CARE HOME ADULTS 18-65
William Street (2) 2 William Street Calne Wiltshire SN11 9BD Lead Inspector
Elaine Barber Unannounced 18th July 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. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service William Street *(2) Address 2 William Street Calne Wiltshire SN11 9BD 01249 817215 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) United Response Mrs Margaret Williams Care Home 4 Category(ies) of LD Learning Disability registration, with number of places William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th March 2005 Brief Description of the Service: 2 William Street is part of ‘North Wiltshire Community Living’, which is run by the national charity, ‘United Response’. 2 William Street is a detached house in a residential area and is the residents permanent home so long as this is appropriate to their needs. The home is located on the northern side of Calne. There is a parade of shops situated a short walk from the home. A wider range of shops and services were available in Calne town centre. A house vehicle is used when transport is needed. Each resident receives personal care and support throughout the day from a permanent staff team. Each person has their own room on the first floor. The philosophy of care emphasises the importance of an ordinary, domestic home environment and the involvement of people with a learning disability within the wider community. The staff team operates a system of ‘collective team management’. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection and preparation took eight hours. The inspector spoke to four people living in the home, three members of staff and the manager, read records, including personal notes and medication records, and looked at the accommodation. What the service does well: What has improved since the last inspection?
The statement of purpose had been amended to include information about the communal room sizes to provide more accurate information about the service for potential service users. Each person had an up-to-date service user plan to ensure that all their needs were met. Following a six monthly review of the plans each person also had a series of objectives with a plan of action to ensure that all the objectives were achieved. Information about individual people, particularly risk assessments, was being kept separately in their individual files to ensure confidentiality when accessing personal records. A dietician had provided advice about nutrition to ensure that people’s food provided the nutrition they needed. A record was being kept of all medicines entering and leaving the home to ensure all medication was accounted for and people received the correct medication. Written alterations on the printed administration record sheets were being signed and dated by two staff to ensure an accurate record was made so that people received the correct doses of medication. Patient information sheets had been obtained for some medicines to ensure that people had detailed instructions to ensure that they took these medicines safely. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 6 The staffing levels had been increased to ensure that two members of staff were on duty at all times during the day and evening so that staff had sufficient time to complete all tasks, to spend time with people and to take people out individually. The manager had been spending more time in the home and additional support had been provided by the book keeper, secretary and finance manager. Staff were feeling more supported and people were benefiting from a more relaxed atmosphere. 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. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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 William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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) 2 People’s individual needs and aspirations were assessed. EVIDENCE: The four people had all moved into the home before the introduction of care management and did not have care management assessment on admission. They had lived in the home for many years and there was assessment information in their files. They had also had reassessments from social workers. People had support plans for particular needs. People had their needs reviewed and new objectives were set. These monitored two monthly. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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 People knew that their assessed and changing needs and personal goals were reflected in their individual plans. With support, people made choices and decisions about their lives and took risks as part of their independent lifestyle. EVIDENCE: Each person had a record of their daily routine and support plans for particular areas of need such as personal care and going out socially. Each person also had a six monthly review when objectives were set for the next six months, these were recorded in a plan of how the objectives were to be achieved and were monitored two monthly. One person had an individual plan to reduce self harm. Limitations were recorded in the plans and were in people’s best interests, e.g. to reduce self-harm. There was information in the plans about how staff advise people about the consequences of their choices and decisions. One person was a member of a women’s group. There were records in the personal notes of how people had made choices. Staff supported people to manage their money, go to the bank, do their shopping and decide what to buy. The manager was the appointee for one person.
William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 10 Each person had an individual risk assessment. The focus was on the benefits for the person of participating in activities, which may pose a risk. Action to reduce the risk was recorded and risk assessments were reviewed. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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) 13, 15, 17 People used local facilities and were part of the community. They had a range of appropriate leisure activities and were supported to maintain family and personal relationships. EVIDENCE: Support with leisure activities was included in the support plans and integration into community life was included in the review objectives. People said that they went shopping, to the pub, swimming, the leisure centre, horse riding, church, the cinema and the theatre. Two people had been to a reenactment of the battle of Roundway Down the previous weekend and one person was going to the theatre in Bristol the following weekend. During the inspection another person went clothes shopping and to the bank. Since the last inspection the staffing levels had been increased. There were two staff on duty at all times so they could support people with more activities outside the house during the evenings and weekends. Support needed to maintain contact with family and friends was recorded in the support plans and review objectives. People gave examples of how they were supported to keep in contact with their families and friends. People had
William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 12 opportunities to meet other people through their day placements and work activities and were supported to maintain personal relationships. People were supported to choose their own meals, shop for the ingredients, prepare and cook their food. They took turns to prepare the meals. There was a varied menu, which reflected personal choice. A dietician had provided advice about the nutritional balance of the menus. People chose where they ate their meals including the dining room or the lounge. Meal times were flexible and were fitted in with people’s activities. People said that they enjoyed their meals. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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) 19, 20 People’s physical and emotional health needs were met and people were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Each person had an annual plan of health care and was registered with the local GP. Appointments with health professionals such as the GP, dentist and optician were recorded. People also saw a podiatrist, community nurses, a psychologist, psychiatrist and physiotherapist. Staff supported people to attend GP, outpatient and other appointments. Staff monitored people’s health and ensured they had access to health screening. There was a clear procedure for administering medication to service users and helping them to take it. A record was kept of each person’s medication. Each person’s consent to medication was obtained and recorded in their individual plan. Records were kept of medicines received, administered leaving the home and disposed of. A previous requirement to record medication leaving the home had been addressed. The administration record had a symbol to record leave or absence when someone took medication out of the home. There was a separate record of medication leaving the home. A recommendation that all changes to the printed administration records should be signed by two people and dated had also been addressed. Patient information sheets had been
