Inspection on 19/11/08 for Woodbury View

This inspection was carried out on 19th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodbury View 23/11/07

Woodbury View 30/03/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Polesworth Group 68 Long Street

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Woodbury View Martley Road Lower Broadheath Worcester WR2 6QG Lead Inspector Jean Littler Key Unannounced Inspection 19th November 2008 10:00 Woodbury View DS0000068189.V371757.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 Woodbury View DS0000068189.V371757.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. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodbury View Address Martley Road Lower Broadheath Worcester WR2 6QG 01905 641745 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) Kentwood Ltd vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users, including those who will have an additional physical disability, must be sufficiently ambulant to access all parts of the building. 23rd November 2007 Date of last inspection Brief Description of the Service: The Home is situated in the village of Lower Broadheath on the outskirts of Worcester City close to the village Post Office and shop. It is a detached chalet-bungalow with a private garden. There are five bedrooms with en-suite facilities and domestic style living accommodation. Two unmarked vehicles are provided to facilitate community access. The providers have written information about the service that can be sent out to interested parties. The current fees were reported to be £1434 or higher. Additional charges are made for personal items such as clothes, toiletries, some continence aides, personal services such as chiropody and haircuts, and the cost of some activities. A holiday allowance is budgeted for but the service users may need to pay some costs. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission, carried out this Key inspection over 7 hours. The manager, Mr Tandy, was on duty and helped. We looked around the house and three people let us see their bedrooms. The people who live in the home are not able to tell us their views of the service. Surveys were sent to visiting professionals and two replied. We looked at some records like care plans and medication and we spoke to one of the staff. The manager sent information about the Home to us before the visit in a form called an AQAA, (Annual Quality Assurance Assessment). What the service does well: People have their needs written in their care plans and these are kept under review. People are supported to have their personal care needs met the way they like. The routines are relaxed and people can spend time doing things they like at home. People go out regularly and take part in activities they enjoy. They are supported to stay in touch with their families. Peoples medicines are looked after safely. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 6 The house is homely, comfortable and safe. People have nice bedrooms with lots of their own things. The staff team is small so people and their families get to know the staff well. What has improved since the last inspection? What they could do better: The way new people are moved in could be managed better. People could be better supported to develop their life and communication skills. Staff could be replaced more quickly so the people in the home are not affected and agency staff are not needed. Two medicines could be stored more safely. Staff meetings can be better used to make sure people are being supported to develop. The staffing at night should be checked to make sure people are safe if there is a fire. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 7 The owners could better support the new manager and give him the time he needs to carry out his role. 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. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information and systems are in place to manage the admissions process well, however, prospective residents and their representatives cannot be confident that these will be fully implemented to give them the best outcome. EVIDENCE: A Statement of Purpose and Service User’s Guide were developed before the Home was opened. Copies had reportedly been given to the original four residents’ representatives when they were admitted. Mr Tandy has recently put copies in each persons bedroom on new pin boards. One of these personalised Guides was seen on the file of the person who moved in recently. His photograph was on the front and it included a picture of the manager and of his keyworker. The man had transferred two months ago from another of the companys care homes. His social worker said she had not been given a copy of the Statement of Purpose or the Guide by the company senior officers who organised the move. She was not aware if anyone in the home had seen any assessment information about her client. Mr Tandy, the manager who has been in post since June, reported that he did not know if information about the service had been given to this mans family. He had not been part of the decision about his admission. He was just told by his manager that the man was coming in one month. He and a colleague did Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 10 visit him once prior to the move taking place to observe his morning routine. The man visited Woodbury View once after his family had seen the service. Mr Tandy and the staff had not seen any written assessment information until the man moved in, when his current care plan arrived with him. The social work assessment on his file was from February 2006. No new