Inspection on 23/11/07 for Woodbury View

This inspection was carried out on 23rd November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodbury View 19/11/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Woodbury View Martley Road Lower Broadheath Worcester WR2 6QG Lead Inspector Jean Littler Key Unannounced Inspection 23rd November 2007 11:40 Woodbury View DS0000068189.V351655.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.V351655.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.V351655.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 Gareth John Hancock Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Woodbury View DS0000068189.V351655.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. 30th March 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 £1700 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.V351655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 6 hours. The manager was on duty and helped. We looked around the house and one resident let us look at her bedroom. Family, staff and visitors were asked their views about the home. We looked at some records such as care plans and medication. The manager sent information about the Home to us before the visit. What the service does well: The residents are supported to have their personal care needs met in the way they prefer. The routines are relaxed and the residents can spend time doing things they like at home. They are enabled to go out regularly and take part in activities they enjoy. They are supported to stay in touch with their families. The house is homely, comfortable and safe. The residents have nice bedrooms with lots of their own things. The staff team is small so the residents get to know the staff well. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Woodbury View DS0000068189.V351655.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 Woodbury View DS0000068189.V351655.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): 1, 2, 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given information about the service to help them make an informed choice. Prospective residents have their needs assessed before a placement is offered, however they cannot be fully confident that these can be fully meet. EVIDENCE: A Statement of Purpose and Service User’s Guide were developed before the Home was opened. Copies have been given to the residents’ representatives. The Statement of Purpose has not yet been reviewed and some is now out of date. A personalised Service User’s Guide was given to each resident and their family as part of the admissions process. The one seen on this occasion did not seem accurate as it stated the resident would be given one to one staffing in the Home and two to one at times in the Community. This was not being provided. The original four residents are still being accommodated. The assessment process was looked at during the first inspection in March 2007 and judged to have met the standard. The manager reported that the fifth bed was not going to be filled for the time being. The service has been operational for over a year now. Some relatives reported concerns about the compatibility of the group with some being more physically vulnerable and at risk from the behaviours of others. Some care professionals reported concerns about the service’s ability to provide a specialist service for people with Autism. Woodbury View DS0000068189.V351655.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 adequate. This judgement has been made using available evidence including a visit to this service. The care planning system is not being managed in a way that ensures the best outcomes for residents. The residents 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 resident has a care plan and a person centred plan. The person centred plans have been developed by the keyworkers with input from residents’ families. They inform staff of each resident’s preferred ways of being supported with their daily routine, likes and dislikes. It is positive that these are being added to with photographs to form Life Story books. These are not currently being used at care review meetings as part of a person centred planning approach. The care plans have been expanded since the first inspection and the sample seen contained appropriate information. The manager said one was not yet finished but he was aware of the gaps e.g. sensory impairment needs. The planning process is not being well managed, for example the manager had not seen a risk assessment about one resident using a bathing aide that a keyworker had written. A keyworker had not seen a behavioural intervention Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 10 plan that had been put in her key-resident’s plan the previous month. This worker had not attended any staff meetings or care reviews to discuss her key resident’s changing needs. The manager reported that three meetings had been held for this resident with her representatives. Reports had not been prepared for these and he said he relies on the social workers to provide minutes of the meetings. These could not be found. The monthly keyworker summaries showed some of the changes made to this resident’s care arrangements in response to her being very unsettled and at times aggressive, but the care plan had not been changed to reflect these. A report was seen that had been prepared for another resident’s review. This contained an overview of the year but did not make reference to any areas of development or aims and did not state who had written it or when. Daily records are made that provide good baseline information e.g. food intake, wellbeing and activities, health records, night-time monitoring etc. The manager should review the practice of staff writing as if they are the residents. Some unusual examples were seen such as the resident praising the staff on how well they supported them e.g. ‘excellent well balanced care given today’. The residents are not able to state what they want recorded and are not involved in the process. Incident reports and body mark charts were being completed but gaps in recording were found and the information did not seem to have been analysed to inform the planning process. The care plans included information about promoting the residents’ independence skills. Monthly summaries could be developed to better report on progress towards achieving goals. There are discussions about the activities room being used to help life skill development e.g. computers, ironing. Communication systems are being used to aid understanding and staff access the total communication training. A digital camera has been used to show residents where they are going on outings. Professionals involved with one resident have recommended improvements in how she is supported to communicate and a particular type of communication cards have been introduced. The manager had been aware that she would find it difficult to understand that her mother had gone away on a summer holiday, however a meeting was not held to plan how to support her. The residents all rely on staff to make the majority of decisions for them throughout the day. Staff respect residents decisions when they offer them a choice e.g. whether to join in with an activity. A professional gave feedback that an unnecessarily confrontational approach had been taken towards the resident she was involved with e.g. access the kitchen was being restricted without good reason. She reported that a more assistive approach was now being introduced. The manager had attended training on the Mental Capacity Act but this had not yet let to any action about how decision-making is approached in the Home. The residents are being supported to take reasonable risks to enhance their lives e.g. residents with epilepsy go swimming. Woodbury View DS0000068189.V351655.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 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: The manager reported in the AQAA (the annual quality assurance assessment, we ask managers to complete before a key inspection), that each resident has some regular activities arranged based on their known preferences. Two vehicles are provided to enable them to access these. There is more structure during the week as residents often spend time with their families at weekends. One has not been following her plan recently on the advise of her psychologist, however local outings are slowly being re-introduced. Records showed that the other resident was going out each day at least once. Some external activities being accessed include the snoozalem, music therapy, swimming and hydrotherapy. Some of these sessions are specifically for people with disabilities but others are community sessions. The residents are also mixing in the Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 12 community by using local facilities such as shops and cafes. Daily living routines seem to be relaxed e.g. one resident chooses to eat some meals in her bedroom. Each resident has activity equipment and items in their bedrooms and in communal areas e.g. DVDs, favourite music, and sensory equipment. A music therapist holds sessions weekly. Holidays were not arranged this year, but staff reported that lots of days out have been arranged. Feedback from relatives indicated that staff worked hard to provided suitable social opportunities and activities. One said the staff are marvellous but levels mean her daughter is not provided with the wide variety of activities that were promised. The residents’ rights are being generally well respected in many ways and the service is a personalised one. The manager does need to ensure that the culture is enabling whenever possible and restrictions are not used because of staff limitations e.g. staff reported that two residents have less challenging behaviour and this leads to them having more opportunities to go on outings. One resident does spend time sitting in another’s bedroom without this resident’s permission e.g. when she is out of the house. Staff need to ensure they are sensitive when discussing residents in front of them. The staff spoken with had a good understanding of the importance of working with families. The manager acknowledged that family contact is very important for the young people. He said some criticism has been received about from relatives about how they have been kept informed, but this was due to keyworkers being off sick and the weekly phone calls are now taking place. One family confirmed that communication has improved recently, another said it was still sporadic. Staff prepare a weekly menu and cook daily as required. Staff know what the residents prefer and included these ingredients in the menu e.g. one likes cook-in sauces. Care records showed a varied and healthy diet was being provided. Staff reported that there is sufficient money to shop and issues about the cost of staff meals have now been resolved. Woodbury View DS0000068189.V351655.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 adequate. This judgement has been made using available evidence including a visit to this service. The residents are being provided with personal care in a way they prefer. They cannot be fully confident that their physical and emotional health needs will be met promptly. Their medication is being safely managed on their behalf. EVIDENCE: The personal care guidance seen showed that a strong emphasis is being placed on each resident being supported in the way they preferred. This and discussions with staff confirmed the positive findings in this area from the last inspection. The guidance prompts staff to promote independence when possible while assisting people. The residents looked well presented and feedback from families was generally positive about how residents’ personal care needs are being met. Two residents are having their hair cut at a salon and a visiting hairdresser is building up a relationship with the other two who could not yet cope with a salon visit. Staff were seen to knock on bedroom doors before entering and they engaged with the residents in a respectful manner. One worker did talk to the inspector about one resident’s less positive behaviours in front of her. The male staff are involved in assisting the all female resident group with their intimate personal care needs. The current Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 14 residents have not shown any objection to this and their representatives have been consulted. The care plans contained information about the residents’ health needs. The manager reported