CARE HOME ADULTS 18-65
Wickett Hern Road 123 Wickett Hern Road Armthorpe Doncaster South Yorkshire DN3 3TB Lead Inspector
Valerie Hoyle Unannounced Inspection 11:30 16 February 2006
th Wickett Hern Road DS0000032121.V266083.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 Wickett Hern Road DS0000032121.V266083.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. Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Wickett Hern Road Address 123 Wickett Hern Road Armthorpe Doncaster South Yorkshire DN3 3TB 01302 831969 01302 833616 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) DMBC Edmund James Watkins Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The emergency bed is used for a maximum of 12 weeks One specific named service user over the age of 65, named on variation application dated 30th September 2005, to continue to receive respite care at the home 14th September 2005 Date of last inspection Brief Description of the Service: Wickett Hern Road provides a respite service for adults with a learning disability. The home is owned and managed by Doncaster Metropolitan Borough Council. The home can accommodate eight service users; one of the beds is made available for emergency admissions for short stay only. The facility is set within the residential area of Armthorpe on the outskirts of Doncaster. Previously a family home the premises provide a domestic environment for temporary stays.The home has its own transport and this assists service users to maintain their education, work or day centre placements during a period of respite. Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second unannounced inspection of this inspection year. (2005/06) This unannounced inspection was conducted over 3.5 hours where a partial tour of the building was undertaken. The inspector examined two guests (service users) care plans and supporting documentation. Two staff were spoken to during the visit. The deputy manager assisted with the process while examining records, policies and procedures. What the service does well: What has improved since the last inspection?
Staff have improved medication procedures to ensure relatives of service users, accessing respite services bring sufficient medication for their stay. They also ensure that the medication is correctly labelled with clear dispensing instructions to ensure their safety and protection. Wickett Hern Road DS0000032121.V266083.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. Wickett Hern Road DS0000032121.V266083.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 Wickett Hern Road DS0000032121.V266083.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, 4 Guests (service users) are not admitted into the home without a full needs assessment taking place by the registered manager, to ensure their needs can be met. Procedures ensure that visits take place prior to any arranged stays at the home. EVIDENCE: There is a comprehensive assessment used to assess the needs of prospective guests who spend time at the home. The placing authority also provides detailed information about the person and this was examined and the deputy manager said it is used in all cases, including emergency stays, to ensure staff are able to meet the needs of guests. New guests are always encouraged to visit the home for tea and meet other guests and staff before making decisions about if they want to use the respite services. At present the staff at the home do not visit guests in their own home environment. This is an essential part of the pre-admission process and must be introduced. Wickett Hern Road DS0000032121.V266083.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, 9 The home continues to promote philosophies to enable guests (service users) to meet their full potential, with clear care plan instructions and comprehensive risk assessments to maximise their safety and protection. EVIDENCE: Two care plans examined reflected the individual needs of each resident. Specific information on the actions and responses required by staff to ensure identified needs were met were included. Guest’s care is reassessed after each stay and staff at the home are invited to attend formal reviews held at the training centres where the guests attend during the day. Parents and family are also invited to attend the meetings to discuss future stays at the home. Comprehensive risk assessments were in place. The plans described where residents needed more support from staff to stay safe. Staff at the home are currently working with day centre staff to develop strategies, to ensure a consistent approach is maintained while dealing with the complex needs for one guest who will spend time at the home in the near future. The registered manager may need to review staffing levels during this period to ensure the appropriate care can be provided for all guests.
Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 10 As this is a respite service there is emphasis on supporting the same level of independence in decision making that the guest have at home. For many of the guests the respite stay is also an opportunity to make decisions without family support. Staff recognise the need for consistency and ensure that care records detail issues that the service user may have difficulty making decisions about. Wickett Hern Road DS0000032121.V266083.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): 15, 17 Guests are helped to maintain links with family members and follow routines outside of the home, although relatives usually take the opportunity to take a holiday break, while guests are in Wickett Hern Road. Dietary needs of guests are well catered for with a varied selection of food available that meets resident’s tastes and choices. EVIDENCE: The provision of respite care at the home means that guests return to their families after their stay, and therefore staff are aware of the importance of maintaining routines to ensure continuity of care for when they return to their own home environment. The home provides a well-balanced healthy diet, and the inspector was able to examine menus, and speak to staff about the choices offered to guests. The deputy manager said guests who attend training centres usually have a cooked meal at lunchtime, and the home provides a variety of choices for both tea and supper.
Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 12 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 Medication policies and procedures are well managed and staff have the necessary skills to administer the medication to guests, ensuring the safety and protection of residents. EVIDENCE: An audit of medication stocks and records was examined and were found to be correct. Only one guest currently at the home requires medication. Staff at the home ask relatives to ensure sufficient medication is provided for the length of staff of the guest and that it is labelled and in its original packaging to ensure their safety. All staff has received accredited medication training provided by a local college, to ensure they have the necessary skills and knowledge to undertake this task Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 13 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 Guests are provided information to enable them to raise concerns about the home and their care. Adult Abuse Policies and procedures and training of staff on abuse, ensures the protection of guests from abuse. EVIDENCE: The home has a complaints procedure that is available to guests and visitors. The procedure is also referred to in the information given to new guests, identifying the stages to follow; this includes the time scales to respond to complaints. The address and telephone number of the Commission for Social Care Inspection is included in the procedure. The registered manager has a copy of the Local Authorities Adult Protection procedures. They also have an Abuse Policy, which has been prepared by the owners and is incorporated into the homes policy and procedure manual. Training records show staff require adult protection training, this remains outstanding from the previous inspection. Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 14 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, 30 The home provides a well-maintained safe environment suitable for guests to spend their time. The home provides a clean and hygienic environment to maintain the health and safety of guests. EVIDENCE: A partial tour of the building found it clean and free from odours. The home provides comfortable communal areas with one lounge and a dining area. New seating in the lounge provides a more comfortable environment for guests to spend their social time. There is a separate domestic kitchen. Some carpets and the corridor carpets are showing signs of wear and should be replaced. The grounds were tidy, and accessible to the guests, the rear garden includes a small lawned area. It is well situated in Armthorpe, within easy walking distance of all local shops, and parks. Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 15 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, 35 Sufficient staff are employed at the home to meet the needs of guests. Staff have the skills to fulfil their roles within the home, although their remains some outstanding training that needs to be addressed. EVIDENCE: Staff rotas examined showed that there are high levels of sickness, which has stretched resources and put pressure on the remaining staff to ensure sufficient cover is maintained. Staff said although they enjoyed working at the home, they found working additional shifts difficult. Vacancies have also added to the problem but it is hoped that new staff will be employed in the near future. Staff have adequate skills to meet the needs of guests, although they do not meet the requirement of 50 NVQ qualified staff. A number of staff are working towards the award. Staff training files examined showed that staff still require training in infection control, adult protection, First aid, moving and handling and health and safety. Discussion with the deputy manager indicated that staff have not received any formal training to deal with challenging behaviour, therefore staff must attend a behaviour management course to ensure they have the necessary skills to
Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 16 deal appropriately with guests. This remains outstanding from the previous inspection Discussion with staff identified that they are not always able to communicate with guests and require training in the use of Makaton signing; this remains outstanding from the previous inspection Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 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): 37, 42 The home is well managed to ensure the safety and protection of the guests. Staff and guests follow health and safety procedures and records provide evidence of servicing of essential equipment. EVIDENCE: The registered manager was unavailable during this inspection and the deputy manager assisted with the examination of documents. He is currently undertaking the registered managers award and is aware of the requirement to achieve the award by the end of 2005. Maintenance and service records examined were up to date and current to the services provided. Accident records were fully completed for both guests and staff and the manager carries out her own investigation. The manager has the required Health and Safety policies and procedures and displays the relevant notices. Fire safety procedures are in place and service records were examined and were current.
Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 18 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 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Wickett Hern Road Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 3 X DS0000032121.V266083.R01.S.doc Version 5.0 Page 19 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 YA2 Regulation 14 Requirement The registered manager must ensure that all per-admission procedures are completed including visits to the guest (service user) in their own home (timescale 1 December 2005 not met) The registered provider must ensure the staff have the necessary knowledge and skills in behaviour management. The registered provider must ensure that staff have the skills to communicate using Makaton. (timescale 1 December 2005 not met) The registered manager must ensure staff receive training in Infection control, first aid, health and safety, moving and handling, adult protection Timescale for action 01/04/06 2 YA35 18 01/04/06 3 YA35 18 01/04/06 Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 20 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 Refer to Standard YA32 YA37 YA24 Good Practice Recommendations 50 of care staff achieve a care NVQ 2 by 2005 The manager should achieve NVQ4 in management and care in 2005. The registered providers should replace carpets in some bedrooms and first floor corridor as they are showing signs of wear. Wickett Hern Road DS0000032121.V266083.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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