Inspection on 31/10/07 for Winslow Court

This inspection was carried out on 31st October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 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 18/09/06

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 Key Unannounced Inspection 31st October 2007 10:30 Winslow Court DS0000024749.V345184.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.V345184.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.V345184.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 neilbagley@rowdenhouse.com 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 Neil Bagley Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Winslow Court DS0000024749.V345184.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. 18th September 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 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 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.V345184.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 7 hours on October 31st by two inspectors. The manager was on duty and helped with the process. We looked around two of the four units and spoke with four members of staff. Five of the residents, six relatives and several professionals filled out surveys to give their views about the home. We looked at some records such as care plans and medication. The manager sent information to us before the visit. What the service does well: New residents are supported to visit and try out the service before moving in. Their needs and wishes are written in their care plans. The residents are supported to have their health needs met and their physical care needs met in the way they prefer. The residents can spend time doing things they like at home and they all take part in activities that they benefit from. Residents are supported to use communication aids to help them understand things and make choices. They are supported to stay in touch with their families. The units are comfortable and safe and all residents have single bedrooms with their own things in them. They are being protected from harm and abuse. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: All residents could have accessible information about the Home and about how to make a complaint. Some restrictions on residents may not be needed. The residents may be able to be supported with their behaviours in better ways. Guidance about how to keep the residents safe could be made clearer. Some parts of the house could be made more homely. The way the residents’ medication is looked after could be safer. The staff could be more qualified for their jobs and better supported by the managers. The residents and others involved could be asked for their ideas for improvements more often. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are not being offered information in a format that will help them make a choice about where to live. The needs of prospective residents are being assessed however they are not being provided with evidence of how these needs will be met before moving in. Prospective residents are well supported to visit and trial the Home before moving in permanently. EVIDENCE: Five new residents had recently moved into the Home as the Company has just opened a new Home and this has created vacancies. The manager reported that up to date information about the service is sent to prospective resident’s representatives. He felt that the assessment and transition process has been improved since the last inspection. The new assessment format was seen, however this did not cover all the areas of support that need to be assessed before a judgement about the suitability of the placement can be made. An assessment is also being requested from the placing authority. An initial care plan seen for a resident who had moved in two months previously was comprehensive and showed careful planning had taken place. In the AQAA (the annual quality assurance assessment that services have to submit to us) the manager reported that a planning meeting is held after the first week where the initial care plan is agreed and written. The sample seen showed the initial Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 10 care plan included plans for input from the specialist team e.g. a psychology and speech and language therapy assessment. The manager reported that a more structured transition process is being developed. Records supported this and showed that several visits had taken place to support one resident to move in. These included staff spending time with the young man at his current placement and with his family. The service has a good record of taking time to support new people to try the service and settle in. Families and representatives are fully involved and review meetings are around the three month period before any placement becomes permanent. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ needs are reflected in their care plans and these are being kept under review. They are being supported to make choices and take reasonable risks in order to have a good quality of life. Some unnecessary restrictions may be in place. EVIDENCE: Information from four care plans was sampled. These were very detailed and contained clear information about care needs, aims and resources. The plans are not presented in a format that enables the residents to understand the information and person centred planning has not been fully implemented. Daily records are written for each day and night shift and these are used to inform monthly summaries that the residents’ keyworkers complete. The plans have been kept under review by the unit manager and keyworkers, for example temporary care guidelines had been added when a resident was recovering from an injury. Life skills development aims are in place for each resident, although the unit manager reported that the residents are supported to develop skills in more areas than the three or four identified. Intervention strategies are developed with the psychologists. Discussion about one Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 12 intervention strategy indicated that approaches may need to be reviewed as a restriction put in place when he became unsettled was being lifted at the end of that staff shift period rather than when he was calm again. Risk assessments covered a wide range of areas such as travelling in the car, road safety etc. Details under the environment section indicate that some unnecessary restrictions may be in place and risk assessments need to be reviewed. The risk assessment for one resident did not fully reflect how vigilant staff need to be to protect other people from his potential behaviour. Review meetings are held at least six monthly with each resident and their representatives. Reports are