Inspection on 18/09/06 for Winslow Court

This inspection was carried out on 18th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winslow Court 23/10/08

Winslow Court 31/10/07

Winslow Court 27/01/06

Winslow Court 03/11/05

Winslow Court 30/10/04

Winslow Court 17/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Winslow Court Winslow Rowden Bromyard Herefordshire HR7 4LS Lead Inspector Jean Littler Unannounced Inspection 18 September 2006 10:30 th Winslow Court DS0000024749.V301542.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 Winslow Court DS0000024749.V301542.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. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winslow Court Address Winslow Rowden Bromyard Herefordshire HR7 4LS 01885 488096 01885 483361 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) Winslow Court Limited Mr Donald Ellsmore Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents may also have a physical disability or mental disorder associated with their learning disability. 27th January 2006 Date of last inspection Brief Description of the Service: Winslow Court is a residential centre for twenty-four adults with severe learning disabilities and complex behaviour patterns that can challenge staff. It is purpose built and is divided into four units, each of which accommodates six service users. The units are based around a central courtyard. There are communal facilities on site including a computer room, art and music provision and a separate leisure complex that includes a spa pool. The grounds extend to twenty-six acres and there is also a school on the site that is run by the same organisation. The Home is owned by Winslow Court Ltd. a company that comes under an umbrella organisation called Senad. The Home is supported by on site company training, health and safety, and human resources departments. Information about the Home is available from the Home on request. The fees are currently between £1385 and £1980 per week. On top of the fees the residents are expected to pay for personal items such as toiletries and clothes and personal services such as hairdressing and chiropody. Within the fees costs are included up to £500 a year towards holidays. If a holiday is planned with higher costs these will be agreed with the residents’ representatives. The residents may be asked to contribute to some leisure activities if these do not form part of their regular activity plan. Transport costs are included in the fees however if a hire car is needed for a one off trip the residents will be expected to contribute towards this. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on a weekday between 10.30am and 5.50pm. The registered manager and head of care were both on duty and assisted with the inspection process. Two of the four units were used as a sample and both were toured during the inspection. The inspector spent time in both areas and observed the staff interacting with the residents and one group having lunch. The unit managers discussed the care needs and showed the inspector the care records for one of the residents in each unit. In one unit the medication was audited and a member of care staff from each unit was interviewed in private. The past performance of the service, information in the provider’s monthly visit reports and other communication with the Commission since the last inspection were all considered as part of the assessment process. Questionnaires were sent out to a sample of the residents’ relatives and some professionals involved with the service. Those returned indicated through tick boxes mostly positive views. One family wrote, ‘ Excellent residential home operated by caring staff’, another wrote, ‘ all staff concerned with the care of our daughter are extremely kind and compassionate and nothing is too much trouble for them’. Two relatives felt that there is not always enough staff. Some relatives did not seem aware of the Home’s complaints procedure so the manager agreed to send this out again. What the service does well: What has improved since the last inspection? More staff training has been arranged including disability awareness, communication and medication courses. More specialist staff have been provided including a psychology assistant and a second nurse. The speed at Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 6 which staff leave their jobs has been slowed down and there are no staff vacancies to fill. The way communication systems are used is better organised and more consistently used. A new resident’s placement was reviewed after six weeks in line with the Home’s policy. 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. Winslow Court DS0000024749.V301542.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 Winslow Court DS0000024749.V301542.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The needs of prospective residents are not being consistently and formally assessed. Care plans evidencing how the Home will meet the needs of prospective residents are not being developed prior to their admission. Prospective residents are being closely supported to visit and trial the Home before any placement becomes permanent. EVIDENCE: One resident had recently moved into one of the units that was inspected. The unit manager explained how the assessment and transition process had been managed. The resident had been a pupil at the residential school that is on the same site. Care staff had visited the school to get to know the young man and staff from the school had supported him to visit the Home and settle in. The bedroom had not been repainted before the resident moved in as it was the same colour as his room in the school and it was hoped this would help him settle in. He had been involved in moving his possessions into the Home to help him understand what was happening. A review meeting had been held after six weeks with all those involved, including the resident’s relatives, to assess the progress of the placement. Some of his care information had been transferred across from the school to the Home. Much of this was not dated and some information was contradictory e.g. the protocol for administering emergency medication for epilepsy. No Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 9 social work assessment had been completed prior to the admission to form the basis of the placement arrangement. The in-house assessment forms had also not been completed. No record had been made of the transitional visits and trial overnight stays. Winslow Court DS0000024749.V301542.