CARE HOME ADULTS 18-65
Willows (The) The Old Grove, High Pitfold, Hindhead, GU26 6BN Lead Inspector
Graham Cheney Unannounced 29 June 2005 10:30 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. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Willows (The) Address The Old Grove, High Pitfold, Hindhead, Surrey, GU26 6BN 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) 01428 609851 Robinia Care - South Region Mrs Sharron Ann Foulger CRH Care Home 10 Category(ies) of LD Learning disability, 10 registration, with number SI Sensory Impairment, 2 of places Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The age/age range of the persons to be accommodated will be: 18-50 YEARS. 2 Of the ten (10) service users in category LD (Learning Disabilities), two (2) may also fall within the category SI (Sensory Impairment). Date of last inspection 20-October-2004 Brief Description of the Service: Robinia Care Ltd provides a range of residential and day services for people with disabilities on the Old Grove Site at High Pitfold Hindhead. The Willows is a detached bungalow that offers long term residential care for up to 10 adults aged between 19 and 35, with learning disabilities who require a high level of support. The care home has 10 single rooms, three bathrooms and a shower room. The home can be viewed as having two units each providing support for five service users whose rooms are situated in each unit. Each unit has large lounge/dining rooms, although kitchen and laundry facilities are shared. Although designed as two units service users were able to access all areas of the home. Service users have ready access to the immediate grounds, which consists primarily of a hard surface area. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of The Willows in the CSCI year 2005/2006. It was an unannounced inspection, which meant that residents and staff did not know that it was to take place. The inspection commenced at 10.30 a.m. and finished at 1.00 p.m. This inspection was arranged as a part of an audit or review of all the Robinia services in Surrey and Hampshire to look at key aspects of the way the homes were operating. This followed on from issues raised vulnerable adults procedures. (Vulnerable Adult procedures are triggered when there is a concern that clients may be at risk of abuse). It should be noted that the vulnerable adults concerns were not specifically related to The Willows, i.e. there was no particular concern for the care or well being of service users in the home. The implementation of Robinia’s polices and procedures were however assessed. To ensure confidentiality all matters relating to vulnerable adults will be reported under a separate cover. The inspection focussed on care planning and practice, staff recruitment and training, service users’ activities and supervision and finances. The inspector had a full tour of the home and spent time with the senior staff, discussing the way the home was operating, before joining service users for lunch. Although clients in the home had limited verbal communication skills, the inspector spent time engaging with them wherever possible and observing the interaction between them and staff. The rest of the inspection was taken up looking at staffing arrangements, care plans, personal finances, medication and other documents and records. The inspector was made very welcome in the home and found the senior care and staff very open and helpful. What the service does well:
There was evidence from observations and discussions with staff linked to information recorded in care plans to demonstrate an ongoing commitment to improving the service to ensure that clients’ needs were properly assessed and that care and support were provided to meet those needs. Care plans sampled provided a satisfactory level of information about the individual, identifying the individual’s needs and how these were to be met.
Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 6 A number of the service users had regular access to The Grove day centre (Robinia’s Day Centre) for specialist support situated on the same site. Although not regulated by CSCI the inspector was invited to visit the centre to observe the range of activities provided. The Grove provides a range of facilities for clients including a swimming pool used for hydro-therapy, sensory and therapy rooms, horticulture, a communication facility and life skills i.e. cooking. Service users have the option of returning home at lunchtime or having a meal in the centre. Centre staff also support residential staff taking service users into the community. Internally there are two large lounges with dining areas for the two groups of five service users. Service users were able to access all areas, although the kitchen and office were kept locked when not in use to ensure safety and confidentiality. In additional the home provides a range of aids and adaptations to support the daily life of clients. The home has two minibuses to take clients out for trips, appointments or day care, although the funding of transport was one of the areas of concern, please see below. In the interactions observed between staff and clients, staff demonstrated a good understanding of the clients’ behaviours and seemed to respond promptly and appropriately to meet their needs. The inspector joined a group of service users for lunch, during which staff were observed supporting them according to their needs, some needed help with feeding, others were more independent just needing supervision and occasional guidance. Staff were seen to help in a kind and caring manner. Discussion with senior staff and review of the staff roster indicated that staffing levels were being maintained, with evidence that agreed and funded one to one commitments were being met. What has improved since the last inspection?
