Inspection on 15/07/09 for Wilmott`s View

This inspection was carried out on 15th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wilmott`s View 25/07/07

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wilmott`s View 54 Wellingborough Road Rushden Northants NN10 9YN The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry Date: 1 5 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 45 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 45 Information about the care home Name of care home: Address: Wilmott`s View 54 Wellingborough Road Rushden Northants NN10 9YN 01604475333 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : mina.d.msaada@hotmail.co.uk Msaada Care Limited care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: No person under the age of 18 years who falls within the category LD may be admitted to Wilmott’s view. No person over the age of 65 years who falls within the category LD may be admitted to Wilmott?s View. No one falling within the category of LD may be admitted to Wilmott’s View when there are 7 persons of category LD already accommodated within the home. The maximum number of persons accommodated within Wilmott’s View is 7. Date of last inspection 2 5 0 7 2 0 0 7 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 45 Wilmotts View is a care home owned by Msaada Care Ltd. It accommodates up to seven adults with a learning disabilities. Wilmotts View is a large family house located on a residential street leading into Rushden town centre. It offers seven en-suite bedrooms and communal lounge and a kitchen/dining room. Access to the first floor bedrooms is restricted to people who are physically able to manage stairs. There is a small attractive garden to the rear of the building. The Acting Manager gave us the details of the average fees charged, which is £1350.00 per Care Homes for Adults (18-65 years) Page 5 of 45 week. The fees are determined through an assessment of needs. There are additional charges for personal expenditure. People who are considering using Wilmotts View are encouraged to contact the home directly. The full details of the home and any specific requirements can be obtained in the form of the Statement of Purpose and the Service User Guide. This is available in alternative formats upon request. The latest Inspection Report from the Care Quality Commission is available at the home or can be accessed via our website: www.cqc.org.uk Care Homes for Adults (18-65 years) Page 6 of 45 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 45 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We as written in this Inspection Report means, the Care Quality Commission (CQC). Any reference to the Commission for Social Care Inspection (CSCI), should now be taken as CQC, who hold the legal responsibility for regulating care services. As part of this inspection we looked at the Annual Quality Assurance Assessment (AQAA) completed by the manager overseeing the service at the home at the time and sent to us. This information is sent each year and tells us what they think of the service they provide. Page 8 of 45 Care Homes for Adults (18-65 years) The AQAA that was sent to us related to an older persons service not a younger adults service. This made it was difficult to measure the information against the regulations, which means the rules set out. We also looked at the other information sent to us. We gave out surveys to the people who live at the home and the staff who work at the home. We had 3 surveys back from the people using the service and none were returned from the staff. We did this key (main) inspection by visiting Wilmotts View on 15th July 2009. The visit started at 11am and lasted 6 hours. We found out about the quality of service people receive and what the home was like for them. We talked to the people who live at the service when we visited. We looked at the care files and records of four people. Care Homes for Adults (18-65 years) Page 9 of 45 We also spoke to the staff and asked them how they help and support people and looked at the staff records. We have written about what we found out when we visited the home and what people told us. What the care home does well Wilmotts View provides a place for people to be cared for so that they can live a life of their choice. It is a small home, which helps people to experience family life. People are helped by staff if they need. People who live at Wilmotts View make choices about their lives. This means helping people to take part in things that meets their cultural, individual needs and interests. This includes learning new skills to be independent. They go shopping with the staff, help plan the menu and prepare meals. People can go out to the local shops and leisure centers. Care Homes for Adults (18-65 years) Page 10 of 45 People who live at the home help around the home and keep their bedroom tidy. People have their own bedroom with their own shower and toilet. This helps people to take control of their life and caring for themselves or with some help from the staff, if needed. People have decorated their bedroom to make it homely. Some people have brought their own bedroom furniture, when they moved to the home. People see their family and friends and also keep contact with them by telephone if they want to. People know who to speak with if they were unhappy or have a complaint. Care Homes for Adults (18-65 years) Page 11 of 45 The staff are friendly and people said they like the staff. Some staff know the help and support people need that live at the home. What has got better from the last inspection What the care home could do better Care Homes for Adults (18-65 years) Page 12 of 45 Information about the support; care needs and lifestyle of the people who live at the home is out of date. This means staff do not have the right information to help people to live a full, active and safe life. Record keeping must improve to show the right and current information about needs of the people using the service. This includes the support plans detailing the help people need, their goals and aspirations; information about the skills mix and training completed by the staff and the management of the home. The staff induction and training must improve to ensure the right staff with the right skills work at the home on a regular basis. This will provide a stable, skilled team of staff that will help to improve the quality of life people experience. Care Homes for Adults (18-65 years) Page 13 of 45 People who live at the home are not asked what they think about the service that they have. There is also no system to check and measure the quality of the service. