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Inspection on 23/10/08 for Winslow Court

Also see our care home review for Winslow Court for more information

This inspection was carried out on 23rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

New people are supported to visit and try out the service before moving in. People have their needs assessed and written in their care plans. People are helped to express their feelings without hurting themselves or others. People are helped to do things for themselves. People are helped to have their personal and health needs met in the way they prefer. People can spend time doing things they like at home. People are helped to communicate with aids so they can understand things and make choices. People are helped to stay in touch and meet their families. People all have their own bedroom and comfortable living areas. Proper checks are carried out on new staff to protect people. The management team try to learn from events and stay up to date with proffessional developments.

What has improved since the last inspection?

People have been given clear information about the home with pictures to help them understand it. People`s care plans are being changed so they can understand them more easily and their wishes are made clearer. The way people`s medicines are being looked after has been made safer. People are being physically held by staff less often when they become upset. If the plan to start buying food locally is followed, people will benefit from going shopping and having more choice. Some people now have very nice fitted furniture in their bedrooms. People in the home and others are being asked for their views about how the service can be improved.

What the care home could do better:

More activities could be offered in the evenings and at weekends. Some parts of the home could be made more homely. Private garden space could beprovided. Some people may be able to have their own bedroom keys or have free access to their things. People should benefit from the plans to train staff in Positive Behaviour Support. More of the staff should become qualified. Staff numbers could always be at the right level so people can follow their activity plans.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Winslow Court Winslow Rowden Bromyard Herefordshire HR7 4LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Littler     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Winslow Court Winslow Rowden Bromyard Herefordshire HR7 4LS 01885488096 01885483361 neilbagley@rowdenhouse.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Winslow Court Limited care home 24 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 24 Residents may also have a physical disability or mental disorder associated with their learning disability. Date of last inspection Brief description of the care home Winslow Court is a residential centre for twenty-four adults with severe learning disabilities and complex behaviours that can challenge services. It is purpose built and is divided into four units, each of which accommodates six people. The units are based around a central courtyard. There are communal facilities on site including a computer room, art, pottery and music rooms, a separate leisure complex and large wooded grounds. 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. The Company 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 depend on the package of care provided. The fee range is currently not included in the Service User s Guide. On top of the fees people are expected to pay for personal items such as toiletries and clothes and personal services such as hairdressing and Care Homes for Adults (18-65 years) Page 4 of 39 Brief description of the care home chiropody. Within the fees costs are included for an annual holiday. People 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 person will be expected to contribute towards this. Care Homes for Adults (18-65 years) Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out this Key inspection over 16 hours. One inspector looked just at the way peoples medicines are looked after. The manager and a nurse were on duty and helped with the process. We looked around all four units and spoke with some of the staff. We met several of the people who live in the home and looked at some of their bedrooms. Care Homes for Adults (18-65 years) Page 6 of 39 We looked at some records such as care plans and staff rotas. The manager sent information about the Home to us before the visit. What the care home does well: What has improved since the last inspection? What they could do better: More activities could be offered in the evenings and at weekends. Some parts of the home could be made more homely. Private garden space could be Care Homes for Adults (18-65 years) Page 8 of 39 provided. Some people may be able to have their own bedroom keys or have free access to their things. People should benefit from the plans to train staff in Positive Behaviour Support. More of the staff should become qualified. Staff numbers could always be at the right level so people can follow their activity plans. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Prospective residents are being offered information and trial visits to help them decide where to live. Their needs are assessed and they can be confident that these will be met. Evidence: In the AQAA the manager reported that up to date information about the service is sent to prospective residents and their representatives and a planning meeting is held after the first week where the initial care plan is agreed and written. A Service Users Guide has been developed for each unit. The one seen was very clear with the information set out in large, easy read print with pictures, symbols and photographs. The home is fully occupied. Four people have moved in during the last year. The assessment and admission process was discussed with manager of the unit where 2 men moved into during the summer. She described how their needs had been assessed and how they were supported to visit and trial the service. Their individual Care Homes for Adults (18-65 years) Page 11 of 39 Evidence: needs had been carefully considered. For example, one mans bedroom had been painted and set out to be identical to his room at the residential school he was leaving. This mans file showed information had been obtained from his school and work had started on his care plan before he moved in. Staff from his school had worked on the unit for his first 3 days to help him settle in and an experienced shift leader had been designated his keyworker. His care plan was being added to as more information and knowledge was gained. One gap was found, as the unit manager was not aware of the mans first language or his familys religion. The manager later found this information on the computer system, however, this is important baseline information that staff need to know. The unit manager said his family had been consulted about religious and cultural issues along with other matters and had not requested any specific arrangements. They are reportedly very pleased with how well their son has settled. The manager has a new and much improved assessment tool that is due to be introduced. If fully completed this would provide all the information required to establish if the persons needs could be met and enable the first care plan to be more easily developed. Care Homes for Adults (18-65 years) Page 12 of 39 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People can be confident that their needs will be reflected in their care plan and kept under review. They are being supported to make choices and take reasonable risks in order that they have a good quality of life. Some unnecessary restrictions may be in place. Evidence: Three peoples care plans were seen as a sample. These showed that peoples needs and preferences are known and monitored carefully. The plans and risks assessments had been kept under review and updated regularly. The format currently used has made it very difficult for anyone living in the home to understand what is written about them. A new design is now being introduced that is Person Centred and includes pictures and symbols to aid understanding. The design should help ensure staff are made aware of what is important to each person and what their wishes and preferences are. Life Books are also being introduced. The one seen was very well Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: done, with clear information and photographs of the man, important people in his life and activities he enjoys. His family had been asked to review this and his new style care plan so their views could be taken into account. The manager has asked unit leaders and keyworkers to develop a Person Centred Plan and Life Book for each person in the next six months. It is positive that one man is getting involved and is taking photographs for his Life Book. Strategies to help people with their emotions and behaviors are developed by the two psychologists who work between the home and the residential school. They consult peoples representatives and the staff who work closely with them. Staff monitor and record behaviors and incidents and the strategies are reviewed at least twice a year. Risk assessments are in place covering many areas such as traveling in the car, road safety, specific activities such as horse riding and health concerns like epilepsy. Details under the environment section indicate that some unnecessary restrictions may be in place and the risk assessments for these areas need to be reviewed. Daily records are being written along with various charts and activity records. This information is used to inform monthly summaries that peoples keyworkers write. These could be more detailed in some areas, for example they could explain why a persons activity plan has not been fully implemented that month. Review meetings are usually held at six monthly intervals for each person, and their representatives are invited. Reports are written for these to give an overview of issues, concern and developments. Staff reported that people have progressed in the last year. Examples included one man now using words to communicate and another getting more involved in food preparation. Each person has areas they are being supported to develop. A new award programme has been established as a model to promote development and personal achievement. This is reported on in the Lifestyle section below. The staff were observed to support people to make choices within their capabilities. For example, one man was asked if he wanted to go to the kitchen to collect ingredients for the meal. The weekly coffee mornings held on one unit are used to encourage people to socialise and gain skills of choosing a drink and snack. Records showed that one man enjoyed swimming one week but when he declined this the following week his choice was respected. The care plans encourage staff to support people to make choices such as what to wear or what to eat and drink. The speech therapist supports people to communicate with aids such as symbols and sign language. Activity timetables are used to help some people know what is happening that day. One worker felt that more electronic communication aids could be used if funding could be accessed from an external source. Care Homes for Adults (18-65 years) Page 14 of 39 Care Homes for Adults (18-65 years) Page 15 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People 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 are