Inspection on 10/12/07 for Winray Care Home

This inspection was carried out on 10th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winray Care Home 09/05/08

Winray Care Home 18/05/06

Winray Care Home 15/02/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Winray Care Home 17 Clarendon Road Leytonstone London E11 1BZ Lead Inspector Harbinder Ghir Unannounced Inspection 10th December 2007 10:00 Winray Care Home DS0000061891.V356220.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 Winray Care Home DS0000061891.V356220.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. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winray Care Home Address 17 Clarendon Road Leytonstone London E11 1BZ 020 8279 7884 020 8279 6812 Winraycare@hotmail.com www.winraycare.com Winray Care Home 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) Post Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: The homes Statement of Purpose states that the aim is to provide a home for four young adults who are affected by Autistic Spectrum Disorders, Severe Learning Disability and behaviour that can challenge the service. The house is a semi detached property located in a residential area in the London Borough of Waltham Forest and is well situated for access to public transport. Information about the service is available at the front reception area of the home, including inspection reports, to people living in the home and to other stakeholders. As informed by the proprietor of the home at the time of the inspection the services weekly fees range from £800 to £1500 depending on the needs of the resident. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection undertaken by Regulation Inspector Harbinder Ghir on Monday 10H December 2007 between 10am and 4.00pm. During the inspection the inspector was able to talk to the residents residing at the home and staff. Only two people were accommodated at the time of the inspection. Professionals and relatives of residents were contacted by telephone for their views on the service, including the Accreditation Advisor for the National Autistic Society, who is working with the staff team towards autism accreditation. The London Borough of Waltham Forest who are the host authority for the service was also contacted, inviting their comments on the service they are commissioning, which have been included in the report. The London Borough of Hackney and the London Borough of Barking and Dagenham who are each funding the placements of two residents at the home were contacted, inviting their comments on the service they are commissioning. They did not provide any feedback to be included at this inspection. As part of the inspection the inspector toured the home and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager. A completed Annual Quality Assurance Assessment was received by the Commission for Social Care Inspection prior to the inspection. Following the inspection, a meeting took place between the provider, operations manager and the Commission for Social Care Inspection, to discuss issues arising from the site visit, and the views of the provider and operations manager have been taken into account in drafting the report of the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: The service has a comprehensive pre-admission policy to ensure they can meet the needs of prospective residents. The service offers trial visits to prospective residents and also gives opportunities to families/representatives to visit the home. Daily routines are not service led and residents are able to wake up and go to bed as they wish. Staff qualifications evidenced that the service has a ratio above 50 of NVQ qualified staff. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 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 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. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose which provides detailed information on the services provided by the home, must be updated to reflect the actual services and facilities provided by the home, so that prospective residents and their representatives have the information they need to make an informed choice about where to live. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. EVIDENCE: The service’s Statement of Purpose states “Winray residential care home is for four adults who fall within Autistic Spectrum or have a severe learning disability.” The document provides detailed information about the service and sets out the aims and objectives of the home, which is supported by a Service Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 9 User Guide. However, the Statement of Purpose does not accurately reflect services and facilities currently provided by the home. The document refers to a management structure consisting of a manager and an assistant manager. At the time of the inspection there was only a manager in post. The document also refers to the accommodation as providing a visitors’ room and activities room on the first floor. There was no evidence of these two rooms existing during a tour of the home at the inspection. Discussion with the registered provider and the operations manager after the inspection clarified the need to define therapeutic activities, and to ensure that people providing therapeutic services are appropriately trained and qualified to do so. The document is supported by a Service User Guide, which is presented in picture format and was easy to follow and understand. However the guide does not include the correct name of the Commission for Social Care Inspection and again refers to the management structure identified in the Statement of Purpose. The service identifies itself as a specialist service and accommodates individuals with complex care needs and if such facilities are not in place this needs to be clear in the documentation to ensure it is an accurate reflection of the services provided. It is an offence to provide information in a Statement of Purpose, which is intentionally misleading. The service has failed to meet this requirement from the last inspection and therefore it will be repeated as Requirement 1 at this inspection. Failure to comply will result in the Commission for Social Care Inspection taking enforcement action. Admissions are not made to the home until a full needs assessment has been undertaken. The service is working closely with the National Autistic Society to become an accredited service and with their consultation has implemented an autism specific referral and assessment form, which