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rajshree Mistry Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 14 of 45 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 45 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are provided with accessible information about the service but individual assessments of needs are not thorough. Evidence: We read the homes Statement of Purpose and the Service User Guide, which sets out the aims and objectives of the service so that people can choose if this is the right place for them. It shows the types of activities and lifestyle people can expect to have and the support from staff to promote their independence. It sets out the process of how people are involved in choosing to move to the home and important procedures like how to complain. The information did not reflect the appointment of the Acting Manager, their qualifications and experience. However, after the site visit we received a revised statement of purpose and service user guide, containing the current information about the service. The information gathered from the self-assessment completed by the manager overseeing the service at the time stated, people receive the service user guide on admission. The Acting Manager told us they were not aware if the Statement of Purpose and the Service User Guide was available in alternative formats to suit Care Homes for Adults (18-65 years) Page 16 of 45 Evidence: peoples communication needs. Staff spoken with said they were not aware of any information provided to the newest person when they moved to the home and had not seen any information in alternative formats to help people with a learning disability understand information. People using the service were unable to tell us how they came to choosing the home. However, the surveys received all indicated that they were asked if they wanted to move to the home. The statement of purpose stated information is also available in other formats. Therefore, it appears staff are not fully are of what is available for people. Wilmotts View provides care and support to people with a learning disability. All of the people living at Wilmott’s View moved to the home this year. We initially case tracked two people but then looked at the records of the four people using the service. This included the newest person, people with cultural and diverse needs and a person who was referred to the local authority under the Deprivation of Libertys Safeguard. This means that the person cannot make a decision for themselves or might be able to make some decisions not other decisions, which is called lacking capacity. We saw records titled Service User Risk Assessments, which appeared to be the initial assessment of needs carried out by the homes representative. The information gathered looked at the persons physical needs, medication and aspects such as challenging behaviour and communication. The information was limited and omitted key aspects such as dietary needs for one person who has a health need; uses an ileostomy and the importance of their diet. There was no information or assessment of needs documentation carried out by the Care Management Team. We spoke with the staff on duty with regards to the assessment process. They told us that someone from Head Office does the assessment and gives us the information that is in the file. Staff told us they had found having some information about a new person useful. Whilst the assessment of needs carried out by the Head Office is adequate, some key information about the persons care needs and the not having a copy of the care management teams assessment could result in care and support needs not being met. In addition, if the person has limited speech or communication and risks not known, this may result in that person and other people using the service being at risk. We discussed this with the Acting Manager who cut-short their annual leave. They told us they will be involved in all new referrals and assessments of needs to ensure needs are known, can be met and the mix of people living at Wilmotts View is appropriate and safe for all. The care files did not have any contracts or any terms and conditions of stay. There were no individual placement agreements, on file, which is the agreement from the local authority that financially supports the person living at Wilmotts View. The Acting Manager told us they had not seen any formal agreements for the people using the service. This demonstrates that service does not provide any terms and conditions of stay for people that live at Wilmotts View and their right of stay could be compromised or be at risk. Care Homes for Adults (18-65 years) Page 17 of 45 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Improved care planning, risk management and knowledgeable staff would promote peoples independence and well-being. Evidence: We wanted to find out how peoples needs, choices and lifestyle are supported and met by the staff at the home. The information gathered from the self-assessment tool completed by the manager overseeing the service at the time stated, care plans are service user led, which reflects their needs and have detailed risk assessments to protect individuals, staff and individuals in the community. The self-assessment did not provide us with the evidence and practice and stated the service is not yet fully running and therefore, have not had the opportunity to assess areas of improvement. This indicated that since the last key inspection of the service in July 2007, no areas of improvements have been identified through the services own internal quality assurance systems. We spoke with people using the service and made observations of their daily lifestyle and routines. Three people we spoke with described how they are supported by the Care Homes for Adults (18-65 years) Page 18 of 45 Evidence: staff and their lifestyle at the home from planning meals to keeping contact with their family. Two people said they had gone to the local shops in the morning to buy drinks with a new member of staff. They later retired to their bedrooms to watch television programmes. One person said I like to watch Harry Potter on the bigger TV in my room, whilst the other person preferred to watch Asian Bollywood Movies. We saw one person sitting in the lounge with a member of staff watching the morning home make-over programmes on the small portable television in the lounge. Another person had just woken up and having washed and dressed herself, came downstairs and prepared her breakfast. This showed the range of lifestyle people had. We looked at the care records, the support plans, risk assessments and daily notes that states the support people need to promote their independence. We found only 3 people had support plans in their care files. However, in one instance, the support plan being used was from their previous place of residency and the other two support plans were out of date as peoples needs had changed. We found assessments of risks in the care files, which is used to ensure people are supported and their health and safety protected. Although there were risk assessments in place for the out of date support plans, there was no evidence of risk assessments being reviewed or updated to reflect new or changing risks. Although people using the service were able to express how they wish to be supported, staff reading the support plans would be mis-informed as to how to support a person who may display challenging behaviour and may not recognise signs