being provided with meals they enjoy. Evidence: The nature of the service means peoples development aims often focus around reducing certain behaviours. As mentioned positive examples of development in this area were given. People are also being encouraged to develop skills and become more independent. Some attend college courses and in the last year ASDAN awards have been introduced (Award Scheme Development and Accreditation Network). A coordinator has been appointed and she is working closely with the two activity and art facilitators and the pottery tutor. All but four of the residents are working towards Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: these recognised national awards and some have already finished modules. Modules include everyday living, independent living, horticulture, cookery, pottery and being out in the community. Staff spoken with were enthusiastic about the awards. One said they help remind him that he should be enabling people to be as independent as possible rather than doing things for them. This programme is still in its early stages but it is already having positive outcomes for people. A photo display showed a group at Birmingham Art Gallery which they visited as part of a project. The co-ordinator is supporting staff to understand and help with the award programme. She is considering how relatives can be kept informed if they are unable to visit regularly to see photo displays or individuals portfolios. Each person has an activity plan that includes a variety of on-site activities and outings as well as time spent in their units. One person now attends college twice a week after their one day course was a success. Art and pottery sessions continue to be provided on site but these are now linked with the ASDAN awards. One man is being supported to visit a temple in Birmingham, which is the nearest one for his faith. Three men on one unit went off for horse riding after lunch. Recent staff surveys highlighted that staff felt evening and weekend activities could be improved. The manager has made some changes as a result and these are going to be trialled. One worker reported that he felt some people would benefit from more physical activities such as a trampoline. There are 2 swings but he felt activities are needed to help people use up their energy. The Spa Pool has not yet been opened after continued difficulties with how infection control issues will be managed. Some structural changes are now planned and the plan is for it to open in the spring. The sample of records seen showed that people are being supported to follow their activities plan on most days. One unit has experienced more staffing difficulties than the others and this has affected activity plans. The men on this unit all need the support of two staff when attending off site activities and in some cases the risk assessment dictates that experienced staff are needed. Recent staff changes across the site should alleviate the problem while more staff are recruited and newer staff gain experience. Not everyone goes on holiday, as this is not felt to be in their best interest. Staff have worked hard to support some people to go away for the first time. People are supported to stay in touch with their families. A facility is available on site for families who live a long way from the Home to stay overnight. Keyworkers have the responsibility to keep relatives informed and they are invited to review meetings. Staff currently prepare all meals in the unit kitchens but the ingredients come from the large catering kitchen that supplies the food for the residential school next door. When Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: the current contract ends in the Spring the service will return to buying food locally as it did several years ago. Staff spoken with felt very positive about this as they continue to be unhappy about the quality of some of the ingredients and feel strongly that residents should shop themselves. One unit manager said several of the men on the unit enjoy shopping and can cope with the full weekly shopping trip. The manager reported in the AQAA that peoples religious and cultural dietary needs are met. One unit avoids one food type as two people on the unit have the same allergy. Good efforts have been made to find alternatives that people enjoy equally. Care Homes for Adults (18-65 years) Page 18 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People are receiving personalised support with their health and care needs. There are generally safe arrangements in place for the management of medicines but standards could be further improved so as to always protect the people living in the home from any unnecessary risks with medication. Evidence: The care plans sampled included detailed information about how people prefer to be supported with their personal care. The staff spoken with said the daily routines are personalised and flexible. Staff were seen to knock before entering peoples bedrooms and one mans permission was sought before some visitors were shown his room. Everyone looked clean and well presented and records showed that people were being offered baths or showers each day. The manager reported in the AQAA that privacy is promoted and only breached when someone is at risk. The majority of residents are male so same gender personal care cannot be provided at all times but it is for the females. Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: Records showed that people are being supported to access community health services, for example chiropody, eye tests and dentals. Notes had been made after appointments and health issues had been summarised for review meetings. The manager reported that each person now has a Health Action Plan, however, staff on one unit could not find these. The manager was unsure if the nurses were keeping them in their office. Clear health information was seen in the care plans and in the new style Person Centred Plans. The Speech Therapist had completed an eating and drinking review in April 08. Issues regarding weight were being addressed proactively in one unit by a dietician coming to speak to staff. One persons family had agreed to work on the same eating plan during home visits to increase the effectiveness for the young person. There are plans to introduce a new approach to how people are supported with their behavioural needs through links with a Welsh University. Senior staff are going to be trained first and then the training will be cascaded. The way medical emergencies have been responded to during the year continues to demonstrate that health needs are taken seriously, and that staff go the extra mile to support people when they are unwell. The staff are helped to meet peoples needs by a team of professionals who give advice. These include two site nurses, a speech and language therapist, a psychologist and her assistant. These professionals contribute to the staff training programme e.g. the nurse trains staff in epilepsy and diabetes. Surveys returned by these people were positive and they felt that people were having health needs met. Care plan information included an outline of the arrangements in the event of a persons unexpected death. People and their families have been consulted about this. As part of this key inspection one of our pharmacist inspectors visited the four units and looked at some of the arrangements for the management of medication. He looked at some stocks and storage arrangements for medicines, some medication records, procedures and spoke to five members of staff. Feedback was then provided to the manager and Head of Adult Provision. Staff who have undertaken a training process for the safe handling of medicines were responsible for the management and administration of medicines for people living in this home. Staff have also been trained for more specialist administration of some medication that some people living in the home may need to meet their particular health needs. The company were introducing a new comprehensive medicine policy and procedures and some staff told us about the training they have had for this. The new procedures were in various stages of implementation in the different units with a target date for completion by December 2008. This helps to make sure that all staff are aware of how Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: the company expects medication to be handled in a safe way. A protocol for homely remedies was included in the new policy. Careful consideration is needed about including one medicine (ibuprofen) in the protocol, as there may be a number of potential interactions and contra indications to this. At the time of the inspection nobody was assessed as able to self administer medication. We saw examples of peoples preferences for the way their medicines were administered and handled by staff were in the records but this was not so for everyone. In one case we found written agreement was needed that the particular way the medicines were administered was in the best interests of that person. In discussion, staff told us there were no equality or diversity issues that would impact on medication. On one unit the manager described how the needs of two people to be protected from a particular allergy were met without impacting too much on the choice of other people living in the unit. Two staff were involved as a check when medicines were administered. We saw one case where the second person did not actually check the medication out of the pack. We discussed with staff and the manager about making sure that safe practices are always followed when medicines are prepared and administered. Staff should avoid walking through the unit just with the medicines in a small pot. Staff described various ways they try to achieve safe practice and we heard that improvements are planned as part of the new policy and procedures. Safe arrangements for the administration of medicines are needed to make sure that people living in the home are not at unnecessary risk from mistakes with medication and to comply with regulation 13(2) of the Care Homes Regulations 2001. On each unit we looked at some of the records kept for each person about the medicines received, administered and leaving the home or disposed of through the pharmacy. Complete and accurate records about medication are important so that there is a full account of the medicines the home is responsible for on behalf of the people living here and so that people are not at risk from mistakes, such as receiving their medicines incorrectly. The samples of records we looked at were generally in order and indicated that all the medicines needed for people living in the home were in stock. We found just a few examples where more attention to detail in the records was needed in order to fully comply with the Care Homes Regulations 2001. On one unit records for three people for three medicines administered the night before the inspection were missing but checks we made indicated that the medicines had been given but the record missed. The unit manager was investigating this. We found that staff were not always recording what dose they had actually administered to people where a variable dose was prescribed (one or two tablets for example). Some records needed more specific information about using creams for example so that it was clear Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: when, where and why to use. Another example was for eye drops where some records needed to indicate right, left or both eyes as appropriate. Since the last