CARE HOME ADULTS 18-65
William Street (2) 2 William St Calne Wiltshire SN11 9BD Lead Inspector
Elaine Barber Unannounced Inspection 4th January 2006 14:40 William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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 William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service William Street (2) Address 2 William St Calne Wiltshire SN11 9BD 01249 817215 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) None United Response Mrs Margaret Williams Care Home 4 Category(ies) of Learning disability (4) registration, with number of places William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 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. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection and preparation took seven hours. The inspector spoke to three people who lived in the home, two members of staff and the manager, read records, including personal notes and medication records, and looked at the accommodation. A separate visit was made to the area office to check recruitment and staff training records. What the service does well:
Each person had an individual support plan and a daily routine. The plans were reviewed six monthly and objectives in the plan were monitored every two months to ensure that they were met. People knew that their assessed and changing needs and personal goals were reflected in their individual plans. People were able to take part in age, peer and culturally appropriate day time and leisure activities. They had a range of day time activities including a day service, work experience voluntary work and access to college courses. Their interests and hobbies included, swimming, cricket, sailing, music, the library, knitting, photography and bowling. People had opportunities to make choices including how to spend their time and how to be supported with personal care. They were involved in the routines of the home so that their rights were respected and their responsibilities were recognised in their daily lives. People received personal support in the way that they preferred and required. Their preferences for personal care and support were identified in their daily routines in their personal notes. People had access to specialist support and advice. They chose their own clothes and hairstyles. Their physical and emotional health needs were being met. All the people were registered with a GP and had access to specialist healthcare including a psychologist and psychiatrist. They also had regular appointments with the dentist and optician if required. Medication was stored appropriately and the required records were kept. The general arrangements for managing and recording medication ensured people were protected. There was a procedure about protection and staff had information about how to report an allegation of abuse using the local multi-agency adult protection procedures. Staff had appropriate training so that people were protected from physical abuse, neglect and self harm.
William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 6 People lived in a homely, comfortable and safe environment. The accommodation, furnishings and fittings were domestic in style. Each person had their own bedroom which was individually decorated and furnished. The home was generally clean and hygienic except some attention was needed to the laundry arrangements. There were two staff on duty at all times when people were at home and one member of staff sleeping in at night. Staff received a range of relevant skills and training. One person had a National Vocational Qualification level 2 and was working towards Level 3 and three staff were working towards an NVQ. Some staff had worked in the home for many years and were familiar with the people’s needs. People were supported by an effective team of staff, who were appropriately trained and competent. There was an appropriate recruitment procedure and all the required checks were made before a new member of staff was confirmed in post. People were protected by the home’s recruitment practices. The manager was appropriately qualified and kept her training up to date. There were management systems in place so that people were benefiting from a well run home. There was an extensive range of health and safety checks and measures so that people’s health, safety and welfare was promoted and protected. What has improved since the last inspection? What they could do better:
The staff had identified that the accommodation could be improved and updated for people’s benefit by some redecoration, which they planned. People will benefit from support by more qualified staff when three staff members have completed their NVQ’s. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 7 The financial records could be improved to safeguard people from financial abuse. It would be good practice when a person withdraws money from their cash box for the person and a member of staff to sign the record. When a person is unable to sign two members of staff should check and sign the record. To prevent people from being exposed to cross contamination a procedure should be put in place to ensure that food stored in the garage is not contaminated by soiled linen when it is laundered there. The cleanliness of the laundry area could also be improved by painting the walls and sealing the floor to make them more easy to clean. Further work was needed on the quality assurance system to ensure that people’s views underpin all self-monitoring, review and development by the home. The registered person must develop a system for reviewing and improving the quality of the care provided based on consultation with service users and their representatives. The registered person must supply a copy of the report of any review to CSCI and make a copy available to service users. 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) DS0000028465.V274902.R01.S.doc Version 5.1 Page 8 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 William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 9 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): These standards were not assessed. EVIDENCE: William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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 the following standard(s): 6 People knew that their assessed and changing needs and personal goals were reflected in their individual plans. 