Inspection on 09/05/08 for Winray Care Home

This inspection was carried out on 9th May 2008.

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

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winray Care Home 10/12/07

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 Peter Illes Unannounced Inspection 9th May 2008 09:40 Winray Care Home DS0000061891.V363204.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.V363204.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.V363204.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) Julius Ssonko Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th December 2007 Brief Description of the Service: Winray Care Home is a privately operated care home, registered to provide personal care and support to four younger adults who have learning disabilities. The homes statement of purpose confirms that the home is currently offering a service to young adults who fall within the autistic spectrum and/ or have severe learning disability. The home is a converted semi-detached property with accommodation on three floors. The ground floor contains one resident’s bedroom, toilet, bathroom, a lounge, a kitchen/ dining room and adjoining utility room. This leads to a garden that currently contains a large trampoline and an outbuilding that contains a sensory room. The first floor contains three further residents’ bedrooms, staff office, toilet and bathroom. The second floor contains the main office and a second room that is currently being used for storage. The corridors in the home are narrow, there is no lift and there is a step on the first floor so the accommodation is not suitable for residents or visitors with significant mobility problems. The home is located in a residential area in the London Borough of Waltham Forest and is close to public transport. A stated aim of the home is: to provide a home to four people and to develop the concepts of Community Presence, Relationships, Choice, Competence and Respect and Dignity, for people living in the house. 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. The weekly fees charged at the home are from £800 per week, depending on people’s assessed needs. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took approximately seven hours and was undertaken by the lead Inspector. Terms such as “we”, “our” and “us” are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager was available and assisted throughout the inspection. There were four residents living at the home at the time and no vacancies. The inspection activity included: meeting and speaking with the people living in the home, although detailed discussion was limited due to people’s communication needs; detailed discussion with the registered manager; independent discussion with three staff members; independent discussion by telephone with a care coordinator from L.B. of Newham and independent telephone discussions with a community nurse and a speech and language therapist, both from the L.B. of Waltham Forest’s Community Learning Disability Team. Also as part of this inspection we specifically looked at safeguarding issues to assess whether people that use this service are kept safe. Further information was obtained from an Annual Quality Assurance Assessment (AQAA) submitted to us before the last key inspection, a tour of the premises and documentation kept at the home. What the service does well: The registered manager and his staff team are working hard to develop a specialist service to meet the needs of people living at the home who have complex needs, including communication needs. A care coordinator spoken to stated “(the person) is doing fine at the home compared to where they were living before, they are now taking part in activities, like going swimming, and they have not done that before”. The home is seeking input from the National Autistic Society and is working towards accreditation with that organisation; the home is also working cooperatively with health and social care professionals. Systems being developed, including paperwork such as care plans and risk assessments, are helping staff to develop and provide a more individualised service to residents. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Three improvements are still needed and are restated from the last inspection. These relate to: ensuring the systems for monitoring the money the home holds for people are robust and accurate, to ensure that their finances are safeguarded; protecting people living at the home by ensuring all recruitment checks are robustly carried out before new staff start work at the home and more effective monitoring visits to the home by the registered provider to monitor the quality of care being provided. Failure to act on requirements impacts on the welfare and safety of people living in the home and may lead to the Commission taking enforcement action against the registered persons, in order to secure compliance. Two new requirements are made at this inspection regarding: dealing with complaints in accordance with the home’s own complaints policy in order to promote the welfare of residents and to protect all those involved with the complaint; and, to improve infection control by not bringing soiled laundry through the kitchen. Three good practice recommendations are also made at this inspection regarding displaying the complaints procedure in a communal area of the building, sound proofing key areas of the building and seeking professional advice to further improve infection control. