CARE HOME ADULTS 18-65 Windsor House 9 Cabbell Road Cromer Norfolk NR27 9HU
Lead Inspector Ann Catterick Announced 12 April 2005 13.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Windsor House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Windsor House Address 9 Cabbell Road Cromer Norfolk NR27 9HU 01263 511438 01263 511141 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Robert Jeans Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Windsor House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Ten (10) people with a Learning Disability may be accommodated. Date of last inspection 23 November 2004 Brief Description of the Service: Windsor House is a care home providing personal care and accommodation for up to 10 adults with learning disabilities. There were 10 people living in the home on the day of inspection. The Registered Providers are Sarah and Robert Jeans and the manager is Mrs Rachel Stevens. Rachel is completing her registered managers award and has made application to become the registered manager. The home is located very close to the sea in the coastal town of Cromer and is close to shops, pubs and all local amenities. Windsor House is a large Edwardian terraced property with accommodation on four floors. The fourth floor is living accommodation for the manager. The property has been in a poor state of repair but the proprietor is in the process of making improvements throughout the home. Windsor House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was the home’s announced visit, which took place over 6hrs. The first part of the day was spent with the proprietor and manager of the home and the second part of the day was spent with service users and staff. There was also the opportunity to talk to the relatives of two of the service users and have a tour of the building. The inspector had not received the pre inspection questionnaire. The inspector was able to look at care plans and some policies and procedures as well as meet with staff. The inspector was able to spend time with most service users and to also join them for tea. No complaints had been received about the service since the last inspection. What the service does well:
Care plans were seen and included the specific details of the individuals assessed needs. The care plans gave all of the information needed to allow the reader to be aware of the service users individual needs. Those relatives spoken to felt that their relatives were very happy in the home and receiving a good caring service. Staff were seen to be caring and kind to service users and had a good understanding of the needs and preferences of the service users. Examples of this were seen at tea- time when individual preferences of what service users had and in what order they ate it were observed. Service users seemed happy and well supported. Windsor House Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Windsor House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Windsor House Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Not enough information was gathered prior to admission, or in the case of the emergency admission, soon afterwards, to give the home the information they needed to be sure to meet the individual’s aspirations and needs. EVIDENCE: Since the last inspection two service users have been admitted to the home. One of these service users was admitted following an assessment by social services and by the home. Some of this information was over a year old and therefore not particularly relevant. The other service user was placed as an emergency without a pre placement assessment. In this situation an assessment should have been completed within 5 working days and this did not take place. No medical assessment had been received for either service user and it was not clear how the home had assessed that the prospective service users needs could be met within the home. However the needs of both of these service users appeared to being met on the day of inspection. . Windsor House Version 1.10 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and9 The individual needs of service users were being met, and they were able to make decisions and choices about their own lives with the confidence that this would be supported by staff. The independence of individual service users was promoted and this was, mostly within the framework of risk assessments. EVIDENCE: The care plans seen were detailed and comprehensive given clear information about individual service users. Wherever possible these had been signed by the service users or relative. Two relatives were spoken to and both thought the needs of their relatives were being met within the home and spoke positively about the care being provided. One of these relatives said that her son’s confidence and communication skills had improved over recent months. She felt that all of his care needs were being met and that all aspects of the care he received were positive. She said that his independence was encouraged and that he was more contented and less withdrawn. Service users said that they were happy with the care they received and that they were supported in doing what they wanted within their lives. Windsor House Version 1.10 Page 10 Individual and environmental risk assessments had been made. These were detailed and supported and encouraged the opportunity for service users to be able to take appropriate risks that other people take in their day-to-day lives. There was no risk assessment relating to the radiators and a requirement has been made in this area. Windsor House Version 1.10 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,15,and17 The home is in the centre of the town and service users are able to access facilities and entertainment within the local community. Visitors and friends are welcomed in the home and this was seen to be of benefit to service users. Service users were seen to enjoy their meals although there may be a need to monitor the nutritional value of food. EVIDENCE: One of the service users works in a charity shop in the local community. Service users use the local shops and facilities and have the opportunity to visit lots of the summer attractions that are found in a seaside town. Family are welcomed in the home and on the day of inspection one service user had returned from a stay with her brother and another was enjoying a visit from his mother. Both relatives said that they were always made welcome and this was seen to be the case on the day of inspection.
