Inspection on 30/03/07 for Woodbury View

This inspection was carried out on 30th March 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 no outstanding requirements from the previous inspection report, but made 13 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 23/11/07

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 Unannounced Inspection 30 March and April 5th 2007 10:50 th Woodbury View DS0000068189.V329684.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.V329684.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.V329684.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodbury View Address Martley Road Lower Broadheath Worcester WR2 6QG 01453 766441 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.V329684.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. NA Date of last inspection Brief Description of the Service: Kentwood Ltd was set up in 2003 to provide care services for younger adults with learning disabilities. The company have three care homes and other types of services. Kentwood worked with Worcestershire Social Care Services to set up a care home in the county for service users leaving school. 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 and 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.V329684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced key inspection was carried out over two days. It was the first inspection since Woodbury View opened in October 2006. All four residents were observed being supported by staff with their daily activities. The senior support worker and deputy assisted with the inspection on the first day. The second visit was announced and the manager, deputy and the service line manager were all present. Three other staff were spoken with in private. Questionnaires were given out to residents and their relatives before the inspection and some were returned. Information known about the service from the recent registration process and the monthly provider visit reports that have been sent to the Commission were all considered as part of the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Arrangements to meet all the assessed needs must be in place before any new resident moves in. Each resident needs to have a completed care plan. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 6 Support from health professional needs to be asked for more quickly when a resident’s needs are not being met. Staff need to work more consistently with the residents. The staffing arrangements at night need to be reviewed. Staff must be given training to meet all the residents assessed needs. Staff need to gain formal foundation training and more need to become qualified. The manager needs to become qualified. All decisions made about how hazards and risks are being managed must be written down. The owners must make sure the policies to guide staff are correct. 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.V329684.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.V329684.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, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents and their representatives are given information about the service in a variety of formats. The residents’ needs are carefully assessed and they are supported to try out the service before making a decision. In general the residents aspirations and needs are being met as identified in the assessment process. Each resident has a contract in place and have been given a copy of the Home’s Terms and Conditions. EVIDENCE: A Statement of Purpose and Service User’s Guide were developed before the Home was opened and submitted as part of the registration process. Copies have been given to the residents’ representatives. Information has been provided to each resident in a way that aims to aide their understanding e.g. photographs of the Home. The staff have access to the Widget symbol and clip-art computer programmes to help them produce information in accessible formats. One resident’s relative felt more information about the service would have been beneficial. As part of the quality monitoring process feedback should be sought from families about their experiences so far so improvements can be made for future residents. The residents are funded by Worcester Local Authority and so the formal contracts are between the Council and the providers. There are Terms and Conditions of Residency that have been issued to each resident’s Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 9 representatives. Some of those have been signed and a copy returned, others are still outstanding. The assessment process was carried out by a senior manager in the Company rather than the Home manager. These records are held at the head office, however the findings had been clearly summarised for each resident to start off the care plan. The placing social workers and the residents’ families had also provided assessment information. Some of the residents had agreements made about them moving into the Home before the service was registered. Staff already employed used the time before the Home opened to visit these young people at different settings e.g. their day centre, to become familiar with them and their needs. All residents have visited the Home and stayed over night before moving in for a trial period. One example was found where a resident had moved into the Home without some of the care staff being appropriately trained to meet one of her health needs. Although she was admitted in late 2006, this shortfall was not addressed until urgent action was required as a result of this inspection. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 10 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 residents’ care plans do not yet reflect their personal needs and goals. The residents are being supported to make decisions within their capabilities. They are also being supported to take appropriate risks to enable them to have a good quality of life. EVIDENCE: The care guidance for each resident is being developed. This is at different stages for each resident and although what has been produced is of a good quality there are still significant gaps in all care plans. It is positive that the manager has been encouraging keyworkers to do this work but they do not have designated administration time and the work has not moved on quickly enough. Some of the gaps include very important areas such as guidance on risk management and behaviour intervention strategies. There are essential to safeguard residents and ensure staff work in a consistent way. It was clear that sensible decisions were being made about managing risks and the residents were being enabled to take reasonable risk that they benefit from e.g. restricting access to the kitchen at times, residents enjoying swimming even though some have epilepsy. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 11 There was some evidence in the sample of care plans seen about developing the residents’ independence skills. Daily notes showed staff have this in mind, however clear goals need to be in place and the progress monitored in a meaningful way. It is positive that care information is being developed in a person centred way and information has been produced for each person about their preferred ways of being supported with their daily routine, likes and dislikes etc. These could form the basis of ‘Life Books’, if they were added to with more photographs and information each year. The manager has attended a workshop on person centred planning and the information has been passed on to staff. The manager may wish to explore links with the Worcestershire Person Centred Planning Co-ordinators who can support the Home with this work and provide free staff training and a DVD. The residents all reply on staff to make the majority of decisions for them throughout the day. There were good examples of staff supporting the residents to make decisions and staff respecting their wishes e.g. whether to join in an activity or not. The care records are not held in secure storage in the office, as the confidentiality policy states they will be, but the office is kept locked when not in use. There are a variety of records being used to log relevant information e.g. daily diaries that include food intake, general wellbeing and activities, health records, night-time monitoring etc. There are charts for some other areas such as contact with families, sleep patterns and epileptic seizures. The recording of behaviours that are undesirable could be improved, as the current information would not provide enough information to a specialist health professional. It is positive that monthly care summaries are being written to summarise this information and to give a general overview. The way these are used can be improved, as issues identified are not always being transferred into the care planning process. For example, in October, the behaviour of one resident whilst travelling by car was reported as a significant concern, but this had still not been formalised as a goal and professional support had not been sought. Care review meetings are being held after the first month and then three months of each placement. Reviews are then going to be held every six months in-line with the National Minimum Standards (NMS). Once clear developmental and person centred goals are in place these systems can be used to monitor progress. It is positive that keyworkers are being given care management responsibilities but they need time to carry them out effectively. The manager should consider holding staff meetings more frequently than three monthly, as the service is in a transitional stage and the residents have complex needs. The meeting minutes seen did not indicate that they are being used to review monthly care summaries and ensure staff are working in a consistent way. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. The way residents are supported to develop can be improved. The residents are being encouraged to take part in a range of appropriate activities and mix in the local community. Some factors need to be kept under review. The residents’ rights are being respected and they are well supported to maintain strong links with their families. A varied diet is being provided and mealtimes are informal. EVIDENCE: There is a strong focus on providing a good range of activities. The individual programmes are still being developed but clear planning is taking place. There is more structure during the week as residents often spend time with their families at weekends. Examples of activities being accessed regularly are the snoozalem, swimming, a sports session and hydro-therapy. Some of these sessions are specifically for people with disabilities but others are community sessions. The residents are also mixing in the community by using local facilities such as shops and cafes. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 13 Activities were originally being accessed in Gloucester where the Company has other established services. Staff reported that this had meant long drives and they felt the residents were now benefiting more from using local resources. Trampolining is the only session still being accessed in this way, but a local facility is being sought. One resident has continued to attend her day centre to provide continuity. The Home has two vehicles and enough drivers to use these daily. The behaviours of some residents’ means only certain residents can travel together and this does impact on how activities are planned. One behaviour has significant impact on the other people in the vehicle and the rights of the other resident using this car need to be considered. The travel arrangements should be reviewed and professional support accessed as soon as possible. There is some tension