that results in some form of challenging behaviour that places people including staff at risk. People were seen making decisions about what they do on a daily basis. Two people were seen answering the front door to visitors. On several occasions people using the service offered to make the staff and us a drink. Throughout the day, people were choosing what they did from relaxing in their bedrooms or sat in the office with the member of staff doing paperwork. The dining table in the kitchen appears to be where people like to gather; talk and eat. This showed people treated Wilmotts View as their home. We saw staff sitting and supporting one person to plan their week from visiting family to household tasks such as laundry, cleaning their bedroom and making a shopping list. People told us they keep in contact with their family and observed a relative calling to speak with their sister who lives at the home. This showed people were supported by the staff to be responsible and help them make choices. The people living at the home have their own money that is held in safe-keeping. People told us they tell the staff when they want some money. We looked at the system for managing peoples money, which is recorded, reconciled and kept up to date with receipts. This demonstrated peoples money is protected by a safe system. We spoke with the two staff on duty, one was permanent and the other was a bank staff on their first day at the home. The permanent member of staff demonstrated a good awareness of the peoples needs, gave examples of how they support the people Care Homes for Adults (18-65 years) Page 19 of 45 Evidence: using the service including managing risks and knowing the signs that may trigger inappropriate or challenging behaviours. When we shared our findings from reading the support plans, they acknowledged that the support plans were not up to date. They told us that the new Acting Manager, new in post is due to update the support plans and risk assessments to reflect peoples current needs and how to support and promote their choice of lifestyle. The bank staff that we spoke with confirmed they had no induction to this home other than fire safety and had not read the support plans for the people using the service, which were either out of date or were not in the care file. In addition, they were not aware of how to manage the risks when going out in the community, as they had gone to the local shops with two people using the service. The risk assessments and guidance was written for the staff to follow, albeit out of date. This demonstrated bank staff not having access to current and up to date information about the people using the service and the lack of induction and procedures to guide them, places themselves and the people using the service at risk. We concluded that the information gathered from the self-assessment was not reflective of our findings on the day. This included the records that we read contradicting our observations and discussion with the people using the service and staff. We shared our findings with the Acting Manager who cut short their annual leave. They acknowledged our findings having been in post for a few weeks and recognised that support plans, were out of date and improvements to the staffing with regards to consistency would benefit the people using the service. Care Homes for Adults (18-65 years) Page 20 of 45 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Better information about peoples interests, needs and dietary requirements and staff skills would improve the quality of life people experience. Evidence: We wanted to find what opportunities and support is provided to people to continue pursuing their interests such as education, leisure and contact with family and friends. The information we gathered from the self-assessment completed by the manager overseeing the home at the time stated, our service is able to support service users to access and participate in their chosen activities and within the community facilities giving our user a sense of achievement and independence. There was no evidence as to what community facilities and activities were attended by the people or how peoples interests were made known. The self-assessment also stated involves a person centered planning co-ordinator to increase and develop users social network. The people using the service were not Care Homes for Adults (18-65 years) Page 21 of 45 Evidence: aware of other staff accept for the Acting Manager, and the two staff on duty. The Acting Manager and staff spoken with were not aware of anyone working at the home or part of the Msaada Care Ltd having the role of person centered planning coordinator. Therefore, the information in the self-assessment was not true. We observed the lifestyle of the people using the service. People had their own routines from the time they woke up, choice of meals to spending time in their rooms or going shopping with the staff. We spoke with one person and they told us they visit the family and go together with the family to their place of worship, enjoy home cooked meals and shared their experiences of the weddings in their family. Another person who had limited speech but able to express themselves told us the films stars that they like and their favourite meals. We saw one person watching the home makeover programme on the small portable television in the lounge. Another person told us they preferred to watch programmes and films in their bedroom as they had a larger television. The surveys responses received supported what people using the service told us. Some of the comments received directly from the people we spoke with showed their lifestyle and experiences: I go to the gurudwara (place of worship) with my family My father and brother coming to see me, my father drives the car I like Priyanka (Bollywood actress) Im watching WAQT (Bollywood movie) We observed the staff on duty interacting with people using the service in a respectful manner, praising them and prompting them by saying do you want to bring down your dirty clothes for washing. One person likes to smoke a cigarette and did so out in the rear garden having collected a cigarette from the staff in the office. People using the service tended to congregate around the permanent member of staff, one person called staff a cheeky monkey or my friend. This showed that they felt confident and trusted that member of staff, as the bank staff was unfamiliar to them. Improvements made to consistency of staff would benefit the people using the service and all the staff working at the home so that peoples individual and well-being can be promoted. Wilmotts View is a small home for up to seven people. The house blends in with the other residential proprieties in the area. Staff spoken with told us there is a local swimming pool, which people can use, a gym close by and that the Acting Manager is looking to identify day/education centers that people using the service may wish to join. They told us people like to be involved in the running of the home and be responsible for their home, by