Windsor House Version 1.10 Page 12 The content of meals within the home has recently changed. The adult training centre, where many of the service users work, has stopped providing a cooked meal. This has meant that many service users now have dinner when they return from work. Menus have changed to accommodate this need but the home needs to ensure the nutritional value of meals provided. The home needs to consider whether or not it is able to provide a nutritional well presented main meal without the support of a cook. At present one of the carers cooks the meal. Windsor House Version 1.10 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The physical and emotional health needs of service users were being met and all service users seemed to be happy, well and settled within the home. The home’s policy and procedures for dealing with medicines was not being followed correctly and therefore were not protecting the safety of service users. EVIDENCE: Staff had a good understanding of the physical and emotional care needs of service users. Service users were seen to be relaxed and happy in their environment with their needs being met. The home has a policy and procedures that are in place to protect the service users however errors were found on the day of inspection. The medication administration records had, in some parts, been signed by staff to confirm that the service user had taken their medication and the medication was found to still be in the monitored dosage blister pack. Staff have had some training in this area and it appears that poor practice is taking place and this needs to be addressed and staff may need further training. Windsor House Version 1.10 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users were encouraged to share their views and preferences with staff and their views and preferences were listened to. EVIDENCE: The home has a complaints procedure and this was on the notice board of the home. No complaints or concerns had been recorded since the last inspection. One service user said that she had a concern and shared this with a member of staff and felt this was acted upon. Service users were able to express their opinions verbally or otherwise and appeared confident that they would be listened to. Windsor House Version 1.10 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27,and30. Service users live in an environment that they seem to find homely and comfortable. Not all areas of the environment were safe. Those areas that the service users had access to were clean and hygienic. EVIDENCE: Since the last inspection the proprietor has begun to improve the accommodation. This is to be an ongoing task and he intends to significantly improve all areas of the home. An example of these improvements was noticed in the dining room. The room has a new ceiling and now has attractive domestic lighting where previously it has a strip light. The bathroom has been completely redecorated with new bath and accessories. The upstairs toilet was in the process of being refurbished. Some new furniture had been purchased and further new furniture was on order. A requirement had been made to risk assess radiators and have an ongoing programme for covering them or replacing them with low surface radiators. This had not been done and the radiator in the bathroom was not covered and was very hot to touch. This made the new bathroom an unsafe environment for service users.
Windsor House Version 1.10 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 36 Service users seemed to be clear about the roles and responsibilities of staff. Staff are offered formal and informal supervision and felt well support by the manager. EVIDENCE: Those service users spoken to were clear on the management structure of the home and were aware of staff roles. The home has a key worker system and service users were aware of who their key worker was. Staff were offered formal supervision and evidence of this was seen on file. The notes on supervision were not very detailed and the content of these sessions could be better recorded. Those staff spoken to felt that they were well supported by the manager and proprietors and offered appropriate training to enable them to fulfil their role. Windsor House Version 1.10 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 The home appears to be well run and the overall management of the home is good. Further improvements will be expected as the manager develops in her role and works towards completing her NVQ level 4 in management. The health and safety of service users was not being fully protected. EVIDENCE: Those staff spoken to said that the manager was very supportive and that her value base was very good. Staff felt that they were encouraged to enable each service user to reach their full potential and felt that this empowerment of service users had developed further since the appointment of the new manager. The manager has some gaps in her knowledge and it is hoped that these will be filled as she becomes more experienced and continues with her management course. A requirement had been made at the last inspection to risk assess and cover all radiators. This had not been completed and the radiator in the bathroom was very hot and put service users at significant risk. An immediate requirement was made in this area.
Windsor House Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 1 x x 2 Standard No 11 12 13 14 15
Windsor House x x 3 x 3 Standard No 31 32 33 34 35 36 Score 3 x x x x 3 Version 1.10 Page 19 16 17 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 1 x Windsor House Version 1.10 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 42 Regulation 13.4 Requirement The registered provider must ensure that the raidiator in the bathroom is immediately covered. The registered provider must ensure that proir to admission prosective service users needs are assessed by a suitably qualified person. The registered provider must ensure that medicine policies and procedures are followed correctly. Timescale for action 7 days 2. 2 14.1 13/05/05 3. 20 13.2 13/04/05 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 36 17 Good Practice Recommendations The staff are offered formal supervision and this is recorded. The detail of this supervision is limited and it is recommneded that supervision notes are more detailed. The provision of meals within the day workshops service users. attend has altered and therefore staff need to ensure that evening meals are varied and nutritious as these are now, for most service users, the main meal of the day.
Version 1.10 Page 21 Windsor House 3. 33 That now that the home is full and most service users have their main meal in the evening that consideration be given to employin a cook at thistime to allow care staff on duty to spend more time with service users. Windsor House Version 1.10 Page 22 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Windsor House Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