William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 14 obtained for all but two drugs. The pharmacist provided advice and staff monitored the condition of people and called in the GP for review when there were changes. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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, People knew how to make a complaint and felt that their views would be listened to and acted upon. EVIDENCE: There had been no complaints about the home since the last inspection. There was a written complaints procedure and a more pictorial and userfriendly version was available to service users. Each person had a copy of the pictorial version of the complaints procedure in their file. People said that they would tell a member of staff or the manager if they had a problem and they would sort it out. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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 People lived in a homely, comfortable and safe environment except for the shower room, which required some attention to the ceiling. EVIDENCE: The location and outlook of the home was in keeping with the stated aims. The property was in keeping with the other houses in the surrounding residential area. The upkeep of the home and on-going maintenance appeared to be of a good standard. The kitchen and bathrooms had recently been refitted although a patch of mould had developed on the shower room ceiling. There were systems for monitoring of health & safety. The accommodation was decorated in a homely manner and was comfortably furnished. The premises were accessible to all the people who lived there and people had access to local shops and amenities. Each person had their own room which was individually decorated and furnished. The Fire Safety Officer visited in June 2003 and the Environmental Health Officer visited in March 2003. There were no outstanding requirements. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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) 33, 34,35,36 People were supported by an effective staff team and their individual and joint needs were met by appropriately trained staff. People were supported and protected by the home’s recruitment policies and practices. People benefited from a supported staff group. EVIDENCE: Since the last inspection a previous requirement to raise the staffing levels had been addressed. Staffing levels had been raised to meet people’s changing needs. The rota and comments from staff showed that there were two staff on duty at all times during the day and evening and one person sleeping in. Two members of staff stated that it was much better with two staff on duty at all times because they could now complete all tasks including the paperwork, spend more time with people and take them out individually. The people and the staff appeared to be more relaxed than at the two previous inspections. New staff had been recruited and there were both male and female staff. The local community team for people with learning disabilities provided specialist services. There was a recruitment procedure and the recruitment records of two new staff showed that this was being followed. New staff were appointed following an application form, interview, two written references, a Criminal Records
William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 18 Bureau check and a Protection of Vulnerable Adults List check. One of the people who lived in the home had been involved in the interviews. New staff said that they had received a copy of the General Social Care Council code of conduct and practice and a statement of terms and conditions. They had a six month probationary period. One new staff member had a training plan and had received training in first aid and food hygiene. Two new staff had undertaken the Learning Disability Award Framework induction, one had gone on to the foundation training and was starting National Vocational Qualification level 2. Existing staff had a range of appropriate training including NVQ. Staff reported and the minutes showed that there were monthly team meetings where staff discussed the needs of service users. These meetings were also used for peer group support and peer supervision. Staff said that the peer supervision included the manager who facilitated the meetings. There were annual appraisals. The manager and staff were satisfied with his arrangement and staff felt supported. However, consideration should be given to providing individual supervision to enable staff to have one to one support from the manager. There were grievance and disciplinary procedures and procedures about physical aggression towards staff. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.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) 37 People were benefiting from a well run home. EVIDENCE: William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 20 CRB checks on the Registered Manager and the Responsible Individual have been carried out. The Registered Manager has a State Registered Nurse qualification and a Diploma in Management Studies. She has also undertaken United Response management development training and support worker refresher training including manual handling and health and safety. The manager and staff reported that the manager attends team meetings once a month. The manager undertakes some of the home’s management tasks from her base in the United Response area office. The manager is also the registered manager for other homes. At two previous inspections owing to shortfalls in care planning, personal records, medication, staff cover and staff supervision a recommendation was made that consideration should be given to the manager spending more of her working hours in the home. Since the last inspection the manager had been undertaking some shifts and visiting the home more frequently. Additional support had also been provided by the book keeper, secretary and finance manager. Improvements had been made in care planning, personal records, medication and staff cover. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 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 3 x x Standard No 22 23
ENVIRONMENT Score 3 x 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 2 x x x x x x Standard No 11 12 13 14 15 16 17 x x 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
William Street (2) Score x 4 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 22 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 Regulation Requirement Timescale for action 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 20 24 36 Good Practice Recommendations All prescribed medicines should have written or printed instructions as to their use provided by the doctor either on the prescription or as separate instructions. The shower room could be improved by cleaning the mould from the ceiling and repainting if indicated. Staff should receive regular individual supervision from their line manager at least six times a year in addition to regular contact on day to day practice. William Street (2) D51_D01_S28465_WILLIAMST_v200965_180705_STAGE_4.doc Version 1.30 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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