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents’ needs are reflected in their care plans and kept under review. The normal planning procedures had not taken place for a new resident. The residents are being supported to make appropriate decisions about their lives and take reasonable risk in order the have a good quality of life. EVIDENCE: The one care plan sampled relating to a long-term resident was very detailed and contained guidance for staff under appropriate heading. The risk assessments included information about how the resident is to be protected from unreasonable hazards but still enabled to do normal things e.g. use the mini-bus safely for outings and keep a seat belt on, go swimming and go out in the community. The judgements and control measures seemed reasonable and the focus was on allowing the resident to do things not on preventing them. One about the resident searching for plastic bags could be expanded to include the risk of choking and what action staff need to take on a daily basis. The risk assessments are printed in a very small font that does make the information very clear for staff. Some of the content is mirrored in the care plan however Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 11 some was not e.g. when the resident was to use a wheelchair. Consideration should be given to adding a mobility heading to the care plan and making the risk information much clearer. Risk assessments could be numbers and directly linked to the care plan content. Daily records are being made about the resident on each day and night shift and these are used being to inform monthly summaries. Development aims have been agreed and these have been reviewed at the meetings with the resident’s representatives held six monthly. Some information relating to the care plan for this resident have been covered in other sections. A new resident had been in the home for four weeks but little progress had been made on completing his care plan. A six-week review had been held with his family and agreements made about trying new activities such as swimming and horse riding. A risk assessment had been completed relating to the need for physical intervention. This was felt to be low risk but it has been used once in the recent past. A behavioural chart had been put in place but this was blank. The unit manager reported that historic behaviours had only been displayed in a very minimal way. This is very positive as it means he is settling well and responding well to the staffs’ approach. A listening monitor is currently being used in the resident’s bedroom even though he has not had a seizure for 2-3 years. A risk assessment has not been completed to explore if this is necessary or if the risk is low enough to give him his privacy. The staff were observed to support residents to make choices within their capabilities e.g. what drinks they wanted with their lunch, what CDs they wanted to play. The speech therapist has recently returned after a period of leave and it was clear that greater emphasis is being placed on the use of the communication systems used such a PECs. The residents are benefiting from this as they are clearer about what is happening next in their day and assists them to make choices. A new resident uses an electronic communication systems and staff were getting used to using this with him. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being encouraged to develop personally, take part in appropriate activities and have a good quality of life. They are being supported to stay in contact with their families and socialise with each other. They are being provided with a reasonable diet, however the meals service is not domestic in style and this limits choice and flexibility. EVIDENCE: As detailed above residents have aims in their care plans. Because of the nature of the service aims often focus around reducing negative behaviours but the residents are also being encouraged to become more independent. A new resident is being encouraged to socialise by a routine being established where by he watches a video with others residents each evening. This is proving effective. All residents have an activity plan that includes a variety of on-site activities and outings as well as time spent at Home. Some residents can occupy themselves and spend time in their bedrooms, others need to be kept focused at all times. This is considered with the psychologist when their intervention plans are developed. The resident whose care was tracked in one Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 13 unit returned Home after being on a shopping trip with the outreach group. This is where a group of eight from two units go into town but then split into smaller groups while each resident gets their personal shopping. Care records showed in recent days the resident had also been for a walk by the river, to a garden centre and out for a drive. He was going out two to three times a week. On site activities include gardening, pottery, art, IT, music and use of the spa pool and leisure complex. In one unit cake making has been taking place and they are holding regular coffee