Evidence presented indicated that both of the requirements of the last inspection had been met. These related to: 1. The need to review the way medication is administered, which the manager has completed. The outcome of this was that the staff continue to dispense medication in the office and administer (give) it to the service user elsewhere. This was not in line with the Royal Pharmaceutical Society’s guidance, but the manager had risk assessed the process and considered it to be the safest way of giving medication. Evidence presented showed that medication given was being witnessed by a second member of staff. 2. At the last inspection there were concerns that leads trailing from lights and televisions etc may present a safety hazard. Observations confirmed that all such wiring had been tidied and secured safely. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 7 There was evidence that permanent or regular staff were covering most shifts and that the use of agency staff had decreased. This should provide service users with more consistent support. Otherwise this was a brief inspection and no other improvements were observed. On the evidence of this inspection the home continues to provide a good level of care and accommodation to the current service users. 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. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 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 standard(s) Not assessed. These standards were not assessed on this occasion. EVIDENCE: Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, Whilst the evidence presented indicated that the assessed standards were being met, it was observed that the clients were very dependent on the staff to support them and enable them to retain some control and independence in their lives. This highlighted the importance of having detailed care plans and a regular staff group in providing a consistent level of care and support in meeting clients’ needs and aspirations. EVIDENCE: Care plans sampled provided a satisfactory level of information about the individual, identifying their needs and how these were to be met. There was evidence from observations and discussions with staff linked to information recorded in the care plans to demonstrate an ongoing commitment to improving the service to ensure that clients’ needs were properly assessed and that care and support were provided to meet those needs. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 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) 11, 12, 13, 14 Evidence gathered indicated that the assessed standards were being met. There were opportunities for clients to access the local community, however there were some issues around the funding of transport, which were being investigated under Vulnerable Adult procedures and will be reported under separate cover. The needs of the current clients made them highly dependent on staff and this was an area needing continual monitoring. EVIDENCE: The home has two minibuses to take clients out for trips, appointments or day care, although the funding of transport was one of the areas of concern, please see below. Finding staff able to drive had been an issue previously. A number of the service users had regular access to The Grove day centre (Robinia’s Day Centre) for specialist support situated on the same site. Although not regulated by CSCI the inspector was invited to visit the centre to observe the range of activities provided. The Grove provides a range of facilities for clients including a swimming pool used for hydro-therapy, sensory and therapy rooms, horticulture, a communication facility and life skills i.e. cooking. Service users have the option of returning home at lunchtime or
Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 12 having a meal in the centre. Centre staff also support residential staff taking service users into the community. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Evidence gathered indicated that the assessed standards were being met. Indications were that service users’ health and personal care needs were being met. The improved process for witnessing medication given should reduce the risks to service users. EVIDENCE: The need to review the way medication is administered, which the manager has completed. The outcome of this was that the staff continue to dispense medication in the office and administer (give) it to the service user elsewhere. This was not in line with the Royal Pharmaceutical Society’s guidance, but the manager had risk assessed the process and considered it to be the safest way of giving medication. Evidence presented showed that medication given was being witnessed by a second member of staff. Care plans sampled included good records on health and personal care needs being met. Robinia has retained the services of a GP to provide direct support to service users. Senior management indicated that specialist health care professionals may be employed to support service users in addition to their normal rights to access the health service. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 14 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) This inspection was arranged, in part, to look into concerns, which have been raised under Vulnerable Adult procedures. Findings relating to these will be reported separately. Judgement of these standards will be reported following the conclusion of the Vulnerable Adult procedures and followed up at the next inspection. EVIDENCE: This inspection was arranged as a part of an audit or review of all the Robinia services in Surrey and Hampshire to look at key aspects of the way the homes were operating. This followed on from issues raised vulnerable adults procedures. (Vulnerable Adult procedures are triggered when there is a concern that clients may be at risk of abuse). It should be noted that the vulnerable adults concerns were not specifically related to The Willows, i.e. there was no particular concern for the care or well being of service users in the home. The implementation of Robinia’s polices and procedures were however assessed. To ensure confidentiality all matters relating to vulnerable adults will be reported under a separate cover. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 15 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, 25, 26, 27, 28, 29 The Willows was a pre-existing, (prior to 2002) registered care home. Given this the evidence gathered during this inspection confirmed that the home provides a good level of accommodation appropriate to the needs of the current residents. EVIDENCE: Internally there are two large lounges with dining areas for the two groups of five service users. Service users were able to access all areas, although the kitchen and office were kept locked when not in use to ensure safety and confidentiality. In additional the home provides a range of aids and adaptations to support the daily life of clients. At the last inspection there were concerns that leads trailing from lights and televisions etc may present a safety hazard. Observations confirmed that all such wiring had been tidied and secured safely. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 16 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) 31, 33, 34, 36 Evidence gathered indicated a sound level of compliance with these standards. Not relying on agency staff helps to provide greater consistency of care and ensure staff are trained to an appropriate level and understand and follow policies procedures. EVIDENCE: In the interactions observed between staff and clients, staff demonstrated a good understanding of the clients’ behaviours and seemed to respond promptly and appropriately to meet their needs. The inspector joined a group of service users for lunch, during which staff were observed supporting them according to their needs, some needed help with feeding, others were more independent just needing supervision and occasional guidance. Staff were seen to help in a kind and caring manner. Discussion with senior staff and review of the staff roster indicated that staffing levels were being maintained, with evidence that agreed and funded one to one commitments were being met. There was evidence that permanent or regular staff were covering most shifts and that the use of agency staff had decreased. This should provide service users with more consist
Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 17 Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 18 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) 38, 42 Aspects of these standards were inspected under the Vulnerable Adult procedures and will be reported as such. Judgements have not been made on standards 40, 41 or 43 due to this situation With the exception of Standard 42 Health & Safety (please see below) the evidence gathered indicated compliance with the standards. Indications were that the service benefits from sound operational management. EVIDENCE: The inspector found evidence that the staff were dispensing chemicals (possibly disinfectant) from the original container into smaller spray containers for use in the home. One such container had been left in a service users bedroom. This was contrary to COSHH (The control of substance hazardous to health) regulations and must be stopped promptly to reduce the potential risk to staff and clients. Inspectors looked at how the home supported clients with their personal monies and allowances. This was particularly important as all of the current
Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 19 clients needed support in this respect, making them potentially very vulnerable. The way clients’ monies were used and what they were charged for were concerns raised under the vulnerable adults procedures and will be reported as such. Findings in The Willows were that Robinia’s current policies on supporting service users with personal finances were being properly followed. Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 x Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score 3 x 3 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Willows (The) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 2 x H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 13 Requirement Inspectors found evidence that the staff were dispensing chemicals (possibly disinfectant) from the original container into smaller spray containers for use in the home. One such container had been left in a service users bedroom. This was contrary to COSHH (The control of substance hazardous to health) regulations and must be stopped promptly to reduce the potential risk to staff and clients. Timescale for action Ongoing 04/0705 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 Good Practice Recommendations Willows (The) H58_s13887_The Willows_v236669_290605_stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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