing to the person’s social worker. Concerns were raised in the last report about the potential for adverse incidents to take place whilst transporting service users to activities. This referred to the behaviour of one specific person. Risk assessments are now in place which ask staff to assess the person’s mood before any trip is undertaken with aim to reduce potential for an incident. The manager advised that there have been no incidents in the car since the last inspection. There is also a risk assessment about the same service user accessing the kitchen (see also Standard 23). Some service users are able to access the community independently. The home has a missing persons’ procedure. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 and 16 Service users are supported to maintain and manage relationships and friendships, are reminded of their responsibilities and are able to exercise autonomous choices. EVIDENCE: On the day of the inspection one service user went to visit their family. It was observed that the service user who lives in the sister home very near Westend, came in to the home with the supporting member of staff. The person brought their own breakfast which they consumed in the dining area. Shortly afterward the person returned to their home. This matter has also been picked up at the Announced Inspection at the sister home and discussed with the providers. Further discussion about appropriateness of this practice is likely. Flexible routines were observed on the morning of the visit. Two service users were up. One person was still in bed and one service user was being supported with their morning routine.
Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 12 Records seen on the day of the visit provided evidence that people are being supported to maintain relationships and friendships. Any difficulties within the relationships in the home are discussed with the service users, so that they are aware of their rights and are given the necessary support to exercise these. There are concerns about the relationship between two service users in the home and a number of protocols were seen about how any arising conflict will be managed. Steps include talking to service users about their emotions and encouraging the service users to walk away from situations which may become abusive. Staff spoken with advised this is not always successful, and incidents of aggression are sometimes unavoidable (see also Standard 23). One person has moved rooms and staff said that the person has settled into their new environment well. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Shortfalls in medication administration and recording systems may lead to errors potentially compromising the wellbeing of the service users. EVIDENCE: A requirement was made in the last report about carrying out assessment of consent for a specific service user. The manager advised that this is has been pursued with the Community Learning Disabilities Team at the time, but is no longer relevant. Medication administration records were viewed and it was noted that tippex was used on some records to amend the signature of the person administering the medication. This is not seen as acceptable and was brought to the attention of the registered manager. Medication administration records must be completed accurately at all times. Where corrections are necessary, these should be clearly made to ensure the clarity of the amendment and countersigned by an accountable person. The list if homely remedies used in the home has been updated as recommended. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 14 Some medication profiles were last updated on 18/11/04 and need to be reviewed. The medication profile for one service user was not dated at all and must be checked to see whether it is still up-to-date. The medication administration policy for the home was last reviewed in November 2004. Policies should be reviewed at least yearly. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Systems for protecting service users from harm may not be appropriate in some cases and this may leave the service users feeling unsafe in their own home. EVIDENCE: Information about reporting concerns or complaints to the Commission needs to be amended to provide the correct telephone number 01452 632750. There were records of incidents of aggression taking place in the kitchen. The kitchen is relatively small and acts as access to the conservatory. This area was notably busy, as staff were cooking Sunday lunch and service users were coming in for their breakfast and to talk to staff. Concerns are noted in the last inspection report about the risks this arrangement may present. Suggestions were made to review the use of the conservatory as the dining room. The manager advised that this option has been explored but the current arrangement was felt to be more appropriate. There are plans in place which allow staff to lock themselves in the kitchen in the event of one specific service user displaying aggression. This practice was backed up in a reactive strategy for a specific service user who may pose significant risks to others. Further consideration must be given to the message this practice sends out to the service users in the home. This practice is also seen as restrictive and needs to be discussed at a multi-disciplinary level. Like with any restriction, there must be a clear and documented process of how the decision to use this approach was made, what other less restrictive approaches have been considered / tried and what is the outcome for the service user if this approach is to be used.
Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 16 The registered manager provided a rationale for the use of the above restriction as part of the agreed behaviour management strategy. She advised that this approach has been sanctioned by the service users parents as well as by the PRT trainer who is affiliated with British Institute of Learning Disabilities. Further discussion on this matter may be necessary in future inspections. A reactive strategy was seen which requires for one service user to be supported one to one at all times of day (apart from when the person is attending to their personal care). This is to protect the person because of an adverse relationship with another service user. There have been instances when physical intervention was used to manage some incidents of aggression. Records around this were comprehensive. There is evidence of debrief for staff following violent incidents and this is good practice. The home does notify the Commission of events which adversely affect the wellbeing of the service users. However, an audit of incident records between October 2005 and December 2005 showed that this was not being done consistently, with the home failing to inform the Commission of some significant events. This included incidents of aggression; violence, absconding and other incidents which could have led to service users being put at risk. The necessary notifications must be made to the Commission as soon as possible after the incident first verbally (where practical) and then in writing in line with Regulation 37. New guidance has been issued by the Commission about notifications and this will be forwarded to the home in the near future. A record of restraint was seen from 24/12/05 during which the service user sustained an injury. A corresponding body chart was completed showing the location of the injury. The manager advised that the registered manager at Fieldview (the sister home) will be providing training about protection of vulnerable adults. Staff at Westend will have access to this training. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Service users live in a homely environment, which is well maintained but could benefit from some minor improvements. EVIDENCE: A requirement was made following the last inspection for blinds and / or fans to be fitted in the conservatory. In response to this freestanding fans have been provided. The home would need to monitor whether these are sufficient to keep a comfortable atmosphere in the conservatory during hot weather. Locks on some bedroom doors may not be suitable for their purpose. A lock has been obtained for a specific service user to enable the person to operate this independently whilst still protecting their privacy. The lock on another bedroom door needs to be checked to ensure that this can be opened from the inside of the room, even if it is locked from the outside. A first floor bathroom did not have a window restrictor and this must be provided. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 18 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): 33 Service users are supported by a dedicated staff team although the skill mix of the staff on some shifts may not be appropriate to meet the needs of the service users effectively. EVIDENCE: There were three staff on duty on the day of the visit. One was a senior care worker who has worked in the home for some time. The newly appointed deputy manager was in charge of the shift. He has been working in the home for 2 weeks, although had significant previous care experience. Another staff member has only worked in the home for two weeks. The competency of staff on duty should be monitored closely to ensure that service users are supported by staff who have the right skills and knowledge. This will be followed up at future visits. Positive interactions were observed between the staff and the service users. A requirement was made in the last report about providing appropriate numbers of staff on duty to ensure safety and wellbeing of the service users. This was with particular reference to having a waking night staff so that the needs of the service users overnight can be better met. The manager advised that no changes have been made to staffing arrangements at night and explained the reasons for this. Some of the service users may require assistance at night. One person has an alarm on their bedroom door and listening devices have been placed in some bedrooms in order for the sleep in
Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 19 staff to be alerted in case of a seizure. Appropriateness of staffing requirements will be monitored at future inspections. The new deputy manager confirmed that all necessary recruitment checks were undertaken prior to him starting employment in the home. Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 20 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): 42 Health and safety measures are in place although some identified shortfalls may potentially compromise the safety and welfare of the service users. EVIDENCE: The home manager has been successful in gaining her registration with the Commission. A discussion with the registered manager provided confirmation that there are no blender valves on water outlets. Staff are asked to check the temperature of the water in the bath but do this without the use of a suitable thermometer. Risk assessments have been carried out to establish the potential for harm occurring. The home should consult the Environmental Health Department to determine whether the risks from hot water in the home are being managed in a satisfactory way. It is recommended that blender valves are installed to regulate the temperature of water outlets in order to minimise any potential risks to the service users. Bath thermometers should be provided and staff should receive guidance on how to use these appropriately.
Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 21 At least one first floor window did not have a restrictor in place and presents a significant hazard (see standard 24). Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 22 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 X 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X X X X 2 X Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 23 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 YA23 Regulation 13(6) Requirement Review the use of restrictive practice of locking the kitchen door (see text). The review must include evidence of discussion at a multi-disciplinary level. There must be a clear and documented process of how the decision to use this approach was reached, what other less restrictive approaches have been considered and tried and what is the outcome for the service user if this approach is to be used. Further consideration must be given to the message this practice sends out to other service users in the home. Medication administration records must be completed accurately at all times. Timescale for action 31/05/06 2. YA20 13(2) 31/03/06 Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 24 Medication profiles for service users must be updated where necessary and those that are not dated, must be reviewed to check whether the information is still current and rewritten as necessary. 3. YA23 17(2)Sch.4.12(b)37 Incidents detrimental to health or welfare of service users must be reported to the Commission without delay. (Timescale of 16/06/05 not met). 13(6) Suitable door lock must be provided for a specific service user to ensure the person does not get trapped in their room and there is no potential for this person to be locked in. 13(6) A suitable window restrictor must be provided in the first floor bathroom. 31/03/06 4. YA24 31/03/06 5. YA24 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA20 Good Practice Recommendations The Statement of Purpose should be amended with the correct details as described in the text. Any corrections or amendments to Medication administration records should be clearly made to ensure the clarity of the amendment and countersigned by an accountable person.
DS0000034022.V280154.R01.S.doc Version 5.1 Page 25 Westend The medication administration policy for the home should be reviewed. 3. 4. 5. YA22 YA24 YA24 Information about reporting concerns or complaints to the Commission should be amended to provide the correct telephone number 01452 632750. It should be checked that all bedrooms are fitted with locks which can be operated by the service users from within the room, even if the door is locked on the outside. It should be checked that all windows in the home are fitted with suitable safety restrictors where necessary. The home should monitor whether freestanding fans are sufficient to keep a comfortable atmosphere in the conservatory during hot weather. 6. 7. YA23 YA33 Staff should attend training in the Protection of Vulnerable Adults. The competency of staff on duty should be monitored closely to ensure that service users are supported by staff who have the right skills and knowledge. Blender valves should be installed on water outlets in the home so that the temperature of hot water can be regulated whilst maintaining safety precautions against legionnella. Bath thermometers should be provided and staff should receive guidance on how to use these appropriately. The home should consult with the Environmental Health Officer about the adequacy of the safety measures which have been taken to protect service users from scalding. 8. YA42 Westend DS0000034022.V280154.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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