CARE HOME ADULTS 18-65
Whitewalls Bells Lane Hoghton Llancashire PR5 OJJ Lead Inspector
Helen Lindsey Announced 07 July 2005 2:00pm 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. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Whitewalls Address Bells Lane Hoghton Lancashire PR5 OJJ 01254 852288 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) CARE (Cottage and Rural Enterprises Ltd) Mrs Pamela Smalley LD Learning disability 6 Category(ies) of LD Learning disability (6) registration, with number of places Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3 February 2005 Brief Description of the Service: Whitewalls is a large detached property situated in the village of Hoghton between the towns of Blackburn and Preston. The village provides access to local facilities and services and transport links to larger towns nearby. Registered to accommodate six adults with learning disability, Whitewalls is a community home with strong links to the much larger Stanley Grange, also owned by CARE, some 2 miles away. The two-storey home stands in its own grounds and contains a lounge/dining area, a small conservatory area, kitchen, two bathrooms, separate toilet facilities, five bedrooms and a staff room. There is also a self contained flat attached to the home which accommodates 1 service user. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced, carried out by one inspector and started at 2.00pm. It took place over 3 1/2 hours. The inspectors spoke to 6 service users, 1 member of staff and the registered manager. Staff and care records were examined, and a full tour of the premises was undertaken. As part of the inspection process the inspectors used “case tracking” as a means of assessing some of the National Minimum Standards. This process allows the inspector to focus on a small group of people living at the service. Since the last inspection there had been no complaints about the service. What the service does well:
Individual plans had been well written, and since the last inspection had started to be produced with larger text, in a clear format, and with pictures, to ensure that the information could be understood by people with different communication skills. This showed a commitment by the staff to making sure the service users were kept fully informed in the process of making decisions and recording them. The service users living Whitewalls really enjoyed the independence they were able to experience, whilst also knowing there was support available if they needed it. By learning how to keep themselves safe, and daily living skills, individuals were being able to increase their experiences of being more independent, which gave them a real sense of achievement. Families also commented that they felt their relatives were able to experience a wide range of opportunities, and were happy at Whitewalls. Service users explained the different jobs and college courses they did, and were proud to talk of their achievements and the certificates and qualifications they had received. Each person had made individual choices about what to do with their time, and had chosen things they really enjoyed like working with animals, or working in shops and the tea rooms. Socially, individuals also were involved in a whole range of activities and made choices on a daily basis about what they wanted to do, and when they wanted to do it. This was a really positive feature at Whitewalls, which helped individuals to be happy and fulfilled. Staff training continued to be of a high standard, and this included the induction being done to both the Skills for Care (previously TOPSS) and
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 6 Learning Disabilities Award Framework (Ldaf) standards. Care as an organisation provided a wide range of opportunities for internal training courses, and there were also external training courses offered. A number of staff also continued to do National Vocational Qualifications (NVQ) qualifications at levels 2 and 3. 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.
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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 Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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 The admissions procedure for new service users enabled them to make an informed choice about moving to the service, and the process was also clear to ensure the resident’s needs were assessed. Existing service users were also considered to ensure individuals had similar needs. EVIDENCE: Service users were involved in the process of assessment before they moved to the service by visiting Whitewalls, completing a ‘getting to know you’ document which was used along side assessments from social services, and input from families where appropriate, to get a full picture of each individuals needs and agree what service was to be provided. There had been no new admissions since the previous inspection. Service users spoken to said they were able to visit Whitewalls before they decided to live there. Also when new people come to look at the service, they met the potential new service users, and were then asked their opinion on them moving in to the home. Records from previous admission had been improved as was requested in the previous report.
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 9 Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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 standard(s) 6,7and 9 Care records were detailed and easy to read, written in a way the service users could also identify with. The health and social care needs of service users were assessed, and then reviewed on a regular basis, ensuring needs continued to be met. EVIDENCE: Service users said they were involved in their Independent Person Plan meetings (IPP’s). Individuals were encouraged to identify goals that they wanted to achieve, such as new college courses, using the bus, and spending time in the home without staff being there. Service users explained the things they had done since the last inspection, such as work placements, spending time in at Whitewalls on their own, and going shopping for groceries. All were pleased that they were getting more ability in daily living skills. Records were also seen of the ‘paths’ individuals had done as part of their Person Centred Planning (PCP). This process involved identifying those things that are important to individuals, and identifying where they would like to be in the future. Those spoken to said it was good to do.
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 11 Staff felt it was good to spend one to one time with individuals and really support them to develop new skills including household skills, but also interpersonal skill and social skills. Staff felt everyone was doing well to achieving their goals. Comments from relatives were also positive, one person saying ‘our relative receives the best possible care’. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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 standard(s) 12 and 15 Daily life at Whitewalls was flexible, giving every individual the opportunity to make decisions and choices. Service users were well supported to maintain links with family and friends. EVIDENCE: Service users chatted about the holidays and trips they had been on, nights out with friends and partners, leisure activities they were involved in, and how they had every opportunity to make choices in the way they spent their time, and lived their lives at Whitewalls. Comments like ‘I love going to work’ ‘I go down to the pub with my friends on Saturday nights’ and ‘I cant wait for my holiday’ were made by the service users. All service users felt the staff were supportive, and respected them as people. One said ‘the staff are nice to talk to’. Service users were seen to be interacting in a positive way with staff, and were comfortable with some teasing and joking between the group.
