Inspection on 16/05/07 for Wisteria House

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Bramley Avenue (73)

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Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Wisteria House Wisteria House 492, Nacton Road Ipswich Suffolk IP1 9QB Lead Inspector Jane Offord Key Unannounced Inspection 16th May 2007 13:00 DS0000068347.V339804.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 DS0000068347.V339804.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. DS0000068347.V339804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wisteria House Address Wisteria House 492, Nacton Road Ipswich Suffolk IP1 9QB 01473 726326 01473 320436 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) Kingsley Care Homes Ltd Post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000068347.V339804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any of the 7 younger adults accommodated, whose primary care needs are a result of their learning disability, may also have associated mental health problems. Date of last inspection 31st August 2006. Brief Description of the Service: Wisteria House is a detached house set back from a main road leading into the centre of Ipswich. There are local shops and other amenities within walking distance of the house and a regular bus service into the town. The house provides accommodation for up to seven younger adults with a learning disability. The service was taken over by Kingsley Care Homes Ltd. in November 2006 and the deputy manager was appointed as the registered manager. The building offers a large kitchen/diner, a comfortable lounge and a single bedroom for each resident. En suite facilities are only hand basins but there are sufficient bathrooms and showers to meet the needs of the group. The house is set in its own grounds that extend quite a distance to the rear of the property. There is a patio, greenhouse and activities room in the garden that the residents are planning to make into a snoozelem. There is off road parking to the front of the house. Fees for accommodation range between £518.00 and £806.00 weekly but do not include toiletries, clothing, hairdressing, chiropody, magazines and books, dry cleaning and some transport costs. DS0000068347.V339804.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection looking at the core standards for care of adults (18-65) took place on a weekday between 13.00 and 16.30. The registered manager had recently left the service and an area manager for Kingsley Homes was managing the home until a new appointment was made. The area manager was available throughout the inspection. This report has been compiled using available information and evidence found during the inspection visit. A tour of the home and gardens was undertaken and a discussion with the manager about the proposed extension was held. Some staff and residents were spoken with and care practice was observed. A number of documents were inspected including medication administration records, residents’ care plans, training records, minutes of meetings and menus. On the day of inspection the home was clean and tidy. Residents were making use of all areas and looked relaxed and comfortable in the environment. Conversation between residents and staff was appropriate and covered subjects of general interest such as holidays and shopping. What the service does well: What has improved since the last inspection? At the last inspection there was a requirement left relating to the storage of medication. This has been actioned and the medication is now stored in a purpose made medicine trolley attached to the wall of the dining room. The senior carer on duty holds the key. DS0000068347.V339804.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000068347.V339804.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000068347.V339804.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4. Quality in this outcome area is good. People who use this service can expect to have information available to make an informed decision about living in the home and be able to visit before being admitted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has six residents at present most of whom have been there a number of years. Kingsley Care Homes have produced an updated statement of purpose and service users guide since they took ownership of the home. The documents are available for perusal and form part of an information pack given to anyone who enquires about the service. Potential residents are encouraged to visit the home and meet the other residents and staff. On the day of inspection a prospective resident was visiting for the fourth time and having a cup of tea with the residents who were at home. The manager said a full assessment of care needs would be undertaken prior to admission if the person wanted to live at Wisteria House. DS0000068347.V339804.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is excellent. People who use this service can expect to be supported as they wish and consulted about life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files and care plans of two residents were seen and showed that the support each resident required was detailed and there was evidence that there was regular review of the plans with the resident. The interventions encouraged independence so one entry said, ‘self care – can meet all needs with verbal prompts’. Minutes of a recent residents’ meeting were seen and showed that residents were given information about any changes in the running of the home that would impact on them such as the resignation of the registered manager and the plans to manage the home until a new person could be appointed. There was also discussion about the proposed new extension. DS0000068347.V339804.R01.S.doc Version 5.2 Page 10 Plans for new blinds to go in the bedrooms were talked about and future activities such as a visit to the theatre or the pub and an Easter egg hunt for Easter Sunday. The minutes were taken and written up by one of the residents. The manager said that they had short listed for appointing a new registered manager and all the candidates had visited the home and spent time with the residents so they could form opinions about the prospective managers. One resident had recently been working with an occupational therapist to learn to access public transport to visit the town centre alone. They returned from meeting some friends in a café in the town, where they had gone unaccompanied, and the manager said they always kept to the times they had agreed for returning to the home. DS0000068347.V339804.