CARE HOME ADULTS 18-65
William Street (2) 2 William St Calne Wiltshire SN11 9BD Lead Inspector
Elaine Barber Key Unannounced Inspection 6th February 2007 10:40 William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 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.V331178.R01.S.doc Version 5.2 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.V331178.R01.S.doc Version 5.2 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) www.unitedresponse.org.uk United Response Mrs Margaret Williams Care Home 4 Category(ies) of Learning disability (4) registration, with number of places William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th January 2006 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 are available in Calne town centre. A house vehicle is used when transport is needed. Each person who lives in the home 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 fees are £1088.54 per week. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home on 6th February 2007. During the visit information was gathered using: • • • • Observation Discussion with the three people who lived in the home Discussion with two staff Reading records including care records. Other information and feedback about the home has been received and taken into account as part of this inspection: • • The manager provided information prior to the inspection about the running of the home. Two comment cards were received from people who lived in the home. What the service does well:
People’s individual needs were assessed so that their needs could be met. Each person who lived in the home had their needs assessed by staff at 2, William Street. They also had re-assessments by social workers. Detailed support plans had been developed for different needs. There was evidence that these were reviewed. New objectives were set and support plans were amended. People had their abilities, needs and goals reflected in their individual plans. There was evidence that people could make choices. People were supported to manage their money. Any restrictions were recorded and seen to be in the person’s best interests. People made decisions about their lives with assistance as needed. Risks were assessed and the benefits of participating in activities were considered. People were supported to take risks and given opportunities for independence. People were provided with a range of activities and opportunities to go out into their local community. They attended a day service, work experience and voluntary work. They also went to church, the shops, library, pub and restaurants. Activities were suited to their individual needs and preferences. People were able to maintain and develop appropriate relationships with family and friends. One person had visited their mother on the day of the inspection.
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 6 People kept in contact with people living in other houses which were part of the organisation. People were involved in the routines of the home including, washing, shopping and cleaning. They made choices and decisions. People’s daily lives had an appropriate balance between necessary routines, and individual choice. People were involved in shopping for food and meal preparation. They chose the meals they ate. People were offered healthy, nutritious and enjoyable meals. There was information about people’s individual needs and preferences in their assessments and care plans. People’s routines were recorded in their personal notes so that people received support in ways they preferred and required. People’s healthcare needs were included in their personal plans. Each person was registered with a GP and they saw a range of health professionals including a physiotherapist, community nurse, occupational therapist, psychiatrist, dentist, optician and chiropodist. People’s physical and emotional health needs were met. Staff supported people to take their medication. There were appropriate arrangements for the storage and administration of medication and people were generally protected by the home’s policies and practices. There was a complaints procedure and the people who lived in the home knew how to make a complaint. People’s views were listened to and acted upon. There were policies and procedures about protection from abuse and staff had received relevant training. People were protected from abuse, neglect and self harm. There was a large lounge with a dining area and a large kitchen. People lived in a comfortable, clean and safe environment, suitable to their needs. The shared spaces complemented people’s rooms. There were infection control guidelines and the laundry facilities met the needs of the people who lived in 2, William Street. The home was clean and hygienic. There were six support workers and the manager. There was a range of training to ensure that staff could meet people’s diverse needs. All the staff were working towards a National Vocational Qualification. People were supported by an effective staff team, who were appropriately trained and competent to meet their needs. There had been one new staff member since the last main inspection and all the appropriate recruitment checks were completed before they started work. People were protected by the home’s recruitment practices. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 7 The registered manager was suitably qualified, competent and experienced, so that people benefited from a well run home. A quality assurance survey had been conducted and views of people who lived in the home and relevant professionals had been collected. A report had been written and areas for improvement had been identified. People’s views underpinned all selfmonitoring, review and development by the home. There was a range of health and safety measures and staff had received appropriate training. People’s health, safety and welfare were protected by the health and safety systems. What has improved since the last inspection? What they could do better:
Some improvements need to be made to the recording of medication to ensure that the right medicine is given to the right person at the right time. When a member of staff makes a written addition to the medication administration records they should sign and date the record and a second member of staff should witness the addition and sign the record to confirm that it is correct. When medication is dispensed with the instructions ‘As directed’ staff must refer back to the prescribing doctor to obtain full directions to ensure it is given correctly. Some improvements could be made to the financial records to ensure that people are safeguarded from financial abuse. It would be good practice when a person withdraws money from their cash box for the person and a member