baseline assessment had been provided to Mr Tandy by the company as a starting point. The social work assessment said he needs to be able to pace without restriction. There was no indication that this had been considered. At Woodbury View this can only be offered in the garden as the living areas are quite small. The care plan contained good baseline information but this was from 2006. This did indicate some needs that do not seem compatible with the current very vulnerable residents. To date the placement has been successful and it is clear staff have worked hard to support him. A worker said he is settling in, eating better and smiles more when getting up. She did report that he does not like the loud noise one person can often make. In the AQAA the previous manager reported; The impact upon the people who currently live at Woodbury View by the new person moving in is closely observed and the opinion of the current service users or their advocates is taken very seriously before any decision on a permanent move is made. The man had not been offered an overnight or weekend stay as his family felt he may be confused. There was no evidence that the man had been admitted on a trial basis. His contract was from his previous placement and that care home name had just been crossed out and changed to Woodbury View. There was no date to show this had been signed by his representatives in relation to Woodbury View. The company has a policy of assessment and placements being managed centrally. The manager of the care home should be more involved and serious consideration should be given to prospective residents having a longer transition to ensure they are compatible with people already settled in the home. When well supported any potential confusion can be reduced greatly and be less stressful than a sudden move without preparation. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are having their care needs monitored but care plans are not always being changed as soon as they should be. People are being supported to make decisions within their capabilities and take appropriate risks to enable them to have a good quality of life. EVIDENCE: Each person has a care plan and a separate person centred plan. The person centred plans were developed by keyworkers in 2007 with input from peoples families. Mr Tandy reported that these need updating when the staffing situation improves and keyworkers can have some office hours. One persons plan was sampled. The information tells staff how each person prefers to be supported with their daily routines and what they like and dislike. The care plans are not written with a view to the residents understanding the content. They contain guidance for staff on how to support people with areas such as behaviour, mobility, personal care etc. Risk assessments are included for areas such as bathing, using a vehicle, accessing the community. Health information is kept in a separate Health Action plan. A record is being made after each health appointment. A new worker said she had found all the care information Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 12 very useful. She reported that only one person showed any behaviour that can be challenging and she had observed all staff responding in a gentle and similar way. The new residents plan was also seen. Mr Tandy had not had time to review or update the plan since the man moved in. Risk assessments were included regarding safety in the home and how health concerns need to be managed. Most of the information appeared to be still relevant but obviously changes are needed to reflect his new environment and the different local activities available to him. Some gaps also need to be addressed, for example, there was no mention of his foot care needs. He had brought a Person Centred Plan with him. This contained helpful but brief information and was linked to the risk assessments. Daily records are completed for each person. The sample seen for both people gave good baseline information on food intake, wellbeing, activities and personal care. Charts provided additional information on areas such as behaviour, weight or epilepsy. Mr Tandy has arranged for the care plans to be reviewed each month. Prior to September 08 this practice was not consistent. Comments made are brief, but, he hopes to improve how keyworkers monitor care needs when staffing levels improve. The care plans include information about promoting peoples independence skills. Each person has at least one goal. Examples seen were based around staff organising holidays or new activities for them to experience. Communication systems such as the use of digital photography are now being developed to aid understanding, choice and independence. For example two residents have their own kitchen cupboard with their picture on and they are being encouraged to get more involved in food and drink preparation. Personal development in life skills and communication are areas that can be focused on more with goal planning and closer monitoring of progress. People are having their care and support reviewed. One persons review meeting was being held on the day of the inspection. Her keyworker had come in on a day off to attend and assisted her family with their transport needs. Mr Tandy is aware that reviews should be held at least six monthly. He has found it difficult to care plan in a proactive way because the staffing shortages have led to him not having the required office hours. The residents all rely on staff to make the majority of decisions for them throughout the day. Staff do respect peoples decisions when they offer them a choice, for example, when to get up, whether to join in with an activity. Training on the Mental Capacity Act has been provided. Peoples capacity to make decisions should be assessed and form part of the care plan along with guidance about when and how decisions will be made on their behalf. People are being supported to take reasonable risks to enhance their lives, for example, people with epilepsy go swimming. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are being encouraged to take part in a range of appropriate activities they enjoy and maintain strong links with their families. A varied diet is being provided and mealtimes are informal. EVIDENCE: Mr Tandy reported in the AQAA, The people at Woodbury View are supported to participate in many activities of their choice. Two clients attend college once a week. All three clients attend hydro activity and one client attends a one to one music session. Two clients also attend individual relaxation sessions at a local sensory establishment. Furthermore one client is supported to go to her own personal private health spa. All clients are actively encouraged and sometimes choose to interact with people in the local community by doing things like walking around the village and accessing the local pub. Every fortnight all the clients are offered the opportunity to attend a local disco.There is also an activity that involves a visit from a local business that is set up to provide a form of music therapy, this has proved a very popular activity. The Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 14 home supports visits by one clients’ family by picking and dropping the family off at the local bus terminal. Two of the people we support have formed a successful routine with a visiting hairdresser,and another client is supported to visit her parents home to get her hair cut. The people at Woodbury View also individually shop for their food, when they choose and one client particularly enjoys helping to do the main food shopping every week. This activity encourages clients to think about and select their menu items and to put what they want in the trolley. The food menu has been developed in consultation with the parents’ taking into account previous lifestyle choices made by the clients before coming to live at Woodbury View. Each person has some regular activities arranged based on their known preferences. Two vehicles are provided to enable them to access these and most of the staff drive. Mr Tandy has worked hard to promote people trying new activities. For example, the new resident was showing signs of being restless in the evening so he is being offered the opportunity to walk to the local pub. Mr Tandy reported that he has been enjoying this time that is usually with two male staff. Records showed that people are going out regularly and for the first time summer holidays were arranged. A trip to Disney is planned for the Spring. At weekends people go bowling and swimming. A worker confirmed that the staffing shortages have meant that some outside activities have not been attended in recent weeks. People are being given the opportunity to develop. As mentioned under Needs and Choices this may be improved if goal planning is focused more on life and communication skills. The service continues to involve peoples families and Mr Tandy plans to increase the frequency of parents meetings. The last one was held in August and the minutes showed that all agreed that they were happy with current level of activities. Families views are being responded to, for example, one person is having a weekly meal out and efforts are being made to find a lively church to attend, on her mothers request. Peoples rights are being well respected in many ways and the service is a personalised one. Mr Tandy is working to remove restrictions that were in place, for example people are being encouraged to access the kitchen more often. One person has a child gate across her ground floor bedroom doorway to prevent another person entering and possibly damaging her property, which includes many breakable items. It became apparent during the inspection that the gate means she cannot leave her room without staff support, even when the gate is open, due to her mobility needs. Mr Tandy agreed to change the gate to a frameless design. After the inspection he confirmed this had been done and that they would aim to remove the gate completely. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 15 A senior has recently taken over the menu planning role and made some changes. Food records seen showed a variety of meals are offered such as, fish, chilli, lamb, tuna bake, pancakes, roast dinners and curry. A worker spoken with said there is an adequate food budget and that staff are aware of what people like to eat. One person needs to gain weight so consideration should be given to offering high calorie foods such as puddings more often. The dining area is not large enough to seat more than four comfortably. Because two people need staff support during mealtimes they eat with staff and the other two eat afterwards. If a fifth person is to be admitted consideration should be given to how the building could be adapted to provide increased dining space. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. People are being provided with sensitive personal care in a way they prefer. They are having their health needs met on a daily basis but health prevention planning can be further improved. Their medication is now being safely managed on their behalf. EVIDENCE: Mr Tandy reported in the AQAA; Privacy and dignity are always maintained to a high standard by staff and individual routines are identified in their Support Plans. These include how a person likes to be supported and their ability to participate. They are of a comprehensive nature and include all aspects of an individual’s personal care and health needs. The people who are supported at Woodbury View are allocated a key worker and a co key worker who take the lead in the provision and co-ordination of support. We have good relationships with all of the professionals who are involved in the lives of the people we support. Staff support clients with their regular health care appointments and liaise with parents and families. All medical appointments are recorded in care plans and medication is stored and administered in accordance with all current legislation. We always strive to support single gender care where possible and this is recorded in the daily diaries. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 17 The personal care guidance seen showed that a strong emphasis is being placed on each person being supported in the way they preferred. Records showed that people are offered baths and showers once or twice a day. People all looked well presented. Mr Tandy said he has changed the laundry system so peoples clothes are all washed separately. Peoples health needs are included in their care plans. Each person also has a Health Action Plan. The two seen were both in use, however, there is no date to show when these were last reviewed. There are some gaps and actions that need clarifying. For example, both showed that people cannot carry out their own Well Man/Well Woman body checks, but no action plan has been developed for this need. These areas can be included in annual health checks that their GP surgeries should be asked to provide. One reported that the person had no sleep issues, however, they take a large amount of sedation at night. This showed that staff may not always be clear about what people are taking medicines for. Health concerns and the outcome from appointments are being recorded and there is evidence that areas of concern are being monitored. The new person had been registered with a GP and dentist shortly after his admission. The medication management arrangements have improved since the last inspection as better stock monitoring and recording systems have been developed. Storage is sufficient in size and secure. The records were found to be clear and a sample seen showed doses had been given as prescribed. Care plans included information about how people prefer to take their medication, such as in yoghurt. Mr Tandy started completing the company audits of the medication system in September, which the last manager had allowed to lapse. Two scheduled Controlled Drugs are in use. One is being logged in the CD register and a check showed this was accurate. The other is not being recorded in this way, so this is recommended. One of these medicines is only used in an emergency; however, there was a stock of 20 doses. Mr Tandy agreed to reduce the amount held on the premises to reduce the risk of misuse. No approved CD storage has been provided. Following the inspection Mr Tandy reported that this has now been obtained and that the register is being used for both. The emergency medicine is now stored appropriately in the persons bedroom so night staff do not have to leave the person during a seizure. A protocol and risk assessments have also been written in relation to the management of this medicine. Mr Tandy reported that medication regimes are reviewed by the GP but often this is just the standard procedure the GP does to authorise another six months of repeat prescriptions. He agreed to ask the doctors for a more indepth review that involves a discussion and consideration of any relevant documentation, such as behaviour, sleep or epilepsy charts. A system is in place whereby staff are delegated responsibility to administer medication after being observed and assessed as competent. It was reported Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 18 at the last inspection that staff were attending accredited medication training, however, this is not the case. Mr Tandy reported that the training is brief and only relates to the use of a Monitored Dose System. This therefore does not meet the standard as it will not inform staff about wider issues such as side affects. Mr Tandy reported shortly after the inspection that some staff will attend this course in December 08. Two medication errors have occurred in the last year, in one case doses were forgotten over a two day period. Ms Powell, was involved with both errors. Neither report indicated that the doctor had been informed even through one missed dose seemed linked to an increase in the persons seizures the next day. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Concerns have not always been managed appropriately with the best outcomes for people. People can be more confident as the new management team seem committed to improve this area and operate a transparent service. EVIDENCE: An Easy Read version of the complaints procedure has been developed for the residents. Mr Tandy has put a copy of this in each persons bedroom. Despite this peoples needs mean they depend on others to raise any concerns on their behalf. The Company has a complaints procedure that was reportedly given to the original resident’s families when the service first opened. There was no evidence that a copy had been given to the new mans family, so Mr Tandy should ensure they have one. It is positive that keyworkers are allocated to each person and their family and that parents meetings are held. Both provide a way relatives to give feedback and have some influence