amongst the team about the funds available to provide activities. An example was given of staff being confused on a day trip to the coast about who pays for the staffs’ expenditure. A weekly budget is available for the more therapeutic sessions and the residents pay for leisure activities e.g. bowling. A clear policy needs to be developed to guide staff, and families should be informed, as some may be willing to fund additional activities rather than them not being provided. In-house each resident has activity equipment and items in their bedrooms and in communal areas e.g. DVDs, favourite music, sensory equipment. A music therapist visits and three of the residents were observed to join in and enjoy this session. The therapist reported that she had good first impressions of the service and had found the staff to be helpful and committed. Family contact is acknowledged as being very important for the young people. The staff spoken with had a good understanding of the importance of working with families and empathised about how the transition into residential care may have felt for the residents and their families. One family arrived unannounced during the inspection and staff welcomed them. One family reported their daughter was very happy in the Home and her speech and mobility had already improved. Another relative was also positive but did feel that more staffing and structure is needed at times to meet her daughter’s needs. These views were echoed by staff who felt community activities are limited when only three staff are on duty, and that one resident in particular, needs greater structure and staff consistency. Communication systems are being used to support some residents understanding. There seems to be scope to increase their use e.g. one resident signs and uses PECS symbol system but staff do not sign routinely and do not use the PECS system to plan each days activities with her. Her timetable is not always kept up to date. She did become upset because she had got confused about when a family member was due to visit. Staff do have access to a digital camera and this has been used to help communication e.g. to show residents where they are going on outings. Some staff did feel this could be used more Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 14 widely. Consideration should be given to using social stories and support should be accessed from speech and language therapists if needed. Total communication training is provided to care staff by the Worcestershire speech therapists. Staff prepare weekly menus and cook daily with a knowledge of what the residents’ prefer. Records showed a varied and healthy diet was being provided. Consideration should be given to how the nutritional overview can be monitored e.g. there was no oily fish on the menus. Dietary needs could be further considered e.g. one resident’s health plan stated she had not special needs yet other information indicated diet may help health problems. There is some tension amongst the staff team about the size of the weekly food budget. From the information provided this does seem low considering that staff should eat with residents as part of supporting them to develop their social skills. There has been some debate about staff paying for their own meals or bringing in food because they feel the residents will go without if the budget has to also cover their food. The residents are young and active and none have weight problems. The providers should carry out a review and then give clear guidance to staff. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 15 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 good personal care in a way their prefer. The residents’ physical and emotional needs are being met in most areas. Medication is generally being well managed on the residents’ behalf but there were shortfalls in staff training arrangements. EVIDENCE: The personal care guidance seen showed that a strong emphasis is being placed on each resident being supported in the way they prefer. The guidance also prompts staff to promote independence where possible. The residents were very well presented and discussions showed that staff ensure residents are dressed in an age appropriate and fashionable way. Guidance prompted staff to allow the residents time alone to soak in the bath, where this was safe to do so, and staff were seen to knock on bedroom doors before entering. Staff engaged with the residents in a respectful and adult manner, whilst still being supportive and personal. As four full time male staff are employed and all the residents are female providing same gender personal care has been an issues since the Home opened. All the families are aware that male staff do provide personal care and a record is kept of when this has occurred. The situation at night has improved now female waking night staff have replaced day staff sleeping in. Being the only worker on the premises at night had made some Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 16 male staff feel vulnerable to allegations. When future staff are employed this issue should be considered and the residents or their families consulted. Arrangements are in place to meet most of the health needs of the residents. Health Action Plans have been set up and are near completion. Some gaps were found e.g. who is providing foot care, when is the first dental appointment due. It is positive that an arrangement has been made with the GP for each resident to have an annual health check. Some issues need further clarification e.g. how breast checks will be provided. A record is being made of weights, accidents or any marks or bruises noticed. Links are in place with some external professionals e.g. the continence advisor. As detailed above professional support in other areas is needed and in one case the Home has been very slow to seek this support. The deputy reported at the