inspection the home have introduced improved systems for dealing with medicines in a safe way whilst people are away from the home. We noted that some of the records needed to state the strength of the tablets for example in order to fully describe the medication. A number of people living in the home were prescribed medication to use when required. In some cases there were written directions in place for staff describing the use of each particular medicine to meet the needs of the person. Some of these directions or protocols needed updating or more specific information, such as when to use one or two tablets. In other cases we found that there were no written directions or protocols in place. The new medication procedures provide specific forms to complete containing the information that is needed to help make sure that staff have the information to make sure the medication is used correctly according to the needs of that person. The company has set a date of December 2008 for implementation of the new procedures so this matter should be dealt with soon. Staff we spoke to were able to tell us how they would use some of these medicines. We recommend that the method ordering medicines be reviewed so that the doctors prescriptions for each person are seen in the home before they are sent to the pharmacy for dispensing. This could make it easier to make sure that the dispensed medicines and printed medicine administration charts are labelled with complete and up to date directions. Staff in the home are in a better position to liaise directly and quicker with the surgery about such matters. There were safe arrangements for storing medication and further improvements are planned with new cupboards on order for controlled medications and new medicines fridges had recently been delivered. We recommended that particular emergency medication was stored and recorded as a controlled medicine; the manager confirmed that plans were in hand to put this in place as a company policy. On two units the location of the medicine cupboards was not ideal, as it did not really provide sufficient space to prepare medicines quietly. Some cupboards needed some reorganisation so that medicines that were applied to the skin were segregated from those that were swallowed. We saw evidence that regular audit checks of medicines were in place. People in the home have access to local GPs and for some people specialist consultants review their medication in liaison with the GP. Care Homes for Adults (18-65 years) Page 22 of 39 Care Homes for Adults (18-65 years) Page 23 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents and their representatives are listened to and complaints are taken seriously, however, in some cases the response could be quicker. Arrangements are in place to help protect the residents from abuse and self-harm but the management team need further training to ensure they consistently implement these. Evidence: A complaints procedure is in place and a flow chart shows how a complaint would be progressed through the organisation if a local resolution could be found. The majority of residents have family members to advocate for them, and some have independent advocates. All have key workers whose role is to take a specific interest in their care quality of life. Some families reported in the homes feedback survey that they were not fully aware of the complaints procedure. The manager said he would be providing them with another copy. Each persons representatives have been given a copy in the Service Users Guide in the past. The majority reported that they have not had any concerns or that when issues have been raised they have been appropriately addressed. Records of the two complaints received in the last year were seen. The issues had been looked into and some action taken to address the concerns. For example, one man is now being encouraged to move away from another mans bedroom when being noisy as this mans family felt the noise level upset him. Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: No formal complaints have been received by us in the last year. One family did make contact and report that they had concerns about the staffing arrangements on their sons unit. They said they had shared their concerns with the service but felt the manager had been slow to react. As experienced staff had left the unit over recent months this had impacted on the level of activities provided. A record of these concerns had not been made as they were not put in writing. The manager and service manager said they had learnt lessons about how the opening of a new small group home and enabling staff to transfer to support the people moving out had impacted on the service at Winslow Court. Care plan records did indicate that staffing levels were stretched and activities affected over this period. The situation is being addressed now with a recruitment drive, two experienced staff moving across from other units and the vacant unit managers post being filled. The manager was advised to record verbal concerns to demonstrate, in line with the service aims, that concerns are taken seriously and acted on. He should also be proactive and inform people and their representatives when there are difficulties so people are aware of the efforts being made to resolve the issue. The manager reported in the AQAA that he plans, with the help of the Speech Therapist, to develop a booklet that clearly explains to people living in the home how to complain. The organisation has a history of aiming to learn from complaints and will make policy and procedural changes rather than just reacting to each individual issue as they arise. Some people can display behaviour that puts them at risk, including self-harming. Policies and care plans are in place about how