mornings where others on site can come and buy drinks and cakes. The residents are serving these and using the PECs system to communicate with their customers about what they want. Some information relating to activities is included under the staffing section. Staff reported that the holidays this year had gone very well and felt this was down to through planning and risk assessing. Not all residents have gone away with the Home. Some have breaks away with their families. Staffing levels prevented one resident going away but special days out have been provided instead. Staff are at times taking residents to their homes. The worker spoken with about this said there are always two staff present and the residents benefits from it greatly and enjoy getting to know the family members. This can be a very positive and inclusive experience for residents. A specific risk assessment should be included in the care plan. Residents are being supported to stay in close contact with their families and in some cases staff assist with transport in enable visits to take place. A facility is also on site that can be booked by families if they live a long way from the Home and need to stay overnight. Keyworkers have the responsibility to keep relatives informed about the residents’ changing needs and any concerns. The main meals are provided at lunchtime from the main kitchen, which is run by a catering company. This is set up to meet the needs to provide school dinners to the residential school on site. Difficulties earlier in the year that led to complaints from relatives and staff seem to have now been resolved. Staff opinion was mixed but there is still concern that the ingredients are poor quality. The residents are not able to give an informed opinion about this point but it was reported that they eat the meals and seem to enjoy them. It was suggested at the last inspection that an independent nutritional review be carried out but no information about this has been forwarded to the Commission. Breakfasts and evening meals are made in the units with ingredients from the main kitchen. There have a float to buy drinks and snacks with the residents each week. It is unusual for most adults to eat main meal at lunchtime and then carry on with busy activities. This could affect some residents’ motivation levels. Consideration should be given to allowing each unit to cook the main meal once a week as a trial so this could be provided in the evenings. The lunchtime meal observed was calm and staff encouraged the residents to make choices and to help clear the table and wash up. A new resident is being encouraged to try new foods and is enjoying things that the school reported he did not like. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are receiving personalised care and support. They are being supported to have their health needs met. Medication is being safely managed. Recommendations have been made in these areas to further improve arrangements. EVIDENCE: The care plan sampled showed that detailed information has been included about how the resident preferred to be supported with his personal care needs. As detailed above no assessment or care plan was in place for a new resident to guide staff about how to meet his needs in this area. Staff are being provided with training that relates to health conditions such as epilepsy and diabetes. The staff spoken with seemed well informed about the residents’ needs and they said the daily routines were personalised and flexible. The staff are supported to meet the residents’ needs by the in-house health professionals. Appropriate links are also in place with health professionals in the community e.g. for well man checks, chiropody, eye tests and dentals. The site nurse is currently developing a health care plan format in line with the ‘Valuing Peoples’ aim for all people with a learning disability to have a health action plan. This was being worked on at the last inspection in January 06. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 15 The resident whose care was case tracked has needed input from a physiotherapist in the past. He has been discharged now but staff do exercises with him and he is meant to go swimming regularly to help keep his mobility. His swimming was only detailed in his care plan under leisure not as a health need. The monthly summaries seen indicated that he was not going swimming every week and one month he had not gone at all. The unit manager felt this information may not have been accurate as she felt the swimming sessions were considered a priority amongst the staff team. The six monthly review report indicated that the aim was to provide six swimming sessions per month. Elsewhere in this report it said this target was being met. It is positive that the resident has maintained his mobility against medical predictions, however any aims relating to health needs should be closely monitored and accurately reported. One resident had been taken ill on the morning of the inspection. The manager went to the hospital to support the care staff while the resident was in surgery. There was obvious shock and great concern about the resident but the staff in the Home remained calm and professional and supported their colleagues over the phone. Arrangements were made to provide staffing to relieve those at the hospital for the afternoon/evening and to ensure the resident had personal items taken up to make him comfortable. The manager liaised with the family. The medication in one unit was inspected. An appropriate storage cabinet is being used, however because there is no office in this unit this is located in a cupboard, which means there is no space for staff to work. The unit manager said the kitchen is used but this was being refitted. The keys are being held by the senior staff on duty. Records showed that doses had been administered as prescribed. A daily running balance of quantities in stock is kept each day. Two balances were incorrect but it was discovered they had been written in the wrong columns. One bottle of medication for emergency medication did not have a pharmacy label on it, this must have been on box that had been disposed of. This was being taken out on outings in a small bag that was also being used for another resident who is also prescribed the same medication. The unit manager agreed to liaise with the pharmacist to ensure the bottles are labels. A separate labelled bad should also be used for each resident on outings. The site nurse trains and then confirms staff are competent to administer medication before they are given this responsibility. Accredited training is now also being provided through the pharmacy. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ and their representatives are listened to and every effort is made to respond to any concerns. Robust arrangements are in place to help protect the residents from abuse and self-harm. EVIDENCE: A complaints procedure is in place. Several families reported in their questionnaires that they were not aware of this procedure. The manager agreed to send copies out to all advocates and families. The majority of residents have families to advocate for them, some have independent advocates. All have key workers who have a duty to take a specific interest in their care arrangements and quality of life. No new complaints have been received since the last inspection. The two complaints received prior to the last inspection about the quality of the catering have been satisfactorily resolved. A complaint from one resident’s relative has been ongoing for the duration of his placement. The manager has recently taken the decision that a new placement needs to be found as efforts to resolve the areas of concern have not been successful. Some of the residents can display behaviour that puts them at risk including self-harming. Policies are in place about how extreme behaviour is managed. The psychologist guides the intervention strategies and staff are being appropriately trained. A brief and clear ‘Abuse’ policy is in place. This makes reference to the local multi-agency procedure for dealing with ‘Vulnerable Adult’ concerns. A Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 17 ‘Whistle Blowing’ policy is also in place that states staff will be protected if they report a concern. All staff are provided with training about abuse and their duty to protect vulnerable people from the Herefordshire Adult Protection Manager. These areas are also covered in the LDAF foundation course for new staff and in the NVQ Care awards that are promoted. No adult protection issues have occurred since the last inspection, however when these have arisen the senior staff have been quick to take action to protect the residents and have then cooperated fully with the multi-agency protocol. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are living in comfortable, clean and well-maintained units within this large site. Their bedrooms have been personalised to meet their needs and adapted to enable them to use them independently. Some communal areas could be made more homely and accessible, but plans are being developed. EVIDENCE: The Home is in a very rural location and this does not enable residents to use public transport or walk to local facilities. On the positive side it does mean there are extensive attractive grounds that residents can use without disturbing neighbours. It is on the same site as a residential school and many of the facilities are shared including the main kitchen, laundry, reception area and leisure complex. In addition the Home has an office area and rooms for residents to take part in sessions such as art and computer work. The Home is made up of four units with six single bedrooms. Each unit is self-contained with a lounge, dining room, kitchen and communal shower and toilet facilities. Some units also have a staff office area. Consideration should be given to providing each unit with an enclosed back garden area that residents could spend time in without the staff support. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 19 Two units were toured and the areas were clean and attractive. The bedrooms seen were comfortable and had been personalised. A new resident’s bedroom looked very nice with his family photos on the walls and many personal possessions around. The unit manager explained the plans to change his furniture to better suit his needs. Another resident likes fresh flowers and buys these for his room each week. He was busy at his desk, which he obviously uses regularly to pursue his hobbies. Repairs are usually carried out by the on site maintenance team who also manage the grounds. The providers monthly visit report showed there has recently been some delay in getting repairs dealt with e.g. a damaged floor covering in a dining room took two months. This situation seems to have improved now and work was again being processed promptly. Since the last inspection many areas have been redecorated and all units are having new kitchens fitted. Work in the first one has started. All units are also due to have new floor and wall coverings fitted to the bath and shower areas. This is very positive, as these areas look unattractive and institutional. In one unit a resident is slamming the toilet seats and has broken three toilets as a result. Options are being considered to ensure the residents do have seats to use. Someone suitably experienced should carry out a review of the environment in relation to the needs of people with Autism Spectrum Disorder. Consideration should be given to the frequency of any strip lights and to the hard and echoing acoustics created in the dining rooms by the lack of soft furnishings. The