would be used for any new prospective residents admitted to the home. The accreditation advisor has stated that good work has been achieved in this area and has recommended that this format is used to re-assess the needs of the current residents. On closely examining two files of residents, it was evident that the assessment was conducted professionally and sensitively and involved the individual, and their family or representative, where appropriate. Assessments comprehensively covered the mental health needs of residents, their personal care needs, dietary preferences, communication needs, mobility, religious and cultural and social care needs. Assessments and information had been obtained by health and social care professionals where appropriate. Trial visits are offered to all prospective residents. Individuals can visit the home up to three to four times. One resident stayed at the home for a week before deciding to move in. A relative spoken to as part of the inspection, informed that she visited the home, prior to her loved one moving in. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. More detailed and person centred care plans would further provide staff with personalised information to meet the needs of residents. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, but these are not always followed. Service users’ financial interests are safeguarded, but improved systems of recording residents’ outgoings and incomings of money would further ensure all monies are correctly accounted for. EVIDENCE: Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 11 There is a care planning system in place, which comprehensively covers the physical, mental, health, communication and emotional needs of residents. Care plans were easy to read and follow and clearly described how care staff were to meet needs in all areas of the individual’s life. The sexual needs of residents were identified and positively identified how staff were to support one resident to meet his needs. Care plans focused on promoting the independence of people living at the home and centred on tasks residents could complete independently. One care plan stated, “Y can assist with carrying used clothes to the laundry safely.” Another resident’s care plan stated “Staff are to continue involving X in taking decisions and making choices about her personal life by consulting her. Talk regularly to X in a positive way to boost her confidence.” Care plans were also presented in picture format and the detail of some information in the care plans evidenced that they had been devised with the consultation of family and the resident themselves. However, information on care plans did not always reflect the actual preferences specified by the resident. For one resident the proprietor informed that the resident will not allow his nails to be trimmed by care staff and will only allow his mother to do this. On viewing his care plan, this information was not recorded. Staff also informed that a female resident has specified same gender care, this information was also not recorded on the care plan. One care plan stated that the resident is “woken up at 6am to go to the toilet”, as part of his toileting regime. On speaking to a member of staff he informed that the resident now goes to the toilet independently. The manner in which information on care plans was recorded in relation to daily routines was not person centred although there was evidence to support that this was not the practice at the home. Both care plans stated that residents are to be woken up by staff at the same time everyday and go to bed each day at the same time. On examining the daily case recording notes of residents it was evident the residents went to bed or got up at their preferred times and daily routines were very flexible at the home promoting the rights of residents. Although the care planning document provides sufficient information on the needs of residents it was disappointing to find that the care plan was not a live working document utilised by the service. Both care plans were stored away in the homes office on the third floor, which did not ensure that any members of staff or newly recruited staff could quickly access the documents and inform themselves on the needs of people who use the service. It is Requirement 2 that care plans accurately reflect the daily care needs of residents to ensure staff are provided with the correct information to meet their needs and that they are used as a live working document accessible to all care staff and residents. The service had completed comprehensive risk assessments for each resident. Risk assessments included risks in the bathroom, kitchen, using public places, the bedroom, using transport and included behaviour management guidelines when residents presented challenging behaviour, which highlighted that both residents required one to one support. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 12 The service is responsible for managing the daily personal finances of one resident. An audit was carried out of the resident’s money in safekeeping to check if the amount was the amount recorded in the resident’s financial transaction book. The amount recorded was £29.58 but the amount counted was £29.56. Whilst the discrepancy was small, it is important to ensure that records tally with sums of money held. The Registered Persons must check the recordings of expenditure to ensure they are correct and all incomings and outgoings of money are recorded correctly. This is Requirement 3. Evidence was seen of care plans being reviewed on a six monthly basis, but the registered persons must ensure that care plans are updated accordingly as discussed above. Monthly meetings between the resident and key worker have also been implemented to ensure residents are happy with the way their needs are being met. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16, 17 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Daily routines respect the rights of residents ensuring their needs are met in the way they prefer. Residents are not always offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 14 EVIDENCE: The service has made a strong commitment to enabling people who use the service to develop their skills, including social, emotional, communication, and independent skills. Individuals are now supported to identify their goals, and work to achieve them. Activities included visiting the park, the local farm, music therapy, craft activities at the home and going out shopping. One resident attends college twice a week undertaking a skill based course and attends a day centre once a week where she participates in paid employment. A member of staff from the home supported her throughout the day at these venues. During the inspection staff were seen to take residents out to the local park and supported one resident to college. Each resident’s religious needs were also identified in their care plan, which care staff supported residents to meet. One resident was supported to attend church every week. Residents have a detailed activity planner in their care plan, which was not up to date and was not an actual reflection of activities residents participated in. For example one resident’s days to attend college had changed, which had not been included in their planner. It is Recommendation 1 that each resident’s activity planner is updated to ensure they and staff have the correct information on their daily activities each day. Family and personal relationships are actively promoted by the home. Family, friends and relatives are encouraged to visit their loved ones and residents can also visit family over the weekends. A relative spoken to stated, “I visit every other day and sometimes contact the home everyday. They are helpful and are always willing to talk to me.” On viewing the home’s menu, it was identified that residents are only offered a choice of one meal at suppertime and at lunchtime. There was a selection of foods to choose from at breakfast. Residents were not actively supported to help plan meals. For one resident who did not communicate verbally the service had identified in his care plan and by working with his Speech and Language Therapist that the resident should be encouraged to communicate to them through pictures and therefore had devised a daily picture book for him but had not considered to provide a comprehensive picture format menu for him to choose his daily meals from. This would have promoted him to actively make choices and decisions in regards to the meals he wanted to eat. There was also little evidence of residents going out to eat or of foods being prepared of their choice. The service must provide foods and meals, which is varied, and a choice of meals to meet the preferred dietary needs of residents which ensures their rights to choice and autonomy are promoted. This will be stated as Requirement 4. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 15 Winray Care Home DS0000061891.V356220.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): 18, 19, 20, 21 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive personal support and care in the way they prefer and require. Medication practices ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. EVIDENCE: All residents have a detailed plan of their daily routine including the type of support needed in relation to personal hygiene, according to their level of care needs. All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to personal preferences in relation to the provision of personal care. Personal support takes account of individual’s choice of dress and appearance is respected. Residents were observed to be well dressed and were well groomed. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 17 Residents are supported by staff to attend appointments with healthcare professionals and their health is closely monitored and prompt referrals are made. There was evidence of staff taking a female resident to well women checks and the involvement of multli-disciplinary healthcare professionals where required were made to dentists, chiropodists, GP’s, speech and language therapists and community psychiatric nurses. As part of the inspection the speech and language therapist was spoken to who made very positive comments about the care provided at the home. She stated, “I am happy with the way care is provided for the resident I work with. When I’ve got something to say, they are good at taking my comments on board and staff are very quick to pick up on things. They do follow my instructions.” Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure the death of a service user is handled with respect and as the individual would wish. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined, which were all in good working order. Winray Care Home DS0000061891.V356220.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): 22, 23 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure in place and residents can be assured that their views are listened to and acted on, but complaints need to be recorded, to demonstrate effective management of dissatisfactions. All staff have attended training in Safeguarding Adults, to ensure they are provided with the knowledge to ensure the safety of residents. EVIDENCE: The complaints procedure was seen which was provided in text format and in picture format for residents. A complaints logbook is kept by the home, which was viewed. There was one recent written formal complaint logged about the high noise levels within the home, the service investigated the concerns highlighted satisfactorily. As part of the inspection the host authority for the service, The London Borough of Waltham Forest was also contacted. A commissioning officer from the borough informed that they also received this complaint and contacted the home, who investigated the complaint satisfactorily. The officer informed that “the home behaved responsibly and managed the situation.” A relative also spoken to stated “I have had no reason to complain about anything serious, but have spoken to the home about general issues, and they have always resolved them.” However evidence was not found of any of these concerns recorded or how they had been actioned. All concerns about the care of service users, regardless of source or how they are made, must be recorded and evidence how they have Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 19 been responded to. This will be stated, as Requirement 5.The Commission for Social Care Inspection has not been informed of any complaints. All staff attend POVA training and safeguarding adults is comprehensively covered in the induction programme. The service has obtained safeguarding adults procedures devised by The London Borough of Waltham Forest and the Department of Health’s and “No Secrets” guidance. However, on requesting to see the service’s policy on safeguarding adults this was not readily available in their policy and procedure folder and had to be printed from the service’s computer system. This did not assure the inspector that staff have procedural information readily available to follow in the event of an allegation being made. Therefore it is Requirement 6 that all procedural information in relation to safeguarding adults is readily available to staff to follow, to ensure the protection of people who use the service. Winray Care Home DS0000061891.V356220.