CARE HOME ADULTS 18-65
Whitby Drive (8) Biddick Washington NE38 7NW Lead Inspector
Mrs Elsie Allnutt Announced Inspection 13th October 2005 10:00 Whitby Drive (8) DS0000015756.V251727.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 Whitby Drive (8) DS0000015756.V251727.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. Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Whitby Drive (8) Address Biddick Washington NE38 7NW 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) 0191 4172448 0191 4172448 Community Integrated Care Care Home 5 Category(ies) of Learning disability (5), Physical disability (3) registration, with number of places Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th May 2005 Brief Description of the Service: 8 Whitby Drive is a home that provides a service for 5 people with learning disabilities 3 of whom have high dependency levels. The age range is between 48 and 62 years. The home is situated in a cul-de-sac of detached houses and bungalows. It is close to a school, pub and local shops and is close to local transport that provides access to Sunderland and Newcastle City centres. The building is a bungalow with a large conservatory at the back that accommodates a ball pool and sensory objects. There is an overhead tracking system in one of the bathrooms and several other mobility appliances, which meet the needs of the service users. Each person living at the house has a single bedroom with the facility to lock the door for added privacy. There are also shared facilities that include a large lounge/dining area, kitchen, utility room, bathroom and toilets. Attractive well-kept gardens are accessed via French windows via the conservatory and a ramped access via the side of the building. Staff are available 24 hours per day, seven days a week to support people in their daily lives and to provide waking night cover. Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took 6.5 hours over one day in October 2005. Questionnaires were sent out to service users and their relatives prior to the inspection, none were returned from service users and two were returned from relatives, both indicated that they were satisfied with the service delivered, however one indicated that they were not aware of the home’s Complaints Procedure. The views of the four service users and six members of staff were sought, as were the views of one service user’s family member who was visiting at the time of the inspection. As all but one of the service users do not have verbal communication, an understanding about their views and feelings of the service was interpreted through the observations of body language, interaction with staff, discussions with staff and the examination of records. As part of the inspection process the service users’ care files and a sample of the homes records were examined and a tour of the building took place. What the service does well: What has improved since the last inspection?
Many improvements have been made to the environment of the home since the last inspection providing an attractive and homely place for service users to live. The lounge conservatory and kitchen have been decorated and small furnishings have been carefully chosen to harmonise with the chosen colours. New double-glazed windows and doors provide added warmth and security to the home while sensory equipment in the conservatory provides a stimulating environment for service users. Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 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. Whitby Drive (8) DS0000015756.V251727.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 Whitby Drive (8) DS0000015756.V251727.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): 2,5 Service users needs are assessed prior to admission in order to determine that their needs can be met in the home. Each service user receives a copy of the terms and conditions of residence, so that they are aware of what services are to be provided, the conditions of their stay and the cost incurred. EVIDENCE: There have been no new admissions to this home for some time; however as currently there is vacancy a prospective service user has visited the home to look around and meet staff and the people living there. Staff confirmed the visit and records demonstrated the dates and included a preadmission assessment and care plan, including risks to be addressed, from the social worker. Each service user has been given an up to date Contract that includes the terms and conditions of their stay and the full fees charged, identifying who is responsible for payment. Although the manager on behalf of the Provider has signed the new contracts, the service user or their representative has not. This was discussed with the manager who agreed to address it. Whitby Drive (8) DS0000015756.V251727.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 There is a new care planning system in place that is accessible to service users and service user lead. However they are not used consistently neither do they include important information in relation to how service users are supported to make decisions about their lives. Service users therefore might not be supported and cared for in a consistent way by staff. EVIDENCE: Each service user has a care plan. The manager explained that the home is currently in the process of transferring the information from the old system into the new. The new system has been clearly developed to be accessible to the service user and to be lead by the service user. Different sections of the document are illustrated to describe, in picture format, what area of the person’s care is recorded and the dialogue is written with a person centred approach. Although a good effort has been made to achieve this at this home, the style of recording is not consistent throughout the care plans and in some, information projects the service user in the negative. A discussion took place with the manager in relation to the importance of maintaining the detailed information found in the previous care plans in relation to the service users individual needs and how these can be transferred
Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 10 and recorded, while at the same time projecting a positive image of the service user and recording how they are supported to make decisions about their own lives. Whitby Drive (8) DS0000015756.V251727.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): 13, 14, 16, 17 Service users are currently supported to take part in some age appropriate community based activities, however there is room for these to be further developed so that service users live a full and valued lifestyle. The home supplies a good range of meals that meet the service users’ dietary needs. EVIDENCE: During the inspection it was evident that staff support service users in activity. One service user was assisted to go to a planned hospital appointment and later in the day service users and staff went out for lunch to a nearby pub that is regularly used. One service user was observed, later in the day, interacting with others in the ball pool, a facility along with other sensory equipment that is provided in the conservatory to stimulate and engage service users. Staff confirmed that this sort of activity was a regular occurrence and other activities such as swimming at a nearby school’s hydrotherapy pool and cooking in the home were also included in the activities programme. However none of these activities were reflected in a structured activity programme for
Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 12 individual service users, neither were there records in relation to individual activities that service users enjoyed and preferred. It was recorded however that one service user did not like crowds or noise, yet this did not relate to the activity or type of holiday they had recently experienced. All of the service users had been on holiday to Blackpool in a hotel that caters for people with disabilities. Staff confirmed that they all had enjoyed the experience so another holiday at the same venue was planned for later in the year. A discussion took place with the manager in relation to the importance of offering different experiences, so that responses to the experience could be observed and recorded and used as a basis for supporting service users to make more informed choices. The manager agreed and discussed ideas to further develop the activities programme and holiday experience. Whitby Drive (8) DS0000015756.V251727.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, 20 Staff provide sensitive and flexible support in relation to service users’ personal needs, however the information in the care plan does not always reflect how this is achieved, therefore service user may not receive a consistent approach in relation to how their needs are met. Satisfactory systems are in place for the administration of medication with clear arrangements to ensure service users medication needs are met. EVIDENCE: Staff were observed assisting service users with their personal needs sensitively and effectively. Care plans reflected service users’ needs regarding the level of assistance required in relation to washing, bathing and dressing. However the care plans do not reflect planned daily routines that might support individual service users to change position or find comfort in another situation, who because of physical disability are unable to move or change position independently. One service user has an easy chair that was designed and built for their particular needs, that is currently not in use. The manager stated that the chair was in need of being serviced and a referral had been made to the Community Learning Disability Physiotherapist in relation to reassessing the service users physical needs in relation to seating arrangements. Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 14 The home continues to follow robust procedures in relation to administering medication. The medication records examined and were satisfactory. Staff confirmed that they had received in house training in relation to the administration of medication and signed records in staff files confirmed this. They also confirmed that they are currently working through a distant learning package with a local college in relation to the administration of medication. Whitby Drive (8) DS0000015756.V251727.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 The home has a Complaints procedure that protects service users from abuse. However although the manager and staff are aware of the general issues surrounding abuse they are not aware of the local authority’s protection of vulnerable adult procedures, known as MAPPVA (Multi Agency Protection Panel for Vulnerable Adults). To further enhance the protection of service users from abuse further training must be offered to the manager and staff in relation to these EVIDENCE: There have been no complaints or concerns recorded since the last inspection. A discussion took place with the manager in relation to recording concerns and the importance attached to treating concerns seriously even when the complainant prefers not to have it recorded as a formal complaint. A relative visiting at the time of the inspection confirmed that they would know what to do if they were unhappy about something relating to the care and service delivered. However a comment made by another relative on the pre inspection Comment Card indicated that they were not aware of the home’s Complaints Procedure. This was discussed with the manager. The manager stated that she felt appropriately supported by the Company to address a recent Adult Protection issue in this home, resulting in the Company taking disciplinary action against a member of staff. Issues surrounding the company’s policy on Gender Sensitivity, the service users’ bathing needs and how they are recorded and the need for all staff to receive training in relation to Moving and Assisting were addressed as outcomes to the investigation and are requirements of this report.
Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 16 In discussion with the manager and staff they all demonstrated an awareness of the issues surrounding abuse and the action they would take if it was witnessed, however neither the manager or the staff were aware of the local authority’s MAPPVA procedures or the role they would play in these. The manager was advised of the people to contact in relation to arranging MAPPVA training and advised that this should be arranged as a matter of priority. This training has now been a Requirement of three reports. Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 The standard of the environment within this home is good providing service users with a clean, attractive, safe and homely place to live. EVIDENCE: The refurbishment of this home commenced prior to the last inspection and is now almost complete, resulting in an attractive and comfortable environment for service users to live. A new heating system has also been installed. All service users have individual bedrooms that are decorated to reflect individual personalities. The manager discussed plans for one service user to move into a larger bedroom where their needs will be accommodated more comfortably. As recommended in the last report consideration should be given to replacing the clinical bed with a bed suitable to the service users needs yet more domestic in appearance. The manager was advised, to discuss this with and seek advice from, the Physiotherapist from the Community Learning Disabilities Team. Some staff confirmed that they have recently successfully worked through a 12 -week distant learning course in relation to Decontamination Awareness. All agreed that this had raised their awareness to infection control.