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 7 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.V363204.R01.S.doc Version 5.2 Page 8 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.V363204.R01.S.doc Version 5.2 Page 9 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Up to date information is available to prospective residents and other interested people to make an informed choice about living in the home. People’s needs are being thoroughly assessed before the person moves into the home to ensure that the their needs can be met. Once admitted, people’s needs are regularly reviewed to assist staff be aware of any changes in these needs. EVIDENCE: At the last inspection a requirement was made that the Statement of Purpose and Service User Guide was further developed to ensure that it accurately reflects the services and facilities that the home provides. At this inspection copies of both documents were given to us and the requirement was seen to have been complied with. At this inspection the files of the four residents were inspected, two of whom had been admitted to the home since the last inspection. The files of the two people admitted since the last inspection showed a range of detailed assessment information including: a community care assessment from the placing authority, specialist health professional assessments, a detailed inWinray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 10 house assessment including identifying peoples’ needs and preferences regarding their culture, religion and sexuality, an agreed transition strategy and a separate in-house skills assessment. All this information had been available to the home before the individual was admitted. The files also detailed how the person’s introduction to the home would be made, including a series of trial visits planned in a way to meet the person’s individual needs. The files included a report after each visit to ensure the transition process worked as smoothly as possible. The files of the other two residents that had lived at the home for a longer period also contained a range of detailed assessment information that had been obtained before the person moved into the home. The files also showed evidence that people’s needs and wishes were kept under review once they had moved into the home. This included monthly reports by allocated key workers from the home and reviews with placing authorities. Key workers spoken to independently were able to describe people’s needs, if these had changed over time and how the home was addressing people’s needs and preferences. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 11 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 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s current needs and wishes are well recorded in their care plans as well as clear guidance to assist staff in meeting these. People are supported to maximise their independence by making as many decisions as possible for themselves although a further improvement is still needed in the recording of money kept for them by the home. People are supported and guided in relation to taking appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: At the last inspection a requirement was made that care plans accurately reflect the daily care needs of residents to ensure staff are provided with the correct information to meet these needs and that the care plans are used as a live working document accessible to all care staff. Evidence was seen at this inspection that this requirement was being complied with. Copies of current Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 12 care plans for all the residents were readily available to staff on duty on the day. All four care plans were seen to be detailed, based on up to date assessment information and gave clear guidance to staff on how to address the person’s needs and preferences. The care plans had sections relevant to each individual’s identified needs and preferences including: communication, social relationships, sexuality, community presence, personal care, continence, eating and drinking, community presence and employment. The care plans also contained a “24-hour support plan”. This showed the amount of staff support each person needed during each 24-hour period including what checks were needed for each person throughout the night by the waking night staff. Staff spoken to independently were able to describe how they were endeavouring to meet people’s needs and preferences and were able to give relevant examples, one member of staff for example was able to say how one person was being assisted to have a more positive experience in the community and this reflected what was described in this person’s care plan. At the last inspection the money held by the home for the two residents living there at the time was checked and a two pence difference noticed in the money held for one residents and the record of this. Whilst it was acknowledged that the discrepancy was small, it was judged important by the inspector undertaking that inspection to ensure that records tally with sums of money held. A requirement was therefore made that the recordings of residents expenditure are checked to ensure they are correct and all incomings and outgoings of money are recorded correctly. The registered provider had written to us following that inspection stating: The existing procedure of recording of expenditure of service user’s money is working effectively. The registered person will continue to ensure that all incomings and outgoings are recorded correctly. The 2 pence, which caused a discrepancy in the report, was found in a letter in the package, which has all the service user confidential documents. We will now ensure that (their) funds are kept separately from (their) confidential documents so that this unfortunate occurrence is no longer possible. At this inspection financial records and cash for residents held were sampled. It was therefore disappointing that on this occasion there was a discrepancy of one pound between the record and the cash held for one person. Advice was given to the registered manager about how he may introduce systems that were more robust, including a physical check of residents’ cash and related records at each staff handover. This requirement is amended and restated. Two of the residents at the home are non-verbal and in depth communication with the other two was limited because of their particular needs. Staff are developing their skills, including in makaton sign language, to assist them communicate with all the residents. During the inspection staff were seen interacting with residents with respect including in a firm but professional way where appropriate. Some limitations are imposed on residents and the reasons for these are fully recorded, including in care plans and risk assessments. