Inspection on 06/05/05 for Windsor Residential Care Home

This inspection was carried out on 6th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Windsor Residential Care Home 23/05/08

Windsor Residential Care Home 30/05/07

Windsor Residential Care Home 05/09/06

Windsor Residential Care Home 23/12/05

Windsor Residential Care Home 16/08/04

Windsor Residential Care Home 16/04/04

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

CARE HOME ADULTS 18-65 Windsor Residential Care Home 18-20 St Mildreds Road Westgate-on-sea Kent CT8 8RE Lead Inspector Patrick Gough Unannounced 6 May 2005 9:10 th 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 Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Windsor Residential Care Home Address 18-20 St Mildreds Road, Westgate-on-sea, Kent, CT8 8RE 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) 01843 836055 Parkcare Homes Ltd Mrs Carole Saunders Care Home 17 Category(ies) of Learning Disability (17) registration, with number of places Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16/08/2004 Brief Description of the Service: Windsor Residential Care Home is registered to provide residential care for up to 17 adults with learning disabilities. At present there is no identified upper age limit. The Home is owned by a large company and has a Manager who is responsible for the day-to -day running of the establishment. Windsor is situated in a residential area of Westgate, which is adjacent to the seaside town of Margate. The Home, which has a small front garden, is within walking distance of most local amenities, including the seafront and local shops. There is limited off road parking but there is on road parking to the front of the property. There are staff on duty 24 hours a day including staff on wake duty at night. The health care needs of the residents are met by the local primary health care team. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which commenced at 9.10 am and lasted for five and a half hours. The manager, deputy manager and four other care staff were on duty. A number of the service users were sitting in the lounge and others were in their room or talking to staff. The inspector spent some time with the manager and deputy focussing on the requirements and recommendations made at the previous inspection. Service user’s files and other documentation were examined and the inspector spoke with five of the service users. The Home has made significant progress on the action plan produced in response to the inspection report. What the service does well: What has improved since the last inspection? The needs of the people accommodated, have been re-assessed and the care plans have been updated. There is now more emphasis on working closely with people and engaging them in life skills, activities and social events. There is better support for the Manager and the Manager and senior staff provide better support for the rest of the staff team. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 6 Record keeping has improved and the information in the reports is more relevant. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 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 Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 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) 1,2,3. The Home has made considerable progress in improving its assessment of service users needs and is continuing to work with service user representatives to establish common objectives. Outcomes are not yet fully met. EVIDENCE: The Manager and Deputy Manager confirmed that the timetable for care plan reviews and needs assessments, submitted to the Commission following the previous inspection, had, except one, which is still outstanding, been conducted as planned. The Manager was advised to pursue the completion of the outstanding assessment. There have been no new admissions in the past year. Records reveal that the outcome of the assessments has been incorporated by key workers in their care planning preparation. The records of three service user’s, which were inspected, were up to date. The Home’s own Observation Based Evaluation (OBE), which has been partially completed for some of the service users, is designed to assess the needs of new admissions in order to Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 9 identify resources to meet individual needs. Although some training has been given to staff on how to use it as an assessment tool, the staff appeared to have some difficulty using it effectively. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7. The management and staff have re-established the care plan process and now service users needs are monitored more closely and reviewed, although more detail needs to be provided to evidence satisfactory implementation. There is a recognised need to develop further methods of communication with service users who have communication difficulties in order that staff can effectively communicate and assist them with decision making. EVIDENCE: Three service user’s files were sampled. The recording of care plan material and subsequent implementation was re-established in November 2004. Some material in one file was undated and unsigned and this was discussed with the Manager. Lack of sufficient detail in the plans made it difficult to evidence that objectives were achieved. Care plans are reviewed each month and given the lack of liaison with Care Managers in the past it was advised that Care Managers are provided with a plan update on a three monthly cycle. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 11 The staff were observed to be interacting with the service users and indicated that they were reasonably able to discern their needs and wishes through verbal prompts and gestures. Some staff have completed Makaton training. Through discussion with the Manager it was established that, given that the ability to communicate is a primary difficulty for a large percentage of the service users, that specific training and advice should be sought to enhance the staff skills. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12, 13 and 14. The Home provides opportunities within the Home for the service users to develop and maintain their daily life skills. Community involvement is encouraged and the service users are supported to participate in activities, which enhance quality of life. EVIDENCE: It was confirmed that three of the service users attend a local college one day per week to participate in a gardening course. Two other service users attend music and movement sessions. It was stated that there is a life skills component to each activity. It is projected that more service users will be incorporated in college courses from September 2005. One service user indicated that he was looking forward to going to the music and movement session, on the afternoon of the inspection. Another service user stated that he was soon to go on holiday and the staff confirmed that he was being supported to holiday with a friend. Arrangements have been made for all the Home’s residents to have a holiday this year. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 13 Service users access a number of local community activities such as, the pub, ten-pin bowling, cafes, the hairdressers and go on walks. There is greater cooperation between the Home and its sister home, with joint ventures being organised such as, for example, a Halloween Ball and the Christmas party. Those service users with the confidence and ability are encouraged to perform daily life skills tasks, and some are assisted with purchasing their own clothing in local shops. All service users are given support to try the activities. The Manager was advised to ensure that the staff keep a record of such activities to inform care plan reviews. The Manager stated that links with local centres are being developed to provide more opportunities. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19. The service users are given support and assistance with their personal care. The Home has provided the required equipment to support the staff with the physical care of service users with more complex disabilities and continues to explore sources of advice and guidance to assist with their care. EVIDENCE: Observation of practice indicated that service users were addressed respectfully and given assistance where appropriate. The staff were engaging the service users in conversation. Two service users were able to confirm that they were being well looked after. The incident and accident records were well written and indicated that each event was responded to in an appropriate way and in accordance with the Home’s policies and procedures. The staff have had access to training as planned. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 15 The Home now has nine recliner chairs to be used specifically for those service users who have difficulty with movement. Tilting and height adjustable beds have been provided for service users with complex physical needs as well as an assisted bath and other equipment. The service users are supported to access healthcare facilities in the locality. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 16 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) 22,23 The management provide the necessary training and support for staff and they engage the appropriate procedures to maintain the safety and protection of the service users The manager has responded quickly and effectively to registered complaints. EVIDENCE: Two complaints, which were registered with the Commission, have been addressed in accordance with the Company’s stated practice and to the satisfaction of the complainants and the Commission. Practice records indicate that the staff have responded in the appropriate fashion to difficult behaviour and received the necessary support from senior staff. Adult protection training has been accessed by 50 of the staff team and three more are due to participate in training in June 2005. There are plans for the company to provide more in-house training on adult protection behaviour management. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 17 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) 24,25,27,30. The service users live in clean accomodation but their comfort would be enhanced through the implementation of a programme of maintainance, redecoration and refurbisment, throughout the interior of the building. The lack of proper handwashing facilities increases the spread of infection. EVIDENCE: The service users bedrooms were clean, odour-free and well ventilated. The majority of the service users enjoy spacious single room accommodation with adequate furnishings and equipment. Where there are shared rooms, the deputy manager confirmed that both service users agree to sharing and benefit from it. Many of the bedrooms are in need of redecoration and one bedroom requires new carpet. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 18 Some of the furniture in the two lounge areas is old and worn and the seating, apart from the new reclining chairs, needs to be replaced. The carpet needs replacing. The dining room is dark and uninviting and the wooden tables and chairs are bare and scored. All three rooms are in need of redecoration and refurbishment. Plans to replace all the windows have not yet been implemented; consequently the exterior of the building is shabby and the redecoration of the interior of the premises has been delayed. There will be requirement for the registered provider to proceed with repairs and provide the Commission with a planned maintenance programme, indicating the areas to be redecorated and refurbished and a timescale. The door, leading from the small kitchen to the garden, was in a damaged state. There were no soap dispensers in any of the toilet areas used by the service users and the flooring in one of the toilets was peeling at the edge increasing the risk of seepage into the floor. The Home will be required to access advice on suitable hand washing facilities designed to prevent the spread of infection and appropriate to the needs of all the service users. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 19 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) 32,33,36. The staff have not received the level of professional training to equip them with the skills to meet the range of needs presented by the service users. The current staff/service user ratio is adequate and the staff receive regular support and supervision. EVIDENCE: The supervision and management of the service users is maintained despite the current staff vacancies. The manager is currently recruiting three staff to cover night duties, however in the meantime, staff on daytime duties are providing night cover. There is a lack of suitably qualified staff, however the staff team demonstrates a commitment to providing a good quality of care. Staff meetings are held regularly and staff receive formal and informal supervision and support. The manager and the deputy manager are trained to provide supervision and share the supervision schedule Training is provided to meet basic and primary practice needs but currently no staff are engaged in training leading to professional qualification. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 20 Inspection of a sample of staff files confirm that the recruitment process followed by the Company is in line with the guidance in the National Minimum Standards and fulfils the requirements in the regulations. There will be requirements for the Home to provide professional training for the staff team including a qualification in management for the manager. It will be recommended that staff are given access to specialised training, particularly training aligned to working with people with learning disabilities. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 21 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) 39,41 The monitoring and regulation exercise, conducted by the responsible individual has supported the manager to improve the quality of the provision at the Home. Similar internal monitoring, by the manager, incorporating the views of service user’s advocates, and visiting professionals is needed to enhance the self auditing process. EVIDENCE: The responsible individual or a manager from another of the Company’s Home visits the Home on a monthly cycle and provides a report to the manager and the Commission indicating good practice and highlighting aspects of the provision that requires attention, primarily the quality of care given to the service users but also including the physical appearance and structure of the building. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 22 The manager, however, does not conduct an internal self-monitoring process, based on records of practice, observations and feedback from service users and other relevant people. There will be a recommendation that this is put in place. Policies and procedures are regularly reviewed. Records of practice, which were inspected, including service user’s files, incident and accident records and recruitment information, indicate that staff are more rigorous with their record keeping. In one instance, a care plan evaluation was undated and unsigned. The importance of dating and signing material was discussed with the manager. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 2 x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 x 2 x x 1 Standard No 11 12 13 14 15 16 17 2 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x 1 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Windsor Residential Care Home Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x 2 x 3 x x H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 24 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 24 Regulation 16,23 Requirement Timescale for action 1/07/2005 2. 30 13 3. 32 19 4. 39 24 The company shall create a maintenance and refurbishment plan for the Home and provide a copy to the Commission. The Manager shall make suitable 1/07/2005 arrangements for maintaining satisfactory stamdards of hygiene in the Home, to prevent the spread of infection. The Company shall ensure that 1/09/2005 all care staff are given the necessary training to perform their role to the required standard. The Manager shall establish and 1/07/2005 maintain a system for reviewing the quality of care in the Home at regular intervals and provide a report to the Commission. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations The Home should complete the assessment of service users needs and provide the necessary support to staff to H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 25 Windsor Residential Care Home 2. 3. 4. 5. 6. 7. 3 7 11 23 27 33 enable them to do so. The Company should conduct a staff skills audit to determine their training needs in order to ensure that service users needs are addressed. The Manager should ensure that the staff have access to sufficient training on methods of communication with service users. The Manager should ensure opportunities given to service users to engage in life skills activities are recorded in their care plan information. The Company should ensure that all staff receive adult protection training. The Company should progress the redecoration programme proposed for the building to improve the quality of the service users bedroom accommodation. The Company should ensure that there are sufficient staff within the home to provide a high quality of support to the service users at all times. Windsor Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU 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 Residential Care Home H0 H56 S23628 Windsor House V224938 06052005 Stage4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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