CARE HOME ADULTS 18-65
Winslow Court Winslow Rowden Bromyard Herefordshire HR7 4LS Lead Inspector
Jean Littler Unannounced Inspection 31st January 2006 11:30 Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 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.V281404.R01.S.doc Version 5.1 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.V281404.R01.S.doc Version 5.1 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.V281404.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents may also have a physical disability or mental disorder associated with their learning disability. 3rd November 2005 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 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 leisure complex that includes a spa pool. The grounds extend to twentysix acres and there is also a school on the site that is run by the same organisation. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a weekday between 11.30am and 3.30pm. The main focus of the inspection was to review the catering arrangements to see if recent difficulties in this area had been satisfactorily resolved. Some of the standards that were not covered at the last inspection were assessed. The manager was on site and assisted with the inspection process. Two members of the care team were spoken with in private and other support workers were observed interacting with the residents, several of whom were at Home for part or all of the inspection. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection were all considered as part of the assessment process. What the service does well: What has improved since the last inspection?
Arrangements to provide induction and refresher training for staff have been improved and new staff will now have attended all essential training before they start work with the residents. Difficulties with changes to the catering arrangements have been resolved and there is now general satisfaction with the meals being provided. Health and safety arrangements continue to be improved through constant reviewing of arrangements and monitoring of new legislation.
Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 6 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.V281404.R01.S.doc Version 5.1 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.V281404.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 9 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): 9, 10 The residents are being supported to take reasonable risks in order for them to lead fulfilling and valued lives. This involves a high level of professional judgement to be exercised on a daily basis. Suitable arrangements are in place to ensure residents’ personal information is held securely and remains confidential. EVIDENCE: The residents seen were well presented and seemed relaxed and confident in their Home surroundings. The staff spoken with gave examples of how residents are supported to take reasonable risks in order to be involved in activities they enjoy and to experience new things e.g. going horse riding, going into the community and crossing roads, learning to prepare and cook food, those with epilepsy going swimming. Both workers reported that the risk assessments in the care plans are followed, and the shift leader takes day-today responsibility for judging if a resident is in the right frame of mind to participate in an activity that involves an element of risk. When new activities or situations are going to be tried those involved in the resident’s care are appropriately consulted. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 10 The two staff spoken with had both been informed during their induction of the need to keep residents’ personal information secure and confidential. Appropriate storage is provided in each unit and in central office areas. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 11 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): 17. Residents are being provided with a range of suitable meals that they enjoy. EVIDENCE: All members of the staff and the management team spoken with felt the problems with the meals service have now been resolved. Staff reported that the catering manager is liaising closely with them and has responded positively to any concerns they have raised about the quality or quantity of the food. The catering company has now employed two permanent chefs and other catering staff and this has helped improve standards. The operations manager is continuing to meet with the catering manager most weeks to review arrangements and discuss any problems. Staff are being given the opportunity to complete quality monitoring forms after each meal, however not many had been returned during December and January. An independent dietician has assessed the menus and meals service but the findings have not yet been reported upon. The report, and any relevant action plan, should be shared with the Commission when it is received. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 12 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): 20. Medication was being safely managed. EVIDENCE: The medication arrangements in one unit were inspected. Doses had been administered as prescribed by trained and authorised staff. The storage was secure and the keys were being responsibly managed. Some areas detailed below should be considered by the manager and the site nurse to further improve arrangements. -review the practise of senior staff taking medication records home to update them, as records should always be available for inspection. -review if the practice of only one worker signing in new medication and logging the quantities received is robust enough, as one recording error was noted. -review if the PRN (as needed medication) guidance instructions should include details of who issues them and when. -review if a system is needed to track the PRN tablets that are outside of the blister pack system and are taken in and out of the premises on outings. -review how to improve communication systems and the sharing of reports, as the unit manager was not aware that the supplying pharmacist carries out periodic audits of medication and reports on these.
Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: These standards were not fully assessed, however a previous complaint from a relative about the quality of the food provided has been satisfactorily resolved. An allegation of abuse has been made against a member of staff. A worker promptly reported the concerns in line with the ‘Whistle Blowing’ procedure, and appropriate action was taken to safeguard the residents. This matter is now being dealt with under the multi-agency vulnerable adult policy. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were not fully assessed, however the areas of the Home seen during this visit were clean and comfortable. Efforts are continuing to encourage residents to accept and look after normal household furniture. It was very positive that one resident is due to have his built in single bed replaced by a larger bed of a normal domestic design. The laundry has been expanded, equipped with new machines, and a new floor has been laid. This part of the service has now been contracted out to the same company that are providing the catering services. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 15 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): 31, 34, 36. There is an effective line management structure and staff are clear about their role and responsibilities within it. Staff felt they were well supported by their supervisors. The Home’s recruitment procedure was not being consistently implemented. EVIDENCE: The staff spoken with were both quite new to the team, however they felt well supported and were clear about the limitations of their role and the responsibilities of staff in other roles e.g. their shift leaders/supervisors and the unit managers. Arrangements to provide induction and refresher training for staff have been improved. A rolling programme of bi-monthly induction training has been set up over a two week period and any existing staff who need to attend refresher training will join the group for that particular session. Two recruitment files were sampled and the human resources (HR) officer assisted by explaining the recruitment process. Both files showed that candidates are interviewed formally following their completion of an application form. CRB checks had been taken up for both workers, one had been returned prior to the worker starting the induction training, the other had been returned after the training but before the person started work with the residents. In both cases verbal references had been taken up but in one case the person had commenced employment prior to any written references being returned. This is a breach of the regulations.
Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 16 When the HR officer has queried recruitment issues she has kept a copy of the emailed responses from the operations manager. The registered manager was not aware that a breach of regulation had occurred even though he holds legal accountability for the conduct of the Home. Consideration should be given to changing the recruitment procedures to ensure the manager given consent for each new worker to be recruited. The quality assurance system should include checks to ensure the Home’s recruitment procedure is being consistently implemented. It is very positive that efforts to improve staff retention have reduced turnover from 39 a year to 20 over the last two years. This helps provide consistency for residents and their relatives. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 17 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): 42. Health and Safety is given high priority and there are established management arrangements in place. Two areas for further consideration were identified. EVIDENCE: A Health and Safety manager is based on the site and is responsible for ensuring risk assessment and control systems are effective. He is one of the representatives of the site Health and Safety Committee that meet monthly. The last two sets of meeting minutes showed these are effective meetings that help ensure H&S standards continually improve in line with changes in legislation, as well as agreeing action to address new hazards that have been identified in the Home e.g. slippery surfaces. Accident statistics have been collated for the previous 3 years and the Organisation is making a concerted effort to reduce the number staff and resident accidents. The manager and H&S manager agreed to review the need to keep fire doors open in the units to provide freedom of movement for the residents and to provide protection for staff and residents. Currently some fire doors are being Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 18 propped open for these reasons. Automatic closure devices may be needed on some doors in communal areas. A risk assessment has been completed for a worker who is pregnant and her work duties have been changed to reduce the risks to her health. Some staff have obtained a qualification in first aid and all others attend a one day basic training course. Currently the rota is not arranged to ensure that a qualified first aider is on duty at all times, in line with the standards. The manager agreed to complete a risk assessment regarding the level of cover provided. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 19 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 x ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 3 32 X 33 X 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 4 3 LIFESTYLES Standard No Score 11 x 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X X X X 2 x Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 Regulation 18 Requirement Two written and satisfactory references must be in place prior to a member of staff being recruited. Review the need to keep fire doors open in communal areas. If there is a need for this practice then suitable arrangements must be put in place in a timely manner. Timescale for action 31/01/06 2. YA42 13 15/02/06 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 Ensure reviews are held for new residents in line with the Home’s admissions policy. 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 assessed). Carry out a risk assessment regarding the level of First Aid
DS0000024749.V281404.R01.S.doc Version 5.1 Page 21 2. YA42 Winslow Court cover provided in the Home. Make arrangements to increase levels of training if any shortfalls in current arrangements are identified. Winslow Court DS0000024749.V281404.R01.S.doc Version 5.1 Page 22 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
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