Inspection on 04/05/05 for Westwood House

This inspection was carried out on 4th May 2005.

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

The inspector 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

Westwood House 19/09/07

Westwood House 23/11/06

Westwood House 15/11/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Westwood House Belmont Crescent Swindon Wiltshire Lead Inspector Bernard McDonald Unannounced 4 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Westwood House Address Belmont Crescent Swindon Wiltsshire Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01793 542069 Milbury Care Services Limited Mr Philip Pederson Care Home 10 Category(ies) of LD Learning disability - 10 registration, with number LD(E) Learning dis - over 65 - 1 of places Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The maximum number of service users who may be accommodated in the home at any one time is 10. Service users accommodated may be aged between 35 years and 64 years. Only the names female service user referred to in the application dated 1 December 2004 may be aged 65 years and over. Date of last inspection NA Brief Description of the Service: Westwood House is one of a number of services owned and managed by Milbury Care Services. Westwood House was opened in December 2004 and provides 24 hour care for a maximum of 10 service users with learning disabilities and associated mental health issues. The aim of the home is to provide a structured environment that enables service users to develop their skills and achieve maximum potential to live as independent a life as possible. The home is staffed by a minimum of four staff on duty on each shift throughout the day. There are two waking night staff and a senior member of staff on call. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over nine hours. The inspector viewed all areas of the home and met with four service users and six care staff. The inspector had the opportunity to meet with two service users in private to obtain their views on the care they receive. The inspector was unable to communicate effectively with three service users. One service user stated they were happy living at the home; another service user was very complimentary about the care and facilities provided. A number of records were examined including five service users care plans, risk assessments, health and safety records and four staff recruitment files. The pharmacy inspector was present for a part of the inspection. What the service does well: The home ensures service users have sufficient information and opportunity to visit prior to moving in. One service user stated they had a choice of which bedroom they could have when visiting the home prior to moving in. Where appropriate, meaningful daytime activities are being explored for service users at the home and one service user commented they had recently started a new work programme, which they really enjoy. Accommodation provided is of a good standard, safe and well maintained. Service users are being supported to personalise their rooms to reflect their individual tastes. There are sufficient numbers of staff employed at the home that have a clear understanding of how service users should be supported and protected. Training is being provided to ensure the protection of vulnerable adults and all staff had a clear understanding of what constitutes abuse and were very clear on what action they would take to ensure the safety of service users. There was a good rapport between staff and service users and one service user commented that staff were helpful and supportive. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 standard(s) 2, 4 Assessment procedures do not currently demonstrate that the home can safely meet the needs of service users. Introductory visits to the home by service users are being appropriately managed. EVIDENCE: The inspector examined the pre admission assessments of all service users. The contents of the assessments provided by the placing authority covered all areas of personal and health care needs. The home had also completed a pre placement assessment. This assessment needs to be expanded, as the quality of the assessment was limited with a number of parts incomplete. The pre admission assessment did not form the basis of development of a service user care plan and restrictions and risk assessments had not been completed prior to admission. Discussion with the manager and staff demonstrated the home does invite service users to visit the home prior to admission. One service user confirmed they were able to visit the home, meet with staff and service users and was able to choose their room. The manager stated that trial placements and pre placement visits are negotiated on an individual basis and is dependent on the needs of service users. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 standard(s) 6,7, 9 Records do not demonstrate the strategies for managing difficult and challenging behaviour to ensure the needs of service users are being safely met. EVIDENCE: The inspector examined five service users care plans. The information held on individual files had not been collated into a working document on how the service will meet service users needs. Service users have needs that challenge the service and care plans did not clearly reflect how those needs are being met in the home. Care plans did not reflect specialist interventions or how service users are involved in the care they receive. There was no plan of care that covered areas of therapeutic interventions, management of behaviour or assistance with communication. Care plans did contain guidelines for managing service users care but these did not cover the holistic needs of service users and related mainly to practical interventions such as smoking, meals and bathing. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 10 This practice was reflected in the risk assessments. While some service users had no risk assessments, other service users had minimal risk assessments completed. No risk assessments reflected the risks from extreme behaviours and reasons for restrictions on service users choice or freedom to ensure their safety and the safety of care staff. Discussion with staff and the manger did demonstrate an understanding of the needs of service users and how they are to be met at the home and strategies and interventions being adopted for managing behaviour were clearly understood. Behaviours charts were being completed though the reason for maintaining this record could not be evidenced. Examination of records and discussion with two service users demonstrated where choices have been made. Less evident was how staff ensure service users with communication difficulties are enabled to make choices. The home has implemented communication passports but these need to be further developed to become an effective tool to aid communication. The manager stated that one service user does have an advocate and it is recommended that the manager explore this option for other service users. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 standard(s) 12, 15, 16, 17 Opportunities to support service users personal development are being provided, though access to the local community needs to be further developed. Nutritional needs are being assessed and met at the home. EVIDENCE: One service user currently accesses specialist day services, while the remaining service users are supported in the home. There is information regarding local activities available in the home however due to the specific needs of service users community contact is limited. Discussion with staff and the manger demonstrated how service users are being encouraged and supported to access the wider community. To ensure all service users are provided with opportunity to go out of the building it is recommended that where choices have been offered and refused it is recorded. This will ensure that service users who at the present time are reluctant to go out of the home continue to be offered opportunities to engage with their local community. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 12 Service users are supported to maintain contact with family and friends and staff confirmed visitors are welcome at any time. Staff confirmed service users receive their mail unopened and this practice was confirmed by one service user who also confirmed they have been offered a key to their room. Discussion with staff demonstrated an awareness of the need to ensure privacy to service users. The home has a large kitchen where two service users are able to assist in the preparation of meals. Choices are routinely offered at meal times and the menu is normally planned a week in advance following consultation with service users. The home ensures that where necessary, advice is obtained from the dietician. There is a large dining area where service users can choose to eat their meal. Two service users spoke positively about the meals provided at the home. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 standard(s) 18, 20 Although staff have a clear understanding of how to provide personal support to service users, care plans do not reflect service users’ preferences on how they are to be supported. The current system for the use of as required medication could be unsafe. EVIDENCE: Staff were observed providing support to service users in a sensitive and caring manner. Discussion with staff demonstrated a clear awareness of how one service user needs to be supported and guided to ensure their safety. These strategies were not recorded. One service user confirmed there was a relaxed and flexible routine adopted at the home. Staff confirmed all personal support is provided in the privacy of the service users bedroom or in the bathroom. However exactly what personal support or assistance is required by individuals is not clear as care plans do not provide sufficient information regarding how personal care needs should be met in the home. The pharmacy inspector found that medication is stored in a locked drug cupboard in a separate clinic room. A monitored dosage system is used with printed medication administration records. The record for a new resident was hand-written and not signed. Temazepam was stored with the other medicines, not in separate controlled drug storage. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 14 Some medication was prescribed ‘as required’. The records showed no criteria for the use of this medication or plan for managing behaviour which may lead to its use. A medication policy was in place and staff had received training in medication handling. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 standard(s) 22, 23 Staff have a good understanding of what constitutes abuse and how service users are to be protected. However the complaints procedure does not ensure all service users views can be listened to. EVIDENCE: The home has received no complaints since their registration in December 2004. The homes complaints procedure ensures all complaints are addressed within twenty-eight days. The complaint procedure is not in a format suited to the needs of service users, which would indicate service users are unable to effectively make their views known. The home has clear policies and procedures for the protection of vulnerable adults. Discussion with staff on duty demonstrated a clear understanding of what constitutes abuse and what action they would take if they were concerned about the welfare of service users. Staff confirmed they had received a copy of Wiltshire and Swindon “no secrets” guidance. The majority of staff have received training in abuse awareness through Milbury staff training. The manager confirmed the home was holding money on behalf of service users. The records examined demonstrated the money was being accurately managed. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 standard(s) 24,25,26,27,28,29,30 Service users live in a safe, secure and well-maintained environment. EVIDENCE: The home has recently been registered and all furnishing and fitting are of a good standard and were new at registration. The home is situated in its own grounds close to local shops and public transport routes. The home is situated on two floors with service users bedrooms sited on each floor. All bedrooms have the benefit of en suite facilities that includes toilet wash hand basin and bath or shower. There are additional toilets and bathrooms on each floor. All radiators are guarded and water temperatures are controlled to reduce any risk to service users. All bedrooms provide single occupancy and service users are able to personalise their rooms with pictures and small items of furnishings. One service user stated they were very happy with their room, which they had been able to choose. All bedroom doors have been fitted with a suitable lock to provide privacy to service users. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 17 There is a separate laundry room that has a commercial washer with sluice cycle and a washing temperature that meets disinfectant standards. There is also a commercial dryer. The laundry floors and walls are readily cleanable to reduce the risk of infection. The home does not have a copy of Avon and Wiltshire infection control guidelines and it is recommended one be obtained. To further reduce the risk of infection and also reduce the handling of infected or soiled laundry the home should obtain a supply of red alginate bags that can be placed directly in the washing machine. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36 Recruitment records in the home do not evidence the protection of vulnerable adults. Staff receive training, support and supervision to ensure they have the skills necessary to meet the needs of service users. EVIDENCE: Examination of the rota demonstrated there is a minimum of four staff on duty at all times. The manager confirmed the staffing levels are continually reviewed to ensure there are sufficient in duty to meet the needs of service users. The home has gradually reduced the number of agency staff since first registration. There are two waking night staff and a senior member of staff on call. Discussion with staff confirmed regular staff meetings and supervision is provided at the home and records of meetings were available for inspection. The two senior members of staff provide supervision to care staff and the manager provides formal supervision to the seniors. The home has no procedures in place for dealing with physical aggression towards staff and it is recommended these be developed. The inspector examined the recruitment records of four staff members. Not all records demonstrated safe recruitment practices were being followed. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 19 Discussion with the manager confirmed the documents had been obtained but had not yet been forwarded to the home. The home must ensure all recruitment records specified by regulation are available for inspection. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 The health and safety of service users is being safely managed. EVIDENCE: The manager has over nine years experience of managing a care home and has recently been registered with the CSCI. The manager confirmed he has enrolled on the registered managers award and hopes to complete the training by the end of the year. In addition the manager has recently completed abuse awareness and autism training. Discussion with the manger demonstrated a clear understanding of how the needs of service users are to be met at the home. The manager has also ensured staff have sufficient knowledge and skills to meet the needs of service users, however this is not sufficient to ensure the home is meeting it’s stated purpose and objective. The absence of clear and detailed care plans and risk Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 21 assessments could mean service users needs are not being appropriately and consistently met. The manager is responsible to ensure safe working practices are followed in the home. Records demonstrated health and safety inspections are completed every month. COSHH risk assessments have been completed and all cleaning products are kept secure. Fire risk assessment has been completed and fire safety checks are carried out at the required intervals. The last recorded fire drill was held on 24/4/05. Staff confirmed they have received training safe working practices. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x 3 x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 4 4 3 N/A 2 Standard No 11 12 13 14 15 16 17 x 2 x x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Westwood House Score 2 x 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 23 n/a Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 13 (4)(c) Requirement The registered person must ensure any potential risk to service users are identified and as far as possible eliminated as part of the admission procedure. The registered person must ensure service users have a detailed care plan that reflects how the holistic needs of service users are to be met at the home. The registered person must ensure any portential risk to service users is identified and action taken to reduce the risk. The registered person must ensure that medication classified as controlled drugs must be kept in separate, secure and appropriate storage. The registered person must ensure clear protocols are available for the use of ‘as required’ medication. The complaints procedure needs to be in a format suited to the needs of all service users The registered person must ensure recruitment records required by regulation are available for inspection. Timescale for action 01/06/05 2. 6 18 15(1) 01/07/05 3. 9 14(4)(c ) 01/06/05 4. 13(2) 20 05/05/05 5. 13(2) 20 01/06/05 6. 7. 22 35 22(2) 19(1)(a) (b)(i) 01/09/05 01/06/05 Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard 2 6 7 7 12 20 30 30 36 Good Practice Recommendations The registered person should ensure the homes pre admission assessment is completed as part of the admission procedure. The registered person should consider providing advocacy information for all service users. The registered person should clearly record any restrictions on service users choice and freedom. The registered person should ensure communication passports arefurhter developed to provide an effective communication aid for service users. The registered person should record where service user have refused choices offered to them. The registered person should ensure hand-written additions to the medication administration record are signed, dated and checked by two members of staff. The registered erson should obtain a copy of Avon and Witshire infection control guidelines. The registered person should ensure there is a suply of red alginate bags to reduce handling risks of soiled linen. The registered person should ensure policies and procedures are in place for dealing with physical aggression towards staff. Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 25 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westwood House DD51_D01_S61297_WESTWOODHOUSE_V223839_040505_STAGE4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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