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 13 The four files inspected all included clear risk assessments that identified risks and gave guidance on how to minimise these. Evidence was also seen that the risk assessments were being regularly reviewed and that the home was consulting with health and social care professionals regarding risk management strategies. The home is also using relevant recording methods to try to understand why behaviour that challenges occurs when it does, this includes recording the incident, recording the events that led up to the incident and recording what happened afterwards. The home is then able to see if there is a pattern to the incidents, which helps to decide how best to help the person minimise these. Identified risks and how staff should help minimise these were included in people’s care plans. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to participate in a range of activities including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish and are encouraged to make as many choices for themselves as possible within their day-to-day lives. People are supported to enjoy healthy and nutritious meals that they enjoy. EVIDENCE: One resident can travel independently in the local community and has a travel pass to assist with this. Evidence was seen that the home is working with the person to explore employment options; this included working with the person to develop a C.V., which showed the person’s work, experience and skills history, as part of the process. Another resident is supported to attend college Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 15 and a day centre. The home continues to demonstrate a strong commitment to enabling people who use the service to develop their skills, including social, emotional, communication, and independent skills. Individuals are supported to identify their goals and the things that may be getting in the way of achieving them, and then work towards achieving the goals in a way that best meets the person’s wishes and needs. Recreational activities within the home include a range of craft activities, the use of a large trampoline in the back garden and the development of a sensory area in an outbuilding in the rear garden. Activities within the community included visiting local parks, a local city farm, a local swimming pool, music therapy, and going out shopping. A care co-ordinator from L.B. of Newham was spoken to independently by telephone. He stated that he was particularly pleased that the home had managed to help his client take part in various activities, including going swimming. He went on to say that the person had resisted such activities in previous placements. The home has a vehicle that is used where appropriate to facilitate outings in the community. The registered manager told us that the home was exploring holiday options for residents with one resident possibly being supported to travel abroad on holiday with the registered provider later in the year. At the last inspection a good practice recommendation was made that each resident’s activity planner is updated to ensure that they and staff have the correct information on their daily activities each day. Activity planners were seen to be up to date at this inspection. Residents come from varying ethnic backgrounds and their cultural and religious needs and preferences are recorded and actively supported. From discussion with the registered manager and staff it was apparent that the home is committed to developing and promoting equalities and diversity within the home. Resident’s religious needs are identified in their care plans, which care staff supported residents to meet. Two residents are supported to attend church in accordance with their wishes. Residents are also supported with their sexual identity in ways that meet their needs. Evidence of how this is achieved was recorded on files seen. Residents are supported to maintain and make contact with relatives and friends in ways that suit all the parties concerned. This was evidenced in residents’ files, confirmed by staff and by some residents spoken to. One resident has contact with a friend outside of the home, which meets both people’s needs. Daily routines in the home are designed to assist promote people’s independence and well-being, for example people can get up and go to bed when they wished, and such flexibility is built in to their care plans. Depending on the person’s needs and wishes they are encouraged to take part in the routines of daily living of the home as far as possible. Staff were seen to interact positively and appropriately with people accommodated throughout the inspection. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 16 At the last inspection a requirement was made that the home must provide foods and meals, which are varied, and a choice of meals to meet the preferred dietary needs of residents. This was to ensure that their rights to choice and autonomy are promoted. At this inspection this requirement was being complied with. The home has a recurring four-week menu that was seen and showed a range of healthy and nutritious meals. Evidence was seen that the menu had been reviewed with input from the residents and also other stakeholders including relatives and health and social care professionals. None of the current residents needs a special diet as such although the home has involved a dietician to assist the home in helping one resident balance their needs and their preference regarding meals. Records are kept of meals eaten by residents and this showed people were able to have a choice of what they eat at meal times. The home also keeps up to date health and safety records relating to the kitchen and kitchen equipment such as fridge and freezer temperatures. However, a requirement is made in the Environment section of this report regarding further work needed to maximise infection control for all at the home. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 17 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and preferences. They are also supported in meeting their physical, mental and emotional healthcare needs with access to specialist input from healthcare professionals were appropriate. People are protected by the medication administration policies and procedures being used within the home. EVIDENCE: The amount of direct support each person requires with their personal care varies. Each person has a detailed section in their care plan in relation to their personal care needs and how the individual is to be supported in meeting these. Key workers spoken to were able to describe people’s individual needs regarding their personal care and give example’s of people’ needs and preferences, including cultural preferences, for example with hair and skin care. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 18 People are well supported to maintain and promote their physical, mental and emotional health. Evidence was seen that all four people are registered with a GP. Satisfactory records of appointments with health care professionals were also seen on the files inspected. These records were clear and included an overview of the appointments an individual had attended and where appropriate included any advice or directions for staff as a result of the appointment. The records showed evidence of appointments with GP’s, mental health specialists, general hospital outpatient departments, dentist and optician. A speech and language therapist and a learning disability community nurse were both spoken to independently by telephone. They both indicated that staff at the home were keen to refer people to their respective specialist services and listened to and act upon the advice that they received. We were also pleased to learn that the home is able to obtain the services of a local dental practice rather than people having to travel to a hospital dental service as often can happen with people that have specific needs relating to a diagnosis of autism. The home had a medication policy that was seen and the registered manager had recorded on the annual quality assurance assessment (AQAA) that this had been reviewed in March 2008. Medication and medication administration record (MAR) charts were inspected for two people living in the home, the registered manager stated that the other two people were not prescribed medication at this time. The records and medication for the two people were accurate, indicating medication is being given as prescribed and there is no mishandling or missed doses. Boots the Chemist supplies medication to the home in blister packs; evidence was also seen that staff receive training from Boots in relation to safe administration of medication. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 19 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 who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their concerns will be listened to and acted upon. The home has policies and procedures in place for dealing with concerns and complaints although these must be properly followed on all occasions for the protection of all. The home’s safeguarding adults policy and procedures assist in protecting people from abuse although further work regarding staff recruitment is needed to maximise this protection. EVIDENCE: At the last inspection a requirement was made that all concerns about the care of service users, regardless of source or how they are made, must be recorded and thoroughly investigated and responded to. This was because a number of relatively minor concerns had been expressed to the home and although information gathered at the time indicated these had been dealt with appropriately there were no formal records available relating to this. The registered provider had written to us following that inspection stating: All complaints about the service are recorded and thoroughly investigated as witnessed during the inspection. The registered person will continue to ensure that this is done. A concerns book has further been included on the recording system to address all concerns, which are not serious enough to be a complaint however minor. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 20 At this inspection the requirement was being complied with. The home had introduced a separate concerns record book. This was inspected and showed three concerns that had been raised with the home and showed evidence that these had been dealt with satisfactorily. At the previous inspection it was noted that a formal complaint had been made regarding high levels of noise at the home and that this had been dealt with according to the home’s complaints procedure. At this inspection a satisfactory complaints procedure was seen. The home’s complaints book was inspected and showed that five more complaints had been received since the last inspection, all from the same person, and again relating to high levels of noise at the home. The entries in the complaints book indicated that on each occasion action had been taken to address the complaint, such as shutting windows in the home, and indicated that the person was satisfied on each occasion. However, the home’s complaints procedure states that a complainant will receive a written response to their complaint within a specified timescale. This is a complaint that appears to be ongoing and may therefore possibly escalate and be pursued with other agencies. It is important therefore that the home can demonstrate that it has followed its own procedures, including sending a formal written response to the complainant and advising of what they can do if they are still not satisfied with the response. A requirement is made regarding this. A good practice recommendation is also made that a copy of the home’s complaints