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 13 Again relative’s feedback was positive, and one said ‘quality of life and personal development is far above what we ever hoped for …(service user)’. Service users records and reviews showed the wide range of education and employment activities they were involved in. This included the workshops at Stanley Grange, work in the tea rooms, college placements, and work placements. Every service user had a full programme of activities, that they had been involved in choosing. Individuals talked about the contact they had with their relatives and friends, which included going to home to visit and parents visiting them at Whitewalls, letters, phone calls, texts, and emails. Relatives said on the comment cards received that they were kept informed of important matters affecting their relatives. Staff described how calls were made to relatives to keep them up to date. There had been an incident of communications with a family breaking down a little, but this had been resolved to both family and the managers satisfaction. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 14 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) 19 and 20 Procedures were in place to facilitate the safe handling of medicines but best practice was not always adhered to when completing medication records, increasing the risk of errors being made. EVIDENCE: Records of individual’s health checks were kept, and helped staff ensure everyone received the support they needed. The service users had attended sight tests, dental check ups, and ‘well woman/man’ appointments. Specialist referrals had been made were needed, ensuring appropriate health care was provided. A service user said ‘I sometimes go to the dentist and the doctor, staff come with me if I want them to’. Training had been provided to the staff to keep them up to date on appropriate issues such as first aid and medication administration. Other more specialist courses had also been attended to ensure staff were familiar with possible health care issues, such as dementia, and epilepsy. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 15 Some service users confirmed they managed their own medication, and assessments around their skills to do this had been done. Records for medications administered by the staff had been completed fully, however the receipt of the most recent stock into the home had not been recorded. The manager explained that a new system had been introduced, and staff needed a refresher of the procedure they needed to follow. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 16 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 Policies and procedures were in place to make sure individuals knew how to complain, and to ensure complaints were dealt with effectively. EVIDENCE: All service users spoken to knew who to talk to if they were not happy at Whitewall. They also knew of the formal complaints procedure. One said ‘when I made a complaint I talked to the manager, I feel it was dealt with well’. Records of two internal complaints that had been made were clear to understand and showed how decisions had been reached. Staff spoken to knew what sort of information they needed to pass on to other professionals to safeguard individuals, and when to keep confidences. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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 standard(s) 24 and 30 The home was maintained to a good standard both inside and out, and a safe environment was provided for service users and staff by following health and safety guidelines. EVIDENCE: Maintenance work was done when needed, and ensured the home remained safe for those living there. The manager said that action was taken if they reported something was not working. Issues with the boiler from the previous winter had been fully addressed. Service users explained that there was a rota for cleaning, and everyone took their turn. ‘the rota tells you what job you are doing, so the home is kept nice and clean’. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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) 34 and 35 Staff recruitment procedures were clear and robust and training opportunities offered to staff continued to be of a high standard, to ensure service users were supported by staff competent and qualified to do the job EVIDENCE: Staff records were stored in a clear and accessible format, and every file contained all information required by the Care Home regulations. Whitewalls exceeded the standard by asking for 3 references for each member of staff employed. New staff members were about to commence the induction programme provided by Care, completed to Skills for Care (previously TOPSS) and Learning Disability Award Framework (Ldaf) standards. Courses included in this induction were first aid, basic food hygiene, moving and handling, and infection control. Other more specialist training courses were offered, and people were also undertaking NVQ qualifications. The training opportunities with care continued to be outstanding. One staff member had completed NVQ training, and two more had commenced the course.
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 19 Service users felt the staff were good at their job, nice to talk to and could be trusted. Relatives were also positive about the quality of the staff. Comments received were ‘the care at Whitewalls is excellent’, ‘I can not speak too highly of the staff there, they are really professional, friendly and caring’. One relative did comment that they felt there was a high turn over of staff, but they did not feel this affected their relative. One member of staff had left since the previous inspection. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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) 41 The home was well managed which ensured a good quality of care was provided to the service users. EVIDENCE: The manager at the home had been working there for some time, and was very familiar with the service users. They were seen to be organised and thorough in undertaking their role, which meant the home was well run, and service users rights and interests were safeguarded. Service users said they liked the manger, and thought they did a good job. Staff also felt the manger was approachable. Records within the home were stored securely to make sure individuals information was kept confidential.
Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 21 The quality assurance system at Whitewalls had been in place since February 2005, but was not assessed on this inspection. As part of this quality assurance a family forum had also been developed and relatives commented that this was giving them a voice in the consultation process about the service, and its future. Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 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 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x 3 x x Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Whitewalls Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x 3 x x F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 23 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 20 Regulation 13(2) Requirement The registered person must ensure medications recieved into the home are recorded. Timescale for action 15/08/05 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 20 Good Practice Recommendations Where a hand written entry is made onto a Medication Administration Record sheet, it should be checked and signed by 2 people to ensure the information has been written correctly. The registered person should ensure that 50 of the staff are qualified to NVQ level 2 by the end of 2005. 2. 35 Whitewalls F57 F08 S5929 Whitewalls V224523 070705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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