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): 24, 25, 26, 28, 29, 30. People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable home, but further decoration would improve the environment of the home. EVIDENCE: The premises were clean and free from offensive odours. Furnishings and fittings in communal areas were domestic and unobtrusive. Residents’ rooms were viewed during the inspection, all residents had personalised their rooms according to their individual taste. However, furnishings in the communal areas of the home were limited and further furnishings would give it a homely feel and personalise the environment. No risk assessments were seen during the inspection that would place residents at risk by the home doing this. There is a small communal lounge and kitchen diner and a sensory room in the back garden for residents to use. There are no other communal areas for the residents to use, contrary to the information provided in the Statement of Purpose, which refers to a visitors’ room and an activities room on the first Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 21 floor of the home. On viewing the sensory room it had been provided with padding to the walls and soft furniture. As the room was located in the garden, it was not sufficiently heated to enable the facilities to be used spontaneously. It is Requirement 7 that all parts the premises used by residents provide sufficient heating to ensure residents are comfortable and safe. In order to encourage outdoor activities the service has purchased a large trampoline in the homes rear garden for one resident. The resident was seen using the trampoline throughout the day. However, the trampoline has taken up a considerable amount of space in the garden and the service has not considered the impact of this on the other resident residing at the home who does not use the trampoline, and is not able to use that garden area. The service lacks forward planning, which does not ensure they can meet the needs of all residents without considering the infringements that may be placed on residents’ rights to choice and autonomy. The corridors at the home are very narrow and two people could not pass at the same time. It continues to be of concern as to how staff would deal with any incidents in these restricted areas, as staff would have very limited space to move. A community learning disabilities nurse spoken to as part of the inspection also expressed concern at the homes narrow corridors and limited communal space. He stated “The environment at the home is not ideal or has been personalised and I would not place prospective residents there with autistic needs of challenging behaviour. The service is aware of my views. They are trying to do the best they can within the current environment and they do encourage residents to be active.” An accreditation advisor from the National Autistic Society also expressed concern at the layout of the physical building and how staff would manage potential incidents of aggression. One resident’s room was also kept locked. The member of staff informed that the room was locked, as another resident would go into the resident’s room. However, on viewing the resident’s care plan, no information could be found of that resident going into the other resident’s room. Locking the resident’s room without his involvement is restricting the resident’s right to go into his room at his choice and is inhibiting his rights to choice and freedom. The registered persons must clearly record why the resident’s room is kept locked and if there are any risks posed to him or anyone living at the home in his care plan. This will be stated as Requirement 8. The staff team also need to consider how they can manage the behaviour of the resident who enters the accommodation of others. Winray Care Home DS0000061891.V356220.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): 32, 33, 34, 35 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment vetting procedures are in place but need to be further improved to ensure residents are in safe hands at all times. Whilst training is provided to staff in mandatory area, staff would benefit from further training in understanding and managing challenging behaviour and autism to provide them with the skills and information to meet the specialist needs of residents the service accommodates. The Commission cannot be confident that services users are always supported by adequate numbers of staff. EVIDENCE: Three staff files were closely examined one of which was of a recently recruited member of staff. Files were found to be in good order with all the required Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 23 checks and documentation being in place. However character references received by the service, which did not include company stamps were not further confirmed, to ensure they were provided by the people the applicant, had named on their application form. To ensure the protection of residents and staff the service must complete robust recruitment checks before the applicant is employed. This will be stated as Requirement 9 The service’s Statement of Purpose states “Winray residential care home is for four adults who fall within Autistic Spectrum and or have a severe learning disability.” The service is working towards accreditation as an autism specific service with the National Autistic Society. An accreditation advisor from the society informed the Commission for Social Care Inspection that he has been working with the manager of the home and the staff team for approximately one year and that the service is at the foundation stage and is primarily working on its paperwork for autism methodology including assessment tools. He stated that the work has been of a good standard and future is promising. Later on, the advisor will be involved in observations of staff practice, to back up the methodologies currently being developed. The service has accommodated two individuals with high complex needs who both fall within the Autistic Spectrum. On viewing staff training files the training provided to staff to meet the specialist needs of these individuals required further improvement. All staff have undergone an introduction