Inspection on 02/06/05 for Wilcot Road (19)

This inspection was carried out on 2nd June 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wilcot Road (19) 31/01/08

Wilcot Road (19) 15/05/06

Wilcot Road (19) 08/12/05

Wilcot Road (19) 24/01/05

Wilcot Road (19) 14/09/04

Wilcot Road (19) 25/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Wilcot Road (19) 19 Wilcot Road Pewsey Wiltshire SN9 5EH Lead Inspector Sally Walker Unannounced 2nd June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wilcot Road (19) Address 19 Wilcot Road Pewsey Wiltshire SN9 5EH 01672 562746 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) Keepence Homes Mrs Raine Goadby Care Home 4 Category(ies) of LD Learning Disability (4) registration, with number of places Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th January 2005 Brief Description of the Service: The home is a large detached house within easy walking distance of Pewsey. It is run by Keepence Homes and managed on their behalf by Raine Goadby. The home provides care and support to 4 younger people with leaning disabilities. It is anticipated that the residents will live at the home long term. All residents accommodation is single bedrooms to the first floor. There is a bathroom to the first floor and the staff sleeping in room. To the ground floor there is a relaxation room with some sensory equipment, a large kitchen, a sitting room with separate dining area and a conservatory. There is also an accessible shower room with toilet. To the rear of the property there is a large enclosed garden. The home has its own transport for residents use. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from 1.30pm until 5.40pm. Mrs Raine Goadby, registered manager, was on leave that week and Sadie Joliffe assisted with access to records and information. Two residents were spoken with and both members of staff on duty. The care plans; daily notes, menu books, accident log and medication log were examined. A tour of the building was made including viewing 2 residents’ bedrooms. The inspector gave feedback to Mr Keepence, one of the proprietors, the next day on the telephone. What the service does well: 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 Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 6 contacting your local CSCI office. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards have been inspected as no new residents have been admitted to the home for some time. EVIDENCE: Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Residents benefit from staff being aware of their needs being identified in their care plan. Residents are supported to make decisions about daily living using their own preferred methods of communication. Risk assessments do not prevent residents from enjoying a full and active life. Daily reports do not show how often complex needs are met. EVIDENCE: Each resident had a care plan which identified different areas of need, for example, self care, communication, social skills, household tasks, mobility, healthcare, community activities, education and finances. Care plans were set out with good evidence of how staff were expected to meet individual needs. There was also good evidence of how residents who did not necessarily have speech communicated with body language, gestures or objects of reference. There was no clear record of whether residents made decisions about their lives, but it was clear from observations during the inspection that staff encouraged residents with every day decisions making, for example, having a drink or what they wanted to do. The inspector advised that care plans should be dated to show evidence of review. Staff said they had been reviewed and revised and awaited the manager’s signature. Although the care plans showed that residents often had complex care and support needs and there was much detail in how care was to be given, the daily reports did not necessarily reflect Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 10 this. Daily reports varied, with some staff recording a list of what residents had done during the day. However there was some excellent recording of how residents had been supported with communication, made choices and been supported with things they could not make sense of. The inspector is of the view that this recording showed evidence of the experience, skill and knowledge of staff. It was clear from observations and discussions that staff were very familiar with residents support needs and were able to meet them with skill, but they were not always recording the detail. Discussions were held with staff about the need to record evidence of how the care plans were directing the care. Staff were advised that statements, for example, “inappropriate behaviour” and “uses behaviour to show feelings”, are unclear and should be more precise. Mr Keepence was advised that further guidance should be sought on dealing with behaviours from either the behavioural nurse or the community psychiatric nurse. Residents had been assessed with regard to any risks identified for daily living, for example, bathing, choking, seizures, accessing the kitchen, using the stairs or going out in the vehicle. These assessments had been updated as required at the last inspection. There were separate plans for residents to achieve manageable short-term goals. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 15, 16 & 17 Residents enjoy a range of different activities at home and in the local area. Residents with a diagnosis of autistic spectrum disorder do not benefit from a sufficiently structured activity programme. Residents did not loose contact with family and often went home for visits. Residents should not pay for meals already paid for as part of the fee. EVIDENCE: Most of the residents had a weekly programme of activities which included day services, college, walking, swimming, trips out and some home based activities. Activities were reviewed and new opportunities sought as residents’ needs changed. Trips away from the home were dependent on specific need, for example, one resident did not like going out in the rain. Staff were aware of what was available and accessible locally. The home had its own transport which was being serviced on the day of the inspection and residents