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is excellent. People who use this service can expect to have opportunities to take part in the community and receive a healthy diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an individual weekly plan of activities and leisure pursuits that they are supported to follow. Some attend clubs such as Gateway and the Y-club while others work in Scrap Stores or a charity shop. One resident is attending Otley College and plans to do a course next year about animal care. The local Salvation Army has a café and drop-in that some residents help in. One resident likes to attend the Salvation Army services to maintain social contacts. Records showed that a variety of leisure activities are undertaken from swimming to horse riding and cooking lessons to visiting the gym. DS0000068347.V339804.R01.S.doc Version 5.2 Page 12 Each of the files seen had contact details for the next of kin and records showed that some residents were able to visit and stay with relatives. One file recorded that the resident had requested that they had no contact with their family and this was respected. During the afternoon residents who came to the kitchen were offered drinks and spent time chatting about visits and activities that were being planned. A caravan holiday near the coast is planned for next month and some residents want to go shopping for new clothes and shoes in preparation for that. A barb-que is planned for bank holiday Monday and residents recently went to a performance by the Chinese State Circus when it visited Ipswich. Shopping for food is done at local shops and the menus are created and chosen by the residents. Residents who are able help with food preparation. The menus are displayed on the refrigerator and included dishes such as cod in lime and coriander sauce, moussaka, roast duck and stir-fries. There was a choice of fresh vegetables or salad and potatoes, couscous, rice or pasta. On the day of inspection a large green salad had been prepared for the evening meal and included radishes that had been grown in the garden. DS0000068347.V339804.R01.S.doc Version 5.2 Page 13 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 good. People who use this service can expect to have health needs met and be protected by medication administration practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ files seen had details of any health professional involved in the support of the resident and records of visits to or by them. Some residents could exhibit behaviour that challenged and care plans had interventions specific for that resident about recognising ‘triggers’ and how to de-escalate the behaviour. One resident had developed disruptive behaviour during mealtimes and advice had been sought from a psychologist to help manage the behaviour and keep mealtimes pleasant for the other residents. The psychologist was coming to Wisteria House to work with the resident in their own surroundings. Psychological and emotional needs were addressed in care plan interventions. One said, ‘can appear insecure’, followed by how best to reassure the resident when they were anxious. DS0000068347.V339804.R01.S.doc Version 5.2 Page 14 Since the last inspection a medicine trolley has been purchased for the correct storage of medicines. The trolley is kept locked and attached to the wall in the dining room. The key is held by the senior carer on duty. The training files of two staff members were seen and showed both had had training in medication handling. One had completed a self-study course and was then assessed by the manager for competency. The medication administration records (MAR sheets) were seen and showed stock numbers were recorded to allow an audit trail, codes were correctly used if medicines were not administered for any reason and there was a specimen signature sheet at the start of the file for all members of staff who administered medication. There was an identification photograph of the resident with each MAR sheet and, in one case, a letter from a doctor about a change of dose had been kept with the MAR sheet. Most sheets were correctly completed but one had a series of signatures that had then been scrubbed out. It was unclear if they had been signed in error, as there was no explanatory note. The medication policy from Kingsley Care Homes was looked at and contained guidance on ordering, storing, administering and disposing of medicines. There was no guidance on covert administration of medicines or altering medication from the format licensed by the manufacturer. DS0000068347.V339804.R01.S.doc Version 5.2 Page 15 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. People who use this service can expect to have complaints taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a robust complaints policy that is available in the entrance hall of the house. Residents spoken with said they knew who they could go to if they had any concerns. Neither the home nor CSCI has received a complaint since before the last inspection. In discussion with the manager they said issues were dealt with at residents’ meetings and often prevented from becoming a complaint. Minutes of meetings seen recorded issues that were raised by residents, sometimes about the behaviour of other residents, and how they were handled. Staff files seen contained records of training attended on Protection of Vulnerable Adults (POVA). Staff spoken with confirmed they had had the training and that it was updated. When questioned they were able to explain the POVA referral and were clear about their duty of care. DS0000068347.V339804.R01.S.doc Version 5.2 Page 16 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, 30. Quality in this outcome area is good. People who use this service can expect to live in a pleasant, homely environment that is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home and gardens was undertaken and everywhere was tidy with no unpleasant odours present. The furnishings were appropriate for the client group and looked comfortable. The residents have helped in the decoration of the communal bathrooms and toilets and chosen a sea and fish theme for one bathroom. There is a large patio behind the house that can be accessed from the lounge and kitchen. The garden has a greenhouse that is currently supporting some tomato plants and other vegetable seedlings. One resident has