CARE HOME ADULTS 18-65
Wolverton Court Alkham Valley Road Alkham Dover Kent CT15 7DS Lead Inspector
Julie Sumner Unannounced Inspection 1st March 2006 11:00 DS0000023630.V263365.R01.S.doc Version 5.0 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 DS0000023630.V263365.R01.S.doc Version 5.0 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. DS0000023630.V263365.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Wolverton Court Address Alkham Valley Road Alkham Dover Kent CT15 7DS 01304 825544 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) High Quality Lifestyles Limited Miss Samantha Jane Ward Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000023630.V263365.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th August 2005 Brief Description of the Service: Wolverton Court is a home for people with learning disabilities and communication difficulties who present challenging behaviour at times. The home is owned by the private company: High Quality Lifestyles. The companys philosophy is to support people who have displayed behaviour that has caused them and others difficulty and has limited ordinary/usual kinds of life opportunities by positive guidance and a specialised environment. Wolverton Court is registered to provide accommodation for up to 8 people. At present 5 people live in the home and need a high level of support. It is the companys intention for a maximum of 5 people to live in the home in order to provide a high quality level of support to each individual. The home is a detached property in large grounds situated in the Alkham Valley, which is mid way between Dover and Folkestone. It is a semi rural area and the home provides transport to ensure the service users are able to access facilities in Dover or Folkestone and pursue a variety of activities. The local bus route is on the main road opposite the home. All the bedrooms are single and situated on the ground and first floor and are decorated to suit individual needs and preferences. Communal rooms are spacious and are also furnished to suit the individuals living in the home. DS0000023630.V263365.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one day in March. Around 5 hours were spent in the home. Three service users were in the house and two were out. Others went out later in the day. Some time was spent with the service users and they participated as much as they were able in the inspection. The following methods of inspection and information gathering were used: observing activity in the home, spending time with service users and staff, including having lunch with everyone, some one-to-one discussion and group discussion at different times with staff and some limited interaction with service users, touring the home and reading and discussing policies, plans and records including individual service user plans, medication charts, some staff records including training records and duty rota. What the service does well: What has improved since the last inspection? DS0000023630.V263365.R01.S.doc Version 5.0 Page 6 There is ongoing maintenance in the home. The kitchen has been refurbished and looked smart, clean and practical. Bedrooms have been redecorated. Some of the flooring in the communal parts of the home has been replaced. A training coordinator has been employed to design a training programme for the staff employed by the company. Training related to the health and safety of service users and staff has been organised as priority and there has been some progress in staff attending and updating this training. There are still some gaps in overall training needed so part of the requirement has been carried over from the last inspection. Unannounced monitoring visits have been carried out monthly by the company director of development and reports have been sent to CSCI. The director has considerable experience working with people with learning disabilities and communication difficulties. The company are in the process of developing the current quality monitoring system and finding ways to involve service users in this. 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. DS0000023630.V263365.R01.S.doc Version 5.0 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 DS0000023630.V263365.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected at this time. DS0000023630.V263365.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users know that their views are taken into account and that their personal goals are reflected in their individual plans and potential risks are managed. EVIDENCE: This group of standards was assessed more fully at the previous inspection. A sample of service user plans and individual daily logs were viewed and were clearly written with a good range of relevant information. Staff described how they support individuals. Staff were observed to be responsive to service users’ wishes and were guided constructively. DS0000023630.V263365.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16 Contact with service users’ families and friends is encouraged and supported. Routines in the home are flexible and freedom is promoted within risk assessed boundaries. EVIDENCE: Contact details are kept in the service user plans. Visits are arranged and the staff help with transport. The manager and staff keep relatives informed of what is happening and relatives are invited to individual reviews. Service users have one-to-one support and can access all areas of the home except other people’s bedrooms with support. Areas like the kitchen have been risk assessed and are locked when not in use. All service users bedrooms have locks that provide privacy whilst still enabling service users to get out without restriction. DS0000023630.V263365.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Service users’ preferences in how they are supported are taken into account. The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. EVIDENCE: Each service user has one-to-one support. Staff were observed supporting each individual in a different way depending on what support they needed and interaction observed was service user led. Guidelines for support are included in the service user plan of care. Medication storage and administration records were viewed and discussed with the senior member of staff on duty. All senior staff responsible for administration of medication have attended training. The training records were viewed. DS0000023630.V263365.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 There is an effective complaints procedure and systems are being developed to make it more accessible to service users. There are effective procedures in place to protect service users from risk of abuse. EVIDENCE: There is a complaints procedure and this is included in the statement of purpose/service user guide. Staff get to know service users and judge from their responses and behaviour if they are unhappy about something. At present the complaints procedure does not extend to service users who have learning disabilities and communication difficulties. There have been no complaints. Three staff have attended adult protection training. Four staff have completed adult protection training as part of their induction training. Staff spoke about their responsibilities and were aware of the adult protection procedure and what constitutes abuse. The procedure is displayed on the notice board in the office. As staff read the homes procedures they sign that they have read and understood. DS0000023630.V263365.