Inspection on 06/02/07 for Westminster House

This inspection was carried out on 6th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Westminster House 20/11/07

Westminster House 18/01/06

Westminster House 10/05/05

Westminster House 02/02/05

Westminster House 15/09/04

Westminster House 17/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Westminster House Westminster Lane Newport Isle of Wight PO30 5DP Lead Inspector Janet Ktomi Unannounced Inspection 6th February 2007 12:00 Westminster House DS0000032663.V315812.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 Westminster House DS0000032663.V315812.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. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westminster House Address Westminster Lane Newport Isle of Wight PO30 5DP 01983 526310 01983 520372 jeremy.baker@iow.gov.uk 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) Isle of Wight Council Mr Jeremy Ernest Baker Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home currently includes 4 pre-existing residents in the LD/E category. 18th January 2006 Date of last inspection Brief Description of the Service: Westminster House is a local authority owned respite care facility situated on the outskirts of Newport, offering both day and residential respite care to adults with a learning disability. There are in excess of 75 people using the service over a twelve-month period and the philosophy of the service is to provide an accessible and flexible respite service that meets the individual needs of the service users, and the needs of the carers. The home is owned by the Isle of Wight council and managed by registered manager Mr Jeremy Baker. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for Westminster House, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the key National Minimum Standards. The visit to the home, was conducted by one inspector over one day lasting a total of six hours, where in addition to any paperwork that required reviewing the inspector met with all respite service users and staff (on duty) and undertook a tour of the premises. The inspection process also involved pre fieldwork visit activity, with the inspector gathering information from a variety of sources, the commission’s database, pre-inspection information provided by the service, questionnaires completed by residents, their relatives and care managers. The inspector also spoke with previous inspectors who have visited the home. Westminster House provides a homely respite environment for up to ten younger adults with learning disabilities. The home may provide a service for up to four people with a learning disability who are over sixty-five years old. Overall Westminster House provides a good respite service to younger adults with learning disabilities and their families. Unfortunately an incident occurred shortly before the inspectors visit which has adversely affected a number of areas within the report. What the service does well: The respite care service offers service user a comfortable and homely environment for short periods of either day or residential respite care. The service users spoken to said they enjoyed staying at Westminster House. It is evident that the service is run with the needs of the service users, and their carers, always given priority. The daily routines are flexible and informal and service users are encouraged and supported in their choices and preferences for social and leisure activities, as much as possible. Service users stated they were able to decide what they did and external activities and outings were undertaken with staff support. There is an experienced staff team, many of who have worked at the home for a number of years. Service users and their relatives are very positive about the service provided at Westminster House. Service users, both during the inspectors visit and via comment cards, were very positive about the staff employed at the home. Comments in service users cards included ‘my sons demeanour indicates a clear affection for Westminster house and the staff’, ‘he is always well looked after and has developed a bond with staff’. Also ‘the staff Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 6 are always helpful and ask me what I want to do’, and ‘the staff like me and I like them’. Comment cards from relatives were also positive about staff one stating ‘ my son is well looked after during his stays’, ‘Westminster House has always been an excellent place for us to leave our son. The staff are caring and wonderful to all the clients and always ready to help’. The service users forum meets regularly and has developed a system of formal feedback to the management and staff of any service user issues and concerns. The forum meets independently of the manager and staff. The home has a very thorough pre-admission procedure which when used would ensure that only people whose needs can be met are admitted to the home. What has improved since the last inspection? What they could do better: Although the service provided at Westminster House meets the standards required, a recent incident occurred at the service that indicated that the staff and acting manager are unable to ensure that their usually high standards are maintained. Staff were instructed to admit two people whose needs they had identified they were unable to meet and who may present a risk to vulnerable people already using the service. The provider, Isle of Wight Council and the responsible individual must ensure that senior social service staff are aware of the Care Standards Act 2000 and that the homes staff must not be placed in the position of breaching the regulations and failing to meet the standards. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 7 The home must not admit people whose needs have not been fully assessed and whose needs the home may not be able to meet. All service users must have a care plan and risk assessments. The home must not admit people if it does not have sufficient staff to meet needs. The provider, Isle of Wight Council, must ensure that service users are not placed at risk of abuse or neglect due the unplanned admissions of people whose needs are unknown and when there may be insufficient staff to meet their needs. 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. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 8 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 Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 9 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 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home has appropriate admissions procedures these was not used for two recent admissions whose needs were not assessed and who the home admitted without sufficient staff to meet their needs or any information as to risks that may be presented to existing service users. EVIDENCE: The inspector viewed the admissions information for the three most recent admissions to the service and discussed the homes admissions procedures with the acting manager and staff. The inspector discussed with service users at the home their admission procedure and this was included within the comment cards completed by many of the people who use the service. The inspector met one service user who was having a first introductory visit to the home. The acting manager described the homes usual admission process to the inspector. This starts with the home receiving a completed referral form from a care manager. The form is comprehensive and covers all the areas relevant to a referral in sufficient detail to enable the home to decide if it is appropriate to proceed with the admission procedure. The acting manager showed the Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 10 inspector the file that contained referrals received. The inspector noted that all staff have the opportunity to read referrals and give their thoughts as to their appropriateness. One was seen to have a note attached from a staff member stating that this was an inappropriate referral. The inspector read the referral and would agree that the issues identified would place other service users at significant risk. The home did not proceed with this referral. Should the referral be appropriate a member of the senior team arranges to meet the service user and gain information from a variety of other sources to complete a preadmission assessment. The service user is invited to visit the home as often as they wish for various lengths of time prior to commencing day or residential respite. The inspector was shown the file relevant to one new service user who was transferring from the children’s respite service and had complex needs. The service user had not yet commenced using the adult service, however members of staff had undertaken visits and worked with the service user at the children’s respite home to ensure that the home understood and could meet all the complex needs. Care staff confirmed that they had received both theoretical and practical training to meet specific care needs. On the afternoon of the inspectors unannounced visit to the service a new service user was having her first visit to the service with a support worker from her day services. Comment cards from service users all stated that they had visited the home on a number of occasions prior to commencing respite. Service users accessing the service during the inspectors visit also confirmed that they had visited the service on a number of occasions prior to commencing respite. If the policy and procedures as described above are followed then the home would only admit people whose needs it could meet and who would have the opportunity to visit the service prior to use. The inspector asked for information about the other two most recent admissions to the home. The above procedure and information gathering exercise had not occurred. There was no pre-admission assessment stating health, social or care needs. There were no care plans or risk assessments and very limited information. The records held stated that the home had been contacted at about 9.30 at night by the out of hours team and asked to take two younger female service users who had made their way from the north of England to the Isle of Wight unaided and had nowhere to stay. The home had stated that they had insufficient information about these referrals who may present a risk to some very vulnerable people using the service and would therefore not accept them. The home only had the available beds as a decision had been made not to offer these beds to existing service users as the home had insufficient staff (due to the high support needs of the other service users already booked into the service). The home was then contacted by a senior manager in social services and told that they had to accept these referrals who were brought to the service at 10pm. The senior on duty in the home had stated to the social services manager that they did not have enough staff and Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 11 at 10.00pm. The social services manager suggested that the home try to get staff in to cover. This resulted in one member of staff who had worked the afternoon shift volunteering to stay on and working an awake night shift. If this person had not stayed on and worked the home would have been understaffed and potential service users needs would not have been met and people would have been placed at risk of neglect. This represents an unacceptably long shift for staff to work. The duty officer who brought the service users provided no written or verbal information about the service users. The service users stayed in the home one night and were collected the next morning by the out of hours worker and put on a ferry (unescorted) to return to the north of England. Neither service user lived in a residential care home in their home town. The above situation indicates that the service is unable to meet the required standard in respect of ensuring that it only admits people whose needs it can meet, not because of the policies and procedures and staff within the home, but because of the actions of senior social service managers who have placed the service in the position of breaching regulations and the Care Standards Act. Service users already using the home were placed at risk from the admission both because of staffing issues and due to the lack of information available about the admissions, who by their actions had already indicated that they could be unpredictable and did not consider the consequences of their actions. Whilst it is acceptable that the home may have a need to consider emergency admissions a decision as to whether to admit or not must be based on information gained from a thorough pre-admission assessment and consideration of staffing and existing service user must not be placed at risk. There have been no previous concerns about the statement of purpose, service users guide or contracts. Therefore these documents were not viewed and the relevant standards not assessed. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has comprehensive care plans and risk assessments that clearly state how service users needs should be met, however neither care plans nor risk assessments were available for the two most recent admissions. Service users are encouraged and supported to make decisions. EVIDENCE: The inspector viewed care plans and risk assessments for two of the people staying at the home at the time of the visit to the service and for the most recent admissions. Following the previous inspection the home was required to ensure that all care files contained a written plan of care to be provided and risk management Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 13 plans that should be regularly reviewed. All service users have care files that were seen to contained appropriate care plans and individual risk assessments that were regularly reviewed. Part of the care file is a service level agreement that is agreed with the social services care manager, service user, relatives and the home. This states the level of service each service is allocated. Care plans and risk assessments were appropriately detailed to reflect the health, social and care needs of individual service users. The inspector viewed the information available for the two most recent new admissions to the service. As stated in section one no information about health, social, care or risk needs was provided to the service by the out of hours care manager. The home was therefore unable to produce either risk assessments or care plans for these two service users who were only in the home overnight. Due to their late arrival it would have been impossible for staff to undertake assessment work which should have been carried out by the out of hours duty care manager before he made the decision to contact the home, or the senior social services manager who must have undertaken some assessment prior to his decision that the service users must be accommodated at the home. Had the home been provided with information by the out of hours care manager or the senior social services manager then they could have complied a basic care plan and risk assessments. All service users must have care plans and risk assessments. Throughout the inspectors visit service users were seen being asked and freely giving their opinions to staff and each other. Comment cards from service users stated that staff listen to, and act on what they say. Additional comments included reference to the homes service users forum that meets monthly and is run by service users independent of any staff. One service user is restricted to the amount of time that he may use the computers and Internet due to a risk of seizures with prolonged exposure. The service user clearly understood the reasons for this restriction and appeared happy to comply with them stating he would go back on the computer later in the evening for another half hour. The home does not become involved in service users personal finances as it provides a respite service. Service users bring in small amounts of personal money for outings and activities whilst they are staying at the home. Some service users manage their own money and are provided with a lockable facility in their bedroom to store this securely. For other service users the home will hold their money in the office safe and appropriate records and receipts for spending were seen. One service user was going home during the inspectors visit and the inspector saw the staff checking out his remaining personal money, which was all accounted for and giving this to his support worker to return to the service users parents. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have opportunities to engage in a range of social and leisure activities of their choice. Service users enjoy their meals and are provided with a healthy diet appropriate to their needs and wishes. EVIDENCE: The inspector spent time with the people accessing the service at the time of her visit. Comment cards were returned from many of the service users and were positive about the range of social and leisure activities available. The home has a range of in house leisure equipment, having four computers with Internet access, television and music facilities, sensory/relaxation room and sensory equipment that can be provided in individual rooms. One service user arrived for his respite stay and having selected his favourite room he Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 15 asked, and was supplied with, a portable television for his bedroom. Three service users were using Internet computers and were clearly enjoying this activity. Others were doing drawing activities or talking to staff. Service users confirmed that they often go out with staff to pubs in Newport and other parts of the island. Receipts and financial records confirmed that service users go out to a variety of social and leisure activities. Service users tend to continue their regular daytime activities whilst staying at Westminster house with service users seen returning from college, day services and time with support workers. The home has a minibus suitable for transporting people who require wheelchairs. Comment cards returned by service users stated that they could do what they wished throughout the day, evening and at weekends. The home has a number of lounge and communal areas in which service users can spend their time and choose who they mix with. Service users confirmed that they choose what they do and where they spend their time. Service users are encouraged to maintain contact as appropriate with their families and friends whilst accessing the respite unit. During the inspectors visit staff were overheard talking to the families of several service users to keep them informed as to how respite stays had been or how their relative was enjoying their stay. This is important as many service users are admitted direct from day services or with support workers so family carers may not have direct face-to-face contact. Menus were supplied with the pre-inspection questionnaire and appeared varied and nutritious. Service users were all positive about the meals supplied and confirmed that they could ask for different food if they did not want what was on offer. Some service users require special diets and this information is provided to the homes chef and appropriate meals are provided. The inspector joined service users for their evening meal and enjoyed the meal. Service users and staff all eat together and support if required was appropriately provided. Service users were offered choices for both their main and pudding. Service users confirmed that they are able to make or ask for drinks and snacks as they wish. Service users are provided with a packed lunch to take to day services or college if this is their usual routine and can choose what they have for breakfast. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 16 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): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer and require. Service users physical and emotional health needs are met. Medication is appropriately managed within the home. EVIDENCE: Pre-admission assessments contain information about service users personal and healthcare needs and care plans as to how these should be met. Manual handling assessments and management plans are in place. The home has a variety of manual handling equipment including overhead tracking hoists, hoists in baths, walk in showers and profiling beds available for people who require them. All bedrooms are for single occupation with four on the ground floor suitable for people with a physical disability. The staff are dependant on family carers providing accurate and up to date information about changes of physical or emotional health needs. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 17 Staff identified that they are now receiving referrals and providing a service for people with multiple and complex needs. Staff confirmed that they have received additional training in respect of a new service user who requires PEG feeding and felt confident that they will be able to meet his needs. A comment card was received from a community learning disability nurse who stated that there was an excellent partnership working with the home and a commitment from the home to provide a service user led service. The nurse was satisfied that the overall care provided to service users in the home and that staff demonstrate a clear understanding of the care needs of service users. Three comment cards from care managers were received and also confirmed that they felt service users needs were met at the home. As stated the home provides a service to a number of people with complex and high support needs. The home ensures that it has adequate staff to meet their needs, and those of the other people staying at the home, by closing beds when necessary. This was the case when the home was recently told to admit two additional service users. The inspector saw the bed management plan which clearly indicated that the beds had been closed and there would be insufficient staff to meet the needs of more service users based on those already accepted as bookings. The fact that staff on duty were told they must admit additional service users without the necessary staff placed existing service users at risk of not having their needs met. Service users confirmed that times for going to bed and getting up are flexible. The home has a consistent group of staff who confirmed that they will undertake additional shifts to cover staff on holiday or sickness. Staff clearly had a good understanding of individual service users needs and were seen communicating effectively during the inspection. The inspector was shown the homes procedures in respect of medication. Service users bring medication in with them and the home is clear with families that medication must be in its original packaging. This is checked into the home by two staff, one of them senior who has undertaken medications training. Full records are maintained of all medication brought into the home, administered to service users and returned to the service users family carer on their discharge. Medication is appropriately stored in the home. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to complain and feel their views are listened to and acted upon. Service users were placed at risk of neglect and harm when two additional service users were admitted to the home without assessments and when the home had insufficient staff to meet their needs. EVIDENCE: Comment cards were received from many of the service users and all stated that staff listen to them, act on what they say and that they would complain to staff if they were unhappy with anything. Comment cards from care managers and the community nurses stated that they had not received any complaints about the service. Discussions with service users during the visit to the service indicated that they would feel free to say anything to staff and those able stated that if they were unhappy they would tell staff. As the home provides respite service users would also be able to express concerns to their family carers. The acting manager confirmed that the home had not received any complaints. Care staff stated that if service users or their family carers raised any concerns they would try to resolve them and inform the manager or acting manager. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 19 The home has a monthly service users forum that is run by service users and has a system for providing feedback to the manager/acting manager. The service users forum produces a report using widget 2000 on the homes computers that is sent to all service users. Care staff on duty confirmed that they are aware of adult protection issues and have used the locally agreed procedures when there have been occasional incidents between two service users accessing the service. The acting manager explained that consideration is given to compatibility when respite bookings are confirmed. Staff confirmed that they have received adult protection training. The inspector feels that generally the service does not place service users at risk of neglect, abuse or self harm however, as previously identified, service users were placed at risk when two service users were admitted without preadmission assessments and without the home initially having sufficient staff to meet their needs. These risks were correctly identified by staff on duty who stated that they were unable to accept the service users but they were overruled by a senior member of social services management who therefore placed service users at risk. The provider, Isle of Wight Council, must ensure that service users are not placed at risk of abuse or neglect. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 20 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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Westminster House provides a clean, relaxed, homely environment for people using the service. Some areas of the home are starting to show signs of the heavy use they receive, however overall the home is well maintained with all the necessary fixtures and fittings required by service users. EVIDENCE: The home is situated on the outskirts of Newport within a residential area that has grown up around the home over recent years. The home was purpose built approximately thirty years ago and had been adapted over the years to meet the increasing physical needs of people with complex needs. However it is hard to envisage how the home can adapt further and meet the increasing demand for respite from a very varied service user group. Overall the home is well Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 21 maintained however areas are showing signs of the high level of use the home is now receiving. All bedrooms are for single occupancy and are individually decorated, and contain all the necessary fixtures and fittings for service users receiving a respite service. The home has four ground floor bedrooms with the remaining bedrooms located on the first floor. Only the bedrooms on the ground floor are accessible to people with additional mobility needs as the home does not have a lift. Bedroom doors are lockable with some service users having keys to their rooms at the time of the inspectors visit. One bedroom has an en-suite shower, WC and washbasin with overhead tracking hoist. The home has ample bathrooms located on both floors. The ground floor bathroom has a chair lift and a walk in shower is also provided on the ground floor. Upstairs there are three further bathrooms. The home also has a range of communal rooms. Downstairs there is a large lounge, separate conservatory with television and music available and a dining area. The home has created a ground floor sensory/activities room equipped with relaxation and sensory equipment as well as further computer and other activity equipment. Upstairs there is a good sized lounge equipped with television, music, computer and games table. Externally the home has worked to improve the garden to make it accessible to all service users. This work is continuing with the provision of a paved walkway round the garden. The acting manager stated that the garden is popular in the warmer months. The homes kitchen, laundry and office are appropriate for the size of the home with a second office on the first floor for quiet work by staff and the storage of documents and confidential information not required on a day to day basis. As previously stated the home has a range of aids and adaptations to support service users with a physical disability. The acting manager confirmed that service contracts are in place for all hoists. The home employs cleaning staff and was found to be fresh and clean at the time of the inspectors unannounced visit. Staff confirmed that they had ample supplies of disposable gloves, aprons and antibac gel for use to prevent the risk of infection spread. The home is quite spread out and night staff have been provided with ‘walkie/talkie’ equipment in case they need to summon assistance in an emergency. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 22 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, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by a competent consistent staff team. Generally sufficient staff are provided at all times. Service users are supported and protected by the homes recruitment policy and procedure. Care staff receive training to meet service users general and collective care needs although the home must ensure that training records are able to adequately demonstrate training attended and that required. EVIDENCE: Service users, both during the inspectors visit and via comment cards, were very positive about the staff employed at the home. Comments in service users cards included ‘my sons demeanour indicates a clear affection for Westminster House and the staff’, ‘he is always well looked after and has developed a bond with staff’. Also ‘the staff are always helpful and ask me what I want to do’. Comment cards from relatives were also positive about staff stating ‘ my son is well looked after during his stays’, ‘Westminster House Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 23 has always been an excellent place for us to leave our son. The staff are caring and wonderful to all the clients and always ready to help’. Staff duty rotas were provided with the pre-inspection questionnaire returned to the commission prior to the inspectors visit. This was also seen during the inspectors visit and corresponded to the number of staff on duty. Care staff and service users confirmed that there are sufficient staff on duty to meet their needs. Care staff stated that when extra staff are available these are provided at times when more service users are at the home such as weekends. Service users confirmed that there are opportunities to go out in the evenings and at weekends. Care staff explained to the inspector that they are able to ‘close’ beds if the people who have been accepted have high support needs. The inspector was shown the homes booking form and this clearly showed when beds had been closed. This was the case when staff were instructed to admit two additional service users at 10.00pm. Staff on duty informed the senior social services manager that they did not have sufficient staff. The senior social services manager did not re-contact the service to confirm that staff had been found and the out of hours care manager proceeded to deliver the admissions to the home. One member of staff who had already worked the late shift agreed to work the night therefore working a total of approximately seventeen hours including a day and night awake shift. This represents