second visit to the Home that a referral has now been made. Two residents’ epilepsy is monitored using listening monitors placed in their bedrooms. The deputy was made aware that other devices are available that are less intrusive. Obviously any changes to the arrangements would need to be covered in the epilepsy risk assessments and agreed with residents and their families. Epilepsy patterns are being recorded on charts and staff were seen to make sensible decisions about when to remove one resident’s head protector to make her more comfortable. One resident is prescribed medication for emergency situations. The community epilepsy nurse was currently updating the administration protocol. Only half the staff have attended formal training on how to administer this medication as the Company nurse trainer was on extended leave. Untrained staff spoken with felt duty bound to administer it, although this had not occurred, but were aware this could put the resident and themselves at risk. An immediate requirement was issued stating that untrained staff must not administer the medication. The deputy acted promptly, in the manager’s absence, informing staff, arranging the rota to ensure trained staff were on duty and arranging training for the others with the community nurse. This medication is a Schedule 4 controlled drug and advice was given from the pharmacist inspector about what to include in the management arrangements. Medication was being generally well managed. Storage is robust and the keys held securely. The fifth resident maybe on medication so additional storage should be considered. The stock-checking system could be improved for ‘as needed’ medicines. Charts showed doses had been given as prescribed and returns were being recorded and signed for by the pharmacy. Medication profiles are in place, but what each medicine is prescribed for could be clearer. Medication reviews have already been held for some residents, which is very positive. Currently only the manager and deputy have attended an accredited course on the safe handling of medicines. Other staff are delegated authority to give medicines after being assessed as competent over three observations. All staff that administer medication should be attending accredited training. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents and their relatives’ views are being listened to and respected. The residents are being protected from abuse. Both outcomes may be improved if the policies contained accurate guidance. EVIDENCE: A simple version of the complaints procedure has been developed for the residents. Even with this the residents depend on others to raise any concerns on their behalf. The Company has a complaints procedure that was reportedly given to each family with the initial information about the service. One relative said that they did not have a copy. The procedure needs to be amended as it indicates that the Commission is part of the Company’s procedure and will deal with issues if they are not settled directly. The Commission has no statutory right to investigate complaints, and although any information provided will be considered at the next inspection, it is the responsibility of the providers to have an effective complaints process. No complaints have been received by the Home or the Commission. It is clear that residents’ relatives have been encouraged to give their views and it is positive that the first relatives meetings is being held soon. Relatives reported that when they have raised issues they have been listened to and action has been promptly taken. The staff spoken with were confident that the residents were being treated with respect and dignity and that any protection issues would be promptly reported. Adult protection training is provided by the Company but not all staff have attended this yet. No adult protection concerns have been reported to the Home or the Commission since the service was opened. The Company has policies on Abuse and Whistle Blowing. Staff are assured protection if they Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 18 raise a genuine concern. The abuse policy did not reflect current best practice guidance. Following the inspection the providers reported that there is a revised version and this should have been in the Home. They have now taken appropriate action. The Worcestershire Adult Protection manager should also be consulted in regards to the training available on the local multi-agency procedures. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The residents have very attractive, clean and homely accommodation that meets their needs. The size and location of the Home helps them live a normal life as part of a community. The residents’ bedrooms have been nicely personalised, they have full en-suite facilities and they are supported to use their rooms independently. The residents are not always being adequately protected from risks in their Home. 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 are five single, en suite bedrooms with either a bath or shower, toilet and washbasin. Four of these bedrooms are on the ground floor and the fifth on the first floor. The communal loungedining room is on the ground floor. There is a laundry room, a well-fitted and spacious kitchen, and a small communal toilet. On the first floor there is one bedroom for a service user, an activities room, a bathroom, office and sleeping in room with en suite toilet. The sample of bedrooms seen had been nicely personalised and looked homely and comfortable. All have their own towels Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 20 and bed linen. Three residents were seen to use their bedrooms during the day to relax and enjoy preferred activities. Outside there is a car park area and three garages. The garden is fenced in with electronic gates and a locked footpath gate so residents can safely use the space. There are