CARE HOME ADULTS 18-65
Whistley Dene Whistley Road Potterne Devizes Wiltshire SN10 5TD Lead Inspector
Bernard McDonald Unannounced Inspection 12th January 2006 10:00 Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Whistley Dene Address Whistley Road Potterne Devizes Wiltshire SN10 5TD 01380 721913 01380 721913 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) White Horse Care Trust Mrs Tina Tracy Shaw Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th July 2005 Brief Description of the Service: Whistley Dene provides care and accommodation to men and women who have a learning disability and who may also have a sensory loss or associated physical disability. The house is located in a hamlet on the edge of the village of Potterne, which is located 3 miles from Devizes town centre. The home provides high standards of spacious accommodation with extensive and well maintained grounds. Each service user has their own bedroom. Typically the home is staffed by three support workers throughout the waking day. At night time one member of staff sleeps in and is expected to respond to any emergencies or night time care needs as they arise. The home has its own vehicle, which is used to access a range of day services and to ensure community presence. Whistley Dene is one of a number of homes operated by the White Horse Care Trust. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over five and three quarter hours. The inspector met with four service users but was unable to communicate effectively with them to obtain their views on the care they receive. The inspector met with three support staff in private. The deputy manager was on duty to assist with the inspection. The inspector viewed all areas of the home including service users communal living areas and their bedrooms. In addition the care plans of all service users were examined together with risk assessments, medication records and health and safety records. Feedback on the inspector’s preliminary findings was given to the deputy manager at the end of the inspection. One requirement remains outstanding from the previous inspection. What the service does well: What has improved since the last inspection?
The home has updated and reviewed their statement of purpose. The document has been retyped and presents as a more professional document that provides clear information on the services and opportunities provided in the home to service users. Staff supervision is now more structured and timetabled to ensure staff have the opportunity to meet with their supervisors a minimum of six times a years. Discussion with staff confirmed they felt supported in their work. This inspection has found the home has improved the system for ensuring service users care plans are reviewed a minimum of once every six months. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 6 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. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2. The home is ensuring service users have sufficient information about the service but is failing to ensure all service users have a plan of care following admission to the home. EVIDENCE: Since the last inspection the home has updated and reviewed their statement of purpose. The overall presentation of the document has been improved and amendments previous written in pencil and ink have been retyped. The document was last reviewed in September 2005. The deputy manager stated that an audio version of the service user guide has been completed though due to some teething problems it has not yet been made available to service users. No service users have been admitted since the last inspection. The last service user was admitted in October 2004. The home has yet to develop a care plan detailing the needs of this service user. The inspector spoke with the area care manager on the telephone who stated an agreement had been reached with the placing authority to develop a care plan after the service user had time to fully settle in. The reason being the information obtained about the service user was not being experienced at the home and it was thought an extended settling in period would be beneficial. However the inspector could find no written agreement from the placing authority and no clear information gathered by the home on the needs of the service user, or what interventions have been used, which could be developed in a care plan. It was a requirement
Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 9 at the last inspection that a care plan must be developed for all service users. The deputy manager confirmed an individual planning meeting was held in December 2005 and a care plan is now being developed. In view of this comment the Commission has agreed to extend the timescale for meeting this requirement. Failure meet to meet the requirement within the revised timescale will result in enforcement action. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 10 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, 9. Care plans that had been developed reflected service users changing needs however, the home is failing to ensure risks to service users are kept under review. EVIDENCE: The inspector examined all service users care plans and as described earlier in the report one service user did not have a care plan. The remaining service users had detailed and comprehensive care plans and support plans that provided support staff with clear guidelines on how the needs of service users should be met at the home. Discussion with staff demonstrated a good understanding of the needs of service users and also their responsibilities as key worker. Following a requirement at the last inspection the home was now ensuring care plans are reviewed a minimum of once every six months. Reviews monitor service users goals and whether they remain appropriate to their needs. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 11 Individual risk assessments had been developed and could be cross referenced with the service users care plan. However not all care plans had been reviewed in the past year to ensure the risk remain appropriate and do not unnecessarily restrict service users choice and freedom. It is recommended that all risk assessments are reviewed a minimum of once every year. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 12 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, 15. The home is ensuring service users are provided with opportunities to maintain contact with family and friends and engage in activities in non segregated settings. EVIDENCE: Service users cultural and religious needs have been addressed in their care plan. Opportunities are provided to enable service users to develop independent living skills. Service users are encouraged to have responsibilities for keeping their room tidy and assist with some household tasks. This involvement is recorded in their care plan. Discussion with staff confirmed support is being provided to enable service users to maintain contact with people who are important to them. The deputy manager confirmed visitors are welcome at anytime. The home is situated in a rural setting and transport is available to ensure service users have opportunities to meet with people who do not share their disability when they access the local and wider community. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. The home is ensuring medication is safely administered. EVIDENCE: All staff have to complete drug competency training prior to administering any medication to service users. Staff have also received additional training in the administration of rectal diazepam. Examination of the medication records show staff are accurately recording medication when administered to service users. A separate record is kept on any medication received at the home and returned to the pharmacy. All medication is held secure in the home and no service users self medicate. Service users consent to staff administering their medication has been obtained. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The home is making every effort to ensure service users views are listened to and they are protected from abuse. EVIDENCE: The home has received no complaints since the last inspection. An abridged version of the complaints procedure was contained in service users individual files. In addition service users have been provided with a postcard that can be sent directly to the Trust to record any dissatisfaction or complaint. Examination of a sample of money being held on behalf of service users demonstrated the home was keeping an accurate record of money held in the home. Policies and procedures are in place for the protection of vulnerable adults. Discussion with staff confirmed they would have no hesitation in reporting any concerns that affect the welfare or protection of service users. Awareness training for staff in abuse awareness is provided by the Trust. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The home provides service users with a clean, comfortable and safe environment. EVIDENCE: The home is a large single storey building with wheelchair access to the side. The inspector viewed all areas of the home including communal living rooms and service users bedrooms. The home was clean, tidy and free from odour. Furnishings and décor are of a good standard. Discussion with the deputy manager confirmed service users are consulted about the decor in their rooms. There is sufficient communal space to enable service user to spend time on their own without having to resort to using their bedroom. A contract is in place to respond quickly to any minor repairs that may be required at the home. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36. The home is ensuring staff are trained and supported in their work but is failing to ensure sufficient numbers of staff are on duty at all times. EVIDENCE: Examination of the rota show staffing levels fluctuates between two and three staff on duty throughout the waking day. Discussion with the deputy manager confirmed the home currently has 3.7 fulltime staff vacancies. Active recruitment is continuing but due to the rural location and lack of public transport vacancies are proving difficult to fill. Discussion with staff indicated there is a strong team that supports each other and is willing to work extra hours to ensure gaps in the rota are filled. However it is clear that when staffing levels are reduced to two people on shift it impacts on service users access to the community although service users normal routine is currently being maintained. Examination of staff supervision records demonstrate that since the last inspection staff supervision has improved to ensure staff receive supervision at least six times a year. Staff commented that they feel supported in their work. Training records show staff have received training in the principles of caring for people with learning disabilities, epilepsy, person centred planning and communication. The home is also on track to ensure 50 of staff have completed or are working towards a National Vocational Qualification in care.
Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 17 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): 39, 42. The home is making every effort to ensure service users views are considered in developments at the home and their health and welfare is protected. EVIDENCE: The White Horse Care Trust has carried out a quality audit, which obtained the views of service users, families and staff using a pro forma satisfaction survey. The overall outcome of the audit indicated a good level of satisfaction with the service provided at the home. Service users house meetings do not take place but they are able to attend staff meetings. Records of the meetings confirm their attendance. In addition the Trust provides the Commission with monthly reports as required by regulation. The reports are comprehensive and provide a clear opinion on the registered providers view on the standard of care provided at the home. The inspector asked staff for their views on the care provided. Staff stated “very good” another staff stated “excellent” and a further member of staff commented they provided “ a high standard of care”. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 18 Examination of the fire logbook demonstrated safety checks were being competed. The last recorded fire drill was held in December 2005. A fire risk assessment is in place, however this should have been reviewed in November 2005. Control of substances hazardous to health risk assessments and product information are held in the home and cleaning products are kept secure. Health and safety policies and procedures are in place and staff confirmed they had received training in manual handling, fire safety, first aid and infection control. To ensure service users safety radiators are guarded and hot water temperatures are regulated close to 43c. Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 19 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 3 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X 3 X X 2 X Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6YA2 Regulation 4(1)(c) Requirement The registered person must ensure all service users have an individual plan of care. This was a requirement at the previous inspection with a timescale for action of 01/11/05. The registered person must ensure there is sufficient staff on duty at all times. Timescale for action 01/03/06 2 YA33 18(1)(a) 01/02/06 Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations The registered person should ensure risk assessments are reviewed a minimum of once every year or earlier if the needs or risk to service users changes. Following the inspection a copy of the fire risk assessment has been sent to the Commission. The registered person should deploy agency staff at periods of staff shortages. The registered person should review the fire risk assessment a minimum of once a year. 2 3 YA33 YA42 Whistley Dene DS0000028585.V275119.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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