Home is fitted with suitable fire protection systems such as an alarm. The fire doors are an essential part of the fire protection measures in place. As detailed under health and safety section several fire doors have been routinely wedged open to allow the residents easy access around their home and to allow staff to monitor residents when they are in rooms nearby. Alternative measures need to be made as a matter of urgency to meet the needs of the service without compromising fire safety. The main kitchen was not inspected on this occasion. The EHO inspected in July 05 and the kitchen was refitted last year. The laundry is housed in an external building and staffed by a contracted company. They are currently one worker down but the vacancy is due to be filled by agency staff. The worker appeared very busy but assured the inspector that the task was manageable and that the new machines provided in the last year were efficient and effective. She was clear about infection control systems and returned any laundry bags to the care staff if they had not followed the correct procedures. Staff are provided with protective clothing and the equipment to keep the units clean. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents are benefiting from being supported by an effective mix of staff in appropriate numbers to meet their needs. The staff are being well supported and appropriately trained. Some areas where further training and monitoring would be beneficial have been identified. EVIDENCE: Four staff are being maintained on each unit. Staff reported that this only occasionally falls to three at weekends if there is short notice staff sickness. A senior member of staff is always on call and they are responsible for arranging cover or coming in to cover if levels fall below a safe limit. Only 1.5 posts are currently vacant and these have been recruited to. Over the two years efforts to improve staff retention have been successful and turnover has reduced. Six full time staff have left since the last inspection. A fifth worker is made available for certain times during the week in each unit to enable certain activities to take place. Staff feedback indicated that this arrangement in one unit might need to be increased to better meet the needs of the resident group and to facilitate more outings. One resident has made good progress in the year and a half he has been in the Home and many of the negative behaviour he demonstrated have reduced, however staff struggle to engage effectively with him at times and gain his cooperation and this Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 21 reportedly takes a disproportionate amount of staff resources. This is impacting on the other residents and limiting the opportunity for outings. Fifth worker arrangements seemed to work more effectively in the other unit where the residents go out more frequently. There are a significantly lower number of incidents of challenging behaviour in this unit. The unit manager attributes this to the frequent outings and the way the staff keep the residents busy and focused. Incidents are not currently monitored across the service in a strategic way. It would be positive if this were introduced into the quality assurance system including any correlation between outings and the frequency of incidents. Discussions with staff indicated that greater knowledge about Autism would be beneficial. One resident touches the plate of the person near to him at meals. If he cannot control this urge when asked several times he is asked to leave the table. This seemed to be setting him up to fail. The logic of continuing to seat him near other people is to try and get him to stop the behaviour so he can eat meals in the community. This showed a lack of understanding of how ritualistic behaviours relate to anxiety levels and that he may will cope in a quiet café if it is less stressful than the meals in the Home. A team of specialist health and therapy staff also supports the residents. This team has been expanded since the last inspection with the addition of an assistant for the full time psychologist and a second nurse, who is working part time. The pottery facilitator is now working two days a week instead of one, and the speech and language therapist is back from an extended period of leave. A psychiatrist is also contracted to oversee the health care and medication for some residents who do not have access to local psychiatry support because Herefordshire council does not fund them. Staff were observed to use inappropriately and negative terms when talking to or about residents e.g. naughty, silly, tantrum. This shows a lack of awareness of the residents’ needs and basic values of dignity and respect. The way standards in the units are monitored and the effectiveness of training evaluated should be reviewed so shortfalls like this are identified without the intervention of the Commission. Two staff files were sampled to access recruitment practices. Appropriate procedures are in place and applicants are required to complete an application form, provide evidence of their identity and attend an interview. Job descriptions are in place, and contracts and training agreements issued. Senior staff interview applicants with the support of the HR officer and records are made. The required checks were in place for one worker, however for the other only one written reference had been received. In another case a worker had taken up post without written references having been received. Later when these still did not arrive he was given notice to leave. The providers do allow staff to start when a POVA first check has been received prior to the full CRB Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 22 being returned as they partake in a two-week induction without contact with the residents. This does not put residents at risk, however they must not transfer to the Home until all satisfactory checks are in place. A checklist is attached to each recruitment file and this system is meant to be used for the manager to sign off each file as complete before the worker is given a start date. A requirement about references had been made at the last inspection and it is concerning that appropriate action was not taken. The manager said that more staff support has been provided for the personnel officer. Staff training records indicated that 34 of the 66 staff employed at the Home have gained an NVQ award in Care. It is very positive that the target of having over 50 of staff qualified has been maintained. This figure does include 10 relief workers so the percentage of qualified permanent staff is higher. 