were at home. Most staff were drivers of the vehicle. Staff said they would take residents on at least one major trip out each week either singly or in groups and an activity would take place during the morning and another one in the afternoon. The daily report showed some evidence of this. Mr Keepence was advised that where residents had a diagnosis of autistic spectrum disorder, Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 12 they may benefit from a more structured activities programme which may reduce current behaviours, professional advice could be sought at the next review. He said he agreed and that Mrs Goadby was looking at this area. One of the downstairs rooms had been set up as a relaxation room with sensory equipment. Staff said it was generally only used by one resident. Residents retained links with family and had regular visits to stay with them. Mr Keepence was advised that when residents have a meal away from the home or a takeaway, they should not pay for it unless they have already had the meal provided as part of the fee. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Staff know how residents like to be cared for. Residents have good access to healthcare professionals. Epilepsy profiles and behaviours are not reviewed regularly. None of the residents administer their own medication but staff make sure they receive it when they should. EVIDENCE: Residents’ healthcare needs were identified in their care plans. Residents were registered with local GPs and would attend appointments at the surgery. Residents had good access to other healthcare professionals and separate records were kept of appointments and the outcomes. One resident had an epilepsy profile. Residents were regularly weighed and there was evidence that any weight loss was followed up by a health action plan. None of the residents administered their own medication. Staff said that the medication was put up by the manager into a monitored dosage system each week. The medication was appropriately stored in a locked facility. A coding system for administration of medication was in place as required at the last inspection. A system was in place to identify name and dose of disposal of unused and unwanted medication as required at the last inspection. A copy of the medication policy was available alongside the medication records as recommended at the last inspection. Staff were advised that the medication error policy must include notification to the Commission under Regulation 37 when any maladministration occurs. Where residents had difficulties in taking medication the consultant had approved it be taken with food to encourage Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 14 swallowing but not to disguise the administration. Staff said they had recently received updated training in the administration of rectal diazepam from the nursing service. The staff training file showed that some staff had certificates of training in this procedure from an unidentified source in the past. However the training and development plan for this year identified this training as a need. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 &23 Residents and their families know that they can complain to management. Staff are made aware of protecting residents from abuse but are not provided with training in this area. EVIDENCE: The home has a complaints procedure which was in written English and pictorial. The document was included in the service users guide and had been supplied to residents’ families. No complaints have been received by the home or the Commission. The home had copies of the local Protection of Vulnerable Adults procedure entitled “No Secrets in Swindon and Wiltshire”. All staff had been given a copy of the procedure but were not generally aware of the process and Mr Keepence was advised that they would benefit from training. The home also had its own policy on disclosure of abuse. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Residents are provided with a well maintained safe, homely, comfortable and clean home. Efforts are made to maintain this standard. EVIDENCE: Two bedrooms were seen and they were each decorated in a style to reflect the residents’ personality. Staff described the plans for the redecoration of one of the bedrooms. There was a large sitting room and dining area together with a conservatory. One of the downstairs rooms had been set up as a relaxation room with special lighting and activity equipment. The heating was under floor reducing the risk of residents accessing any hot surfaces. Staff said that the garden was enclosed and residents, who were unable to be safe away from the home on their own, were protected from coming to harm outside the property by locked gates. The floor covering to the downstairs shower room had degraded and was becoming difficult to clean. Mr Keepence later reported that this was planned to be replaced in the next month. Residents were involved in some laundry duties. Staff said that the adjacent garage housed the tumble dryer. The home was clean and no unpleasant odours were detected at an time during the inspection. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 17 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) 32, 34 & 36 The minimum standard of at least 50 per cent of staff having NVQ Level 2 have been exceeded. However do not benefit from updated training in other subjects. The home’s recruitment process is not robust enough to protect residents and it does not follow the Department of Health advice on the Protection of Vulnerable Adults. Staff are well supported by management. Staff are skilled and trained but this is not always supported by the records. EVIDENCE: Staff reported that all of them now had NVQ Level 2 and this exceeds the minimum standard of at least 50 per cent having Level 2. One staff held NVQ Level 3. Both staff talked about their previous experience in working in care homes. One staff said that they had completed the Learning Disability Award Framework-accredited training but a previous employer had retained the certificate. They went on to say that most of the certificates of training undertaken accompanied NVQ coursework which was being verified. Staff were advised that documentary evidence of staff