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 8 of staff to sign the record. When a person is unable to sign two members of staff should check and sign the record. The cleanliness of the laundry area could be improved by painting the walls and re-sealing the floor to make them more easy to clean. 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. The summary of this inspection report can be made available in other formats on request. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 9 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.V331178.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person’s individual needs were assessed so that their needs could be met. EVIDENCE: There had been no changes since the last inspection. Three people lived in the home and they all moved into the home before the introduction of care management and did not have care management assessments 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 were monitored every two months. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s assessed needs were reflected in their individual plans. People made decisions about their lives with assistance as needed. People were supported to take risks and given opportunities for independence. EVIDENCE: The care records of three people were read. 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.V331178.R01.S.doc Version 5.2 Page 12 Limitations were recorded in the plans and were in people’s best interests, for example 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. Comment cards were received from two people who lived in the home. They were completed with the help of a support worker. One said that they had made the decision to move into the house and the other said that they made the decision with help. One said that they always make decisions about what they do each day and the other said that they sometimes make these decisions. Both said that they can do what they want during the day and evening and at weekends. During the inspection one person was at home all day and was encouraged by staff to make decisions about what he wanted to do. They were offered choices to go out or to stay at home. At one point they went to the local shop independently. Two people returned home after going to their day service. They chose where to spend their time on their return and staff asked them what they wanted for their evening meal. Each person had individual risk assessments for example access to windows with no restrictors to limit how far they can open, and going on holiday. 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) DS0000028465.V331178.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were provided with a range of activities and opportunities to go out into their local community. Activities were suited to their individual needs and preferences. People were able to maintain and develop appropriate relationships with family and friends. People’s daily lives had an appropriate balance between necessary routines, and individual choice. People were offered healthy, nutritious and enjoyable meals, in line with individual needs and choices. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 14 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. People also had access to the library. Some of the day services were being withdrawn and staff were helping people to find alternatives. However, it was not certain which aspects of the service would be withdrawn and staff said that it was difficult to plan. Staff supported people to manage their own money. One person liked to go for long walks. Another person said that they enjoyed their work and voluntary work. 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 included planning for an annual holiday. At home people had a choice of music and TV programmes. Staff had begun to buy games and puzzles in anticipation of people spending more time at home if day services closed. One person said that they enjoyed knitting, playing patience, doing puzzles and playing games. 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 knocked on people’s doors and only entered 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. 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, and to church. One person went to the local shop independently and another went to the hairdresser independently. They also went to the bank, the library and for meals out with support. There were usually two staff on duty so they could support people with more activities outside the house during the evenings and weekends. The personal notes showed that each person had a holiday. One person had been to Bournemouth and another had been to Butlins. 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 opportunities to meet other people through their day placements and work
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 15 activities and were supported to maintain personal relationships. One person had been to see their mother on the day of the inspection. 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 member of staff said that people tended to choose what they were going to have on the day. A dietician had provided advice about the nutritional balance of the menus. One person said that they helped to prepare the meals. They were peeling potatoes during the morning of the inspection. 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) DS0000028465.V331178.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People received personal support in the way that they preferred and required. People’s physical and emotional health needs were met. People were generally protected by the home’s policies and procedures for dealing with medicines although some improvements could be made to ensure safety. 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
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 17 hairstyles and their appearance fitted with their personality. One person had a wheelchair provided following an occupational therapist (OT) assessment. They also had an adjustable arm chair in the living room. 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. Each person had an annual plan of health care and was registered with the local GP and dentist. People also saw other professionals including a podiatrist, optician, community nurses, a continence advisor, an ophthalmologist, a psychologist, psychiatrist and physiotherapist. A record was made of all appointments and the outcome. 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 people and helping them to take it. A monitored dosage system was used and medication was stored in a locked cabinet. 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 were some written additions to the administration records. Sometimes these additions had two staff signatures and sometimes they were not signed. Two staff should sign when any amendments are made to confirm that the written information is correct. Some of the instructions on the administration records said ‘as directed’. A member of staff said that the directions were on the packet. However information on the packet stated ‘as directed by the prescriber’. Clear instructions must be obtained to ensure that medication is given correctly. Patient information sheets were kept for all prescribed medication. 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 each person. Guidelines for the administration for as required medication were agreed with the psychiatrist. All staff administered medication and had had training. A consultant reviewed the medication. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People knew how to make a complaint and felt that their views would be listened to and acted upon. People were protected from physical abuse, neglect and self harm but some improvements could be made to the financial records to ensure people are safeguarded from financial abuse. EVIDENCE: There was a written complaints procedure and a more pictorial and userfriendly version was available to people who lived in the home. Each person had a copy of this pictorial version in their file. Two people commented about complaints in their comment cards. One person said that they knew to speak to a member of staff if they were not happy. Both said they sometimes knew how to make a complaint. There had been no complaints since the last inspection. At the last inspection 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’ booklet 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.