keeping their bedrooms tidy, doing the laundry with support from the staff, menu planning and shopping, which includes making a shopping list. Two people using the service also told us they often go to the local shop with a member of staff to buy milk and bread for the home and drinks for themselves. Care Homes for Adults (18-65 years) Page 22 of 45 Evidence: We read the support plans and the daily notes in the care files. Whilst the daily records reflected the range of events and activities done by individuals, the support plans did not show people were consulted about their interests or what groups or clubs people attended. Peoples needs and lifestyle would be better supported and promoted if the support plans were up to date and staff were made aware of peoples interests. We saw people choosing their lunchtime meals and were supported by the staff to prepare soup and noodles. People using the service had a choice of meals and were involved in planning the meals for the week. Throughout the day people using the service offered to make us tea or coffee, indicating their hospitality towards guests in their home. One person was seen letting the staff know that they had already done the shopping list, which further demonstrated that people are encouraged to take responsibility. Staff told us that people using the service do help with preparing meals. Both the staff and the people using the service pointed out to us that the oven was not working, so they could not have meals that were cooked in the oven. The comments received from the people we spoke with included: I like dhal (lentil curry), roti and paneer I like doner kebab We spoke with one person who told us that they are not able to eat particular food or only allowed small amounts. The support plan for this person was not in the care file so we could not establish what the dietary needs were for this person and how the staff ensured meals were appropriate for them. The member of staff that we spoke with knew what the person could and could not eat as they have an ileostomy bag. However, use of changing bank staff and lack of up to date support plans would potentially place people at risk with their dietary needs. We shared our findings with the Acting Manager when they arrived. They accepted our findings including the contradictory information in the self-assessment form completed by the manager overseeing the service at the time. Care Homes for Adults (18-65 years) Page 23 of 45 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples personal care needs are met but lack of information means individual health needs are not met fully to promote well-being. Evidence: We wanted to find out how people are supported to manage their personal and health care needs. The information gathered from the self-assessment tool completed by the manager overseeing the home at the time stated, we have detailed service user led care plans, which reflect their needs; detailed risk assessments to protect the service users and able to support users with personal, psychological and social care need; access additional support from psychologists, psychiatrists and community nursing team. The self-assessment did not show the evidence or demonstrate practice within the service to ensure peoples personal care and health needs are met. People living at Wilmotts View manage their own personal care. People have their own morning and evening routines and benefit from having en-suite shower and toilet and an additional communal bathroom. One person was reminding the member of staff on duty that the barber shop was closed and to go to the barber tomorrow. Staff told us that as one person is refusing to have a shower, but has agreed to have a wet wash instead. Staff told us that they will help some people to shave to prevent them from Care Homes for Adults (18-65 years) Page 24 of 45 Evidence: being at risk of cuts or injury to themselves. This showed staff supported people to maintain their own personal care and hygiene. The support plans read were all out of date and one person did not have a support plan in place to reflect their current and individual needs. For example, there was no support plan for one person uses an ileostomy bag or guidance for staff to follow. Whilst the person themselves told us that staff had supported them to learn how to empty the ileostomy bag, consistent with what the member of staff told us, which highlighted potential risks. We found evidence in the care files of health checks, appointments and treatments received by the people using the service. This showed they were accessing health care support such as General Practitioner, Optician and Dentist on a regular basis. We observed two people approaching the permanent member of staff at lunchtime with a glass of water in readiness for their lunchtime medication. Another person told us the number of tablets they take in the morning and evenings, which showed their own awareness and responsibility to take their medication given by the staff. The support plan for one person using the service was out of date as the medication had changed and the arrangements for taking the medication related to their previous place of residency. There was no list of the current medication taken by people. The member of staff was not able to find the policy and procedure for handling and administering medication and we were unable to establish the procedure followed by staff. Therefore, staff reading the support plans and checking the medication records may become confused with what medication people are taking and could place people at risk, without clear policies and procedures. The permanent member of staff described to us the systems for managing and giving out medication, which is done by the two permanent staff and the Acting Manager. We looked at the staff training records but were unable to establish if staff had received training in the administering medication. The member of staff giving out the medication said they had previously been trained in administering medication. The Acting Manager confirmed that medication training is scheduled for 23rd July 2009 to ensure staff follow the current best practice, showing the importance of trained staff. The medication is prepared into blistered packs by the Pharmacist. The management system of medication and the practice to give out medication and recording was good. Staff told us that at present no-one takes any controlled medication, which means taking strong medication. We shared our findings with the Acting Manager with regards to lack of up to date information in the support plans, current medication and support to maintain individual health care needs. They accepted our findings and said they know they have to improve the basics within the service. Care Homes for Adults (18-65 years) Page 25 of 45 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are confident complaints are addressed and improvements to staff training in safeguarding would protect peoples health, safety and well-being. Evidence: We wanted to find out what information is provided to the people