Inspection on 01/09/05 for Westward

This inspection was carried out on 1st September 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Westward 26/10/06

Westward 07/03/06

Westward 28/02/05

Westward 08/12/04

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 Westward 2 Henty Avenue Dawlish Devon EX7 0AW Lead Inspector Susan Samways Announced Inspection 1st September 2005 10:00 Westward DS0000003857.V253042.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 Westward DS0000003857.V253042.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. Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westward Address 2 Henty Avenue Dawlish Devon EX7 0AW 01626 867065 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) Mrs Cathy Poole Mrs Cathy Poole Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2005 Brief Description of the Service: Westward is a large, detached house, in the seaside town of Dawlish. The home is situated within a residential area and has views overlooking the sea. The home is situated close to local amenities and services are easily accessible either on foot or by local public transport. The home is arranged over two floors and can be accessed by stairs. A double storey extension has been completed to a high standard. This has provided additional bedrooms with en-suite facilities. There are car parking facilities in Henty Avenue. The home provides accommodation which reflects the assessed needs as well as the choices/personal preferences of each resident whilst maintaining a homely atmosphere. Westward is registered with The Commission for Social Care Inspection to provide care for up to six adults with a learning disability, who may also have challenging behaviour. The Registered Person and staff team aim to provide each resident with 24hour care and support and assistance in developing their self-esteem and independence as far as is practicable. Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took 6 hours. The registered provider/manager was present throughout the inspection and the operations manager for most of it. The deputy manager was responsible for the care of the residents during the inspection. At the time of the inspection there were four residents living at Westward. All four had completed comment cards and three spent time talking to the inspector. A relative of one of the residents had also completed a comment card. A tour of the premises took place which included being shown one of the bedrooms by the resident concerned. What the service does well: Westward provides care for adults with a learning disability who may also display challenging behaviour. Detailed assessments, care plans and risk assessments, which are regularly reviewed, and the keyworker system ensure that the service meets individual residents needs. Good relationships between staff and residents were observed and one resident described the approach taken by the staff as “firm but fair”. All residents said that they like living at Westward and that they feel safe and well cared for. Following risk assessments residents have choice as to how they spend their day. They have opportunities to develop work, educational, social and life skills both in the home and in the local community. They are involved in the running of the home and their views about the home are actively sought. Residents are encouraged to maintain appropriate contact with family and friends. The registered provider who is also the manager was observed to be open and approachable to residents and staff. Everyone who was asked described her as supportive and a member of staff said that this was particularly so when they had to deal with difficult situations. The registered provider obviously knows the residents very well and was clear about the aims of the home and who would benefit from the service provided. The staff are well trained and receive regular formal supervision. The home is clean, well decorated and comfortably furnished and has a homely atmosphere. Residents can personalise their rooms and there is ample communal space including a good size garden. Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westward DS0000003857.V253042.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 Westward DS0000003857.V253042.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): 2,3 A comprehensive assessment is made of prospective residents, who are also given a detailed service users’ guide, which provides sufficient information to enable all those concerned to make the decision as to whether Westward is an appropriate home for them. EVIDENCE: The registered provider has provided care for the current residents for over five years. However, she was able to clearly demonstrate both in discussion and with documentation that there is a very detailed assessment process which is used before a place is offered to a prospective resident. As well as the individual being assessed other key people such as the care manager, community mental health nurse, relatives or representatives are also involved. The residents’ files examined all included comprehensive assessments. The registered provider was very clear about the care the home is able to provide and therefore the nature of the residents for whom they could provide support. Records showed that staff training is focused on these areas and all staff are expected to complete a course of study regarding challenging behaviour. Staff were observed interacting with residents and this was seen to be done in a positive and supportive way. Westward DS0000003857.V253042.