written for these to given an overview of issues, concerns and developments. A social worker reported that the annual reviews were well documented. A sample of one of the reports showed that the resident was progressing in several areas including communication and self help skills. The staff were observed to support residents to make choices within their capabilities e.g. where they wanted to sit and what book they were going to look at. Care plans promoted choice making under each section e.g. residents choosing the clothes they wear. The speech therapist supports each resident to have a method of communication such as PECs. Activity timetables are used to help some residents know what is happening that day. A new resident uses an electronic communication system and staff were getting used to using this with him. Of the five residents’ relatives who returned surveys four felt they do get enough information to help make decisions for their children and felt the home always gave the support they expected. One family reported that their son is always supported in an individualised manner and staff informed them of incidents and health issues. A care professional reported that the Home manages residents’ complex needs well. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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 are being provided with meals they enjoy. 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. Examples of personal development were reported such as one resident who has been enjoying going for long walks and has surprisingly started to link arms with staff during these. It is positive that some residents are accessing college courses. The manager is planning to have the service registered as an over 19’s ASDAN centre (Award Scheme Development and Accreditation Network) that will enable residents to gain awards in life and work skills. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 14 All residents have an activity plan that includes a variety of on-site activities and outings as well as time spent in their units. Examples of activities included art and pottery on site, art and computer studies at Worcester college, riding for disabled and swimming at the Droitwich Brine baths. Some residents can occupy themselves and spend time in their bedrooms, others need to be kept focused at all times. Care records seen showed that residents were being engaged in planned activities each day. On site activities include gardening, pottery, art, IT, music and use of the leisure complex. It is unfortunate that the spa pool is not yet in use. Vehicles are provided and the residents are supported to go shopping to buy their own personal things such as clothes and toiletries. The manager aims to increase community-based activities. A Halloween party was being held on the day of the inspection and residents were seen to be excited about the fancy dress costumes. Not all residents go on holiday, as this is not felt to be in their best interest. A unit manager talked about how staff were hopeful that two residents on their unit would manage to have a short break in the summer. Surveys from relatives reported that the majority of them felt they were enabled to keep in touch and their children were being supported to live the life they choose. One family said their son’s cultural needs are well met. The residents are supported to stay in touch with their families. In preparation for a possible Christmas stay one resident was meeting his family more frequently at a location near the Home so staff could offer support if needed. 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 about the residents’ changing needs and any concerns. The catering arrangements have been changed since the last inspection. Staff are now preparing all meals in the unit kitchens rather than in the school catering kitchen. This change has allowed the main meal to be moved to the evening if this better suits the residents’ plans and has allowed the menus to be developed around the preferences of the residents in each unit. Ingredients are being purchased locally more often and the manager hopes to make the meal arrangements more domestic. The manager reported that residents’ religious and cultural dietary needs are being met. Guidance in one plan could be made clearer as it referred to a new resident as being a strict vegetarian and elsewhere talked about Halal meat being provided. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are receiving personalised care and support in the way they prefer. Their physical health care needs are given priority but planning in some areas can be improved. Medication is not being safely managed in some areas. EVIDENCE: The care plans sampled showed that detailed information has been included about how the residents preferred to be supported with their personal care. The staff spoken with seemed well informed about the residents’ needs and they said the daily routines were personalised and flexible. The surveys returned from the residents and relatives indicated that people were satisfied with the personal care and support provided. The manager reported in the AQAA that the residents’ privacy and dignity are always respected. Staff were observed to knock on bedroom doors before entering and to speak to residents with respect. All but three of the residents are male but less than half the care staff are male, therefore same gender personal care cannot be provided for male residents. Same gender care is provided for the female residents. One resident’s family felt more men should be recruited if possible to support and be a role model to her son. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 16 Records showed that the residents are being supported to access community health services e.g. chiropody, eye tests and dentals. A health action plan format has been developed by the nurse who is based at the school on the same site. She completes these for each resident. The information in the one that was seen had not been summarised in each section. For example the resident had not had a testicular examination and could not check himself but the reason the nurse had concluded that no action referral was needed was not recorded. An annual health check with his GP could have included this. Surveys indicated that residents, relatives and professionals feel health needs are well managed. The way medical emergencies have been responded to during the year continues to demonstrate that health needs are taken seriously and staff will go the extra mile to support residents when they are unwell. The staff are supported to meet the residents’ needs by a team of professionals who give advice. These include the nurse, 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. Recently a