using the service about their rights and how to make a complaint. The information gathered from the self-assessment completed by the manager overseeing the service at the time stated there are detailed policies on concerns and complaints available to all residents on their admission. We read the statement of purpose kept in the service, which set out the complaints procedure and how the management team would investigate to resolve the concern and the timescale. This was satisfactory. The surveys responses received from the people using the service all indicated they know who to speak with if they are unhappy and know how to make a complaint. People we spoke with named the staff that they would speak with, which were the permanent staff and the Acting Manager. One person said they would tell mum and another person said, Id tell my family. The responses from the people using the service and our observations of the positive interaction of the staff on duty with the people living at the home showed people were confident to express their views and concerns with the staff on duty or through their family. The staff on duty also told us that one person using the service has an Advocate. The care file read also had the contact details of the Advocate, should staff be asked to Care Homes for Adults (18-65 years) Page 26 of 45 Evidence: contact them. This demonstrated that some people are supported by external advocates to support people using the service. The information gathered from the self-assessment tool completed by the manager overseeing the service at the time stated the home received no complaints. This was consistent with the complaints log viewed during the site visit. The Care Quality Commission received no complaints or expressions of concerns about Wilmotts View. We established from our observations that people using the service were comfortable in their home surroundings and mainly with the permanent member of staff on duty. We spoke with Acting Manager with regards to staffing and our observations that people congregated around the permanent staff. They told us that this has improved as previously the home was using agency staff in addition to the bank staff and the permanent staff. They confirmed that they are raising the issue of staffing with the management team of Msaada Care Ltd. (Also refer to sections: Staffing and Conduct and Management of the Home) We spoke with the staff on duty: permanent and bank staff. Whilst both staff had an understanding of safeguarding issues, one member of staff was unclear of their role and responsibilities including recognising the various forms of abuse. Safeguarding means promoting the well-being of people using the service from harm, risk and abuse. Staff training in safeguarding adults procedures differed. The permanent member of staff said they had not received any induction or training since starting employment and the bank staff said they had received an induction, which included safeguarding training, when they were recruited to work at a sister care home with nursing, which is part of Msaada Care Ltd. Staff files checked did not have any evidence of an induction or training completed in safeguarding adults procedures. In addition, staff were unable to find the folder of all the policies and procedures, which should include the safeguarding adults policy and procedure. Both staff we spoke with aware of the whistle-blowing procedure and gave examples of the types of situations that could occur, which would be reported. This showed staff were confident to report poor or unsafe practices of colleagues that could place people using the service at risk. We received a notification of a safeguarding referral for a person living at the home, made to the local authority in March 2009, under the multi-agency procedures to protect their well-being. We spoke with the Acting Manager with regards to the outcome and actions taken to prevent a re-occurrence. The Acting Manager was not aware of any safeguarding referral as they were not employed at the home at that time and there was no information held in the office that they could refer to. This showed communication and key information to protect the well-being of people that use and have used the service is not maintained. (Also refer to section: Conduct and Management of the Home). Care Homes for Adults (18-65 years) Page 27 of 45 Evidence: We establish from speaking with the staff that a referral for one person living at the home, had been made to the local authority under the Deprivation of Libertys safeguard, which is part of the Mental Capacity Act 2005. This means the ways to give people using the service protection they need when they are being cared for, supported or treated in ways that may deprive them of their liberty. The care files contained evidence of an assessment undertaken and concluded that the persons liberty was not deprived. This demonstrated that the service has acted appropriately in line with the new legislation and records are maintained to support this. Care Homes for Adults (18-65 years) Page 28 of 45 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples well-being and choice of lifestyle is promoted by the clean, tidy and homely environment. Evidence: Wilmotts View is situated in a residential area and blends in with other private residential properties. There is car parking space for two cars to the front of the property. There is good access to the local community, shops, social and leisure facilities. Public transport is close by that goes to the town center. On the day of our site visit to the service, people were watching television, had returned from the shops and one person was still asleep. It was a very relaxed atmosphere in the home that was clean and tidy. People using the service treated Wilmotts View as their home, which supported the responses received in the surveys from the people using the service. We saw one person sitting in the lounge squinting their eyes to watch the portable television in the lounge. Another person told us they preferred to watch films in their own bedrooms as they had a larger television. People using the service and staff all told us that the oven is broken and meals have to be planned, which can be cooked on the hob. This restricts people lifestyle choices and preferences. This showed whilst the home environment is comfortable, clean and tidy, consideration should be made to Care Homes for Adults (18-65 years) Page 29 of 45 Evidence: having a larger television to benefit the people who wish to watch the television in the lounge that promotes conversation and interaction and consider repairing or replacing the oven. We noted that with the four people using the service, there was enough shared space in the lounge for all to use at the same time. However, some consideration should be made to the availability of shared communal space when the home is fully occupied. Two people were happy for us to look at their bedrooms. All the bedrooms have ensuite shower facilities, which promotes privacy and dignity to manage their own personal care. The