Inspection on 04/11/08 for Winston House

This inspection was carried out on 4th November 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winston House 27/11/07

Winston House 23/05/07

Winston House 14/08/06

Winston House 14/03/06

Winston House 21/11/05

Winston House 31/03/05

Winston House 01/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Winston House 68 - 69 The Promenade Southport Merseyside PR9 0JB     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: Margaret VanSchaick     Date: 0 5 1 1 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. the things that people have said are important to them: They reflect 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 34 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 34 Information about the care home Name of care home: Address: Winston House 68 - 69 The Promenade Southport Merseyside PR9 0JB 01704532188 01704530112 winston.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Margaret Evelyne Sadi Type of registration: Number of places registered: Parkcare Homes Ltd care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service users to include up to 30 OP and up to 34 PD The service should employ a suitably qualified and experienced manager who is registered with the CSCI Variation agreed for 1 named resident under pensionable age Date of last inspection Brief description of the care home Winston House is a large detached building, which was originally built in the late 1800s and was converted into a nursing home in the 1940s. The home is situated across from the marine lake on the promenade area of Southport, which is within easy access of the amenities of this seaside town. The care home offers nursing care for 34 younger adults with physical disability and 30 older persons with general nursing needs. The home is divided into 3 units over four floors with the older persons unit on Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 30 0 0 34 Brief description of the care home the top floor and the two younger adult facilities on the basement, ground and first floors. There is ramp access to the front of the home and the two lifts access all four floors. A nurse call system is in place and suitably adapted bathrooms are situated throughout the home. Park Care Homes Ltd own Winston House. Weekly fees range from 351.50 pounds to 1342.29 pounds with additional charges for hairdressing, chiropody, newspapers and magazines. Care Homes for Adults (18-65 years) Page 5 of 34 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: A site visit took place as part of the unannounced key inspection. It was conducted over two days by one inspector and lasted 14.5 hours. Forty five service users were accommodated at this time. As part of the inspection process most areas of the service were viewed including service user bedrooms. Care records and other nursing home and young adult records were viewed. Discussion took place with service users, staff and visiting relatives. The inspection was conducted with the registered manager Mrs Margaret Sadi, the clinical manager Mrs Val Kay and the business support manager Carol Dwyer was present for part of the inspection. Discussion also took place with the assistant chef, housekeeping staff, care staff, administration staff and nursing staff. During the inspection four service users were case tracked (their care files were Care Homes for Adults (18-65 years) Page 6 of 34 examined and their views of the service were obtained.) All of the key standards for young adults and older people were inspected. Previous requirements and recommendations from the the last inspection in November 2007 were discussed. Satisfaction forms have your say about. were distributed to service users, relatives, staff and health professionals prior to the inspection. A number of comments included in this report are taken form surveys and interviews. An AQAA (Annual Quality Assurance Assessment) had been completed. The AQAA comprises of two self assessment questionaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current service users and a data set that gives basic facts and figures about the service including staff numbers and training. What the care home does well: What has improved since the last inspection? Quality assurance systems are in place, which provides feedback from service users on how the service is run. Service users, their relatives and staff are regularly canvassed for their views either by questionaires or through monthly meetings. A service user interviewed stated, I go to our voice meetings, we bring things up, they listen to us and then things get better. Service users are protected by the service policies and procedures. Wound care documentation is much improved and the care documentation viewed evidences up to date information about the treatment of the wound and the condition of the wound. The care documentation reflects the changing needs of condition of the Care Homes for Adults (18-65 years) Page 8 of 34 wound. What they could do better: The pre admission process for the younger adult needs to be improved to enure that all of the persons needs and aspirations are highlighted. This will give the service relevant information and personal detail specific to the service user, which should be reflected in the service user plan. The assessment documentation for older persons is still being used for the younger adult. Therefore this needs changing. This has been a problem in the service for some time now. The company have not taken up our recommendation that younger adults service user plans need to be easier to follow. The present documentation used means it takes a lot of time to look at the individual plans. The time taken makes it difficult for service users to look at and follow. None of the service user plans have evidence that service users have signed to agree their planned care. When one of the service users was asked about their service user plan they replied, I have not seen it. Service user plans need to be discussed with the individual and/or their family to ensure all their care needs and personal aspirations are identified with their signed agreement. The service user plans need to be updated to reflect the changing needs of the service user. The service need to provide more input