complaint has been made by an organisation that is carrying out assessment work for a placing authority that fund three residents. The concerns relate to the behaviour intervention strategies that they felt resulted in unnecessary restrictions and a lack of understanding amongst staff about how residents use behaviours to communicate their needs. The providers have consulted a suitably qualified person to seek an objective view. They confirmed shortly after the inspection that shortfalls were identified and a review of this area of the service will now be undertaken to modernise the approaches used. None of the residents are able to manage their own medication. The medication in one unit was inspected and found to be securely stored and the seniors hold the keys. The location in a hall cupboard means staff have to be constantly aware of where the residents are while dealing with the medicines. They also do not have a work surface area. Records showed that doses had been administered as prescribed. Some of the residents are prescribed medication to be taken under certain circumstances. Doses are taken on community outings in case they are needed. The way this was being managed was not considered to be safe e.g. doses were removed from the container they were dispensed in and then when not used they had remained in plastic pots without information about what they were. The manager agreed to take urgent action to improve standards and he confirmed soon after the inspection that he had done this. It is positive that medication regimes are kept under close review by the consultants involved and positive examples were given by staff of how residents had benefited from recent medication changes. Staff reported that medication is not used as a way of managing behaviours unless other intervention strategies fail. The nurse assesses the competence of care staff to administer medicines following several sessions assisting more experienced staff. Accredited training is also provided through the pharmacy. The above findings indicate that further staff training is needed to ensure the Home’s policy is implemented consistently. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. 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. Robust arrangements are in place to help protect the residents from abuse and self-harm. EVIDENCE: A complaints procedure is in place. A version of this was not seen on display in the units in a format to help residents understand how to complain even though some residents do understand this concept. 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. Some families continue to report in the surveys to us that they were not fully aware of the procedure. The manager should consider regularly reinforcing to families that their views about potential areas for improvement are welcomed. All but one of the surveys indicated that when concerns are raised appropriate action is taken and indicated that the residents’ safety and protection are given priority. The manager reported in the AQAA that all complaints are logged and any action taken is recorded. Since the last inspection three have been received. One has already been mentioned under the health section. One was from a resident who was upset by two workers language. He accepted an apology from the workers after an investigation showed there had been a misunderstanding. One parent had raised concerns including how she felt high staff turnover levels were impacting on her son’s care. The manager arranged a meeting to discuss the concerns after his initial correspondence failed to reassure her. In her survey she indicated she still had these concerns. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 18 Some of the residents can display behaviour that puts them at risk including self-harming. Policies are in place about how behaviour that challenges the service is managed. The manager reported in the AQAA that the psychology team guide the intervention strategies and support staff to implement them. 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 residents are rarely held for more than a minute. The Company has Abuse and Whistle Blowing policies and these include appropriate information e.g. they make reference to the local multi-agency procedures. All staff are provided with training about abuse and their duty to protect vulnerable people. These areas are also covered in the LDAF foundation course for new staff and in the NVQ Care awards that are promoted. The manager plans to arrange more in depth adult protection training for the senior staff team. 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 multi-agency agreements to ensure the best outcomes for the residents in each case. Relatives have been appropriately informed and the manager has supported families to be involved in decision making processes about the protection of their children. Recruitment practices have improved since the last inspection and this will provide better protection for the residents. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 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. The residents are not always being enabled to be as independent as possible and some areas could be made more homely and accessible. 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. The Home is on the same site as a residential school and many of the facilities are shared including a reception area and leisure complex. The Home has an office area and rooms for residents to take part in sessions such as art 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 currently have their own private garden, however, the lounges have patio doors and in good weather residents can use the communal grounds under supervision. A Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 20 swing is nearby and some use bikes and play ball games. One resident spent time pacing in a courtyard area while waiting for lunch. This area had a picnic bench but was otherwise plain and empty. Consideration should be given to developing more personalised outdoor spaces. Two units were toured and these were found to be clean and comfortably furnished. The bedrooms seen had been nicely personalised. Many of the residents’ bedrooms still contain built in wardrobes and beds, which are very robust but do not reflect normal living. The senior staff spoken with on the units said they had not given this much consideration but did feel that some residents would not damage strong normal domestic furniture. Many of the residents have access restricted to their personal things such as clothes due to their behaviours. Discussions highlighted that one senior was not aware why a resident on his unit had his wardrobes kept locked. This practice was denying him access to his clothes, even though