behaviour that challenges the service is managed. As detailed earlier in the report planning improvements are being made to this part of the service. The physical intervention techniques staff are trained to use in specific circumstances are approved by the British Institute for Learning Disabilities. Records of all physical restraints are kept and those sampled showed people are rarely held for more than a minute. The Company has Abuse and Whistle Blowing policies and these include appropriate information about the local multi-agency procedures. Suitable recruitment procedures and practices help to protect people using the service. All staff are provided with information about abuse and their duty to protect vulnerable people in their induction and also attend a course on adult protection. These areas are also covered in the NVQ Care awards that staff are supported to do. The service has a good record of staff reporting concerns promptly to senior staff. Since the last inspection adult protection issues have been quickly reported by the manager to social services and us. The management have then cooperated fully with Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: multi-agency agreements to ensure the best outcomes for people in each case. Relatives have also been appropriately informed. A recent incident in one of the small community homes has highlighted the need for the procedures to be reviewed and for all senior staff including the manager to be better trained in responding to allegations of abuse. Care Homes for Adults (18-65 years) Page 26 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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, however, some areas could be made more homely. The majority have nicely personalised bedrooms but some people are not being enabled to be as independent as possible within their bedrooms. Evidence: The Home is in a very rural location and this does not enable people to use public transport or walk to local facilities. It does however mean that people can use the extensive attractive grounds without disturbing neighbours. The Home is on the same site as a residential school and some facilities are shared including a reception area and leisure complex. The Home has office areas and rooms for craft, pottery and computer work. The living accommodation is made up of four units that contain six single bedrooms. Each unit is self-contained with a lounge, dining room, kitchen and communal bath, shower and toilet facilities. Some units also have a staff office area. The units do not have their own private gardens. There are swings in the communal grounds, woods for people to walk in and areas for bike riding and ball games. All the units looked clean and the living areas comfortably furnished. One unit smelt Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: unpleasant due to incontinence. The manager said this was unusual and he would monitor the unit and review cleaning arrangements if necessary. All units have now had their kitchens refitted. The majority of the bedrooms seen have been nicely personalised. Some people have been supported to replace the lockable built in wooden wardrobes, that are plain and unhomely, with bespoke strong but attractive furniture. Bespoke double beds have also started to be purchased by some residents. Some residents cannot manage with personal possessions being on display in their bedrooms so they are quite bare. Family pictures had been taken down from one mans walls as these were distressing him, however, nothing else had been put up to replace these. Staff did say is was positive that he had now accepted a chair being in his room. None of the bedrooms have sinks or en-suite facilities. Consideration is being given to covering part of the breeze block walls in each room. Although the walls are all painted the block effect is not homely, so this is a positive move. Many of the residents have access restricted to their personal things such as clothes due to their behaviours. Since the last inspection these arrangements have been reviewed in some cases, however discussions about one man showed that staff did not know why his wardrobes were locked. He can become upset and may kick things but does not have a history of ripping his clothes. Another resident has his wardrobes locked, not because of his behaviour but in case another person on his unit comes in and damages his property. The unit manager felt he was able to manage a key but had not been facilitated to hold his own bedroom or wardrobe key. This mans bedroom was bare and shabby. The unit manager said it had not been personalised because his funding authority had said the placement was temporary, however, he had been in the service for a year. Regardless of the situation his room should have been improved, decent curtains hung and some pictures or photographs put on the wall. Overall the communal areas looked modern and comfortable. Staff on the units talked about what changes had been made to better meet peoples needs, such as the purchase of large individual large armchairs. Other plans were in place such as new curtains. The built in furniture in communal areas could be made more homely and bright if it was painted. There are plans for one unit to have an enclosed private garden. This should benefit all on the unit but it will enable one man to have more freedom as he needs to be supervised when in the communal grounds. Another unit has a courtyard that is bare. The unit manager said she is considering how to make the space nicer but items put out there may be damaged. Painting some of the boundary may improve it and provide a visual stimulus if done creatively. Private outdoor space for the other units should be considered. The Home is fitted with suitable fire protection