policy is displayed in a communal area of the home so that it is more readily available to residents, relatives and other stakeholders should they wish to raise a concern or complaint. No other complaints or concerns were recorded in the home and none have been made to the Commission since the last inspection. At the last inspection a requirement was made 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. At this inspection a satisfactory in-house safeguarding adults policy was seen along with L.B. of Waltham Forest’s safeguarding policy and procedures. Waltham Forest is the local authority that the home is situated in and the authority that must be informed of all allegations or disclosures of abuse. The policies and procedures were available to staff who were independently able to describe what they should do if an issue of possible abuse be made to them. Staff also confirmed that they had attended training in safeguarding. The home also had a satisfactory whistle blowing policy that was seen and staff were aware of. No safeguarding issues had been reported to the home or to the Commission since the last inspection. However, despite the above being in place, a requirement is made in the Staffing section of this report regarding staff starting work in the home before the required criminal records bureau (CRB) check and protection of vulnerable adults (POVA) clearance had been received. Recruitment checks are considered a very important element in maximising protection for residents against possible abuse and so the outcomes for residents in this outcome area can only be judged as adequate. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 21 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, 26, 28 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home where the physical environment meets people’s current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy although an improvement is needed in how laundry is dealt with to promote better infection control. EVIDENCE: The home is a converted semi-detached property with accommodation on three floors. The ground floor contains one resident’s bedroom, toilet, bathroom, a lounge, a kitchen/ dining room and adjoining utility room. This leads to a garden that currently contains a large trampoline and an outbuilding that contains a sensory room. The first floor contains three further residents’ bedrooms, staff office, toilet and bathroom. The second floor contains the main office and a second room that is currently being used for storage. The corridors Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 22 in the home are narrow, there is no lift and there is a step on the first floor so the accommodation is not suitable for residents or visitors with significant mobility problems. Professionals have expressed some concern in the past about the suitability of the accommodation for residents that may exhibit challenging behaviour, for instance narrow corridors. However, the home has developed strategies to minimise potential limitations in the physical environment and the building judged to be generally meeting the current needs of the people living there. At the last key inspection two requirements were made to make the home more comfortable and to help meet residents needs. One was to ensure that the premises provide sufficient heating to ensure residents are comfortable and safe. This was because of concern about the heating in the sensory room in the garden. The second was to record why a resident’s room was kept locked and if there are risks posed to people using the service in their care plan. None of the resident’s rooms were being locked at this inspection and the registered provider had informed us that the locking of the room had been a temporary emergency measure that had now been addressed. At this inspection a tour of the home was undertaken and residents bedrooms seen had been personalised to varying degrees and were comfortably equipped and furnished. It was clear that because of the resident’s particular needs that the building generally was subject to heavy wear and tear although at this time it was generally well decorated and homely. The registered manager stated that the maintenance systems currently in place were working well. It is noted in the Concerns, Complaints and Protection section of this report that the home had received a number of complaints about noise. A good practice recommendation is made that the home explores further insulation/ sound proofing in key areas of the home given that it may not be practical to close windows all the time during the summer months to assist minimise noise. We were informed at this inspection that two residents had needs regarding continence and evidence was seen that those people’s personal care needs were being properly dealt with. The home had an infection control policy and a proper system for disposing of soiled pads. However, the laundry facilities are situated in the utility room adjacent to the kitchen/ dining room and residents’ laundry, including soiled clothing, was being brought through the kitchen, which is a health and safety hazard. A requirement is made that the home ensures that dirty laundry is not taken through the kitchen/ dining area in order to promote infection control and reduce the associated health and safety risk to people in the home. A good practice recommendation is also made that the home consults with the local authority’s Environmental Health services to assist consider further options for dealing with soiled laundry given the current layout of the building. The home was generally clean and tidy and free from unpleasant smells. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 23 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, 34, 35 & 36 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies and in sufficient numbers at this time, support people living in the home. People living at the home are not properly protected by the home’s staff recruitment procedure as it is not always being followed properly. People are supported by staff who have access to a range of appropriate training opportunities. Formal supervision and appraisal is also provided to staff to assist in further meeting the needs of people living in the home and in their own personal development. EVIDENCE: The home employs a registered manager, nine permanent support workers and has six identified bank staff that work when required. Nine of these staff have either achieved or are working towards the national vocational qualification (NVQ) level 2. At the last inspection only two residents were living at the home. A requirement was made that appropriate risk assessments are put in place to identify the level of risks that residents and staff may be exposed to and that Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 24 staffing levels are increased to ensure residents and members of staff are protected at all times; the staffing rota must also be an accurate reflection of staff on duty. At this inspection it was clear that the staffing levels had increased to a satisfactory level to meet the needs of the four residents, two of whom had been admitted to the home since the last inspection. The staff rota was seen, was up to date and accurately reflected the staff on duty on the day. Four staff work the morning shift, three the afternoon shift and there are two waking night staff. The registered manager is included on some shifts on the rota each week. At the last inspection a requirement was made that the service must ensure the protection of residents and staff by completing robust recruitment checks before the applicant is employed. This was because an identified character reference seen at that time did not include a company stamp and was not checked further to ensure the person providing the reference was the person the applicant had named on their application form. The registered provider had written to us following that inspection stating: The home’s recruitment policy ensures that all staff are thoroughly checked and vetted before starting work. The case mentioned on confirmation of character reference on one of the staff files had one of the references stamped. The registered person has made a follow up on this and will ensure that the recruitment policy is followed. The registered manager had also told us in the home’s Annual Quality Assurance Assessment, sent to us on 10th April 2008 that We have a good staff team, well motivated, and CRB checked to work with vulnerable adults. The files of two staff members, recruited since the last inspection, were looked at. Given the previous requirement and the responses received, it was disappointing to note that the records seen for both staff indicated that they had started work at the home before an enhanced criminal records bureau (CRB) check and a protection of vulnerable adults clearance had been received. The registered manager and operations manager stated that the problem with the CRB checks appeared to have arisen because the home had recently changed the clearing house that they apply for CRB checks through. The operations manager went on to say that the previous clearing house had automatically obtained a POVA First check. This is a check which, if satisfactory, means that in exceptional circumstances, a staff member can commence work, under supervision at all times, while waiting for the full CRB check to be received, as they are not recorded on the POVA list. No POVA First check had been obtained for these two staff although the registered manager stated that both staff members had in fact been supervised at all times before the CRB check was received. It was also noted that for one of these staff both references received were dated after the person started work in the home. The requirement was not being complied with. It is essential that the home’s recruitment policy is robustly followed and all recruitment checks received before the person starts work in the home. This is to maximise protection to residents and the requirement is restated. Failure to act on requirements impacts on the welfare and safety of people living in the home and may lead to Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 25 the Commission taking enforcement action against the registered person, in order to secure compliance. Training records were sampled and showed that staff were receiving proper induction training and a range of other required training in key areas. Records showed that recent training provided had included first aid, moving and handling and safe administration of medication. Staff spoken to confirmed that they had received training in the required key areas and that it had been useful. At the last inspection a requirement had been made that further training is provided 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. At this inspection evidence was seen that some specialist training had been provided and that other specialist training had been confirmed for June, July and September 2008 to meet this requirement. Evidence was seen that all staff were supervised at least two monthly and receive an annual appraisal; documents sampled and staff spoken to both evidenced this. Winray Care Home DS0000061891.V363204.