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. The person, members of their family and appropriate professionals were involved in the reviews. One person had an individual plan to reduce some behaviours. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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): 12, 14, 16 People were able to take part in age, peer and culturally appropriate day time and leisure activities. People’s rights were respected and their responsibilities were recognised in their daily lives. EVIDENCE: Information in the daily routines and support plans showed that people had a range of day time activities including a day service, work experience and voluntary work in a charity shop. One person’s objective following their review was to find a job. People also had access to the library and to college courses. Staff supported people to manage their own money. People’s objectives included the interests, hobbies and leisure activities which they wished to pursue. Staff supported people with activities on an individual basis including attending church, going bowling, music, the library, cricket, sailing, swimming, knitting and photography. The support plan objectives
William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 12 included planning for an annual holiday. At home people had a choice of music and TV programmes. Each person’s notes included a daily routine which reflected their choice of personal routine and how they wished to be supported. People chose how to spend their time. When they returned from their day time activities they chose to go to their own rooms or to the sitting room. People were involved in the routines of the home including cleaning their own rooms, doing their laundry, preparing their own meals, laying the table and clearing away. Privacy was respected and staff were heard to knock on people’s doors and only enter if invited. Staff talked to and interacted with the people on their return from the day service and not just to each other. People had unrestricted access to the shared areas of the home and to the garden. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People received personal support in the way that they preferred and required. People’s physical and emotional health needs were met. People were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: People’s preferences for how they were supported were reflected in their individual routines and specific support plans. Assistance with personal care was identified in the support plans and personal support took place in the privacy of people’s own rooms or the bathroom. People’s preferred times for getting up and going to bed were identified in the daily routines while meal times were fitted in with activities. People chose their own clothes and hairstyles and their appearance fitted with their personality. There was only one technical aid. One person had a wheelchair provided following an occupational therapist assessment. People had access to specialist support and advice including OT, psychology, psychiatry and community nursing. People also had access to advocacy and had support from their family and professionals.
William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 14 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. There was a separate record of medication leaving the home. A recommendation that all prescribed medication should have written instructions about their use had been addressed. Patient information sheets had been obtained for the drugs. Staff monitored the condition of people and called in the GP for review when there were changes. Staff had agreed a list of acceptable non-prescribed medication with the GP for two people and were discussing this issue with the GP for the third. All staff administered medication and had had training. A consultant reviewed the medication. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 People were protected from physical abuse, neglect and self harm but the financial records did not safeguard people from financial abuse. EVIDENCE: United Response guidance for staff was contained in a ‘Prevention of Harm’ policy and procedure. Staff members had also received a copy of ‘No Secrets in Swindon & Wiltshire’, giving guidance on the local arrangements for the reporting of suspected abuse. No allegations or incidents of abuse had been reported. Staff received training about prevention of harm. There was a physical intervention plan for one person. There was guidance about the management of people’s money, valuables and financial affairs. Two people were supported to manage their own money and the manager was appointee for one person. Records were kept of all financial transactions. Two people were able to sign the records when they received money. Staff signed the records when dealing with money. However, there was not always a second staff signature or a signature of the person when money was withdrawn. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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 the following standard(s): 24, 30 People lived in a homely, comfortable and safe environment. The home was generally clean and hygienic except some attention was needed to the laundry arrangements. 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. A requirement from the last inspection to clean a patch of mould from the shower room ceiling had been addressed. This had been caused by a leak in the upstairs bathroom, which had been repaired. There were systems for monitoring of health & safety. The accommodation was decorated in a homely manner and was comfortably furnished. Staff said that they planned to do some redecorating. 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) DS0000028465.V274902.R01.S.doc Version 5.1 Page 17 The home was maintained to a good standard and the accommodation looked clean and tidy. There were no unpleasant odours. There were infection control guidelines. The washing machine and tumble drier were kept at one end of the garage. At the other end two freezers and some vegetables were kept. There were no hand washing facilities but the shower room with a wash hand basin was nearby. Two people could do their own laundry independently. The washing machine had a high temperature wash to disinfection standards. The walls of the laundry area were unpainted breezeblocks and the floor was unsealed concrete so these were not easily cleanable. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34,35 People were supported by an effective team of competent staff who were appropriately trained. People were protected by the home’s recruitment policies and practices. EVIDENCE: There were six staff and one vacant post. One member of staff had National Vocational Qualification Level 2 and was working towards Level 3. Three other staff were working towards an NVQ. Once these staff members have qualified over 50 of care staff will have an NVQ and this standard will be met. Most staff members had experience of working with people with learning disabilities and had a range of relevant training. There was an annual training plan for the Western Area of United Response. All staff had in-house training in food hygiene, first aid, health and safety, manual handling. medication, challenging behaviour, ‘Prevention of harm’ and ‘The way we work’, a course about the ethos of the organisation. Training needs were identified in supervision and appraisal. Several staff had been in post many years and had a wide range of training. The training records showed that they kept their training up to date and had attended a range of courses including autism, epilepsy awareness, values, sexuality and Makaton
William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 19 signing. New staff had specialist Learning Disability Award Framework induction and foundation training. Staffing levels had been raised before the last inspection 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. One member of staff stated that there was double cover during evenings and weekends so that they could take people out. The local community team for people with learning disabilities provided specialist services. There was a recruitment procedure and the recruitment records of one new member of staff showed that this was being followed. New staff were appointed following an application form, interview, two written references, a Criminal Records Bureau check and a Protection of Vulnerable Adults List check. The new member of staff had had all these checks and had completed a declaration that they had no offences. Copies of their previous training certificates were kept. Since being in post this person had had an induction and attended all eight courses that staff were required to take by the organisation. New staff were given 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. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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 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, 39, 42 People were benefiting from a well run home. Further work was needed on the quality assurance system to ensure that people’s views underpin all self-monitoring, review and development by the home. People’s health, safety and welfare was promoted and protected. EVIDENCE: The manager has responsibility for a number of homes that are run by United Response in the North Wiltshire area. The manager has a Registered Nursing qualification, a diploma in management studies and a qualification in the care of people with a learning disability. She keeps her training updated. There was a ‘Getting it Right’ manual which was a quality assurance manual with policies and procedures to ensure that a range of standards were met. The area manager conducted the monthly visits as required under Regulation
William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 21 26 of the Care homes Regulations. The manager conducted two monthly checks of health and safety, finance, training, supervision and care. There was a two year corporate plan for United Response. There were annual care reviews and monitoring of objectives to demonstrate year on year development for each person. The manager reported that at present there were only monthly monitoring visits to assure quality. However, they were developing a questionnaire to send to a range of stakeholders to obtain their views of the service. These had not yet been sent and there was no report of the findings. There was a health and safety handbook with action to be taken in order to comply with the relevant regulations. A number of risk assessments and safe working procedures had been recorded. A risk management manual had been produced by United Response. There were arrangements for the training of staff in moving and handling, fire safety, first aid and food hygiene. A monthly ‘hazard’ inspection of the home was carried out. Hot water temperature regulators had been fitted to all outlets, other than in the kitchen. Hot water temperatures were taken and recorded weekly and before bathing. There were individual risk assessments for bathing. There were COSHH assessments, the boiler and equipment were regularly serviced and portable appliances were tested annually. There was a fire risk assessment and records of fire safety checks. There were risk assessments about the safety of radiators and windows. These were not considered to pose a risk to people who lived in the home so radiators were not covered and windows were not restricted. There were general risk assessments about safe working practices. Accidents were recorded and reported if appropriate. William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 23 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 YA39 Regulation 24 Requirement The registered person must develop a system for reviewing and improving the quality of the care provided based on consultation with service users and their representatives. The registered person must supply a copy of the report of any review to CSCI and make a copy available to service users. Timescale for action 14/03/06 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 YA23 Good Practice Recommendations It would be good practice when a person withdraws money from their cash box for the person and a member of staff to sign the record. When a person is unable to sign two members of staff should check and sign the record. A procedure should be put in place to ensure that food stored in the garage is not contaminated by soiled linen when it is laundered there. The cleanliness of the laundry area could be improved by painting the walls and sealing the floor to make them more
DS0000028465.V274902.R01.S.doc Version 5.1 Page 24 2. 3. YA30 YA30 William Street (2) easy to clean. 4. YA36 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. (Carried forward from the previous inspection). William Street (2) DS0000028465.V274902.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Chippenham Area Office 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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