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): 6,7,8,9 Residents can be confident that their care plans clearly identify their needs and how they will be met. EVIDENCE: The files for each of the residents were examined. These were well organised into sections so information could easily be found. The sections included a profile of the resident, assessment, care plan, risk assessments, daily records, medical history, family history and a record of events and incidents. The care plan and risk assessments are regularly reviewed. The frequency of the reviews is determined by the activity concerned and the response of the resident. They can vary from weekly to six monthly, the interval before the next one being agreed at each review. The care plans include the residents’ daily routines, the activities they will participate in, their preferences and the support they will require and how that will be managed. Records showed that residents are encouraged to make decisions about their lives and the level of support to be given to enable them to do this. The registered provider was able to give examples of situations when residents’ behaviour was unacceptable and detrimental to their or others well-being and Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 10 the action that had been taken to address it. One resident described the approach taken by the registered provider and the staff team as “firm but fair”. Residents were observed participating in the day-to-day running of the home e.g. going shopping, putting the shopping away, and residents stated that they were responsible for keeping their rooms clean and tidy and that they help prepare and cook meals. Records confirmed that there are regular, documented meetings involving residents and staff regarding life in the home. Part of the philosophy of care at Westward is to enable residents to be as independent as is practical, within the scope of individual assessed care needs and care plans. Records and assessments seen confirmed that residents are supported in taking risks. Detailed risk assessments have been completed for all potentially hazardous activities and these identify the level of support or intervention by staff which is required to minimise the risk and promote residents’ independence. These are regularly reviewed at a frequency determined by the level of risk and the resident’s behaviour. All risk assessments and reviews are kept in the residents’ files. Westward DS0000003857.V253042.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): 11,12,13,15,16,17 Good staff support enables residents to access social, educational and work opportunities both in the home and in the local community and to develop independent living skills. EVIDENCE: Residents are encouraged by staff to participate in activities which will assist in developing their social, emotional, communication and independent living skills. This was evident from the care plans and risk assessments seen in the residents’ files and was confirmed in discussion with residents. One resident works in the local authority gardens while others attend a local college for courses such as cookery, use of computers and basic life skills. Good use is also made of community facilities such as the library, cinema, theatre and leisure centre as well as going to the shops, the pub and attending any special events in the town. The residents’ files include information about their family and friends and the assessment process includes the degree of involvement they wish to have with them. Discussion with the registered provider and other staff showed their recognition of the importance of supporting the residents to maintain positive Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 12 relationships with their family and friends. Residents are encouraged to maintain family contacts and this was spoken of positively by two of the residents. One resident spoke rather unrealistically of their expectations of their family and this was dealt with in a very supportive way by the registered provider. The registered provider and the residents stated that family and friends are welcome to visit and this was confirmed by a comment card received from a relative who also said that visits could be in private if they wished. Residents are encouraged to practise independent living skills. Each resident has an agreed rota listing their responsibility for tasks such as cleaning communal areas and individual bedrooms, doing the laundry and assisting with food preparation and cooking. Records showed that residents are actively involved in all aspects of the provision of meals. They are supported by staff to plan menus, budget and shop for the ingredients. They are then encouraged to prepare, cook and serve the meals. Residents’ nutritional needs are assessed and regularly reviewed and any risk factors are recorded in individual care plans. Westward DS0000003857.V253042.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 receive care and support in a way which promotes privacy, dignity and independence. Medication is managed in a way which safeguards residents and promotes well-being. EVIDENCE: The home operates a key worker system which ensures that each resident’s individual needs are identified and met. The registered provider stated that limited assistance with personal care is required by the current residents although prompting is sometimes needed. Residents confirmed that their privacy is respected and that they can spend time alone in their rooms if they wish. Times for getting up in the morning were seen to be flexible although the registered provider stated that prompting is given if a resident has an early appointment to attend. Residents said that they choose their own clothes and these reflected their own taste. Residents were observed to interact with staff in an appropriate manner. Records showed that all residents are registered with a G.P. and access other local health services as required. The registered provider stated that residents are encouraged to manage their own healthcare but support to attend appointments is provided if requested or identified through a risk assessment. Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 14 Medication is all kept in a locked box in the staff office. Records are kept of all medication received, administered and leaving the home or disposed of to ensure that there is no mishandling. An individual record is kept for each resident of current medication. At the time of the inspection no resident was self-medicating. The registered person has completed written risk assessments for each individual resident, kept on their individual care plans, as evidence to support this decision. Westward DS0000003857.V253042.R01.S.doc Version 5.0 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): 22,23 Staff training in the protection of vulnerable adults protects service users from abuse. EVIDENCE: All the comment cards received from the residents and from a relative said that they would know what to do if they needed to make a complaint. Each resident has a copy of the home’s complaints procedure. The registered provider stated that no formal complaints had been received in