Whitby Drive (8) DS0000015756.V251727.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): 33, 34 Although some staff vacancies remain, service users are now receiving more consistent and effective care due to a more consistent staff team and satisfactory recruitment procedures. EVIDENCE: At the time of the inspection there was an effective number of staff on duty in relation to the needs of the service user present, this included the manager and three support workers. Staff rotas confirmed that the minimum number of staff on duty during the day is three, and this includes the manager. Currently there are four service users living at this home and there is one vacancy. The manager stated that depending on the level of need of the new service user, she felt that the ratio of staff would need to be reviewed. Although the staffing problems found at the last inspection have been addressed and new staff have been recruited, vacancies in relation to the staff team remain. Records proved that the home followed the Company’s recruitment procedures, however one file of a newly recruited member of staff did not include the full copy of their CRB, although the CRB number was available. The manager was advised that the CRB documents of newly recruited members of staff must be kept to be inspected at the nearest inspection. This was a requirement of the last inspection. Whitby Drive (8) DS0000015756.V251727.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 The new manager demonstrates that she is hardworking and has good organisational skills resulting in the successful refurbishment of the home where a safe and comfortable place for service users to live is provided. However so that the service users are fully protected the manager must develop her knowledge of the legal responsibilities she has for running the home, while also developing a Quality Assurance System that gains the views of the service users and their relatives in relation to the service delivered. EVIDENCE: A new manager has been appointed to run the home who is experienced in working with people with learning disabilities. The manager stated that she worked as a temporary manager for 5 months in her previous employment and as a Deputy manager for 5years in another service for people with learning disabilities. Although she could demonstrate her knowledge in certain aspects related to her role as manager, further development is needed regarding knowledge relating to recent legislation, Valuing People, The Care Act 2000 and the National Minimum Standards and Care Homes Regulations for Adults (18-65).
Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 20 The manager must make application to the CSCI to be considered for registration as the Registered Manager for the home and be fully qualified with the Registered Managers Award and NVQ 4 in Care by September 2007. The manager stated that she is currently included on the staff rota and has no time allocated to solely address her managerial role. So that she can address her managerial responsibilities this must be addressed. Although the home has quality monitoring systems in place these are recorded in different files. It was suggested to the manager that the quality monitoring of systems might be more effective and easier to access if they are kept in one file that was referred to as the Quality Assurance File. The manager was receptive to this and thought that senior managers were currently developing this. Staff were aware of health and safety issues and carried out their roles accordingly however a recent incident in the home proved that not all staff carry out appropriate moving and assisting techniques. The fire log and accident book were examined and were satisfactory. Whitby Drive (8) DS0000015756.V251727.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 X X 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 2 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Whitby Drive (8) Score 2 X 3 X Standard No 37 38 39 40 41 42 43 Score 2 3 2 X X 2 X DS0000015756.V251727.R01.S.doc Version 5.0 Page 22 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 YA55 Regulation 5(b) Requirement Timescale for action 30/11/05 2 YA6 Service users, their family or their representative must sign the new Contract, explaining the terms and conditions of the service users’ stay at the home. 12(1)(4)(a) Care must be taken to transfer the detailed information found in the previous care plans, in relation to the service users individual needs and how these are met, while at the same time projecting a positive image of the service user. 12(2) 30/11/05 3 YA7 4 YA18 23(2)(c ) & 12(3) There must be enough 30/11/05 information in the care plan in relation to how service users are supported to make decisions about their own lives. Care plans must include details 30/11/05 in respect of how service users are supported to change position or find comfort in another situation when, because of physical disability are unable to move or change position independently. With particular reference to the service user’s specially built easy chair, special appliances
DS0000015756.V251727.R01.S.doc Version 5.0 Page 23 Whitby Drive (8) 5 YA42 & YA23 6 7 YA23 YA42Y & A23 YA33 8 9 YA34 10 YA37 that are used to support service users must be satisfactorily maintained. 13(6) & The manager and staff must 10(3) attend training in relation to the local authority’s Protection of Vulnerable Adult Procedures, and in the handling of verbal and physical aggression. (Timescales of 28.01.05 & 30.09.05 not met.) 12(4) The home must address the Company’s Gender Sensitivity Policy and follow it accordingly. 13(5) All staff must receive training in relation to Moving and Assisting Techniques and in relation to the use of the mobility equipment. 18(1)(a)(b) To ensure continuity of care the current staff vacancies must be addressed. Prior to the service user vacancy being filled the manager must review the staffing ratio to ensure that there are enough staff to address service users’ needs. 17(2) Individual CRB certificates must be kept in the home until they have been examined by the CSCI during the nearest inspection. 9 The manager must develop her knowledge regarding her responsibilities in relation to legislation and work towards the Registered Managers Award and NVQ4 in Care. The manager must also have hours allocated so that she can address her managerial responsibilities. The manager must submit an application to the CSCI for registration as Registered Manager. 30/12/05 30/11/05 30/12/05 30/11/05 30/11/05 30/12/05 Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 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 Refer to Standard YA14 Good Practice Recommendations It is recommended that the variety of activities offered are developed as planned, and the holiday destinations expanded as discussed. .(This was also a Recommendation of the last report). The manager should ensure that all service users, their relatives and anyone else involved in their care are aware of the home’s Complaints Procedure. The plans to replace a clinical type bed with a more domestic, comfortable design for a particular service user, should go ahead. (This was also a Recommendation of the last report). 2 3 YA22 YA26 Whitby Drive (8) DS0000015756.V251727.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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