over the service. Mr Tandy reported in the AQAA that one complaint has been received by the Home, prior to him being manager, this had been responded to within 28 days. A record showed that the issues the parent raised about laundry and personal care had been addressed. Concerns were raised with us prior to the inspection about the timing of evening medication, early bedtimes and the food budget being insufficient. There was no evidence found to suggest any shortfalls in the meals service and people are choosing when to go to bed. The owners were asked to investigate the two issues, has medication been given earlier than prescribed and has this practice triggered one person having seizures the next morning. Following the inspection they reported that there was not enough Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 20 evidence to establish either point but they were confident that good practice was now in place. They found that the previous senior managers had initiated an investigation regarding the medication but that this had not been concluded. The owners have policies on the management of allegations of abuse and staff reporting concerns. Mr Tandy reported in the AQAA that staff are trained in Safeguarding Vulnerable Adults and that discussions are also held during team meetings. Staff spoken with said they would raise concerns and that Mr Tandy is very approachable. One resident was removed from the service in January 08 after her mother lost confidence in the ability of the service to support her behavioural needs. There was no record of these circumstances in the complaints file. Specific concerns were investigated under the local Safeguarding procedures. The findings were inconclusive, however, the case highlighted that the care planning and staff support were inadequate and that Mr Hancock, the manager at the time, was slow to request input from professionals when this persons challenging behaviour escalated. Mr Tandy is clear that he would request support quickly if someones needs changed. Behaviour charts are in place where needed with plans about how staff should respond to known complex behaviours. Staff are trained to respond positively to behaviours and also in techniques for physical intervention, should it be required as a last resort. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have a clean, well maintained and attractive home that meets their needs. EVIDENCE: The premises are an extended family home on two floors that has been adapted into a care home. The home is situated on the edge of a village with rural aspects and on a main road. There is car parking and a good-sized garden that is relatively secure. The communal rooms include a lounge/dining room, laundry, a spacious kitchen and a communal toilet. There are four single bedrooms on the ground floor. On the first floor there is one resident’s bedroom and two other rooms currently used as offices. All rooms have en suite facilities with either a bath or a shower. The lounge has been carpeted, which looks more homely than the previous wood floor. There is comfortable seating and entertainment equipment. The lounge/diner is relatively small for a group of five people with such special needs. The plans to convert some of the garage space into a sensory room has not been put into action. The sample of Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 22 bedrooms seen had been nicely personalised and looked homely and comfortable. Each person has their own towels and bed linen. The premises were completely refurbished prior to the Home opening and a rolling programme of redecoration has kept up the high standards. In the last year new carpets have been laid in several areas and one of the bedrooms has been redecorated. A garden water feature has been installed, solar lights for the paths and there are plans for a sensory garden and vegetable patch. A maintenance worker is available to deal with any repairs. Dates were given in the AQAA to show all equipment and installations have been routinely serviced. Approved fire prevention systems are in place and checks are being made. The Home was clean and fresh. Appropriate arrangements are in place to reduce the risk of infection and staff follow cleaning schedules during the day and night. The access to the laundry is through the dining room, which is not ideal. A protocol is in place to help reduce the risk of cross infection, however, facilities should be set up so staff can wash their hands before leaving the laundry room. This room has no natural ventilation but an improved extraction system has helped. An Environmental Health inspection has rated the kitchen and food management 5 star. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 23 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, 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Difficulties staffing the service continue to limit the benefits to the people living in the home. Workers are very committed, attend appropriate training and are well supported by the current manager. People are being protected by the recruitment practices. EVIDENCE: There has been a high turnover of staff with six leaving in the last year. Only four of the current team have been in post for more than a year, including Mr Tandy. Unfortunately one of the seniors is leaving soon. There have been particular staffing shortages in the last two months due to vacancies and other issues. One recruitment drive led to the appointment of two staff but one gave up waiting during the recruitment process. The use of POVA First checks should be considered under such circumstances to speed up the process. Mr Tandy