in the AQAA that annual health checks have not yet been arranged with the GP but this is a future aim. All residents had Worcester Health Action Plans set up on admission, however the one seen was not fully completed and the manager said these are not being used as the Company has its own forms. Relatives reported that they are told about health issues and that the staff are committed to providing good health support to residents. One resident has complex needs associated with epilepsy and these are being fully met now more of the staff are suitably trained. Two relatives had felt the need to complain about issues related to health and personal care issues. The manager acknowledged that there had been unacceptable delays in arranging chiropody and dental services. Feedback from health professionals raised concerns that their advice was not always followed in relation to residents’ emotional and behavioural needs, although they felt the manager had been more responsive recently. An example of one delay was in relation to referring one resident for psychiatry support. The resident is now on temporary medication that is benefiting her. A delay in requesting specialist support was reported at the last inspection. The medication management arrangements have improved since the last inspection. Additional secure medication storage has been provided and the recording systems have been made more robust. Stock monitoring systems could be further improved if the balance of any tablets not in the blister packs is checked and brought forward each month. When codes are used on the administration charts it should be clear what these mean. ‘F’ was being used without any explanation. A member of staff is now always on duty who is trained to administer emergency medication to one resident. A system is in place whereby staff are delegated responsibility after being observed and assessed as competent to administer medication. Staff also access accredited training is also provided. Woodbury View DS0000068189.V351655.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 adequate. This judgement has been made using available evidence including a visit to this service. The residents cannot be fully confident that action will be taken quickly enough to address their or their relatives’ concerns, or to safeguard them. EVIDENCE: A simple version of the complaints procedure has been developed for the residents. Even with this it is clear that the residents depend on others to raise any concerns on their behalf. The Company has a complaints procedure that was reportedly given to each resident’s family when the service first opened. One relative said again that she did not have this and would appreciate a copy. This was mentioned in the last inspection report. Since the last inspection three complaints have been received by the Home. None have been received by the Commission. The manager reported in the AQAA that all had been responded to in the necessary timeframe and that the residents’ views are listened to and respected. Two were from one resident’s mother who had raised issues about personal care matters not being addressed, such as toenails being cut. The third was from another resident’s mother who raised several areas of concern more formally. These included no summer holiday being arranged, delays in chiropody and dental care being arranged, delays in a bath aide being provided in the en-suite. The manager reported that a further delay occurred as he had assumed staff at his head office would make the referral for an occupational therapy assessment, as that is where the complaint letter had been sent. He acknowledged that there had been shortcomings and felt a lot had been learnt from these complaints. He reported that as a result communication with families has been improved. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 16 Two residents’ relatives reported that the manager has not responded to information until a complaint has been made. One lacked confidence that the manager would take appropriate action if future concerns were raised. One family said action is always taken when issues are raised. The Company has policies on the management of allegations of abuse and staff reporting concerns. The manager reported in the AQAA that residents are protected by these and by staff management and recruitment procedures. Adult protection is covered within the staff training programme. One worker had not attended this although she had been employed for nearly a year. She said she had not been made aware of the past three courses that had been held. Those spoken with were confident that any protection issues would be promptly reported. One such concern has been raised to social services since the last inspection. This arose when a resident’s relative found injuries on her arms and staff reported having difficulty in stopping her hurting herself and being aggressive to others. The referral has led to a number of external health and social care professionals being involved in supporting the service to meet this person’s needs. It is concerning that the situation had been allowed to develop in this way without the manager raising the need for urgent professional intervention. The difficulties and incidents were not reported to us. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 17 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. The residents 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 has been made relatively secure. There are five single, en suite bedrooms with either a bath or shower. The communal rooms include a lounge/dining room, laundry, a spacious kitchen and a communal toilet. On the first floor there is one resident’s bedroom and office space. The second bedroom on this floor is being set up as a computer and activities room for residents and for staff training. This is a good use of this space as the drone from the laundry equipment below was very noticeable and this would not be acceptable if a resident was allocated the room. It is positive that there are no plans to admit a fifth resident at this stage as there are some compatibility issues in the group and the lounge and dining areas are relatively small for a group of people with such special needs. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 18 There are plans to convert some of the garage space into a sensory room and the equipment has already been acquired. Planning issues are being investigated before work commences. The sample of bedrooms seen had been nicely personalised and looked homely and comfortable. One resident’s mattress appeared to be sagging and may need to be replaced for her wellbeing. Checks on these should be added to the regular building checks carried out. All residents have 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. A maintenance worker comes weekly to deal with any repairs. Dates were given to show all equipment and installations have been routinely serviced. Approved fire prevention systems are in place and checks are being carried out. Some doors were being wedged open, however since the last inspection these doors have been fitted with devices that will automatically close when the fire alarms sound. Consideration should be given to fitting more electrical sockets in some rooms to remove the need to use multiple adaptors. The home does not have a call bell system or a lift between the floors, so it is not suitable for anyone with significant mobility problems. As mentioned earlier a referral has now been made regarding an assessment for a bath aide. 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. This room has no natural ventilation and this continues to cause problems. Appropriate arrangements are in place to reduce the risk of infection e.g. protective clothing for staff. The Home was clean and fresh and staff follow cleaning schedules during the day and night. An Environmental Health Officer has carried out a second visit since the Home was opened. The manager reported that no recommendations were made. He confirmed in the AQAA that hot water regulators are now fitted to all hot taps used by the residents. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care workers are very committed but at times there are not sufficient staff. The residents are not benefiting from the support of a wellqualified, supported and managed team. They are being protected by careful recruitment practices. EVIDENCE: The Home is currently staffed by a team of eight care staff including a deputy and a senior. Three of the staff are male including the manager and senior. The senior team is more balanced now, as the new deputy is a woman. Three staff have left since the Home opened. This is a relatively low turnover that should help bring stability to the residents. There is usually three staff on during the day. The providers have judged that one waking worker on duty at night is sufficient, with a senior person being on call. Some agency staff have been used to cover gaps on the rota. The agency worker who arrived at short notice on the afternoon of the inspection had come straight from working in another care home. The manager hopes to increase the number of bank staff employed so agency staff are not needed. There are currently two vacancies and staff are regularly working over their contracted hours. A sample of rotas confirmed that staff have worked some double shifts 7.30am to 10pm to provide cover and on some weekends only two staff have been on duty. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 20 The November records for one resident showed two of her activities had been cancelled due to a shortage of staff. A lack of drivers is also causing some difficulties. Staff reported that they do not have enough time to complete their responsibilities such as writing monthly keyworker summaries. One resident’s relative felt that staff are having to spend a disproportionate amount of time with two residents who have more challenging behaviours. Staff reported that one resident needed two staffs’ attention while she had been so unsettled but this had not been provided. One to one support is provided at times such as for outings. The staff spoken with seemed clear about their roles and had a good value base. Those on duty interacted appropriately with the residents. Staff feedback indicated that the team works hard to improve the service but morale was being affected by the lack of leadership from the manager. Positive feedback about staffs’ attitude was received from families and visiting professionals. Some felt that some staff needed to become more skilled in responding to the needs of residents’ with Autism. The manager reported in the AQAA that all staff are provided with regular supervision. Feedback suggested that the staff supervised directly by the manager were not being provided with appropriate support and guidance e.g. one reported having one twenty minute session during 2007. Staff meetings have not been held regularly even though two residents have had changing needs and meetings could have been used to ensure these were consistently responded to. One worker said two had been held during 2007 but she had not attended these and had not seen any minutes. New staff work through the Company’s induction and foundation. The providers are working towards this being accredited so staff can gain the Learning Disability Award Framework. One worker reported that she had completed the induction workbook and returned it to the manager, but she received no feedback or input. Training is managed centrally in the Company and training records are held for each worker. Training was being advertised on the staff notice board, however staffing shortages have made it difficult for workers to be released to attend courses. Of the current permanent team of eight care staff three have a NVQ 2 or above. Two others are working towards an award, however one worker reported being frustrated because she was ready and keen to start an award but this had not been facilitated. Staff said the two day Autism course was beneficial, however in view of the feedback from professionals about this part of service the providers should further develop the team’s skills and knowledge. Central staff in the Company support the staff recruitment process. The files seen at the last inspection showed the company’s policies were being followed. The manager confirmed in the AQAA that one shortfall has now been addressed. One checklist was seen that showed appropriate checks had been carried out before the worker was cleared to start in post. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 21 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. The residents are not fully benefiting from the service because of management shortfalls. EVIDENCE: The manager has experience of working with people with learning disabilities in other care homes. He has completed his NVQ level 3 in Care and other relevant training. He has not yet gained the NVQ 4 in Care and Registered Managers Award and could not confirm when he would. The requirement that these are achieved by March 08 has been removed, as it is now unlikely to be complied with. The providers need to review the situation and inform us of how they intend to enable the manager to become qualified. The manager reported that he is now receiving better support and regular supervision from the providers. He gave useful information in the AQAA, although this was returned late and some information was not factually accurate. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 22 The manager works some shifts and has administrative days each week. Feedback from staff indicated that the manager was approachable but lacked team management and organisational skills. Although other members of the team seem to have worked hard to compensate for these shortfalls the residents have been negatively affected e.g. with delays in health interventions. Some relatives reported that he has difficulty following through agreed actions and this is lowering their confidence in the service. Record keeping systems are in place, however as detailed in the report these are not all being effectively managed. The manager had needed to be reminded by his line manager to report an incident to us when a resident was not administered her evening medication. The report arrived a month after the event and did not include the action he had taken to try to prevent it recurring. Health related incidents have been reported but some others to do with incidents that led to physical intervention being used were not. A set of policies are in place and the manager reported in the AQAA that these had been reviewed during 2007. The details given indicated that a policy is not in place for the event of a resident dying. If this is correct the providers need to develop one. Findings indicate that policies are not being fully implemented e.g. those relating to care and health planning and staff supervision. Company quality assurance systems are in place e.g. periodic audits carried out by a senior officer and in-house building checks. The Company is also working towards ISO9000 and the Investors in People awards. Two families’ meeting have been held in 2007 to try to increase their involvement and feedback. The Company’s standard practice is to send out annual questionnaires. The manager assumed this had been done but did not know when or any of the findings. He was therefore unable to include this information in the AQAA to show how consultation had influenced decisions. The provider’s are carrying out their monthly visits. It would be beneficial if these could be expanded to better demonstrate how the issues within the service are being addressed. Generally hazards were being appropriately managed and monitoring systems are in place e.g. hot water testing and regular fire equipment checks. Two fire drills had been held in 2007 but the staff present had not been recorded. Although the night staff work alone the manager thought only one of the two currently employed had taken part in a drill. Discussions showed that the manager was not clear about how he expects night staff to deal with a fire at night. A requirement to review the night time staffing arrangements was made at the last inspection. This had not been fully addressed as fire arrangements at night had not been given due consideration. Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 2 4 x 5 X 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 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 4 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 1 2 2 2 2 2 x Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes. 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 YA42 Regulation 23(4A) Timescale for action The requirements of the 31/01/08 Regulatory Reform (Fire Safety) Order 2005 must be met – with particular reference to the assessment of risk from fire at night, staff awareness of evacuation procedures at night and to the staffing levels necessary to ensure the safety of people. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Develop the care planning system and ensure the staff team is appropriately involved and informed about residents’ needs and providing consistent and specialist support. Ensure residents’ health needs are acted on promptly and the views of professionals involved with each resident are DS0000068189.V351655.R01.S.doc Version 5.2 Page 25 2 YA19 Woodbury View respected. 3 YA20 A record should be maintained each month of the medicines not dispensed in the monitored dose system. Any codes used on charts should be clearly explained. 4 YA32 YA35 Support more staff to gain an NVQ in Care so the team is better qualified. Brought forward. Improve arrangements to support new staff while they complete their induction and foundation. Develop the team’s knowledge and skills in supporting residents with complex needs such as Autism. 5 6 YA33 YA36 Ensure the staffing arrangements meet the needs of the residents and fulfil the aims of the service. Increase the frequency of staff meetings and focus these on working consistently with the residents particularly on behaviour intervention strategies. Brought forward. Provide staff with support and supervision in line with the home’s policies. The provider should ensure that the manager obtains appropriate qualifications and develops his management skills to improve outcomes for residents and their families. The providers need to ensure that the manager submits Regulation 37 notifications to the Commission appropriately and without delay to help safeguard the residents. Brought forward. 7 YA37 8 YA41 Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Woodbury View DS0000068189.V351655.R01.S.doc Version 5.2 Page 27 - 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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