for younger adults and provide a choice of learning opportunities that they are able to access easily as some of the external opportunities are difficult to access. It is strongly recommended that the planned structural changes to ensure access for the younger adult discussed should be carried out promptly. It is also recommended that the wheelchair department is informed as soon as the service user moves to an alternative bedroom as this will then enable the service user to become familiar with their wheelchair whilst waiting for their bedroom changes to become complete. It is strongly recommended that younger adults should be involved in the planning of and preparation of meals served to them. It is also strongly recommended that service users have a choice of meals for lunch and that this choice is on display and documented. At present only one course is on offer on the displayed menu giving no choices to service users althought the assistant chef told us that they can have cold meats or an omelette. Service users interviewed with regard to food served stated, The food is not bad, I had chicken casserole but you cant find the chicken and The food is okay but if I ask for something different like an omelette that is quite. It is strongly recommended that all younger adults should have an annual health check up. It is strongly recommended that all medication is signed for as soon as it is administered. Care Homes for Adults (18-65 years) Page 9 of 34 The service needs to look at providing more private and suitable sitting room accommodation for older persons as at present the only space they have is a sitting area between the hallways. This is not very private. The service need to promote the use of the kitchen/dining and sitting room space for the younger adults so thaat they can have the use of the kitchen in planning/preparing there meals with staff support. It is strongly recommended that service users should be more involved in the selection of new staff. It is strongly recommended that staff files and training records should be better organised so that information about staff recruitment and the training should be easy to find. 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 10 of 34 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 11 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission process for the younger adult needs to be improved to enure that all of the persons needs and aspirations are highlighted. This will give the service relevant information and personal detail specific to the service user, which should be reflected in the service user plan. Evidence: The assessment documentation in use is still with regard to the older person. As the service has a majority of young adults and the service have admitted young adults since the last inspection this means that the assessment is not really geared to identify their aspirations and needs. One of the service users interviewed with regard to their assessment process stated, I cant remember the assessment. Two pre admission assessments of the most recently admitted service users were viewed with regard to the admission procedure. Both pre admission assessments were signed. Copies of social work assessments were in place for both service users. Not all of the assessment documentation was completed such as religion, marital status, pain, sleep and mobility. There is insufficient information and detail in some areas. In particular with Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: regard to the service user who has had loss of mobility following a fall and operation. Prospective service users are given the opportunity to stay the night or have a meal with other people who live there. One prospective service user went out on a day trip with some of the other people who live in the service. This enable them to get to know the other service users. New service users have a three month probationary period and social workers review their care and support to see if the service is the right placement for them. Care Homes for Adults (18-65 years) Page 13 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans need to be discussed with the individual and/or their family to ensure all their care needs and personal aspirations are identified with their signed agreement. The service user plans need to be updated to reflect the changing needs of the service user. Evidence: None of the service user plans have evidence that service users have signed to agree their planned care. When one of the service users was asked about their service user plan they replied, I have not seen it. The company have not taken up our recommendation that younger adults service user plans need to be easier to follow with the possibility of a picture format where needed. The service user plan documentation in present use covers a lot of paperwork and it took some time for the inspector to view the individual plans. The time taken to view the plans would make it difficult for service users to look at and follow. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: There has been some improvement with regard to some of the information recorded in the individual service user plan but this still needs to be improved. The service user plan identifies personal safety and understanding of the fire alarm system for individual services users. One service user interviewed confirmed they had a choice with regard to who provided personal care and stated, Care staff help me with my shower, I prefer a shower and a lady helps me, I prefer a lady. The mobility problems of one service user is not fully documented therefore care staff will not be fully informed of the service users individual needs. Another service user who has deteriorating mobility problems has been referred by the service for a further assessment of their needs. This service user was also under the physiotherapist for rehabilitation but this is not evidenced in care documentation. A service user has been identified as having a problem with incontinence but there is no evidence that further advice has been sought with regard to the management of this problem. There are good records with regard to sleep patterns and the service user plans viewed evidences detailed information. The service user plans just