reported that even with staff helping by working overtime the team cannot cover the shift pattern. Agency staff are being used regularly and there is now a small team of relief staff who cover shifts. Waking night staff were working extra evening shifts prior to their waking night shifts, where they work alone in the home. Long working patterns such as this are not considered to be good practice and could put people at risk. Fortunately the practice has now Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 24 been stopped. Three staff continue to be provided each day, but Mr Tandy is aware that the permanent staff are tired as agency staff are not able to take on an equal share of the duties and responsibilities. This has led to keyworkers not having time for their duties and a delay in planned developments being implemented. The senior structure has been changed and the deputy post vacated by Mr Tandy when he was promoted has only been replaced by a third senior post. A senior is on duty each day shift. To achieve this while there is a senior vacancy a support worker is acting up into this role. The providers have judged that one waking worker on duty at night is sufficient, with a senior person being on call. As the new resident is less able than the person who left the night time fire risk assessment should be reviewed. The lone worker at night needs to be able to get all residents to a place of safety within two and half minutes of an alert, in line with Fire Authority guidance. Drills need to show this is achievable, if not the night time arrangements must be changed. The staff team is quite well balanced in terms of gender and age. They are not culturally diverse but nor are the residents. Most have previous relevant experience and more than half hold an NVQ award. Staff supervision has not been provided consistently during the year, for example, Mr Tandy said he only had one supervision meeting with the previous manager. He is working hard to provide his staff with monthly meetings and these were planned ahead on a timetable. Due to the cost of using agency staff Mr Tandy has been told by the owners that he cannot have the three admin days each week usually allocated to the manager. This has been the case for the last two months. He is therefore finding it very difficult to carry out his role as well as work regularly on shift. Mr Tandy has not been able to hold many staff meetings. The minutes from the last one, held in October, showed that each residents needs were not discussed. This should be a main focus of meetings to help ensure a consistent approach to their support and development. The minutes from two staff meetings in the Spring, when Mrs Powell was manager, were of a very poor quality. They would not have appropriately informed staff who missed the meeting of any decisions. Training is managed centrally in the Company and training records are held for each worker. Training was being advertised on the staff notice board. Staffing shortages have made it difficult for workers to be released to attend courses, particularly as Mr Tandy has been told not to continue booking local courses. Staff have a significant travel time to reach the company courses, which further impacts on the staffing rota. New staff work through the Company’s induction and foundation. They are not being given the opportunity to gain the Learning Disability Qualification. Staff were observed to interact appropriately with the residents. The worker spoken with felt she is well supported by her colleagues and manager but confirmed that the staffing situation is stretching them. She was clear about Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 25 her role and said she observed good care practice in the home. She had been in post for two months but had five years experience. She reported that she had worked on shadow shifts for two weeks and not left unsupported until she had attended essential training. Fire safety had been covered on the first day. She had been given supervision by Mr Tandy after one month and had since met with him again. Both meetings had been very useful and supportive. She had now attended most of the baseline training such as Autism, Mental Capacity Act, Food Hygiene and Managing Behaviours. She was waiting to attend infection control and first aid. She plans to start her NVQ after six months. Central staff in the company support the staff recruitment process. The file seen showed the policies are being followed. Mr Tandy reported he has been involved in interviews but he does not see the references and is only told if there is a problem with a candidate. He was made aware of his legal responsibilities as manager and advised to take a more active role in satisfying himself that an applicant is suitable for the post. He was also reminded of the need to establish from all previous employers the reasons why an applicant left their employment with vulnerable adults or children. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People do receive a personalised service, however, they have not had the benefit from management changes and staffing shortages. EVIDENCE: Mr Hancock, the registered manager, left in January 08. Mrs Powell was the deputy and she took over the role. Detailed in the report are some shortfalls in her management, such as a lack of staff supervision. She did not apply to be registered and left in June 08. Mr Tandy has experience of working with people with learning disabilities in other care homes. He has worked at Woodbury View since it opened as a senior and then a deputy. He acted up into the managers role and was then confirmed into post. He has an NVQ 3 in Care and has attended several short courses relevant to the roles he has held. He is currently working towards the NVQ 4 in Care. He will then need to obtain the Registered Managers Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 27 Qualification. He had not submitted his application to be registered at the time of the inspection, as this had been delayed at Head Office; however it has now been received by us. It is unfortunate that a relatively new service has already seen two managers and two deputies leave. Mr Tandy seems very committed to operating a proactive and transparent service. He has not been a manager before and the owners are not supporting him as well as they could. The staffing shortages have put pressures on him, along with the removal of the deputy post and for the last two months not having his administration hours. The company shareholders changed earlier in the year and Kentwood Ltd. now comes under the umbrella of the Lifeways Group. The new Responsible Individual is Mr Paul Merriner. The way the change has been managed has added to the pressures as Mr Tandy was told to change the recording systems to Lifeways corporate forms and more recently told to change them back to the Kentwood ones. Mr Tandy returned the AQAA on time and has a clear idea of the areas in the service that need to be developed in the next year once staffing levels improve. He is working hard to engage residents more in the life of the home and communicating well with their families. Feedback from staff indicated that he is approachable and supportive. Policies are in place and record keeping systems have been improved. Health and safety systems are in place with appropriate monitoring such as hot water testing and fire equipment checks. An internal audit in September 08 showed an Excellent rating. An inspection in November 08 from the fire authority was also reported to be positive. Company quality assurance systems are in place, for example monthly care plan audits and building checks. Families are being consulted through meetings, care reviews and annual feedback questionnaires. The folder for the companys Regulation 26 visits indicated that the required monthly visits have not been carried out every month during 2008. . Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 1 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 4 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 2 2 x 3 3 2 3 2 3 x Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. YA2 Refer to Standard Good Practice Recommendations People moving into the service should have their current needs careful assessed. The manager should be fully involved and should have the information to enable a clear plan to be made about how these needs will be met. A new person should be able to trial the service over a period of time so a genuine assessment can be made about the suitability of the placement and their compatibility with other residents. Make sure the care plans contain all the detailed information staff need to help them meet peoples needs. Develop a system to show how decisions are being made in peoples best interest, in line with the Mental Capacity Act. Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 30 2. YA4 3. YA6 YA7 Include in goal planning development on life and communication skills. Hold review meetings at least every six months. 4. YA19 Make sure the health action plans are fully completed and address all areas of health support including annual health checks with GPs and Well Man or Well Woman checks. All staff who administer medication should attend an accredited safe handling of medicines course. Store all Controlled Drugs in an approved CD cabinet and keep a record of the stocks and use of these medicines in the CD register. Keep the minimum quantity required of medication that is only administered in emergencies. Hold more in depth reviews of peoples medication regimes with relevant health professionals, at least annually, and use records that will help inform doctors. Obtain the current Royal Pharmaceutical Society Guidance on the Administration of Medicines in Care Homes, and ensure the homes procedures are in line with this. 6. 7. 8. 9. YA24 YA28 YA30 YA32 YA33 YA42 Give consideration to how the communal space can be increased, particularly if a fifth person is to be admitted. Facilities should be in place so staff can wash their hands before leaving the laundry room. All staff should be given the opportunity to gain the Learning Disability Qualification. Review fire risk assessment and ensure a lone night worker can evacuate the residents to a place of safety within 2.5 minutes. If this is not reliably achievable than another worker must be in the building at night. Ensure the staffing arrangements meet the needs of the residents and fulfil the aims of the service. Staff meetings should focus on working consistently with the residents particularly on behaviour intervention strategies. DS0000068189.V371757.R01.S.doc Version 5.2 Page 31 5. YA20 YA19 10. 11. YA33 YA36 Woodbury View 12. YA37 The provider should ensure that the manager is well supported and given the time he needs to fulfil his legal responsibilities. The providers need to ensure that Regulation 37 notifications are submitted to the Commission without delay to help safeguard the residents. Regulation 26 monitoring visits should be carried out every month to ensure the directors are kept informed about the service. 13. YA41 Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodbury View DS0000068189.V371757.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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