plans to develop the outside facilities this summer. The premises have been altered and furnished to a modern, homely, high standard taking into consideration the needs of the resident group. A maintenance worker comes weekly but the main issues have been snagging faults after the refurbishment. Dates were given to show all equipment and installations have been recently services. As part of internal quality assurance systems weekly building inspection take place. The home does not have a call bell system or lifts between the floors, so it is not suitable for anyone with significant mobility problems. Some aides have been provided e.g. plate rim guards. Some doors are kept locked so staff often use keys and this does distract from the homey atmosphere. An electronic fob should be considered for the kitchen door as this could also enable some residents to access the kitchen. The door into the laundry is in the dining room and a protocol for soiled laundry is in place. Ventilation is poor and has been an issue for staff working in the laundry. There is also no work surfaces. Chemicals are stored in a unlocked cupboard because the laundry door is locked. The manager should complete a risk assessment about the likely outcome if the main door was left open in error and a resident gained access. COSHH data sheets are available but staff do not sign to show they have read these. Arrangements are in place to reduce the risk of infection e.g. a sluice cycle on the washing machine, red disposable bags used for soiled items, staff training, protective clothing, cleaning schedules, colour coded mops and chopping boards. The waking night staff have some time to do some cleaning duties. Relatives reported that the Home is always clean. Fridge/freezer and hot water temperatures are being monitored. One resident has changed bedrooms and is now using a bath that does not have a regulator fitted to the hot water. Records showed the water is 67c but a risk assessment had not been completed. This needs to be completed as a matter of urgency and a regulator fitted if needed. Approved fire prevention systems are in place and routine checks carried out. Some fire doors have been wedged open. A bedroom door had recently been fitted with an approved device, but while one was on order for the dining room door a wedge was still in use. A requirement was made and a device was promptly obtained and fitted. Another bedroom door is still being wedged. This should be discussed with the Company’s fire safety advisor and included in the fire risk assessment if a device is not fitted. A fold-down barrier has been fitted at the bottom of the stairs to prevent residents who need staff support to climb stairs going up unaccompanied. The resident sleeping upstairs is able to operate the barrier and the providers reported after the inspection that a risk assessment was in place regarding this. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 21 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): 31, 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 residents are benefiting from a committed and enthusiastic staff team who are clear about their role. Staff training and the number of qualified staff needs to increase to better meet the residents’ needs. The residents are benefiting from a generally well-supported and directed staff team. The residents are being protected by careful recruitment practices. EVIDENCE: The Home is staffed by a team of eight care staff who are supported by a senior, deputy and manager. One of the senior staff is usually on duty during the day. The Home is considered fully staffed for the four residents admitted so far. There has been no staff turn over, which is positive for the residents and their families. The rota is planned ahead and there is usually a minimum of three staff on during the day unless some residents are visiting their families. No agency staff have been used but occasionally due to short notice sickness staffing levels have dropped to two. When this happens it should be reported to the Commission through the Regulation 37 or 26 reports. There is flexibility in the rota system to enable staff to cover for each other or to respond to the residents’ needs. Consideration is being given to setting up a bank of temporary staff to help provide cover. As detailed earlier in the report how staffing levels around activities and the number of male staff in the team Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 22 need to be kept under review. The fact that all three senior staff are male may also have some implications. The two senior and two junior staff spoken with seemed very clear about their roles and they had sound care values. As stated earlier staff were observed to interact appropriately with the residents. Handovers take place at shift changes each afternoon and night. Shifts are planned and a delegation sheet is produced to guide each worker. All staff are provided with regular supervision. The views on how beneficial these are were mixed, but staff do find both the manager and deputy approachable. The quarterly staff meetings are found to be useful and staff can share their views. As mentioned above a consistent staff approach to residents’ behaviours needs to be developed and consideration should be given to holding meetings more frequently to help achieve this. Staff felt the Home was moving in the right direction and that the team was dynamic and committed to providing a personalised service. Positive feedback about staffs’ attitude was received from families and visiting professionals who felt the residents were always treating well. When the Home first opened one worker slept-in over night. This system was replaced in March 07 when two female waking night staff were recruited. Although this is better, particularly as three residents have epilepsy, it still means only one worker is on the premises