Inspection on 22/01/08 for Wimbourne House

This inspection was carried out on 22nd January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wimbourne House 01/03/07

Wimbourne House 07/10/05

Wimbourne House 16/05/05

Wimbourne House 17/08/04

Wimbourne House 01/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Wimbourne House 16 Wimbourne Road London N17 6HL Lead Inspector Jane Ray Key Unannounced Inspection 22nd January 2008 10:00 Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wimbourne House Address 16 Wimbourne Road London N17 6HL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8493 9947 020 8801 0620 Mr Kwame Adusei Mr Kistnasamay (Chris) Thandrayen Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 4 1st March 2007 Date of last inspection Brief Description of the Service: Wimborne House is located in a residential area close to Bruce Grove, in Tottenham where there are a range of local shops and easily accessible public transport. The home is registered to provide residential care for four people with a mental disorder. The registered provider, Mr Kwame Adusei, owns a number of similar small homes in this area. The home is an ordinary house, on a domestic scale and fits in well with the surrounding area. It has four bedrooms one of which has en-suite facilities, as well as a separate bathroom and shower room. There is a shared lounge, kitchen and dining area and a rear garden. The home has a small team of staff and staffing levels vary according to the needs of the people living in the service. The home also has a part-time cleaner. The organisation’s brochure states that it specialises in supporting service users who may have a forensic history or may be on the supervision register and that the aims are to respect the resident’s privacy and dignity, maintaining and promoting personal identity and the right to choose. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 5 Fees charged at the home range between £700 and £1000 per week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place on the 22 January 2008 and was unannounced. The inspection lasted for five and a half hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to speak to and observe the support given to two of the current residents. The inspector was also able to spend time talking to the manager as well as one member of care staff. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. What the service does well: The home provides a good standard of care and support to a group of residents who have complex mental health care needs. The residents feel that they are supported to make progress in their lives in terms of addressing problems linked to their mental health such as addictions. They also feel that they are able to make some choices in their daily lives and to develop their independent living skills. Whilst the residents would prefer to live more independently they recognise the benefits of the support they receive from the staff working in the home. The home has a well-established and very stable team of staff who are being supported by a manager. The staff demonstrated a good knowledge of the people living in the home and were able to recognise their individual needs, especially in relation to their support needs. The residents were also observed to have a good relationship with the staff. The home is comfortable and clean and residents are supported to personalise their rooms. The people living in the home are protected and supported by the effective use of policies and procedures including medication systems, adult protection procedures and health and safety procedures. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The inspection has identified a number of areas of improvement for the service. In terms of improving standards of support for the residents it is required that the activity co-ordinator post is filled to develop an individual programme of activities for each person based on their individual interests. It is also recommended that alternative options such as a domiciliary service for dental and optical checks are explored to support the residents to access primary healthcare checks. The environment in the home also needs to improve by repairing the oven and broken kitchen cupboard doors. In addition the laundry arrangements need to be reviewed to ensure they provide adequate standards in terms of infection control. There also needs to be somewhere secure in the home to store petty cash and other valuables. Staffing issues need to be addressed including ensuring that staff have current permission to work in the country where this is needed, ensuring all staff have a completed contract of employment, ensuring all staff have completed or updated essential training and supporting the manager with training so he can complete supervisions to an appropriate standard. It is also suggested that staff should not work excessive hours as this may compromise their performance. Staff also need to be supported to develop their key working skills. Health and safety in the home needs to be improved by completing the fire evacuation procedure, ensuring an electrical installation check has been completed, providing health and safety training for all the staff and recording medication returned to the pharmacist. These measures are needed to provide a safe service for the residents. The manager also needs to be supported to ensure he understands his role and responsibilities under the Care Home regulations 2001 and has the training and support to be able to perform his job fully. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will be assessed and that the service can meet their needs. Where possible they are also offered a chance to visit the home in order to help them decide if the service is where they want to live. EVIDENCE: The statement of purpose and service user guide were inspected. The statement of purpose was clearly written, accurate and contained all the necessary information but was not in a particularly user-friendly format. The service user guide was not initially available in the home and a copy was brought over from another service. This information was in a more accessible format for the residents. Three case notes for the people living in the home were inspected and these all contained detailed assessments as part of the admissions process to the home, from a number of care professionals. This demonstrated that the home aims to ensure that it has all the information about the resident so they can make the Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 11 preparations to address their support needs. Two people have been admitted to the home during the last year. Their records also showed that they had been asked about their choices and lifestyles to develop a holistic picture of each person’s wishes. The manager explained that a far as possible the residents visit the home to see if they want to move in. One resident explained that he had to move as an emergency and could not visit prior to his admission and the other resident said he made one visit. The inspector discussed the current needs of the people living in the home with the care staff. They felt they had received the training necessary to meet the needs of the residents. This includes training on specific mental health issues. The manager and responsible person are both nurses with training in mental health and they provide considerable support and expertise for the staff team. The inspector looked at the contracts between the home and the residents for the three current people who live in the service. They all had a contact in place that included all the necessary information and were correctly signed. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home feel able to have control and make decisions in their daily lives. Each person has a person centred care plan that reflects the support they need. EVIDENCE: Three case notes for the people living in the home were inspected. Each person has detailed individual person centred care plans. These highlight their individual support needs and have been signed by the resident to confirm they have read the care plans. Everyone living in the home had their care plans reviewed on a monthly basis by their key worker following an individual recorded discussion with the resident. Two of the residents had only moved in during the last few months to the home. One person had attended a CPA Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 13 review, but the other resident had not yet had a meeting. The record of this meeting had been prepared and was available in the resident’s case notes. The three people living in the home all had the manager as their named key worker, with another member of staff in a supporting role. The manager felt he needed to carry out this role due to his professional skills and experience, but this could be undertaken by other staff once they have received the correct training. It was observed that the staff were communicating very effectively with the residents and clearly knew how to respond to their requests. One resident said, “no-body treats me badly” and another said that a specific member of staff “helps to keep me together”. The staff were observed to be very calm and patient at all times. The three residents whose case notes were inspected all included individual risk assessments covering areas of potential risk. These were very detailed and where restrictions needed to be imposed the reasons were recorded as well as evidence that the opinions of other professionals had been sought. The risk assessments also included guidance for staff on how to support each person appropriately when they became very agitated or angry. One resident was able to describe how he “comes and goes” as he wants, but has certain restrictions in place such as the staff helping him to manage his money. The manager told the inspector that there are usually monthly residents meetings although these have not taken place for a couple of months as one resident is in hospital and so there are only two people actually living in the home and they are able to communicate their wishes on a daily basis with each other and the staff. One resident also said that he did not feel they needed any meetings at the moment. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,14,15,16 and 17 People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to develop their skills but would benefit from being supported to access a wider range of activities in the community. EVIDENCE: The two residents at the home during the inspection both had very separate lifestyles based on their individual needs and interests. The organisation does have an activity co-ordinator post whose role is to facilitate activities but the manager explained that this post is currently in the process of being filled. Both the residents are able to go out independently but one has a support package provided by his placing authority to facilitate him to access some Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 15 leisure activities such as playing football. The other resident said he would like to learn to swim but at the moment is just going out to the local shops and participating in domestic activities. The AQAA described the role of the activities co-ordinator in encouraging and supporting the residents to participate in activities and it is evident that this post needs to be filled. The manager also explained that there are some social events that take place for the residents in all the homes owned by the provider. Recently they were all offered the opportunity to go out as a group for an evening meal. The two residents said that they do not want to practice their religion. The care