bedrooms were individually decorated and personalised to reflect peoples personalities and their interests. One person was able to bring in their own bedroom furniture and bed that made the room comfortable for them. We saw one person bring their laundry downstairs. Staff told us that the majority of people using the service do their own laundry and some with the help from the staff. Staff observed maintained good hygiene practice. Staff spoken with demonstrated their understanding and practice with regards to infection control procedures followed. Whilst staff showed awareness of their responsibility and best practice being followed, staff files did not demonstrate the training completed by the staff. (Refer to sections on: Staffing and Conduct and Management of the Home). Care Homes for Adults (18-65 years) Page 30 of 45 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Improvement to staff induction and training would benefit and promote peoples wellbeing and independence. Evidence: We wanted to find out whether people using the service are supported by trained staff that understand the needs of people with a learning disability. The information we gathered from the self- assessment completed by the manager overseeing the service at the time stated all staff including the manager are well experienced in working with our service user group, all current staff are well trained with NVQ qualifications, all staff have relevant CRB checks and references, staff are supervised and we ensure staff are supported to acquire relative training. The self-assessment stated the evidence of staff recruitment and training would be found in the staff files. We saw people using the service tended to congregate around the permanent staff including the Acting Manager when they arrived. People appeared to be comfortable and had a good rapport with one member of staff on duty, able to communicate and understand expressions and gestures made. This showed staff made people feel safe and valued but consideration should be made to the use of regular bank staff who are confident and trained to support people with a learning disability. We spoke with the member of staff on duty with regards to the recruitment and Care Homes for Adults (18-65 years) Page 31 of 45 Evidence: training. Both staff said they underwent a recruitment process whereby they completed an application form, had an informal visit to the service before they were interviewed and pre-employment checks were carried out. The member of staff from the Human Resource Team explained to us the three stages of recruitment. It transpired that the Human Resource Team manage the whole recruitment process, from the telephone screening, informal visit to the home to meet the people using the service and a formal interview by the Human Resource Team. This highlighted safety and protection issues for the people using the service who are visited by people applying for a job to work at the home that have not had any checks carried out to assess their suitability to work with vulnerable people, known as a criminal records bureau (CRB) check. We spoke with the Acting Manager to establish what role they have in staff recruitment to ensure applicants with the right skills, experiences and qualities are appointed. They expressed their own concerns as they are not involved in the recruitment procedure and confirmed that they have raised the issue with the management team of Msaada Care Ltd. A member of the Human Resource team arrived with the staff files. We looked at four staff files, which included the staff on duty, bank staff and the Acting Manager. All the staff files viewed contained a criminal records bureau (CRB) check. All but one file had a signed application form, one file did not have an application form but we found references and application form belonging to two other staff employed by Msaada Care Ltd in that file. All files had a minimum of two references, although we found a note written by the Human Resource team, requesting the need for a further reference from an employer but there was no evidence that this had been attained. We shared our finding with the member of staff from the Human Resource Team, who admitted that they need to check all the staff files to ensure all the required information is in place. This indicates that whilst people using the service have an opportunity to meet the applicant, the recruitment procedures could be improved to protect the people using the service. All the staff spoken with including the Acting Manager had experienced different induction and training since their appointment. One member of staff had received induction training when they worked at another nursing home owned by Msaada Care Ltd, whilst the others said they did not have any induction training for their role as a care/support worker or a manager for the service. The bank staff told us they were made aware of the fire exits and the fire procedures when they arrived at the home in the morning for duty, as it was their first day. There was no other information available to them to help them support the people using the service. The staff files checked contained some old training certificates from their previous employment but there was no evidence of staff competency being assessed. One member of staff said they had attained the National Vocational Qualification (NVQ) level 3 and the information gathered from the self-assessment stated two staff had attained NVQ level 2. We did not receive any staff surveys back to help us assess if other staff working at Wilmotts View had received an induction or training since their Care Homes for Adults (18-65 years) Page 32 of 45 Evidence: appointment. Therefore, it was unclear what, if any, training programme is provided to new and bank staff. Our findings were shared with the Acting Manager who also told us that they had not received an induction since their appointment in June 2009. The Acting Manager did confirm that medication training has been scheduled for 23.07.09 for the staff. They said discussions have taken place with the management team of Msaada Care Ltd with regards to having consistent bank staff trained to work with people with a learning disability. This showed the Acting Manager recognised the importance and value of trained staff to support the people using the service. We wanted to find out what support is provided to the staff with regards to supervision and sharing of information through team meetings. One member of staff said since the Acting Manager was appointed in June 2009, they have had supervision meeting. They also confirmed minutes of the meeting were kept confidentially in the staff file. However, the bank staff told us it was difficult to have any supervision as they may work in different homes at different times. Whilst this showed permanent staff are supervised, some consideration and procedure should be developed to support the bank staff working in the home. Care Homes for Adults (18-65 years) Page 33 of 45 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There must be improvements