the previous 12 months. Day-to-day problems are sorted out as they arise. Residents said that they were happy to approach the staff with anything that might be worrying them. The Commission for Social Care Inspection has received no complaints regarding Westward. The home has policies and procedures regarding the protection of vulnerable adults, a copy of the Alerter’s Guide and the ‘No Secrets’ video. All staff are required to watch the video and discuss the content. There are also policies and procedures regarding the management of physical and verbal aggression by residents, risk assessments for identified potential problems and detailed records of any incidents that occur and the action taken particularly if this has involved the use of physical interventions. The use of different interventions is agreed with relevant professionals and forms part of the care plan. All staff are expected to undertake training in managing challenging behaviour. Individual lockable boxes are stored for each resident with receipts and records kept for all financial transactions. Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 16 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): 24,26,27,28,30 Westward provides residents with a homely, comfortable and safe environment in which to live. EVIDENCE: A tour of the building took place during the inspection which included one of the resident’s bedrooms. All areas seen were clean, tidy and free from offensive odours. The home is decorated and furnished in a homely way. The communal space includes lounge, dining room and games room as well as a large kitchen and utility room which has a domestic size washing machine and tumble dryer. The home also benefits from a good size garden. One of the resident’s bedrooms was seen as the resident concerned was happy for it to be included in the tour. The bedroom was in the new part of the home and has en-suite facilities. It reflected the resident’s personal taste and interests. The other residents’ rooms are in the original part of the house. They share a large bathroom and there is also a separate toilet. The registered provider stated that they had all been offered the opportunity to move to one of the new rooms but all had declined. Infection control policies and procedures are in place and records show that staff receive appropriate training. Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 17 Westward DS0000003857.V253042.R01.S.doc Version 5.0 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): 32,35,36 Staff have the skills, training and understanding to meet the needs of residents. EVIDENCE: The home has a core team of experienced staff who provide care and support for the residents. The home also benefits from a small number of bank staff, known to the residents, that can be called upon at times of staff shortages which ensures continuity of care. Unfortunately the home has been running on low staff numbers resulting in the registered provider working long additional hours to ensure that there is adequate staff cover. At the time of the inspection posts were being advertised and calls were received by the registered provider from potential recruits. All staff, including bank staff, have completed basic training including manual handling, First Aid, food hygiene and infection control, and two staff have achieved NVQ Level 3 in Care. Records showed that staff receive regular formal supervision from the registered provider but it was also stated that other sessions can be arranged on request. All staff have annual appraisals. Westward DS0000003857.V253042.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): 37,38,39,42 Residents can have confidence that the home is well run and that their views will be taken into consideration in the plans for the home. EVIDENCE: The registered provider also fulfils the role of the registered manager. She is a registered nurse of many years experience and has recently been working towards NVQ Level 5 in Management. Throughout the inspection she demonstrated an in depth knowledge of the requirements for running a care home and clearly knew the residents very well. Staff and residents were observed to approach her with confidence and receive positive and helpful responses. Time was taken to ensure that residents understood replies they were given and to engage in further discussion if they wished. A member of staff described her as very supportive especially in difficult situations. The home has a quality assurance policy and the registered provider was able to describe how quality monitoring is carried out in the home. These include informal feedback from residents which is dealt with immediately taking into Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 20 consideration the effect decisions might have on other residents, formal feedback through the use of surveys, the views of relatives and other interested parties and the regular review of policies and procedures. Residents and their families had been informed of the inspection. All the residents and a relative of one of the residents had completed comment cards. They all expressed satisfaction with the way in which the home is run. The home has a comprehensive Health and Safety policy, which ensures that as far is reasonably practicable the health, safety and welfare of both residents and staff are protected. The registered provider has completed environmental risk assessments. Fire Safety checks are made and recorded in a logbook and all fire alarms are checked weekly, recorded and signed as checked. Annual fire safety training sessions are provided for all staff including the registered provider. DART Fire Safety completes an annual check on all fire equipment. Training records confirmed that staff have had training in fire safety, manual handling, food hygiene, infection control, drug awareness, control and restraint and breakaway techniques, and COSHH (Control of Substances Hazardous to Health) awareness. Westward DS0000003857.V253042.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 3 3 x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Westward Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x DS0000003857.V253042.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westward DS0000003857.V253042.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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