a pet rabbit that lives in a moveable run in the garden. The separate activities room has power connection and contains some gym equipment at present but the residents have said they would like it to be snoozelem. The manager said Kingsley Care had agreed to the idea. DS0000068347.V339804.R01.S.doc Version 5.2 Page 17 Plans have been agreed for an extension to the property that would increase the kitchen, lounge and laundry and make two new bedrooms on the first floor. To meet the standard for communal space the downstairs rooms would need increasing if two new residents were admitted but the plan is to divide the lounge so residents have a separate space for private meetings. This would improve the accommodation and mean that residents do not only have the option of taking visitors to their own bedroom if they wanted privacy. The manager said they thought work would begin in July 2007 and Kingsley Care planned to take the residents on holiday during the period when the kitchen was out of action and the most disruptive work was being done. The laundry was seen and although small was clean and tidy. Staff said residents help with their own laundry and one resident was observed getting washing in from the line in the garden. Staff were able to describe infection control procedures and protective clothing was available if needed. Hand washing facilities were supplied with liquid soap and paper towels. DS0000068347.V339804.R01.S.doc Version 5.2 Page 18 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, 34, 35, 36. Quality in this outcome area is good. People who use this service can expect to be supported by correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duty rotas were seen and showed that there were two staff on duty during the daytime and one member of staff sleeping in each night. Staff spoken with said they felt the present staffing levels were adequate to meet the needs of the residents. The manager said levels would have to be considered if two new residents were admitted after the extension was completed. On the day of inspection the manager did not have the keys of the staff filing cabinet with them so personal records and supervision notes were not available for inspection. However since then the manager has supplied a number of documents to CSCI as evidence that all recruitment checks are made on new staff before they commence in post. These include a POVA first check, two references, documents to prove identity and a full work history. DS0000068347.V339804.R01.S.doc Version 5.2 Page 19 Training records showed that staff had training in moving and handling, food hygiene, equality and diversity, POVA, dementia awareness and managing medication. Staff spoken with confirmed the training they had had and said they were updated regularly. They also said they had regular supervision that covered a wide range of topics including development needs. The manager supplied some supervision notes to CSCI to evidence that. In discussion with the manager it was suggested that, because some residents were older, it may be useful for staff to have some instruction about the aging process so they can better support the residents’ changing needs. DS0000068347.V339804.R01.S.doc Version 5.2 Page 20 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, 39, 42. Quality in this outcome area is good. People who use this service can expect to be consulted about it and have their welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although there is no registered manager in post at present management arrangements for the interim are robust. The area manager is known to the residents and visits the home almost daily. A short list of prospective candidates has been made and residents have met them all. Interviews are planned for later in the week. As noted earlier in this report residents’ meetings are held regularly and residents updated on changes in the home and asked for their views. DS0000068347.V339804.R01.S.doc Version 5.2 Page 21 Quality assurance was last done in July 2006 with very good feedback. The manager said questionnaires were being prepared for distribution at the end of May 2007. They cover the environment, mealtimes and meals, care and management. Some maintenance records and service certificates were inspected and showed that fire extinguishers and alarms had all been tested in February 2007. A food hygiene inspection by Ipswich Borough Council in March 2007 found, ‘very high standards’. Records were kept of water temperatures at the point of delivery. Most were within safe limits but the tap in the main kitchen sink was recorded with temperatures between 60 and 68 degrees centigrade, which are above the recommended level. Environmental Health advice is that washing up should protect by cleansing not sterilising. It is acceptable for water to be up to 50 degrees centigrade in a kitchen sink used for washing dishes but it is recommended that if water is over that temperature up to 55 degrees then residents need a risk assessment for the activity. Risk assessments were in place for residents using the cooker and having window restrictors on upstairs windows. DS0000068347.V339804.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X DS0000068347.V339804.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? None. 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 Regulation 13 (2) Requirement The management of medicines policy and procedure must be revised to include guidance on covert administration of medicines and altering medicines from the format licensed by the manufacturers to protect the residents. MAR sheets must be clearly signed and any errors have a written explanation with no crossing out of signatures to ensure clear audit trails and protect residents making sure they receive the correct medication. Hot water in the kitchen sink must be delivered at or near the recommended temperature of 50 degrees centigrade and if above that residents must be risk assessed for the activity of washing up so they are protected from harm. Timescale for action 30/06/07 2. YA20 13 (2) 16/05/07 3. YA42 13 (4) (c) 16/05/07 DS0000068347.V339804.R01.S.doc Version 5.2 Page 24 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 YA35 Good Practice Recommendations Staff training in understanding the aging process should be accessed to help staff support the changing needs of residents. DS0000068347.V339804.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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