overnight. Concerns were raised about this proposal during the registration process but at that point the needs of the potential residents were not known. An on-call managers rota is in place, however the people on this do not live in close proximity to the Home and would not be able to arrive particularly quickly in an emergency. Now four people have been admitted a comprehensive night time risk assessment should be completed that includes fire evacuation and health needs. If additional support is identified as needed a sleep-in duty should be reinstated. Central staff in the Company support the staff recruitment process. The files sampled were orderly and showed a robust system is in place and the equal opportunity policy followed. One shortfall was found, as the providers were not aware of an additional background checking process introduced in the amended Care Home Regulations in July 2004. This involved establishing in writing why the applicant left previous work with children or vulnerable adults. The provider’s representative confirmed this would be addressed across the Company, so only a recommendation has been made on this occasion. Training is managed centrally in the Company but training records are held for each worker in the Home and a print out shows the manager the needs across the staff team. Some gaps have been identified but staff are booked onto courses. The training provided is appropriate to the needs of the residents. Standard courses are provided over a 12 week cycle that includes all health and safety training and some specialist courses such as Autism and Addressing Special Needs. Some training has been arranged to inform staff about the needs of specific residents, which is very positive. Other local opportunities to Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 23 access courses should be explored as mentioned earlier in the report e.g. person centred planning, total communication, adult protection. Shortfalls in the training around medication have been highlighted earlier. Although staff are working through an induction and foundation process this is not accredited so staff will not gain the Learning Disability Award Framework (LDAF). Accreditation of the Company foundation with LDAF was part of the registration agreement made with the Commission. Staff and managers both reported that the induction process was beneficial. Some staff had ideas about how this could be further improved. Staff are also given a copy of the General Social Care Council Code of Conduct and a starter pack. The deputy has a NVQ 3 award and is working towards gaining his Registered Managers Award. He is also training to be an NVQ assessor and while doing this he is supporting two members of staff through an NVQ 2 award. He is the only assessor and other staff are keen to gain awards. To support staff with their personal development, and to help the service achieve the NMS of at least 50 of care staff being qualified, other ways to facilitate NVQs should be considered. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 24 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 benefiting from a generally well run service that has their wellbeing as the main focus. Further development is still needed in several management areas. EVIDENCE: The manager has nine years experience of working with people with learning disabilities in three other care homes. Since October 2005 he has been employed by Kentwood Ltd. He has completed NVQ level 3 in care and other relevant training. He is currently working towards his NVQ 4 in care and then plans to go onto gain his Registered Managers Award. The Company agreed, in writing, to support this and for both awards to be complete by December 2007. The manager did not seem aware of this agreement. Further discussions highlighted that although the manager had felt supported by the Company while opening the Home. He had gone through an appraisal process and keeps up to date through monthly managers’ meetings. He had not been provided Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 25 with any formal supervision sessions. Had this structure been in place his progress towards the qualifications would have been monitored more closely and he may have been supported to better manage areas such as care planning, residents’ behavioural and medication needs. His new line manager was present on the second day of the inspection and she committed to providing formal monthly supervision. A requirement has therefore not been made but a timeframe of one year has been set for completion of the qualifications. It is positive that staff and other stakeholders felt the manager was positive and approachable. The findings of the inspection indicate that he has a sound value base. His skills in prioritising and risk management need further development. A full set of policies were implemented July 06. As detailed above the sample of these seen showed that they need to be reviewed. A review is planned for July 2007. The records that were in place were generally being well maintained. Some areas where records need to be further developed have been mentioned above e.g. care plans and risk assessments. More serious incidents have been reported to the Commission, as required, but not always promptly enough. A sample of the records were seen relating to how residents’ monies are being spent. These showed the expenditure was appropriate. The residents’ families have remained appointees, which is positive, and so the Home is not managing any bank or savings accounts. Consideration should be given to residents having their money tins in their bedrooms, even if risk assessments mean staff need to hold the keys. Inventories have reportedly been started by keyworkers. Quality assurance systems are in place. Some have been mentioned already e.g. building inspections. Two full audits of the service have already been carried