need to be up to date. There is documented evidence that care plans are reviewed by staff signatures and dates on a monthly basis but the service user plan does not evidence changes in the needs of the service users. One service user has expressed an interest in taking up another interest as evidenced in care documentation but staff have had some difficulty accessing this for them due to insufficient numbers showing interest at the place of further education. The service hope to enable the service user to gain access in the intake planned for the year 2009 but it does become dependent on the college. It would benefit the service users if the company look into alternative venues or tried to access the preferred interests/hobbies for service users through their network. Risk assessments are in place for service users with regard to their daily lives. One service user at risk when going out unsupervised has a good plan of management of this risk in place. This service user has expressed their right to go out unsupervised and action has been taken to enable the service user to do this with risks minimised as much as possible and further information regarding how this is managed is evidenced in the service user plan and care documentation. Care Homes for Adults (18-65 years) Page 15 of 34 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. The service need to provide more input for younger adults and provide a choice of learning opportunities that they are able to access easily. The service need to provide residents with an alternative choice for their lunch time meal. Evidence: Some of the service users who live here have complex needs therefore making it difficult for them to access employment/voluntary work. One service user attends a course at college but another one was unable to as the course did not commence due to lack of numbers. One service user interviewed stated, I go to Art classes on Tuesdays, I go to the gym and an exercise class on Mondays. It would benefit the service users if the company set up a small learning/skills area on the premises and invited trained people to work with the service users. There is sufficient space to do this. Service users who wish to take up additional skills/interests would greatly benefit Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: from such a facility. Some of the younger adults go out independently each day and many of the service users go out to local cafés, cinema, bowling and pub lunches including shopping trips. One of the service users interviewed stated, I go out on my own scooter, just out and about. There are also usually daily trips out in the service bus to various places of interest around the north west and these are well attended. Local transport is close by and some service users have their individual electric wheelchair/scooter. A relative interviewed with regard to activities stated, Some of the activities are bingo and the cinema but my husband is not keen and prefers to watch the television. Many of the younger adults have been on holiday this year to Blackpool and service users interviewed confirmed they enjoyed it. Service users interviewed stated, We go everywhere on our trips out, e.g. Wales and I went to Blackpool on holiday and I stayed in a caravan, for my birthday treat they took me to a hotel and I had a few days holiday in Blackpool, in a hotel, it was very nice. Service users are able to fulfill their spiritual needs. One of the service users has one to one visit from the local clergy and other service users are provided with regular communion from two local churches. One service user interviewed stated, I have been going to Christchurch and the café, I have a support worker who takes me out twice a week, I go by taxi. Service users are supported during elections either visiting the ballot box or postal voting. Family and friends are made welcome in the service and open visiting is in place. One service user interviewed stated, Yes, I have visitors, my big brother came to see me yesterday. The visitors book in the hallway evidences relatives and friends visiting each day as viewed. Another service user interviewed stated, I get visitors on a Saturday and they take me out. A relative interviewed stated, You can visit at any time, its like home from home, I make my own tea. Staff interviewed thought that the care and support provided to the service users was good. Staff interviewed stated, Residents go out on bus trips, we had a magician last week and residents went to the cinema to see Mama Mia and We go shopping with the service users, some go independently and others with staff. Service users preferred form of address is identified in care documentation. Some service users prefer to spend their time in their own rooms rather than mix with others and this is accommodated. One service user has been isolated to their bedroom due to immobility and restricted access. The service has now put final plans in place to re organise the doorway to the service user bedroom and dining room so that they can have access. The service user has also been assessed for a suitable wheelchair. Therefore the Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: service user will shortly be able to access the public areas of the service. Daily routines are flexible. Service users spend their time as they please. Service users get up and retire to bed at various times as evidenced on care documentation. One of the service users represents the other service users at meetings arranged by the company. A service user stated, I go to our voice meetings, we bring things up (its part of Craegmoor), they listen to us and then things get better. Service users interviewed stated, I have been here 10 years, its alright, I like getting breakfast in my room, I have my dinner downstairs. Nutritional assessments are in place for the service users as evidenced in care files. Service users who need to have specialist support have this documented in care files. Mealtimes were noted to be relaxed and some service users ate their meals in their rooms instead of the dining rooms. Cushions have been provided to ensure that service users can sit comfortably at the appropriate height in the dining chairs. New matching crockery and small vases of flowers are placed