he was looking after his other personal possessions very well. Restrictions such as this should only be in place on the basis of a genuine balanced risk assessment and these should be pro-actively reviewed to regularly allow residents the opportunity to develop and change. It is positive that the manager has identified that the communal areas could be further personalised and he plans to explore the possibility of providing sinks in some or all of the bedrooms. Repairs are usually carried out by the on site maintenance team who also manage the grounds. Improvements to the premises continue to be made for example the heating system has been improved and all units now have new kitchens. A rolling programme of redecoration continues to be effective. The bath and shower areas in two units have had new floor and wall coverings fitted and the other units are due for these improvements soon. This is positive as one bathroom floor was heavily stained around the toilet. This and the stained toilet seat looked very unattractive. The manager reported that the psychologist had carried out a review in relation to the environment needs of people with Autism. He did not state if any changes had been made. When residents have needed specialist equipment e.g. after medical procedures, this has been provided and occupational therapy input has been appropriately requested. Access around the units has been improved as more fire doors can now be left open as they have been fitted with automatic closure mechanisms. The Home is fitted with suitable fire protection systems such as an alarm and these are serviced and checked regularly. 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 facilitate them to learn laundry as a life skill. Infection control systems are in place and staff are provided with protective clothing. The walls in the home are painted breeze blocks so the surfaces are not smooth and easily cleaned. For those residents whose behaviours mean walls need to be disinfected this is not ideal. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are generally being supported by a competent and effective staff team in appropriate numbers to meet their needs. Not enough of the team are qualified and additional training and supervision is needed. The residents are being protected by the Home’s recruitment practices. EVIDENCE: Four staff are usually based on each unit supporting six residents. Staff reported that this 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. A fifth worker is made available for certain times during the week in each unit to enable specific activities to take place. Some feedback was that staffing shortfalls had at times prevented residents following their plans. For example one resident cannot always attend church and another had missed some swimming sessions. Recently there has been an contributing factor was that community based care home helped those who moved but Winslow Court unusually high level of vacant posts. One some staff moved with residents to a new the company recently opened. This will have left a deficit at Winslow Court. The manager DS0000024749.V345184.R01.S.doc Version 5.2 Page 22 reported that some agency staff have been used while the posts are filled. One relative expressed concern about high staff turnover levels. Over the last three years efforts to improve staff retention have been successful. Turnover has reduced in the last year by a further 7 to 17 . Feedback from surveys was generally positive about the staff team with families and professionals reporting that staff were helpful and in the main suitably skilled. One felt that communication on their son’s unit could be further improved. The residents said they liked the staff who supported them. The staff spoken with had a positive attitude towards the residents and seemed to have sound values. As well as the specialist health team the care team are supported by a variety of other staff including an operations manager, pottery, art and activity therapists, grounds and maintenance, training, health and safety, human resources, catering and laundry workers. The manager confirmed in the AQAA that appropriate recruitment procedures are in place and that the company equal opportunities policy is implemented. As mentioned earlier the gender balance of the staff team does not reflect the resident group. New methods of advertising for staff are being tried and it would be positive if more male workers and those from more diverse cultural and religious backgrounds could be attracted to better reflect the resident group. Three staff files were sampled and the records showed that all required checks had been carried out before workers started on the units. A new member of staff said she had completed the two week induction training but then had to wait to start work for her CRB check to be returned. The human resources department is now better staffed and one officer works solely for the care home. A training co-ordinator has responsibility to coordinate the training budget. Computerised training records are held for each worker and staff are paid for training days. The new co-ordinator has been in post for less than a month but his impression is that an effective staff development programme is in place. The manager reported that the training programme meets the Learning Skills Council standards. New staff attend a structured induction course. The way foundation training is delivered is being changed to give staff time to absorb the knowledge while working with the residents. Any spaces on courses are used for established staff who need refresher training. The Learning Disability Award Framework forms part of the training plan and the manager reported that staff usually start work towards an NVQ award within their first year. Currently 18 of the 49 staff employed at the Home have gained an NVQ and 27 are working towards one. The level of qualified staff has now dropped below the 50 minimum standard. The manager was aware of this and plans to improve the situation. It is positive that senior staff are encouraged to gain higher awards. As well as core safety and protection training specialist courses are held e.g. the psychologist provides autism training. Staff spoken with reported that appropriate opportunities for training are provided. One had found the MAPA training helped him recognise residents’ triggers to avoid the Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 23 need for restraint. Another had found the epilepsy training useful. As mentioned earlier a review is due to take place about how residents’ psychological needs are responded to by staff. The shortfalls found in the way medication was being managed indicated that further training is needed to assist staff to implement the home’s