to the management of the service, records and systems to improve the quality of the service people experience that protects and promotes their health, safety and well-being. Evidence: We wanted to find out how the management of the service benefits the people living at the home. The information we gathered from the self-assessment completed by the manager overseeing the service at the time made no reference to the management of the service with the exception of stating that a manager has been appointed. Our records showed us that we had not been advised that the Registered Manager is no longer employed to work at Wilmotts View. We spoke with the Acting Manager who cut short their annual leave. They told us they were appointed in June 2009 and have the responsibility to manage the service. The Acting Manager shared their knowledge, skills, experience and qualifications to manage the service but said they had not received an induction or training to familiarise themselves to the service and the Organisation. This may affect the quality of management and leadership of the service, which may affect the quality of life and Care Homes for Adults (18-65 years) Page 34 of 45 Evidence: service experienced by the people living at the home. There is a requirement for care homes under the Care Standards Act 2000, whereby the person in the role of an Acting Manager, submits an application to be assessed to become a registered manager. The representative for the Responsible Individual (registered owner) had given us assurance in June 2009 that a Registered Managers application would be submitted to the Care Quality Commission for this service. The Acting Manager confirmed that they were in the process of completing the application form and attaining the required documentation for submission. We wanted to find out how people using the service are support by the staff working at the home. People using the service approached the permanent member of staff more than the bank staff. Staff told us that there are only two permanent staff who are supported by bank staff. Staff spoke positively about the Acting Manager who provided better leadership. The Acting Manager told us there has been an improvement in staffing as agency staff are no longer used. They also told us that the Human Resource Team advises them of the bank staff due to work at the home. This does not provide consistency and continuity of staffing to support the people living at the home. This contradicts the statement made in the self-assessment tool; we have a stable and reliable staff team, giving consistency to the user group. We spoke with the people using the service with regards to how they are consulted and asked about their views about the home. Whilst they felt able to approach the Acting Manager and staff; there were no formal systems in place to seek peoples views such as Residents Meetings. One person using the service was supported by an Advocate although it was unclear what independent support is offered to the other people using the service. The information we gathered from the self-assessment tool completed by the manager overseeing the home at the time, stated we are of the opinion that the home is wellmanaged from the feedback we get from professionals and residents. We have already established that there were no Residents Meetings, which contradicts the statement made. We asked the Acting Manager what type of quality assurance systems are in place to measure the quality of the service provided. They told us that they were not aware of any quality assurance systems in place. There were no reports from the monthly visits conducted by the Responsible Individual (registered owner) to view as these visits had not been conducted since the appointment of the Acting Manager and no previous records available to demonstrate visits taking place. This shows the Responsible Individual fails to adhere to their responsibilities in conducting the monthly visits known as Regulation 26 visits. This further contradicts the statements made in the self-assessment sent to us. We were unable to view the policies and procedures at the home. The staff on duty we unable to locate the policy and procedure folder. This was consistent with what the Acting Manager told us they have had to develop procedures to guide staff such as Care Homes for Adults (18-65 years) Page 35 of 45 Evidence: medication procedure. This contradicted the self-assessment completed by the manager overseeing the service at the time, which stated policies and procedures are in place. Therefore, we were unable to establish what, if any, guidance, policies and procedures were provided to staff. It highlighted the service is reliant on staff knowledge and what they think is good and safe, which could place the people using the service and staff at risk. People using the service were aware of the records held in the office about them and knew that they could read them at any time. We have already established from viewing the care files, staff files and the records that demonstrate the management of the service were inadequate. For example there was missing or out of date information and guidance to help staff support people using the service and the policies and procedures that could not be found. This affects the quality of support people receive and may not promote a better quality of life to the people using the service. The information gathered from the self-assessment tool completed by the manager overseeing the service at the time, detailed the testing, servicing and checks carried out such as the portable appliance equipment test, fire detection and safety equipment. The Acting Manager also showed us the records of the checks that they carry out with regards to the fire safety equipment. The assessments of risks completed individually for the people using the service were out of date, referred to risks related to the previous home environment or had changed. This shows that improvements must be made in practice, management of risks, better systems and records to benefit and protect the health, safety and wellbeing of people using the service and the staff. Care Homes for Adults (18-65 years) Page 36 of 45 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 37 of 45 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 2 14 15/09/2009 Where a person using the service or is in the process of moving to the home is financially supported by the local authority, a copy or summary of the Care Management Teams assessment of needs and the integrated Care Programme Approach or care plan must be obtained. To ensure care and support needs identified are known by the home and can be safely met. 2 2 14 The registered person must 15/09/2009 ensure the person responsible for assessing the needs of people must be suitably qualified or trained to ensure details of the care and support needs are obtained fully to ensure these can be met. Care Homes for Adults (18-65 years) Page 38 of 45 To ensure the care and support needs identified can be met to promote their health and well-being. 