on tables therefore providing a pleasing setting. Both young adults and the older people who live here share a dining room. Service users are offered cooked meals three times each day. Four choices for the evening menu was on display on the daily menu advertised on the large board in the dining room but there were no other choices available for the lunchtime meal. There was only one choice listed although service users when interviewed did confirm they could have something else to eat. Kitchen staff told the inspector that cold meats and omelettes are on offer at lunchtime. Service users interviewed stated, The food isnt bad, we had chicken casserole but you cant find the chicken, The food is okay but if I ask for something different, like an omelet, that is quite nice. The service needs to provide an alternative meal that is identified on the daily menu for lunch each day so that residents have the opportunity to choose. It would benefit the younger adults if they were involved in the planning and preparation of meals. Two cats that belonged to service users are accommodated in the service. Care Homes for Adults (18-65 years) Page 18 of 34 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. Service users have their personal and healthcare needs met with the assistance and support of care staff. Evidence: One service user has been identified as having needs that staff in the service are having difficulty meeting due to their deteriorating health. This service user is now being re assessed for another more suitable service as their deteriorating needs are causing problems that the staff are having difficulty in managing. Personal support is provided in private and when same gender care staff are requested this is accommodated. Service users are encouraged to maintain their independence with staff assistance and support where needed. Routines are flexible with service users preferred times of getting up/going out recorded and accommodated. Technical aids and equipment for service users needs were in view throughout the service. One service user who has been isolated through lack of access is soon to be provided with a wheelchair suitable for their needs. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Specialist input has been accessed for service users where identified including physiotherapists and occupational therapists. Service users interviewed confirmed they received visits from other health professionals. One service user interviewed stated, I have the chiropodist for my feet and I have seen the optician. Where service users need health support this is provided by staff. One service user interviewed stated, Im on a diabetic diet and the Nurse checks my blood sugars. Family input is recorded where service users are unable to voice their needs and preferences. One relative interviewed stated, He has a specialist nurse and dietitian, as soon as anything is wrong they ring the Dr. Service users have access to other health professionals including chiropody, optician and dentist. Service users also access local surgeries and hospitals as evidenced in care files. Older service users have an annual check carried out each year but documentation does not evidence younger adults have a similar check up. There are policies and procedures with regard to medication in the service. The service have a new supplier and are happy with their input. Medication cupboards and trolleys were tidy and secure to walls. Stock control was satisfactory. Medication records evidenced dates, amounts and strength of medication. Regular audits are carried out by the manager as documented. Action taken by the manager with regard to any discrepancies is recorded. The signature for one residents medication on two occasions was missing therefore it would be assumed they did not have it on these occasions. Service users interviewed confirmed they received their medication with one service user stating, Staff give me my medication. Training records evidence that some of the staff have attended medication training. The controlled drugs register evidences good record keeping of controlled drugs. Care Homes for Adults (18-65 years) Page 20 of 34 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. Service users are protected by the service policies and procedures. Evidence: The complaints procedure is in place on each floor. Each service user has a copy in their service user guide. The service have improved the format making it simpler and easier to follow as viewed. The complaints log was viewed and evidences complaints received since the last inspection. The log also evidences the outcomes for the complainant. A service user interviewed stated, I dont know how to make a complaint, if I had any worries I could talk to V... or M..., I have no complaints whatsoever. A relative interviewed with regard to complaints stated, If I have any worries, for example the light not working, it has been repaired, as soon as anything is wrong, M...on the night staff deals with it. The service have a copy of the Sefton Adult Protection procedure and staff interviewed were aware of what to do should such an event occur. All of the staff have attended adult protection training as evidenced on training files. The service have a good understanding of the procedure as evidenced through their alert system process. A whistle blowing policy is in place. Some of the service users have been unable to open bank accounts. The company have set up an interest paying account on behalf of these service users. Financial records viewed during the inspection evidence that individual service users finances Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: are in order. Care Homes for Adults (18-65 years) Page 22 of 34 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. The service needs to look at providing more private and suitable sitting room accommodation for older persons and promote the use of the kitchen/dining and sitting room space for the younger adults. Evidence: The service is not purpose built and there are areas that need restructuring to try and ensure service users have the access they need. Some of this restructuring is ongoing and plans in place identify further redecoration and refurbishment. One of the service users shower rooms was also