3 staff are currently completing a course and 14 more are due to start. More senior staff are encouraged to gain NVQ 4 in Care and the Registered Managers Award. 3 seniors did these courses last year and 3 more are starting soon. The Learning Disability Award Framework forms part of the training plan for each new worker. Core training is covered in the first two weeks and then they are supported to gain the LDAF within the first few months of their employment. This core training is run every two months for new staff and existing staff attend the sessions when they need a refresher. A new training manager has recently taken up post. She has over 300 staff on this site and then the satellite services. She is also the health and safety manager for this region. Consideration should be given to splitting the roles. It is positive that more external training is being provided. This makes training more interesting for the staff and helps ensure the content is current as each will be an expert in their field. Consideration should be given to arranging periodic additional training as well as the standard training programme e.g. sexuality and personal relationships, loss and transition, and more in depth sessions on Autism. It is positive that a trainer with disabilities is now providing disability awareness courses, and all staff have to attend a communication course. Accredited medication training is also now provided. The unit managers reported that they provide supervision for their team leaders who in turn supervise the support workers. They reported that they have a new form that helps them be focused and constructive during the six weekly sessions. The head of care supervises the unit managers but he is not yet using this form in his sessions. Team managers and care staff felt well supported by the systems in place e.g. the monthly unit staff meetings etc. Senior meetings are also held to help ensure units are run in the same way and good practice is shared. Because there are several layers within the staff team it means there are opportunities for promotion, which helps staff retention. Staff reported morale as being high. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 23 Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents and staff are benefiting from a well run home with a positive ethos. Procedures and record keeping systems are in place to safeguard their best interests, although shortfalls were found in some of these. The residents’ health and safety is being promoted, although shortfalls were found in two areas. Quality assurance systems are in place but these need to be made more robust to ensure high standards are consistently achieved in all areas without intervention from CSCI. EVIDENCE: The Manager who has been in post for many years is due to take up a new position in the organisation as Manager of Adult Services. The post of registered manager is currently being advertised. The providers are taking this opportunity to review the management structure within the Home and the adult services department. A Head of Care who has also worked in the Home for many years supports the manager. Both of these managers are supported by a human resources officer and a manager of health and safety and training. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 25 The unit managers and care staff spoken with said they found the managers supportive however they did not see them much on the units as they were office based and generally only came in if there was a problem. Both managers have shown in the past that they take complaints seriously and liaise closely with families of residents when there are issues or health concerns. There is a culture in the Home where staff are encouraged to take responsibility and develop leadership skills on the units so the day-to-day running of each unit is delegated to the unit managers and their staff. Some quality assurance systems are in place e.g. monthly provider monitoring visits and health and safety audits. Some areas where closer scrutiny would be beneficial have been identified elsewhere in the report e.g. assessment and care planning for new residents, recruitment procedures. A new type of quality assurance system is due to be introduced that includes consultation with residents and/or their representatives and other stakeholders. The previous action planning system failed this year to identify that both requirements from the last inspection had not been actioned. Company policies and procedures are in place and the manager reported that these have been kept under review. Records are being stored securely and the information is being kept up to date. Records relating to the resident’s finances were not sampled on this occasion, however they are scrutinised as part of the monitoring carried out during the regulation 26 visits. As the senior staff in the organisation are also the appointees for some of the residents, consideration should be given to arranging an independent external auditing process to the quality assurance programme. As