out by a senior person in the Company. The percentage rating improved each time as more systems were set up in the Home. The Company is also working towards ISO9000 and an Investors in People award. As mentioned earlier, a families’ meeting is being arranged. The Company’s standard practice is to send out annual questionnaires to stakeholders and then analyse the information. It would be positive if clear aims for the next year were jointly developed to show a cycle of improvement. These can then be reported on next year in line with Regulation 24. The provider’s monthly visits and reports are being carried out, however, the Commission has received only those for November 06 and January 07. The inspector does wish to receive these while the service is still new. Health and safety monitoring systems are in place e.g. weekly fire alarm checks. Most hazards were being well managed but many of these decisions have not been recorded in risk assessments. Some other shortfalls have been mentioned elsewhere e.g. hot water, medication training and fire safety arrangements. Staff currently attend one days First Aid training. If a qualified Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 26 First Aider (4 days training) is not on duty at all times, as indicated in the Standard 42, then a risk assessment should be completed about the level of training provided taking into account the needs of the residents. Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 27 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 4 26 4 27 4 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 4 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 3 2 2 1 x Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 YA35 Regulation 13, 18. Requirement Untrained staff administer medication. Timescale for action must not 30/03/07 emergency 2 YA42 23. The practice of wedging open fire 30/03/07 doors must cease. An approved device for holding open doors may be used if the fire authority has agreed to the arrangement. The remaining care staff who 30/04/07 need to be authorised to administer epilepsy emergency medication must be trained. Risk assessments highlighted as 31/05/07 urgent during the inspection must be completed. A risk assessment must be 31/07/07 completed about the night-time staffing arrangements and a second worker provided at night if needed. Resident’s assessed needs and 30/06/07 how they will be met must be included in their care plans. 3 YA20 YA35 13, 18. 4 YA42 YA41 13, 23. 5 YA33 YA42 13, 18. 6 YA6 15 Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 29 7 YA35 18 Staff need to obtain the LDAF 31/12/07 foundation qualification. (The providers need to get their internal foundation process accredited or access the LDAF through an external provider). 8 YA37 YA41 12, 18. The manager must gain an NVQ 31/03/08 4 in care and the Registered Managers Award. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard YA3 YA11 Good Practice Recommendations Ensure the service can meet the assessed needs of any resident before they are admitted to the Home. Develop links with speech therapists and ensure communication systems are used consistently. Review staffing levels in view of the complex needs of residents when accessing community activities. Keep the gender balance of the staff team under review as new staff are employed. Review the situation and provide clear guidance to staff about funding arrangements for activities and meals. Review the storage capacity and consider how this can be improved. Tighten up stock checking systems for ‘as needed’ medications. Two staff should sign any hand written entries on charts unless the GP makes the change. Liaise with the pharmacist who prints the MAR charts so Woodbury View DS0000068189.V329684.R01.S.doc Version 5.2 Page 30 YA33 YA18 YA40 YA20 7 YA20 allergy details are included. A running balance of stocks held of the Schedule 4 controlled drug should kept. A record should be made each time doses are taken into the community and a check made to ensure all are accounted for afterwards. The guidance to staff to monitor the resident until the seizure has stopped should be extended in line with the GP’s directions as the medication could cause side effects over the following hours. 8 9 YA20 YA35 YA22 All staff who administer medication should attend accredited training. Review the complaints procedure in line with the comments in the report and remove reference to the NCSC which no longer exists. Review if ventilation in the laundry room can be improved. Consider replacing the need for keys on communal doors by fitting an electronic fob system that may also benefit some residents. Update the recruitment procedure to include the need to establish the reason an applicant left any previous work with children or vulnerable people. Support more staff to gain an NVQ in Care so at least 50 of the team are qualified. Increase the frequency of staff meetings and focus these on working consistently with the residents particularly on behaviour intervention strategies. Provide the manager with regular formal supervision and support sessions. Ensure the Home’s policies are fully reflective of the situation in the home and up to date in terms of current legislation and best practice guidelines. Ensure Regulation 37 notifications are submitted without delay. Complete a risk assessment about the level of first aid cover provided in the Home as a qualified First Aider is not currently on duty at all times, as specified in the NMS. DS0000068189.V329684.R01.S.doc Version 5.2 Page 31 10 11 YA24 YA24 12 YA34 YA40 13 14 YA32 YA36 15 16 17 18 YA36 YA37 YA40 YA41 YA42 Woodbury View Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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.V329684.R01.S.doc Version 5.2 Page 32 - 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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