systems such as an alarm and these Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: are serviced and checked regularly. Repairs are carried out by the on site maintenance team who also manage the grounds. There have been some delays but the manager reported that 3 new staff have been employed to address this. Improvements to the premises continue to be made and the rolling programme of redecoration continues to be effective. The bath and shower areas are due to be improved with the breeze block walls being covered with tough white washable boarding. The laundry is housed in an external building and staffed by a contracted company who deal with laundry for the school and care home. Some residents take their washing across, but the industrial set up does not help to facilitate them being more independent in this area. Infection control systems are in place and staff are provided with protective clothing. The most recent inspection from Environmental Health led to a 4 star being awarded for food management. Care Homes for Adults (18-65 years) Page 29 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to the service. People are being supported by a competent and effective staff team. Usually appropriate numbers of staff are provided to meet their needs, however shortfalls on one unit have meant less activities for the people who live there. Training arrangements are effective but more staff need to become qualified. The residents are being protected by the recruitment practices. Evidence: Four staff are usually based on each unit supporting the six residents. One of the four is a senior who runs the shift. The levels can fall to three at times if there is short notice staff sickness. Cover for gaps is more easily found on week days and unit managers who are usually supernumerary can provide cover. 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. Staff felt that the lack of an overtime payment discouraged them from working additional hours to cover sickness. A fifth worker is made available for certain times during the week in each unit to enable specific activities to take place. Two of the unit managers are using these hours to employ a carer to work Monday to Friday office hours. They said this provides a consistency for the residents and helps monitor that the three shift teams work in the same way. Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: Feedback from staff discussions was generally positive. They felt they are provided with suitable training and support from their unit managers. They were positive about the people they supported and felt the psychologists helped them understand peoples behaviours. Those that were keyworkers enjoyed this role. Morale had been effected by staffing shortages over recent weeks on one unit but the situation was improving. The care team are supported by a variety of other staff including an operations manager, the health care team, pottery, art and activity therapists, the grounds and maintenance team, training, health and safety, human resources, catering and laundry workers. Of a team of a hundred and four staff twenty two have left in the last year. This is a slight increase from the previous year when the turnover was 17 per cent. Recruitment is managed by the human resources department. The manager confirmed in the AQAA that appropriate recruitment procedures are in place and that the company equal opportunities policy is implemented. The gender balance of the staff team does not reflect the resident group as the majority of people living in the home are men but more staff are female. The aim continues to be to recruit male staff where possible and those from more diverse cultural and religious backgrounds to better reflect the resident group. Staff files were not seen, however, on request a sample of recruitment details were submitted after the inspection. These showed that the required checks had been carried out before the two workers started on the units. The manager reported in the AQAA that the training programme meets the Common Induction Standards. The induction has been changed and staff now attend formal sessions Monday to Thursday for 2 weeks and spend time on the units on Fridays getting to know the residents. Core safety training is covered in the first two weeks and specialist courses within the first six months. A training co ordinator manages the training and monitors when staff need refresher training through the computerised record held for each worker. Staff are paid for attending training days. The coordinator provides some of the training such as health and safety and the nurses provide courses on health issues. External trainers provide courses for First Aid and Adult Protection. The manager reported that staff are supported to gain the Learning Disability Qualification and then usually start work towards an NVQ award within their first year. Currently 30per cent of the permanent staff have gained an NVQ and 22 are working towards one. The level of qualified staff has been below the 50per cent minimum standard for the last 2 years. It is positive that senior staff are encouraged to gain higher awards. The unit managers have the Registered Managers Award and are now working towards NVQ level 4. The manager reported in the AQAA that all staff are provided with supervision sessions Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: at least six times a year. Staff confirmed they had supervision and that this and the staff meetings are supportive. Unit staff meetings and senior meetings are held periodically. There are several layers of seniority within the staff team, which creates opportunities for promotion. Care Homes for Adults (18-65 years) Page 32 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The people living in the