detailed elsewhere some shortfalls were noted in records seen e.g. recruitment, medication, care assessment. The manager and head of care both attend the company health and safety meetings to stay informed about developments and changes in legislation. The manager reported that essential safety checks are being carried out routinely e.g. fire alarm tests and hot water temperatures checks, and staff confirmed this. Some of the servicing and checks are carried out by on site maintenance staff. Accidents and incidents are being recorded and monitored through the monthly providers visits and by the health and safety officer. Serious incidents involving staff have been appropriately reported under RIDDOR. Risk assessments are in place relating to the environment, work tasks, and the residents’ care needs. These are being kept under review. A new health and safety manager has recently been appointed. Door closure mechanisms are fitted on kitchen doors in the units but several other fire doors were found to be wedged open. A requirement was made regarding this at the last inspection but appropriate action has not been taken. An immediate requirement was made. The providers pay for an external safety audit to be carried out annually. They currently hold a four star rating and are Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 26 anticipating a five start rating after the results of the recent audit are back. The providers should review how this process failed to pick up what is quite a basic and high-risk shortfall in the home. The recommendation to complete a risk assessment about the level of First Aid cover provided in the Home had not been actioned. The manager said there are six fully qualified First Aider but the rota is not planned to ensure one was always on duty (as described in N.M. Standard 42). All staff do however receive basic first aid training. The need to have a risk assessment in place was brought to the attention of the manager in 2005 and should have been considered by the providers across the group. This has therefore now been made a requirement. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 27 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 X 2 1 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 4 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 4 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 3 2 2 x Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 29 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 YA34 YA41 Regulation 18 Timescale for action Two written and satisfactory 19/09/06 references must be in place prior to a member of staff commencing employment. (Brought Forward previous date 31/1/06, not fully actioned). Ensure that fire doors in the care 19/09/06 home are not wedged open unless alternative measures are in place that have been approved by the Fire Authority. (Brought Forward previous date, 15/02/06, not fully actioned). Make suitable arrangements with the doors to allow the residents to move about the home independently. Confirmation was received from the providers on October 2nd that suitable action has been taken to address this requirement. New residents must not be 31/10/06 admitted without their needs being comprehensively assessed and the Home formally confirming that these needs can be met. A care plan must be put in place promptly for all new residents. Carry out a risk assessment 30/11/06 regarding the level of First Aid cover provided in the Home. Make arrangements to increase 5.2 DS0000024749.V301542.R01.S.doc Version Page 30 levels of training if any shortfalls in current arrangements are identified. Requirement 2. YA42 YA29 13 3. YA2 YA6 14, 15 4. YA42 13, 18. Winslow Court 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 YA3 Good Practice Recommendations The health care plan completed by the site nurse should be put in place as early as possible for new residents so it can be considered as part of the three monthly placement review. (Brought forward, not actioned). Consideration should be given to adding a mobility heading into the care plan and making the risk information larger and clearer. Ensure a risk assessment is in place if staff take residents into their homes. Review how the meals service can be made more domestic and flexible so it promotes choice for the residents. Ensure bottles of medication are labelled by the pharmacy as well as the boxes. Use separate labelled bags to take medication out on trips for each resident. Send a copy of the complaints procedure to all residents’ advocates and families. Someone suitably experienced should carry out a review of the environment in relation to the needs of people with Autism Spectrum Disorder. Review if the frequency a fifth worker is provided in each unit is sufficient to meet the residents’ assessed needs and enable outings and activities to take place as frequently as required. Monitor incidents of challenging behaviour across the service in a strategic way including any correlation between these and the frequency of outings. Review if the role of health and safety manager and training manager are too extensive to be effectively covered by one person. Provide more in-depth training on Autism for those staff working directly with residents with this diagnosis. 10 YA39 The registered manager and head of care need to spend time on the units to monitor the quality of the care being DS0000024749.V301542.R01.S.doc Version 5.2 Page 31 2 3 4 5 6 7 8 YA6 YA14 YA17 YA20 YA22 YA28 YA29 YA33 9 YA33 YA32 Winslow Court YA32 provided directly. They should periodically interview a sample of care staff to assess their competence and gather feedback directly. Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Winslow Court DS0000024749.V301542.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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