being used as a storage area therefore making it unsafe and intruding on their space. The manager was advised of this. Redecoration, repair and maintenance was in progress and is ongoing with regard to the service. A rolling programme identifies which service user bedrooms need to be done. A new small sitting room has been provided for the younger adults on the first floor therefore giving them additional public space. A sitting area between the top floor hallways is in use for the older people who live there. This is not very suitable as other people regularly walk through this area. Plans with regard to the restructuring of doorways to enable easier access in the Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: younger adult area of the service where viewed. This building work is iminent and will provide better access. There are two lifts and ramp access throughout the service to enable service users of all abilities to move around. The service provides a laundry facility which is staffed throughout the day. Service users clean laundry is stored in individual baskets and delivered to their bedrooms daily. Service users bedroom storage was checked and the wardrobes viewed showed tidy and clean clothing. Hand washing facilities are in place throughout including the kitchen and laundry. Policies and procedures are in place with regard to infection control. The kitchen provides all meals for the service users. It was clean and organised. The service was in a clean condition throughout and odour free. A kitchen/dining and sitting room area has been identified as possible use for the younger adults as they would be able to be involved in the planning and preparation of meals that they could make for themselves with support from staff. This has not been used yet but would greatly benefit the younger adults who would like to cook. Service users interviewed with regard to their views on their accommodation stated, The laundry is okay, Im happy with my room, its always clean and I like my bedroom, I have a good view, I think its quite nice, my bedroom is a bit on the small side, the laundry is very good now that they have a new machine, its fantastic and My bedroom is nice. A relative interviewed stated, The laundry is very good, they always press his shirts. Care Homes for Adults (18-65 years) Page 24 of 34 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. Staff employed in the service are provided with a training programme that supports the needs of the people who live there. Evidence: The service employ a mixture of trained nurses and care staff to provide care and support for the younger adults and older people who live there. The service provides a good training programme for care staff that includes mandatory training. The training is carried out by external trainers and mandatory training includes, adult protection, basic food hygiene, equality and diversity, fire, first aid, health and safety and infection control. Other training has been carried out also to meet the varying needs of the service users including Dementia, violence and aggression and palliative care. The training programme is evidenced on the training matrix and in some staff files. The training matrix also evidences the planned training for the months ahead. Staff interviewed confirmed they were happy at work and felt they had sufficient training. Staff interviewed stated, I had a fire drill with the manager and Im due further training next Monday. I have done health and safety, first aid, manual handling Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: and infection control and I do like it here, we can be short of staff but we call someone in, not agency, the care takes a little longer, but care is not compromised, the service is friendly, everyone very trustworthy, if I was worried I could talk to M..or V... Thirty percent of care staff have the NVQ level 2 in care and some staff have recently enrolled for this course. Where service users needs are not met effectively by staff employed in the service then specialist advice/treatment is sought from other health professionals. Other health professionals include specialist nurses, Doctors, physiotherapists and dietitians. This is evidenced in care documentation and through feedback from relatives and service users. Service users interviewed were complimentary about the staff. There were no negative comments form service users or relatives. Service users interviewed stated, The night staff are nice and P... is really nice, I talk to the boss, M...she is helpful and The staff are really nice, they bring me supper with toast and jam, I know N...(staff) he is quite caring. A relative interviewed was very happy with the staff that provided the care and support for her relative and confirmed that they were always well groomed. The relative stated, Staff are very good, I can talk to them, I am definitely happy with the staff, staff seem to be pleasant to other residents. Relatives were surveyed for their views and their comments include, My husband is kept in touch with me through the staff, in my estimation the staff do their duties very well and My s...uses their mobile to contact me, they could do better but I am pleased with the support as they do need 24 hour care. From what I have seen the staff appear to be well trained, she tells me the staff look after the other residents well, they are very caring and they appear to have good temperament and patience. New staff are provided with an structured induction and training programme in the first weeks of employment as evidenced in care files and through discussion with staff. Voluntary staff consist of occasional placements of college students who are provided with work experience. Police checks are carried out by the place of education prior to placement. Four staff files were viewed. All had their individual pre employment checks in place including police checks and two written references. The service told us that all new staff have a literacy test to ensure they have acceptable communication skills. Staff files are not well organised and need to be in a format that makes it easier to follow and find information. The manager told us that service users are asked for their views with regard to new Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: staff when they attend for their interview. Service users are not involved in the interview process but are asked their views following the prospective employees visit to the service. Usually after the tour of the service when they are introduced to some of the service users. The service user group (your voice) have been involved in providing some questions for the staff interviews. Care Homes for Adults (18-65 years) Page 27 of 34 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. Service users and staff benefit from a well run service. Evidence: Since the appointment of the new management team the service has improved over the past year. The manager has many years experience at a senior level and through support provided by the team at Winston House and support from Craegmoor the service has moved forward. There are still areas of improvement required but with appropriate support from the company this service can improve further. The manager is a registered nurse and has continued to keep herself up to date with the varying needs of the service users by attending further training including mandatory training. Policies and procedures are in place and followed by the staff in the service. Certificates with regard to the service insurance is in place. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The service provides service users and staff with regular meetings. The minutes of which were viewed during the visit. The minutes evidenced who attended and the items discussed. Meetings are held monthly for service users, staff, heads of department, registered nurses and health and safety. Service users were interviewed with regard to attendance of meetings and confirmed they took place. One service user stated, I go to the meetings, we can bring things up. A relative interviewed confirmed they had attended meetings and completed surveys sent out by the service and stated, I have done questionnaires and sent then in. A selection of returned completed questionnaires was viewed and evidenced positive views. These questionnaires are sent out twice a year to staff, relatives and service users. Monthly visits are carried out by the area manager and their findings are recorded. The service keep a copy of their findings and these were viewed. The reports are detailed. and evidence service users feedback and observations of the service. Policies and procedures are updated by head office and forwarded to the service. Mandatory training is provided to staff employed in the service and training is up to date in regard to fire, manual handling, first aid, food hygiene and infection control. An audit has been carried out by the Fire Service earlier this year and the service have also carried out an internal fire audit. These audits were viewed. The handy person carries out daily checks including fire doors. Weekly fire alarm checks are carried out with various points tested and monthly checks include emergency lighting. Risk assessments are evidenced and all accidents are reported and documented. The fire drill was activated on day one of the inspection and staff were observed to carry out the procedure calmly and efficiently with no service users distressed. Care Homes for Adults (18-65 years) Page 29 of 34 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 30 of 34 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 2 10 The registered provider 22/01/2009 must ensure that all pre admission assessments evidence full and detailed information with regard to the prospective service user. This will ensure that all of the service users needs and aspirations are identified and put in the service user plan. 2 12 12 The registered person must ensure that younger adults are able to access further education/training. This will ensure that younger adults are able to follow their individual interests/goals identified. 02/02/2009 3 24 23 The registered person must 01/03/2009 ensure that suitable sitting room accommodation is provided for the older people who live in the service. Care Homes for Adults (18-65 years) Page 31 of 34 This will ensure that older people have a more private sitting room and are not constantly interrupted. 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 It is strongly recommended that the pre admission documentation used for young adults is relevant to their age group. It is strongly recommended that all service users or their representative should sign their service user plan to agree the planned care. More consultation is needed with the service user to ensure the plan reflects their individual needs. It is strongly recommended that service user plans should be easy to follow and reflect the changing needs of the service user. It is strongly recommended that the planned structural changes to ensure access for the younger adult discussed should be carried out promptly. It is also recommended that the younger adult has access to a suitable wheelchair following their transfer during the restructuring. It is strongly recommended that younger adults should be involved in the planning of and preparation of meals served to them. It is also strongly recommended that service users have a choice of meals for lunch and that this choice is on display and documented. It is strongly recommended that all younger adults should have an annual health check up. It is strongly recommended that all medication is signed for as soon as it is administered. It is strongly recommended that the structural changes planned for the younger adult area to ensure easier access should be put into action promptly. It is strongly recommended that the service should promote the use of the space identified for younger adults to plan and make their meals with staff support. It is strongly recommended that service users should be 2 6 3 6 4 16 5 17 6 7 8 19 20 24 9 24 10 34 Care Homes for Adults (18-65 years) Page 32 of 34 more involved in the selection of new staff. 11 35 It is strongly recommended that staff files and training records should be better organised so that information about staff recruitment and the training should be easy to find. Care Homes for Adults (18-65 years) Page 33 of 34 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. 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