3 6 15 The registered person must ensure service user plan is developed with the individual, is available and kept under review to ensure care and support needs are known and provides clear guidance for staff to follow. This must include details of the correct medication and other health care support. 22/09/2009 To ensure peoples care and support needs are known and safely met by the staff to promote their independence and well-being. 4 9 13 The registered person must 22/09/2009 carry out assessments of risk with regards to promoting individual peoples opportunity to access services in the community and management of challenging behaviours to ensure safety measures are identified to avoid risk to individual and staff have clear guidance to follow. To ensure people are able to participate and promote independence living that promotes their well-being. 5 13 16 The registered person must consult the people using the service about their social interests, daily living activities, education, leisure 23/09/2009 Care Homes for Adults (18-65 years) Page 39 of 45 and accessing the facilities in the community to stimulate and engage them. To ensure people using the service experience an improved quality of life with new experiences and opportunities that promotes their well-being. 6 17 14 The registered person must carry out nutritional risk assessments in consultation with the individual and appropriate health professional, if required, to establish dietary needs and requirements. 23/09/2009 To ensure people using the service are offered meals that suit their dietary needs to maintain their health and well-being. 7 18 15 The registered provider must 23/09/2009 ensure support plans include the assessed care and support needs that gives clear guidance for staff to follow. This will ensure staff provide the level of support to meet personal care needs that promotes well-being and independence. 8 19 12 The registered provider must 15/09/2009 ensure support plans include the level of health care support with regards to individual needs such as managing ileostomy bag, monitoring and support from Page 40 of 45 Care Homes for Adults (18-65 years) health care professionals This will ensure people using the service are support by knowledgeable staff and health professionals that promotes their health and well-being. 9 20 13 The registered provider must 30/08/2009 maintain a record of all current medication taken by the people using the service. To ensure medication administered is correct to promote peoples health, safety and well-being. 10 23 13 The registered provider must 23/09/2009 ensure staff employed by the home receive training in safeguarding adults to demonstrate staff understand their roles and responsibilities in protecting and supporting people in their care in line with current procedures. To ensure peoples health, safety and well-being is protected and promoted. 11 23 17 The registered provider must 23/09/2009 ensure records of all safeguarding issues and referrals are maintained at the home. To ensure peoples health, safety and well-being is protected and promoted. 12 23 13 The registered person must 23/09/2009 Page 41 of 45 Care Homes for Adults (18-65 years) ensure the homes policy and procedure is made available to staff and includes the multi-agency procedure. To ensure staff understand their roles and responsibilities to safeguard peoples rights, health and safety. 13 35 18 The registered person must 23/09/2009 ensure all staff receive an induction and training to perform their work and is regularly updated in line with best practice. This includes health and safety, infection control, safeguarding adults. Records of the induction and training completed must be maintained To ensure staff have the skills to support and promote peoples independence. 14 39 24 The registered person must 23/09/2009 introduce effective quality monitoring and quality assurance systems to enable people using the service and their representatives to comment on the quality of the service. This must be conducted at regular intervals and make a copy of the report available. This would enable the service to measure itself against the aims and objectives set out and improve the quality of service people receive. 15 39 26 The registered person or 30/08/2009 Page 42 of 45 Care Homes for Adults (18-65 years) their representative must conduct the monthly visits and produce a report detailing the findings and action plan to address issues and shortfalls with timescales to ensure the health, safety and well-being of people. A copy of the regulation 26 visit reports must be made available to for CQC inspections. To ensure the home is managed and internal audit systems protects the people using the service. 16 41 17 The registered person must 23/09/2009 ensure the records relating to the people using the service, staff and the management are kept up to date and in good order. These include: care files, including care plans and assessments of risks, staff files; policies and procedures and health and safety records. To ensure people are protected and their health, safety and well-being promoted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The assessment of needs carried out by the homes staff must be comprehensive to ensure all aspects of personal Page 43 of 45 Care Homes for Adults (18-65 years) care, support and lifestyle needs with consideration to dietary needs, communication needs, cultural and diversity needs are known and can be met by the home. 2 6 To consider developing support plans in formats whereby the person using the service may understand and be actively involved in ensuring their views, needs and requirements are reflected. It is recommended that the homes medication policy and procedure is available at the service at all times for staff to access. It is recommended that the recruitment process whereby applicants visiting the people at Wilmotts View is managed to ensure their safety and protection. It is recommended that an audit is carried on all staff recruitment files to ensure recruitment documentation and checks carried out are in the respective staff files. It is recommended that there is a robust planned training programme for all the staff to maintain their skills and practice in line with current best practice and guidance. It is recommended that bank and agency staff receive an induction to the home to ensure bank staff are aware of key health and safety procedures and practices. It is recommended that procedure is developed whereby bank staff have supervision and support to ensure training skills and competency are maintained. It is recommended that there is consistency and continuity of bank staff deployed to work at the service with the skills to support the needs of the people using the service. It is recommended that records relating to all the health and safety checks carried out at the home are available and in good order. 3 20 4 34 5 34 6 35 7 35 8 36 9 37 10 42 Care Homes for Adults (18-65 years) Page 44 of 45 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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