medication procedures. The manager reported in the AQAA that all staff are provided with supervision sessions at least six times a year and that this support structure is viewed to be essential for staff because of the complex needs of the residents. The discussions with three care staff indicated that they had not had supervision in the last few months and did not have a date for their next session. One gave an example of a current concern about a resident she would find it useful to discuss with her line manager. All reported to feel generally well supported with their work and that the on call arrangements to provide management support out of office hours was effective. One was positive about the free access the providers have arranged for employees to a company offering advice about personal matters such as finances. Unit staff meetings and senior meetings are held periodically. There are several layers of seniority within the staff team, which creates opportunities for promotion. Winslow Court DS0000024749.V345184.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. 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 this service. The residents and staff are benefiting from a well run home with a professional ethos. EVIDENCE: A new manager has been employed since the last inspection. He has relevant experience and qualifications and has been registered with the Commission in March 07. He reported that he spends some time on the units in the mornings to observe care practice and support the staff team. The residents clearly found him approachable and staff also reported that he was accessible and helpful. Feedback from families was generally positive. One family reported that there was good management and that overall they were happy with the care service provided and would encourage other carers to choose the Home. The manager has been given the role of supervising the managers of three other company care homes in the county. One of these homes is newly opened Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 25 and he has been visiting twice a week to support the manager. The providers should review this arrangement as Winslow Court is a large and complex service and the residents would benefit from the manager’s full attention. Company policies and procedures are in place. The manager reported that the work of updating these as legislation and best practice change has been passed to an external company. He was not aware of how this company was going to reflect the residents’ rights under the Mental Capacity Act in the policies. The residents’ records are being stored securely and these are regularly scrutinised as part of the provider’s monthly visits. Quality assurance systems are in place such as quarterly audits. As reported the internal systems failed to ensure the residents’ medication was being managed safely. However, following the inspection the manager reported that spot checks would be carried out regularly. The organisation continues to respond positively to areas for improvement identified in inspection reports. Some stakeholders have the opportunity to give feedback at the residents’ review meetings. The quality assurance system does not include planned consultation such as questionnaires or stakeholder forums. The manager had identified plans for improvements in the AQAA and reported that feedback had led to the company opening more small community homes and to the plan to set up the service as a ASDAN training centre. The manager is supported to manage health and safety matters by the training co-ordinator who is also the health and safety advisor. An annual health and safety audit is carried out by an external organisation that results in a star rating being given along with recommendations for improvements. The manager reported that essential equipment servicing and safety checks are being carried out routinely e.g. fire alarm tests and hot water temperatures checks. Risk assessments are in place relating to the environment, work tasks, and the residents’ care needs. Safety shortfalls have been mentioned under care planning and health care sections. Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 4 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 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 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 1 x 3 3 2 3 3 2 x Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. 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 YA20 YA42 Regulation 13 Timescale for action All medication must be safely 31/10/07 managed on the residents’ behalf to ensure their wellbeing. Confirmation was received from the providers on November 14th that suitable action had been taken to address this requirement. Requirement 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 YA1 Good Practice Recommendations The range of fees charged should be included in the Service User’s Guide, in line with the revised Care Homes Regulations. Prospective residents should be provided with a version of the Service User’s Guide in a suitable format to help them make an informed choice about where to live. 2 YA3 YA2 Before a placement is offered to a prospective resident the manager should show that all their needs have been DS0000024749.V345184.R01.S.doc Version 5.2 Page 28 Winslow Court 3 YA6 YA19 assessed and the service can meet these. Risk assessments should include clear information about the actions staff need to take to reduce known hazards. This information should be in a larger and clearer format to help staff to read this essential information. Review behaviour intervention plans and ensure the strategies being used are in the residents’ best interests. 4 YA9 Review the restrictions currently in place and remove those that are not based on a balanced risk assessment. Build in strategies to ensure those that are needed are pro-actively reviewed to allow residents the opportunity to develop and change. Make sure the health action plans clearly show how judgements about preventative health care have been made in the residents’ best interest. Provide information to the residents in a suitable format about their care plans and their right to complain. Review staffing and ensure the residents can access their planned and chosen outings and activities. Develop the quality assurance system to include greater consultation and a more inclusive style of planning. The providers should review the arrangements whereby the manager has responsibility to supervise and support the managers of three other care homes. 5 YA19 6 7 8 9 YA22 YA6 YA33 YA39 YA43 Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Winslow Court DS0000024749.V345184.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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