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 19 There had been one allegation which had been referred through the local procedures and was being investigated. 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. A recommendation was made at the last inspection that when a person withdraws money from their cash box the person and a member of staff should sign the record. When a person is unable to sign two members of staff should check and sign the record. This had been partly addressed, One person who could sign had signed each time they received money and another had signed on most occasions when they with drew money but there were four occasions when there was only a staff signature. Staff signed on behalf of the third person but on occasions there was only one signature. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a homely, comfortable and safe environment. The home was generally clean and hygienic except for some improvements which could be made to the laundry arrangements. EVIDENCE: 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. There were systems for monitoring of health and safety. The accommodation was decorated in a homely manner and was comfortably furnished. The living room and dining room had been redecorated since the last inspection and people had chosen the colour and the new curtains. There were also new sofas and one person said that they had been to the shop with a
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 21 member of staff to choose them. The hall stairs and landing were in the process of being repainted and the front garden had been landscaped. 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 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 there were two freezers. A recommendation was made at the last inspection that 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. This had been addressed by removing vegetables which had been stored in the garage and keeping the two freezers separate from the washing area. 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. There was a further recommendation at the previous inspection that the cleanliness of the laundry area could be improved by painting the walls and sealing the floor to make them more easy to clean. The walls of the laundry area were still unpainted breezeblocks but the concrete floor had been sealed to make it easier to clean. However there had been a problem with this and a member of staff said that it needed to be done again. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,24,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 was working towards National Vocational Qualification Level 3 and five other staff were working towards NVQ level 2. 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
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 23 ‘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, equality and diversity and Makaton signing. New staff had specialist Learning Disability Award Framework induction and foundation training. The rota and comments from staff showed that there were one or two staff on duty at all times during the day and evening and one person sleeping in. Two staff were on duty 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 occasional use of agency staff. There was a recruitment procedure and the recruitment records of one new member of staff were checked at the area office. These showed that this procedure was being followed. New staff were appointed after completing an application form and being interviewed. Two written references, a Criminal Records Bureau check and a Protection of Vulnerable Adults List check were obtained. The new member of staff had had all these checks and had completed a declaration that they had no offences. Since being in post this person had had an induction. 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.V331178.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were benefiting from a well run home. 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
William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 25 qualification, a diploma in management studies and a qualification in the care of people with a learning disability. She keeps her training up to date. 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 26 of the Care Homes Regulations. The manager conducted checks of health and safety, finance, training, supervision and care every two months. 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. A requirement was made at the last inspection that 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. This had been addressed. The manager had obtained feedback from the people who lived in the home, their family and friends and other professionals. The manager had produced a report of the findings, areas for improvement had been identified, such as decorating the lounge, and an action plan had been developed to ensure improvements took place. A copy of the report had been sent to CSCI. 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, thermostatic radiator valves 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. A shelf had been put over the radiator in the bathroom to protect one person from touching the radiator. There were general risk assessments about safe working practices. Accidents were recorded and reported if appropriate. William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 26 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 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 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 27 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 YA20 Regulation 13-(2) Requirement When medication is dispensed with the instructions ‘As directed’ staff must refer back to the prescribing doctor to obtain full directions. Timescale for action 06/02/07 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 YA20 Good Practice Recommendations When a member of staff makes a written addition to the medication administration records they should sign the record and a second member of staff should witness the addition and sign the record to confirm that it is correct. 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. The cleanliness of the laundry area could be improved by painting the walls and re-sealing the floor to make them more easy to clean. 2. YA23 3. YA30 William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 William Street (2) DS0000028465.V331178.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