qualifications and training must be retained in the home. Staff said they each had their own area of delegated administrative responsibility, for example, medication. Staff said they had regular staff meetings and supervision and felt well supported by management. They said that most of the staff had worked at the home since it opened and were well known by the residents. Staff had recently had appraisals and training needs had been identified. Staff said they needed to have updated training in managing challenging behaviour. Staff were seen to Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 18 manage a resident’s behaviours with calmness, firmness and resolved the issue the resident was expressing. One member of staff had commenced duties without a Criminal Records Bureau certificate being received or a PovaFirst request. Staff reported that this person did not work alone nor sleep in. However with only two staff on duty, this meant that they could not be properly inducted into post and had been included in the staffing numbers. As the manager was on leave and the staff personnel records could not be accessed it could not be determined whether all the records required by Regulation 18 had been obtained before the new staff started. Mr Keepence was advised to consult the Department of Health guidance on recruiting new staff whilst awaiting Criminal Records Bureau certificates. There was written evidence that the new member of staff was being inducted into their role. When this member of staff was on duty and having to be continually supervised, it resulted in all residents having to go in the vehicle when only some attended day services. Mr Keepence was advised to carry out a risk assessment with members of staff who were pregnant and consider how they were to be supported to continue working, particularly given the long shifts, up to 13 hours, and the potential for dealing with behaviours. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 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 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 & 42 The home is run for the best interests of the residents. Residents and staff would benefit from knowing who was in charge when Mrs Goadby had her days off. The home ensures residents are safe with risk assessment. Staff are not receiving updated health and safety training. EVIDENCE: Mrs Goadby was on leave during the inspection. The rota showed that Mrs Goadby worked mainly at weekends and had two days off during the week. There was no indication of who took delegated responsibility when she was not on duty. Mr Keepence reported that a deputy post existed in the past and he would consider senior cover for Mrs Goadby’s time off. Staff had been trained in infection control within the last year and most first aid certificates were in date. Moving and handling training had not been carried out since 2002 and staff will need to be updated. Environmental risk assessments had been updated. The accident log was being satisfactorily completed and there had been very few since the last inspection. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 20 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 x x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 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 3 3 2 2 Standard No 31 32 33 34 35 36 Score x 4 x 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wilcot Road (19) Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 2 x D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 21 no 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 YA 20 Regulation 13(2) Requirement The person registered must amend the medication error policy to include the statement that the Commission must be notified if any maladministration occurs. The registered person must ensure that all staff are regularly updated in moving and handling training The person registered must ensure that documentary evidence of staffs qualifications and training are retained in the home. The person registered must ensure that staff receive updated training in managing challenging behaviour. The registered person must ensure that all new staff do not commence working without a PovaFirst confirmation if the Criminal Records Bureau Certificate is delayed. The new worker must not work alone and be supervised by an appointed qualified and experienced member of staff. They cannot be considered part of the staffing rota until a negative Certificate is Timescale for action 30th June 2005 2. YA 42 13(5) & 18(1)(c)(i ) 18(1)(c)(i ) & 19, Schedule 2, para 5 18(1)(c)(i ) 18 & 19 31st August 2005 2nd June 2005 3. YA 35 & 41 4. YA 35 31st August 2005 2nd June 2005 5. YA 23 & 34 Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 22 obtained. 6. YA 6 & YA 41 17 The person registered must ensure that staff report on how they are meeting residents needs as described in the care plan. The person registered must seek further advice from the behavioural nurse or the community psychiatric nurse about strategies for deal with some behaviours The person registered must ensure that residents do no pay for meals that have already been paid for as part of the contract. The person registered must ensure that a policy and accompanying risk assessment is produced with regard to staff who may be pregnant 2nd June 2005 7. YA19 15 31st August 2005 8. YA 17 5(1)(c) & 16(2)(i) 12(5)(a) 2nd June 2005. 30th June 2005 9. YA 40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA 41 YA 16 YA 23 YA 37 Good Practice Recommendations The person registered should consider the use of vague statements such as inappropriate behaviour and uses body language to show feelings. The person registered should consider whether residents with a diagnosis of autism spectrum disorder would benefit from a more structured daily programme. The person registered should consider staff training in the procedure for the Protection of Vulnerable Adults The person registered should consider nominating a person to take delegated charge when the manager has designated time off. Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wilcot Road (19) D51_D01_S28332_WilcotRoad19_V230155_020605_Stage4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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