planning process does explore with each resident their culture and faith and provides support as needed on an individual basis as demonstrated in each residents case notes. One resident talked about how he likes to go out and meet up with friends. The manager explained that many of the residents who have lived in the home have had ongoing relationships. The AQAA talks about how staff encourage residents to maintain beneficial relationships with family and friends but the home also has a visitors policy which was inspected that sets a limit on friends staying overnight in the home. The home offers a positive environment for people who want to maintain or develop their independent living skills. Each person is encouraged to do their own shopping and cooking as well as cleaning their rooms and doing their own laundry. The staff provide as much support as is needed. One resident talked about how much he enjoys cooking. It was observed that the routine depends on each person and their activities. The residents all talked about their different routines and this clearly reflected their individual choices and not the needs of the service. The home has a menu although the residents usually cook for themselves. During the inspection the care staff bought food and this included fresh fruit and vegetables. It was observed that most of the meat is frozen although the manager explained that fresh meat is often thrown away as the residents make different choices each day. One resident had been asked if he would go with the staff to do the shopping and had declined and so he had been asked what food he wanted the staff to buy on his behalf. One resident was preparing himself lunch and a drink at the time of the inspection. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will receive personal and healthcare support particularly based on their mental health needs. The medication system needs to ensure medication being returned to the pharmacist is appropriately recorded. EVIDENCE: It was observed during the inspection that the people living in the home were poorly presented, although the staff were observed encouraging people to use the bathroom. One resident told the inspector that he has a shower every day and has bought some new clothes since moving into the home. The healthcare records were inspected for the three people living in the home. They had all been supported to access the GP and attend appointments with their psychiatrist. One of the residents has been very physically unwell and has Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 17 been in hospital for over a month. The manager explained that they have maintained daily contact with the hospital. One resident sadly died unexpectedly in the home last year and this has been referred to the coroner. The healthcare records reflect that the residents have very complex mental health needs and that the staff in the home, liaise closely with other mental health care professionals when issues arise. The health care records indicate that the residents refuse to see the dentist, and optician for their primary healthcare checks and this was confirmed when speaking to the residents. The inspector did wonder if an alternative provision such as a domiciliary dental or optical service could be explored as one resident’s said his teeth were in a “dreadful state”. The AQAA explained that one staff member working for the organisation has completed training to enable him to provide a drugs counselling service to the residents should they need this input as well as providing them with a range of leaflets and other information. The home uses a blister pack medication system. None of the residents selfadminister their medication. The medication administration records were inspected. The medication entering the home is recorded appropriately on the medication administration record but no record could be found of medication being returned to the pharmacist. The medication available was correct and was not out of date. None of the residents have PRN medication. Training records were inspected and three of the four current staff had received medication training. The medication storage cupboard is in the office and the temperature is monitored daily. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that the correct systems are in place should they need to complain and that staff training and procedures are in place to protect them from the risk of being abused. The culture of the organisation needs to be reviewed to ensure staff feel able to address issues of concern. EVIDENCE: The inspector looked at the complaints record and saw that there had been no complaints since the previous inspection. The complaints procedure was also inspected and this was in a format accessible for the residents. The residents spoken to said they knew how to complain. One person said, “I haven’t needed to make any complaints but if I did I know who to speak to”. An anonymous complaint has been received by the Commission for Social Care Inspection since the previous inspection. This raised concerns about the support given to staff and reflects many of the findings in the staffing section of this report. It is a matter of concern that not all staff feel able to raise issues within the organisation. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 19 The inspector saw that the home had a protection of vulnerable adults procedure. The staff training records were inspected and showed that staff had received training on safe guarding vulnerable adults. The inspector spoke to one member of staff during the inspection and he showed a good knowledge of the complaints and adult protection procedures. The inspector looked at the personal finances for two of the residents. The manager explained that all residents have a bank account and then some choose to place some of their monies for safe keeping in the office. One resident who has a history of alcohol abuse has an agreement that his monies are held on his behalf This is recorded in his case notes as part of his risk assessment. The record of monies held by the provider was inspected and were clear. It was however noted that the manager keeps the homes petty cash in his pocket and there is no-where to safely store money. A secure arrangement to store money and an ongoing record of petty cash expenditure including money entering the home would be advisable. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,27,28 and 30 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are benefiting from living in a clean and a pleasant environment. Residents can personalize their bedrooms according to their individual choices. Health and safety issues need to be addressed in relation to laundry arrangements. EVIDENCE: The inspector toured the building with the manager. The empty room was inspected as well as the room for the resident who is in hospital. One resident also allowed the inspector to look into his room. The bedrooms were furnished to an adequate standard. The inspector noted that all the residents have keys to their rooms, although some choose to leave them unlocked. The front door has an entry system Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 21 operated by the staff so that people entering the home can be monitored. Residents can leave the home as they wish but are asked to inform the staff that they are going out. The dining room and kitchen is very small but meets the needs of the group. It was noticed that the oven door and some of the kitchen cupboard doors were broken. The home has a domestic washing machine and dryer. The manager explained that two of the residents are incontinent and the current laundry arrangements may not be safe in terms of infection control. The advice of the environmental health officer needs to be sought and appropriate laundry arrangements introduced. The home has a small, enclosed rear garden. The inspector noted that the home was clean and the part- time domestic was present during the inspection to clean communal areas of the home. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,34,35 and 36 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a stable and experienced team of staff. Their performance is however compromised by inadequate supervision and training. EVIDENCE: The inspector looked at the staff rota. The staff team consists of a manager, a team of carers and a part-time cleaner. Many of the staff work between all the homes operated by the provider. The staff turnover is low and the AQAA says that no staff have left in the last 12 months. The staffing levels vary and at the time of the inspection there were only two residents actually in the home. This meant according to the rota there were between one and two staff during the day and one at night. It is hard to get an accurate picture of how many hours staff are working as they move between the different homes but one member of staff said he usually works about 60 hours a week, which is very high. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 23 The AQAA explained that most of the care staff have completed an NVQ level 2 or above or are working towards the qualification. The recruitment checks were inspected for four staff who according to the rota were working the most hours at Wimbourne House. They all had the appropriate recruitment checks although one person did not appear to have permission to work in the country and had appeal papers dated 2005 in his file. When this was raised with the manager he said that the registered provider was responsible for staffing matters, but it is not appropriate for the registered manager to not take management responsibility for the staff working in his service. All the staff had a contract of employment but this did not state their hourly rate of pay or their contracted hours of work. The contract had been signed by the employee but not the employer. The record of staff team meetings was inspected and these meetings had not taken place since November 2007. These meetings discussed the residents but there was little evidence that staff had the opportunity to raise concerns about the operation of the service. The induction checklist was inspected. This consists of a comprehensive induction checklist to work through and more recently recruited staff had a completed checklist in their staff record. The staff training records were inspected for four staff. These showed that most staff had either not received or the training was out of date for mandatory health and safety training. A notice in the office said that all staff were expected to pay 50 of the training course costs for all training provided by an external trainer. The manager explained that this includes all health and safety training. The anonymous complaint sent to the Commission said that staff were struggling to pay these training costs. Whilst the Commission cannot comment on staff terms and conditions it is none the less very poor practice for an employer to expect staff to pay towards training that they need to receive as an essential part of their employment. It is also evident that this practice is potentially placing residents at risk as staff are not completing the training. The staff supervision records were inspected for four staff. The staff had all received individual supervision but the record of supervision was very limited, often just a few lines. The manager needs further training to ensure he knows how to undertake supervision to a satisfactory standard. The staff members spoken to explained that they receive regular individual supervision. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,39 and 42 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst a registered home manager in place, there is scope for him to perform at a higher standard. Residents can be assured their views will be considered when monitoring the quality of the service. Further work needs to take place to ensure residents are protected by fully robust health and safety measures. EVIDENCE: The registered manager was on duty at the time of the inspection. He is a qualified nurse and demonstrated considerable knowledge about mental illness and supporting people with mental health issues. He did however appear to have a healthcare rather than social care approach and even referred to Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 25 meeting with each of the residents as doing a “ward round”. Of greater concern was the fact that he did not appear to have a full understanding of the operation of the service, struggling to locate essential documents and appearing to be passing responsibility for staffing issues to the registered provider. One resident said he did “not really like” the manager but “got on well with the other carers” and the other resident said the manager “keeps himself to himself and is mainly in the office”. The inspector recognised that it is important for the manager to be calm and relaxed when working in a service for people with complex mental health needs but gained the impression that the manager was not adequately focused on managing an effective service. The inspector saw the annual quality assurance exercise completed on behalf of all the services. This incorporated feedback from residents and care professionals. Where action was needed there were clear statements about how this was going to be addressed. The health and safety training records were inspected for four staff and as stated in the staffing section of the report, most need to receive the training or have the training updated. This includes training in fire safety, first aid, infection control and food hygiene. The fire safety measures were inspected. The fire appliances and fire alarm had been serviced. Weekly fire alarm and emergency light checks and three monthly drills are recorded as taking place. A fire safety risk assessment is available. The fire safety emergency plan is not complete and does not state where residents should congregate if they need to vacate the home. The self-assessment (AQAA) confirmed that current certificates were available to confirm the maintenance for the portable electrical appliances and gas appliances. The electrical installation certificate was inspected and has expired. The current insurance certificate was inspected and was satisfactory. All serious accidents and incidents have been appropriately notified to the Commission and monthly provider monitoring visits have been taking place. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 3 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 4 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 2 x Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 YA12 Regulation 16(2)(m) Requirement The registered person must ensure that the activity coordinator post is filled and that each resident is supported to develop an individual activity plan that reflects their interests. The registered person must ensure that all medication returned to the pharmacist is recorded and signed. The registered person must ensure the kitchen cupboard doors and oven door are repaired. The registered person must ensure that the correct laundry facilities are provided that provide safe standards of infection control. The registered person must ensure that all staff have where needed the appropriate permission to work in the country. The registered person must ensure all the staff have completed contracts of employment that include their hours of work, rate of pay and is signed by the employer. A copy DS0000010779.V356028.R01.S.doc Timescale for action 15/03/08 2. YA20 13(2) 15/02/08 3. YA24 23(2)(b) 28/02/08 4. YA30 13(3) 30/04/08 5. YA34 19(1)-(5) 15/02/08 6. YA34 19 schedule 2 28/02/08 Wimbourne House Version 5.2 Page 28 7. YA35 18(1)(c) 8. YA36 18(2) 9. YA37 10(3) 10. 11. 12. YA42 YA42 YA42 23(4) 13(4) 13(4) 23(4) must be given to each member of staff. The registered person must ensure that each member of staff has their training updated and that this is not affected by funding issues. The registered person must ensure the manager has the training so he can complete and record staff supervisions appropriately. The registered person must ensure the registered manager is given the training and support to be able to understand and carry out his role to an appropriate standard and fulfil his responsibilities as stated in the Care Home Regulations 2001. The registered person must ensure the home has a complete fire evacuation plan. The registered person must ensure the home has a current electrical installation check. The registered person must ensure all staff have completed or refreshed their health and safety training including fire safety, first aid, food hygiene and infection control. 30/04/08 31/03/08 31/03/08 15/02/08 28/02/08 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The registered person should prepare the statement of purpose in a user-friendly format. The registered person should further develop the role of DS0000010779.V356028.R01.S.doc Version 5.2 Page 29 Wimbourne House 3. 4. 5. YA19 YA23 YA33 the key-worker so that staff other than the manager take this role. The registered person should explore alternative ways to support residents to access primary healthcare checks. The registered person should provide a safe storage area in the home for petty cash and residents monies. The registered person should ensure that staff do not work excessive hours that may compromise their performance. Wimbourne House DS0000010779.V356028.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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