home are benefiting from a service that is focused on their needs and best interests. Evidence: The registered manager has relevant experience and qualifications. He plans to start a masters degree in Positive Approaches to Challenging Behaviours next year. He has responsibility for providing support and supervision to the managers of three other care homes in the local area. The owners should keep this arrangement under close review as Winslow Court is a large and complex service in its own right. The deputy has been taking the role of acting manager at another of the Companys care homes over the last year. One of the four unit managers has recently been promoted to take on this role and a new unit manager has been appointed. The manager completed the AQAA on time giving very detailed information about the service, recent developments and future plans. Staff reported that he spends time on the units and does know the people who live in the home. As mentioned under the complaints section the manager Care Homes for Adults (18-65 years) Page 33 of 39 Evidence: should ensure that service difficulties are relayed to peoples representatives and proactive strategies are put in place promptly. Company policies and procedures are in place and these have been kept under review in liaison with an external company. Evidence indicates that staff are aware of and are supported to follow the procedures. All required records are in place and these are being completed to a good standard to help support and protect the residents. They are being stored securely and are regularly scrutinised as part of the providers monthly monitoring visits. These visits form part of the quality assurance systems. Audits are carried out in house and an external annual health and safety audit is carried out by an external organisation. The management team has a history of being open with external agencies and working to improve any areas where shortfalls are identified. The problems found in the medication management arrangements at the last inspection were taken seriously and arrangements are now more robust. Peoples families and other stakeholders have the opportunity to give feedback at the six monthly review meetings. The consultation arrangements have been improved in the last year as feedback surveys are now being used. These contained suitable questions and the majority were very positive. Comments included, we have never had any concerns, they are always truthful in communications, the psychologists work well to support people. Some suggestions have already been acted upon. Staff have also recently been asked to complete a survey and their ideas are being considered. The manager is supported to manage health and safety matters by the training coordinator and maintenance team. A Health and Safety committee operates and there is a culture of the Company being safety conscious and carrying out risk assessments appropriately. The AQAA indicated that essential equipment servicing and safety checks are being carried out such as fire alarm tests and hot water temperatures checks. Care Homes for Adults (18-65 years) Page 34 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 35 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 When medication is prescribed for use when required, as directed or with a variable dose, make sure there is always clear written direction to staff on how to make decisions about administration for each person and medicine and in accordance with the provisions of the Mental Capacity Act 2005. Where people may lack capacity to consent to the way the medicines are administered keep records of the agreement that the way in which medicines are administered is in the best interests of that particular person in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the 31/01/2009 Care Homes for Adults (18-65 years) Page 36 of 39 correct levels of medication in accordance with their needs and planned action. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 Introduce the planned new assessment tool to ensure any prospective new person has their needs and aspirations fully assessed. Make sure all essential information is included in the initial care plan so staff are fully informed from the start of the placement. 2 9 Continue to review who has restricted access to their belongings and where possible remove these restrictions to promote independence and normal living. Ensure those who have the skills have the choice to hold the keys to their bedrooms or wardrobes. 3 4 12 20 Make sure staffing arrangements are always sufficient to enable people to follow their activity plans. Store and keep records for the particular liquid medication identified at the inspection as for a controlled drug. Arrange to see and check prescription forms in the home before they are sent to the pharmacy for dispensing. Provide information to the residents in a suitable format about their right to complain. Keep a record of concerns that are raised verbally to show that these have been addressed. 5 6 20 22 7 23 Provide further training to senior staff to ensure they know how to manage safeguarding matters in line with local multi-agency procedures. Continue to improve the home to make it more homely. Develop outdoor private space for each unit. 8 24 9 32 Increase the percentage of care staff who hold a relevant qualification to over 50 . Care Homes for Adults (18-65 years) Page 37 of 39 10 11 33 38 Plan recruitment to ensure staff turnover does not impact on service delivery. When a problem with service delivery is known this should be communicated to people using the service and their representatives along with the planned solutions and time frames. Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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