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 who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager is working hard to further develop the home to meet the needs of people with a diagnosis of autism. People are being consulted about the quality of care the home provides however, further work is still needed to make sure the quality monitoring visits undertaken by the registered provider are more robust and effective. The home has effective health and safety procedures in place to protect people living there and others that work or visit the home. EVIDENCE: The home’s manager has been formally registered as such with the Commission, since the last inspection. The registered manager presented as being knowledgeable about the needs of the people living in the home. He is Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 27 working hard to develop further the service to meet the specific needs of people with a diagnosis of autism and who may also have communication needs and behaviour that challenges. Feedback from staff and from health and social care professionals was generally positive about his management style. At the last inspection a requirement was made that quality assurance systems are implemented at the service, to ensure the service is run in the best interests of residents. At this inspection evidence was seen that satisfaction surveys had been sent out to relatives and staff about the quality of care the home provides and that key workers were seeking such information from residents. The registered manager stated that further satisfaction surveys were due to go out to health and social care professionals in the near future and that information in the responses received would be analysed to contribute to the home’s overall aims and objectives. At the last inspection a requirement was made that the reports of the monthly unannounced visits by the registered provider to the home give enough detail on the findings of the visit and the views of residents during the visit. These visits are required by law and the purpose is enable the registered provider to form an opinion on the standard of care provided by the home. The registered provider had written to us following that inspection stating: The service provider will continue to provide regulation 26 visit reports as required on a monthly basis and will provide more details reflecting views of service users. It was therefore disappointing that there were no records available of any report from the registered provider’s visits to the home since the last inspection. The registered manager stated that the registered provider did visit the home regularly but that he had not received any written reports from these visits since the last inspection. The registered provider had written to the Commission following the last inspection and parts of this response have been referred to in this report, primarily where identified requirements made at the last inspection still need to be complied with and are restated in this report. It remains important that the registered manager is further supported to identify and address key areas, such as staff recruitment and control of residents’ money, which still need to be improved, by formal feedback from the registered provider following the required monthly visits. This requirement is amended and restated. The registered provider must ensure that written reports of the required monthly visits to the home are made available to the registered manager, that these reports give sufficient detail on the findings of the visit and the views of residents to assist the registered manager address any perceived shortfalls and that compliance is checked with requirements made by the Commission. A range of satisfactory health and safety documentation was seen including: a gas safety certificate, electrical installation certificate and portable appliance test. The home’s fire log was inspected and showed that the fire fighting equipment had been serviced, weekly safety checks on fire equipment were being carried and that regular fire drills were being undertaken. Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 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 3 25 X 26 3 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA7 Regulation 16 (l) & 17(3)(a) Requirement The persons must ensure that there are robust systems in place to check that the records of expenditure of each resident’s money matches the amount of cash held for each resident. This requirement is made to ensure that residents’ financial interests are robustly protected (Previous timescale of 31/01/08 not met). The registered persons must ensure that all complaints made to the home are robustly investigated and responded to in accordance with the home’s complaint procedure. This requirement is made to promote the welfare of residents and to protect residents, staff and any other stakeholders when a complaint is made. The registered persons must ensure that dirty laundry is not taken through the kitchen/ dining area in order to promote infection control and reduce the associated health and safety risk to people in the home. Timescale for action 09/06/08 2. YA22 22 09/06/08 3. YA30 13(3) 09/06/08 Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 30 4. YA34 19 5. YA39 26 The registered persons must 09/06/08 ensure the protection of residents and staff by the service completing robust recruitment checks before the applicant is employed (Previous timescale of 28/02/08 not met). The registered provider must 09/06/08 ensure that written reports of the required monthly visits to the home are made available to the registered manager, that these reports give sufficient detail on the findings of the visit and the views of residents to assist the registered manager address any perceived shortfalls and that compliance is checked with requirements made by the Commission (Previous timescale of 30/03/08 not met). 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 YA22 Good Practice Recommendations A copy of the home’s complaints policy should be displayed in a communal area of the home so that it is more readily available to residents, relatives and other stakeholders should they wish to raise a concern or complaint. The home should explore further insulation/ soundproofing in key areas of the building given that complaints had been received at the home regarding noise levels and because it may not be practical to close windows all the time during the summer months to assist minimise noise. The home should consult the local authority’s Environmental Health services to assist consider further options for dealing with soiled laundry, given the current layout of the building. 1. YA24 2. YA30 Winray Care Home DS0000061891.V363204.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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