to autism but none have yet received in-depth training in the area. On speaking to the accreditation advisor from the National Autistic Society he also highlighted this as an area of concern, stating that it was his view that staff needed more specialist training in autism to develop their expertise. His view was that there was commitment from the service but that they need more resources especially for the training of staff. Staff spoken to at the inspection also informed they would benefit from further training in autism. Other training received by staff included training in strategy for crisis intervention prevention and staff files evidenced training in medication; protection of vulnerable adults; infection control; food hygiene; manual handling and first aid. Although training is provided to staff in mandatory areas, the service must provide further training to staff in understanding and managing challenging behaviour and autism to provide them with the skills and information to meet the specialist needs of residents the service accommodates. This will be stated as Requirement 10. The service has a staff team consisting of permanent members of staff and agency staff. The service does have a ratio of 50 of NVQ qualified staff working at the home. The ethnic diversity of the staff team reflects the diversity of the local community and the cultural backgrounds of people who use the service. Positive comments were received from relatives and professionals contacted during the inspection. These included “The staff are very pleasant at the home and are always willing to help.” “The staff always listen to me, they are very good.” The speech and language therapist spoken Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 24 to as part of the inspection stated “I have held training workshops at the home in communication strategies with autism with various members of staff, and the staff are all very receptive.” On the day of the inspection there were concerns at the levels of staffing provided at the home. When the inspector arrived at the premises only one member of staff was on duty supporting two residents. Both residents as identified in their care plans can present high levels of challenging behaviour. This was also evidenced by examining the accident and incident recording sheets, which recorded numerous incidents of staff being physically assaulted by residents. On arrival, one of the residents, who can become very excited by visitors as later informed by the proprietor of the home, became very challenging and began to physically hit the support worker on duty on the arrival of the inspector at the home. The support worker could not manage the resident’s behaviour alone and under the difficult situation was placed at risk. As a result the inspector had to leave the building, as she was unable to complete the inspection, until more members of staff came on duty. The member of staff had no knowledge of where the manager was and informed the proprietor who was at the home in the morning had gone out. The member of staff was asked to contact his to proprietor inform him of the situation. The Commission for Social Care Inspection also contacted the proprietor. Two more members of care staff including the proprietor/operations manager arrived at the home 15 minutes later, residents and staff were no longer considered to be at risk and the inspector was able to return to the home to complete the inspection. He stated that he had to go out to purchase an item for a resident which she had requested before she went to college later that day. To prevent any dissatisfaction or a difficult situation with the resident he decided to go out. Feedback back received from relatives and various professionals during the inspection has evidenced that the home is always adequately staffed and that they have had no concerns regarding staffing levels. A relative spoken to stated “I visit the home every other day and sometimes contact them everyday. When I have been at the home they always have enough members of staff on duty.” The speech and language therapist stated “ There seems to be a lot of staff on duty for two residents when I have visited, I have never been concerned by staffing levels.” Another professional stated “ I visit the home announced but have not picked up on staffing concerns.” The Commission for Social Care Inspection acknowledges that this may have been a one off incident and accepts that staff sometimes do have to pop out to purchase items for residents, to ensure they are meeting their needs. On viewing the staffing rota, it was identified that it was not an accurate reflection of staff on duty. The proprietor/operations manager informed that the manager of the home was on a course and they themselves had just popped out. The manager was on the rota for the day and another member of care staff who accompanied the propertier was not on the rota, but supported Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 25 residents throughout the day of the inspection. The rota also identified that there was only one waking member of staff on duty at night and one member of staff on duty on the weekends and on some shifts during the week. No risk assessments were in place for staff to identify the levels of risk posed to them and residents and when working alone. The home provides services to residents who can present challenging behaviour. One member of staff on duty may be placed at serious risk if they are working alone as well as risk to other residents, which does not ensure their protection. Appropriate risk assessments must be put in place to identify the level of risks staff and residents may be exposed to and that staffing levels and the deployment of staff demonstrate that people living in the home and members of staff are protected at all times; the staffing rota must also be an accurate reflection of staff on duty. This will be stated as Requirement 11. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 26 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): 37, 39, 42 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a manager in post, who has not yet registered with the Commission for Social Care Inspection. People who use the service benefit from a well run home. There are no systems for service user consultation, which does not ensure the home is run in the best interests of residents. The welfare of staff and residents is mostly promoted by the home’s practices. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Commission for Social Care Inspection was informed in February 2007 that the registered manager in post had resigned and that the service had employed an acting manager. Since then the service has recruited the acting manager as the manager of the home but has failed to register him with the Commission for Social Care Inspection. Following the inspection, the provider and operations manager were informed of the importance of making an application for the registration of the manager. The Commission was assured that this would be progressed and it would appear that there might have been some miscommunication, and for this reason, no requirement is made in this report. The manager is currently undertaking his NVQ level 4 qualification. Feedback received from staff and professionals spoken to during the inspection regarding the management of the home was very positive. Staff stated “Managers are always on call, they are very supportive. Management always listen to us.” Further comments received from professionals included “The manager is very hot on autism and is working towards to getting everyone better trained.” “The lead manager has worked hard on developing policies and new assessments. He has very good knowledge and expertise on people who use the service. He has worked hard on the paperwork and wants the service to improve.” The provider and manager are working with the National Autistic Society to gain accreditation as an autism specific service. They are involved in developing polices and procedures specific to autism and staff working at the home are also involved in developing these policies. Evidence was seen of these polices developed and being implemented by the service, and the accreditation advisor has commented positively on the work being undertaken. On inspecting policies and procedures of the home and staff training certificates it was identified that information was not easily located, which resulted in the inspection becoming time consuming, whilst care staff located information. Quality assurance monitoring is not regarded or implemented as a core management tool. There were no quality assurance systems in place to ensure the home is run in the best interests of people who use the service. A requirement in relation to these findings will be stated as Requirement 12 Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. The registered person has completed monthly regulation 26 visits and reports, which the Commission for Social Care Inspection has received copies of. However, the reports are very brief and do not provide enough detail of the findings of the visit or the views of service users during the visit. It is Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 28 Requirement 13 that the report format is reviewed to ensure the reports reflect the above information. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 1 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 x 1 x x 3 x Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 30 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 YA1 Regulation 23.1(a) Requirement Timescale for action 31/01/08 2 YA6 15 3 YA7 16 (l) 17 3 (a) 4 YA17 16 (i) The Registered Person must further develop the Statement of Purpose and Service User Guide to ensure that it accurately reflects the services and facilities that the home provides. Repeated Requirement The Registered Person must 28/02/08 ensure that care plans accurately reflect the daily care needs of residents to ensure staff are provided with the correct information to meet their needs and that they are used as a live working document accessible to all care staff. The Registered Person must 31/01/08 check the recordings of expenditure to ensure they are correct and all incomings and outgoings of money are recorded correctly. The Registered Person must 31/01/08 provide foods and meals, which are varied, and a choice of meals to meet the preferred dietary needs of residents which ensures their rights to choice and autonomy are promoted. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 31 5 YA22 22 6 YA23 13 (6) 17 (3) (b) 7 YA24 22 (2) (p) 8 YA26 23 9 YA34 18 (1) (a) 10 YA32 YA35 18 (1) (i) 11 YA33 18 (1) (a) The Registered Person must ensure that all complaints about the care of service users, regardless of source or how they are made, must be recorded and thoroughly investigated and responded to The Registered Person must ensure that that all procedural information in relation to safeguarding adults is readily available to staff to follow, to ensure the protection of people who use the service. The Registered Person must ensure that the premises provide sufficient heating to ensure residents are comfortable and safe. The Registered Person must clearly record why a resident’s room is kept locked and if there are risks posed to people using the service in their care plan. The Registered Person must ensure the protection of residents and staff by the service completing robust recruitment checks before the applicant is employed The Registered Person must ensure that they provide further training to staff in understanding and managing challenging behaviour and autism to provide them with the skills and information to meet the specialist needs of residents the service accommodates. The Registered Person must ensure that appropriate risk assessments are put in place to identify the level of risks that residents and staff may be exposed to and that staffing levels are increased to ensure residents and members of staff are protected at all times; the DS0000061891.V356220.R01.S.doc 31/01/08 31/01/08 31/01/08 31/01/08 28/02/08 30/03/08 31/01/08 Winray Care Home Version 5.2 Page 32 12 YA39 24 13 YA39 26 staffing rota must also be an accurate reflection of staff on duty. The Registered Person must ensure quality assurance systems are implemented at the service, to ensure the service is run in the best interests of residents. The Registered Person must ensure that regulation 26 visit reports provide enough detail on the findings of the visit and the views of service users during the visit. 30/03/08 30/03/08 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 Refer to Standard YA12 Good Practice Recommendations It is recommended that each residents activity planner is updated to ensure they and staff have the correct information on their daily activities each day. Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Winray Care Home DS0000061891.V356220.R01.S.doc Version 5.2 Page 34 - 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. 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