an unacceptably long shift, however it is hard to see how the service could be expected to produce additional staff to work a night shift at 10.00pm at night. The home operates its own staff bank and discussions with staff indicated that they would cover additional shifts required by sickness or holidays. Some service users continue to receive support from their domiciliary care support staff when receiving respite care. One to one funding has been agreed by care managers for some service users. The pre inspection questionnaire stated that the home employs a total of twenty-seven care staff twenty-three of whom have at least NVQ level 2. this equates to approximately seventy-two percent and exceeds the required fifty percent. An additional two staff were reported to be undertaking NVQ level 2. Discussions with care staff indicated that staff receive mandatory and service user specific training. Staff stated that they felt they had the necessary training to meet service users needs. Information about staff training was supplied with the pre-inspection questionnaire. During the visit to the service the inspector requested clarification about the information, which was not clear. However it was not possible to clarify the information as to what training was required and that which had been undertaken. Without clear information about training required or undertaken the service will be unable to ensure that all mandatory and specific training to meet service users needs has occurred. The home must review training required and undertaken and ensure that accurate records are maintained in respect of training. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 24 The home has a consistent staff team and has therefore not needed to recruit many new staff. Staff recruitment records were viewed and found to be fully completed with all the necessary pre-employment checks undertaken. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 25 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): Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 26 37, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has continued to be appropriately managed in the absence of the registered manager however the provider must ensure that inappropriate decisions about the service are not made by senior social services staff who have no direct responsibility for the service except under the Care Standards Act 2000. The service users forum provides excellent quality assurance from a service users viewpoint. With the exception of one incident when service users were placed at risk of neglect or harm the home provides a safe place for service users, staff and visitors. Records are appropriately stored and generally well maintained. EVIDENCE: Unfortunately the homes registered manager had been on prolonged sick leave at the time of the key inspection. In his absence the home has been appropriately managed by the experienced deputy manager who has worked at the home for many years and knows staff and service users well. The deputy manager is supported by a team of senior staff and an experienced consistent staff team. Previous reports stated that the registered manager has all the necessary qualifications and experience and works with staff for the benefit of service users. However, as described earlier in this report, even though staff are clear about making decisions these may be over-ruled by senior social service officers. The provider, Isle of Wight Council needs to be clear about how decisions are made within and about the service. The home has a service users forum, which meets monthly and is run by service users. The acting manager stated that he is invited to attend parts of some meetings when the group have a specific issue or question they wish answered. The service users forum produces a report of the meting on the homes computers with a widget programme. The report is sent to all service users. Comment cards from service users also mentioned the forum and that they get minutes from the meetings. One comment card stated ‘ I am a member of the forum, we talk about Westminster House – note is taken of Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 27 concerns and acted upon where possible’. The home has monthly visits from a representative of the responsible individual and reports from these have been seen both at the commission and in the home. Comment cards from service users stated that staff listen and act on what they say. Throughout the inspection various records were viewed. Overall these were complete and appropriate stored however the home must ensure that the training records are both up to date and able to provide information stating what training is required and that which staff have received. Also the home must ensure that all service users have pre-admission assessments, care plans and risk assessments. Overall the service provides a safe place for service users, staff and visitors. The issue re the inappropriate admission of two service users late at night which placed existing service users at risk of neglect or harm has been identified elsewhere in this report. The home was unable to demonstrate that staff have undertaken all mandatory training. Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 28 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 1 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 4 X 2 2 X Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 29 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 YA2 Regulation 14 Requirement Timescale for action 15/02/07 2. 3. YA6 YA9 YA33 15 18 (1)(a) 4. YA35 18 (c)(i) The home must not provide accommodation to a service user unless the needs of the service user have been assessed and the home can meet the person’s needs. All service users must have care 15/02/07 plans and risk assessments. The home must not admit new 28/02/07 service users unless it has sufficient staff on duty to meet their needs in addition to the existing service users. The home must review training 01/04/07 required and undertaken and ensure that accurate records are maintained in respect of training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 © 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 Westminster House DS0000032663.V315812.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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