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 The home was clean throughout and overall, has been maintained well. There is a good size laundry room with appropriate equipment to meet service users’ needs. Whilst individual privacy is maintained, not all service users are able to see out of their bedroom window. EVIDENCE: The kitchen refurbishment has been completed. Kitchen clean and well designed to meet needs of people living and working in Wolverton Court. All bedrooms have been decorated and furnished to individual preference and are uniquely designed. Two bedrooms have been redecorated. All windows have coverings that protect service users’ privacy and dignity. Apart from one person who is able to see over this, none of the service users are able to see out of their windows. A recommendation has been made to review this. The home was clean overall. There are cleaning schedules in place. Cleaning tasks are allocated to service users at different times of the day and the staff member supporting them assists them as much as is needed. Night staff carry
DS0000023630.V263365.R01.S.doc Version 5.0 Page 14 out routine cleaning jobs also. Liquid soap needs to be placed in all areas where staff wash their hands. There is a separate laundry room with appropriate equipment including a sluice sink. The washing machine is industrial and was working although it had a leak that had been repaired once but there was water on the floor around it and looked like it was still leaking. The tumble drier was waiting to be repaired. DS0000023630.V263365.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 A robust recruitment process is carried out to protect service users and staff are supported well when they start work. Service users benefit from the consistent support of staff who know them well. Continuing to develop the range and type of training provided to staff will enhance their skills for supporting service users. EVIDENCE: New staff spoke to the inspector about applying for their current role, they confirmed that CRB, POVA and references were requested prior to their employment and described their experiences starting work at Wolverton Court. They had received an induction and were currently being mentored by experienced staff. The recruitment and induction process was also discussed with the person in charge of the shift and some documentation was viewed. It was not possible to view recruitment documentation at this time, as the registered manager was not in the home at the time of the inspection. The company has a philosophy of positive behaviour support and a plan to develop the workforce by training in this has been designed. The staff have attended courses arranged in the majority of mandatory subjects. There are some gaps across the range of training and courses have been planned for this year. The current range of training focuses on the mandatory training courses, NVQ and training in techniques to support and manage behaviour which challenges.
DS0000023630.V263365.R01.S.doc Version 5.0 Page 16 NVQ training is being provided to meet the workforce target. 2 staff are currently studying NVQ 3. DS0000023630.V263365.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Service users benefit from a well run home. There is a clear vision and clear direction to develop the service. Development of the quality assurance monitoring system would determine whether the service being provided in the home is what service users want and is meeting their needs. This would provide the basis for the development plan for the home. Continuing the health and safety training provided to staff will make the home and workplace safer. EVIDENCE: The registered manager has over two years experience in management and has completed NVQ 4 in management and care but has not had the final verification and certificate yet. HQL has designed a training programme for the senior staff to provide them with specialist skills to support people who display challenging behaviour. The registered manager is currently studying the first year of this course.
DS0000023630.V263365.R01.S.doc Version 5.0 Page 18 The company are developing the quality assurance system. Records written and kept in the home will feed into this system. Regulation 26 visits have been carried out monthly by a company representative who has direct experience working with people with learning disabilities and communication difficulties. Staff training records and the training plan were viewed. There has been some steady progress since the last inspection in mandatory training attended but there are still insufficient courses provided. Some staff have received training in health and safety, manual handling, fire training, first aid, basic food hygiene and infection control. Not all staff have attended all courses and therefore the requirement to provide training for all staff has been carried over. Other training to protect service users and staff that has been identified by the company as essential including the diversion and management of challenging behaviour has been attended by all staff. DS0000023630.V263365.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x DS0000023630.V263365.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? 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 YA35YA42 Regulation 18(1(a) (c(i(ii Requirement Timescale for action 31/05/06 2. YA39 All staff must attend mandatory training and any other essential training identified by the home to ensure safe working practices and ensure the health and welfare of service users. (A training plan providing sufficient courses for all staff to be up to date this year to be provided by timescale) 24(ab)2)3) To set up a quality assurance audit system within the company to measure success in achieving aims and statement of purpose of the home based on views of service users and their representatives. System structure and planned implementation to be completed by timescale. (previous timescale March 2006) 31/05/06 DS0000023630.V263365.R01.S.doc Version 5.0 Page 21 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. 2. 3. 4. Refer to Standard YA22 YA26 YA30 YA32 Good Practice Recommendations Need to continue to develop ways for service users to communicate their wishes and any concerns/complaints. Review the window covering on bedroom windows so that it is possible to see out of the window and maintain dignity/privacy. The washing machine and tumble drier need to be in working order. Continue to provide NVQ training and work towards achieving 50 of the workforce having NVQ 2 or above. DS0000023630.V263365.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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