Inspection on 17/07/08 for Woodhouse

This inspection was carried out on 17th July 2008.

CSCI found this care home to be providing an Poor service.

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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodhouse 09/06/09

Woodhouse 20/09/07

Woodhouse 18/10/06

Woodhouse 24/03/06

Woodhouse 27/09/05

Woodhouse 01/03/05

Woodhouse 17/08/04

Woodhouse 12/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 Woodhouse Wigton Crescent Southmead Bristol BS10 6DS Lead Inspector Nicky Grayburn Unannounced Inspection 16th July 2008 09:30 Woodhouse DS0000044679.V365046.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 Woodhouse DS0000044679.V365046.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. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodhouse Address Wigton Crescent Southmead Bristol BS10 6DS 0117 9581160 TBA woodhousemanager@shaw.co.uk 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) Shaw Healthcare (Specialist Services ) Ltd Madelynne Veronica Silcock Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 16 persons aged 18 years to 65 years. May accommodate two named people with a learning disability aged over 65 years. Registration will revert to 18 to 65 years when named people leave. 20th September 2007 Date of last inspection Brief Description of the Service: Woodhouse is registered with the Commission for Social Care Inspection to provide accommodation and personal care for sixteen persons with a learning disability aged 18 to 65 years. A variation has been agreed to provide care for two named persons aged over 65 years. Woodhouse is a purpose built facility, first registered in July 2003 and is situated in a residential suburb of Bristol. The accommodation is arranged over two floors, and a passenger lift is installed. Individual accommodation is provided in eight apartments on one side of the building, and eight flats on the other side of the building. The accommodation is linked by communal facilities on the ground floor. The basic fee for this service is a minimum of £2400.00 per week. The exact fee level is dependant on the support needs of each individual service user. This fee excludes services such as hairdressing; chiropody, and people have to pay for things like extra food and drinks they like; toiletries; personalised bedding; items to decorate their rooms; bigger sized beds (singles are supplied). SHAW healthcare’s Mission Statement and Philosophy of Care is written in the Statement of Purpose. Woodhouse’s overall Philosophy and aims states “The home provides a safe and stimulating environment within the community, supported by experienced staff with an awareness of the difficulties and barriers that the individual’s disability and behaviour may present. A clear value of respect, empowerment, autonomy and choice implemented through a person-centred approach underpins the home.” Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was Woodhouse’s Key Inspection. It was unannounced and was carried out over two days. Prior to the inspection, we read the previous inspection report and surveys. We sent a number of surveys to the manager to distribute. Four from staff; six from relatives, and eight from people living in the home were returned to us. All the ones completed by people living in the home were with support. Not all the answers are used in this report. The service’s Annual Quality Assurance Assessment (AQAA) was due back on 25th June. It was sent to us on 18th July. Even though it came back late and after the inspection had finished, it will be used within this report. During the inspection we met the Registered Manager; the Deputy Manger; the administrator; a number of Team Leaders; Senior Support Workers; and Support Workers. We also spent time talking with people living in the home and observing practice. We read key documents relating to the conduct of the home. We attended a handover meeting between shifts. We sat in on two reviews with the Consultant Psychiatrist. We also spoke with external health professionals before, during and after the visits. What the service does well: People live in a spacious and light home. People have large rooms with ensuite facilities. There are some very dedicated members of staff working with people living in the home. Some staff are aware of what constitutes abuse and report it to their manager according to the service’s procedure. People living in the home have high ratios of support staff. Some relatives added comments on their surveys, such as Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 6 “as far as we are concerned, Woodhouse has given *** back [his/her] dignity and certainly her self confidence” “all the staff are extremely courteous” “on the whole, staff are friendly and polite” “I couldn’t ask for a more dedicated team” What has improved since the last inspection? What they could do better: A number of requirements have been made as a result of this inspection. Concerns were raised from people’s surveys and from the findings from the first day of inspection. The second day of the inspection was carried out under the Police and Criminal Evidence Act 1984 to ensure that procedures were carried out properly and fairly. Enforcement action being taken regarding protecting people from abuse and reporting incidents to the correct external agencies. Allegations of abuse must be reported to the local safeguarding team. We must also be informed of all allegations of misconduct. Complaints must be followed up and the person making the complaint must be informed of the outcome. The staff team need more support and supervision in order to carry out their jobs properly. Staff require specialist training to effectively support people living in the home. People’s needs must be assessed and a decision must be made as to whether the service can meet their needs. Advice from professionals must be implemented. The home must be managed in line with the service’s Statement of Purpose. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 7 People must be provided with adaptations to use their own bathrooms. People must consent to staff spending their monies or be assessed for their capacity to make decisions regarding their finances. Relatives added comments on their surveys such as “communication is not good between them [staff]” “a few staff are brilliant, not all by any means” “better communication, activities...nothing happens after 7pm” 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. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is poor. The service has a Statement of Purpose and Service User Guide, which gives information about the home and who can be catered for but the services available fall far short and people’s needs are not met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were given a copy of the service’s current Statement of Purpose and Service User Guide. A requirement was made at the last visit for this document to be updated. The document now meets the regulation. Woodhouse is a registered Care Home for 16 younger adults with Learning Difficulties. There is one vacancy at the moment. The 15 people living at Woodhouse present a wide and complex range of personal, health and mental health needs, for example, learning difficulties; physical disabilities; dementia; severe epilepsy; sensory impairments, and psychological disorders. The ages of people range from 29years old to 81years old. Everyone living in the home is funded by their placing authority. Initial assessments were not read during this visit. The AQAA stated that there has been two admissions to the home in the last 12 months. The newest person to Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 10 move in was in May. The person presents very complex behavioural and mental health needs. The person has assessed needs for psychology input. However, the professionals were not contacted until recently. External professionals are concerned with the admissions criteria and procedure. The service’s Statement of Purpose details the criteria for living at Woodhouse and includes the wide range stated above. The actual admissions procedure is not detailed as it depends on the person’s individual needs. As detailed within this report, it is evident that people’s needs are not being met. Staff do not have the skills and experience to deliver the services, which the home offers to provide. The home has accepted people whose needs cannot be fully met. One person described the home as “a holding place for people”. Many people living in this home require specialist psychiatric input. A suggestion from a professional was that the service should employ a full-time psychologist. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor. Although risk assessments are in place ensuring that people can take risks as part of their everyday lives, plans of care are in place but are not always followed. There is little evidence to show that people make decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people’s plans of care were read. These gave basic information about the person and how they wish to be supported. People have a Key Worker, who leads their Key Worker group. The AQAA states that these groups are ‘person centred so good relations are formed as well as consistency with supervision.’ The person’s key worker reviews people’s individual plans. A survey from a member of staff told us that “every month, guidelines of service users are being reviewed and updated by the key workers group.” For one person, the ‘reviews’ stated ‘no change’ from January to June 2008. Staff told us that they Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 12 do not feel wholly confident in writing these and would like training in writing these, and that members of the key worker team are not consulted for information about the previous months. Monthly reports are written but are sparse and show that people do not do a lot. Some members of staff did not know who their key person was. The policy on ‘Empowerment and Advocacy’ states “Care plans must be adhered to ensure that there is consistency in care practices from all staff.” Observations during the visits confirmed that support workers are not following people’s plans of care. For example, for one person, their communication plan said, ‘talk to me as I understand what you are saying’, but it was observed that support workers did not talk to them. For one person, their care plan says that ‘being left alone is the main cause of anxiety’, and it was observed that they had been left alone and became very distressed. It was clear that some efforts had been made to gain a fuller picture of people, for example, people’s life histories and likes and dislikes. One person had contact with an advocate recently, and another person had an Independent Mental Capacity Advocate involved in a decision regarding medical treatment. We did not see any records evidencing when people make decisions. The importance of this was discussed with the manager, especially in light of the Mental Capacity Act 2005 and people’s ability to make decisions. As written within this report (under ‘Protection’ and ‘Lifestyle’), people are not being consulted upon or given enough choice within their home. The policy on ‘Empowerment and Advocacy’ states “Each resident should have an advocate to act on his or her own behalf.” This policy is not being followed. Risk assessments are in place. There is a folder of assessments for generic activities and health and safety issues. These were reviewed recently, with no changes. People also have individual assessments within their plans of care. Training in risk is included in staff’s induction period. Staff also told us how the process of assessing the risk for new activities is carried out. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is poor. Some people’s lifestyles suit their needs but some people would benefit from having more activities and support. People’s rights are not always respected, and food choices are minimal. Access is restricted within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the range of needs people have within the home, activities and lifestyles are mainly individual to each person living at Woodhouse. The AQAA states that “we encourage each service user to do individual activities…access the community – church, town centre, The Mall, shopping trips, train trips, bus rides, cinema, bowling, hydro, art therapy.” People have Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 14 a television in their room, and there are the two main lounges where people can spend time. The home has an area for people to do arts and crafts; there is a hot tub, and a sensory room. However, we were told by staff; relatives, and health professionals, and observed that these facilities are not used to their full potential. The issues involved with the hot tub are discussed under ‘Environment’. During the visits over the two days, we observed people being supported to go out for walks; go to the local shops; one person was read to; one person did some crafts, and one person went to the cinema. Two people access a local day centre. However, staff are concerned about the appropriateness of this activity. The AQAA states that a plan for improvement over the next 12 months is to research specific drop-in centres for people. An added comment from a health care professional stated “support staff need a lot of structure and guidance to implement care plans – particularly daytime occupation.” Relatives; staff, and health professionals have raised concerns about the level and quality of activities people do. One relative is concerned about the level of activities in the evenings. Staff told us that people do not go out in the evenings. It was observed that many staff spend time sitting, both with and without their allocated person. It was observed that many people spend a lot of time in their rooms/flats, or walking around the building. One person’s care plan is for them ‘to go out in the community as much as possible’. However, in May, this person did not leave the home once, and in June, the person went out twice. Health professionals feel that specialist therapeutic intervention is required to meet people’s needs. Some staff spoken with had a good knowledge of what their key person enjoyed and liked doing. There is a ‘Life Skills’ kitchen, which people can use to learn cooking skills. Staff told us that a few people use this facility and but mainly to cook cakes. At least seven people living at the home have regular contact from their relatives. Two staff members told us about a holiday one person went on recently. They were unaware of other people being supported to go on holidays. The AQAA states that “holidays have taken place.” All doors have locks and doorbells. One person is able to use their key, and they keep their room locked at all times. From the entrance to the home, and throughout the home there are keypad locks disabling people to access all areas of the home. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 15 It was observed how support workers call people by their preferred name. Woodhouse’s Statement of Purpose states “Woodhouse will always try to offer a wide range of choice at mealtimes…A full range of special diets is provided to meet all ethnic/religious preferences or snacks.” The service employs a chef for 5 days a week. A chef from an external agency is employed for one day. For the remaining day, support staff generally go and buy a take-away. The chef does a weekly shop at a supermarket, and fresh fruit, vegetables, milk and bread are delivered weekly. On the first day of the visit, a range of salad foods was bought instead of a take-away, and people had ravioli or a sandwich in the evening (which was not on the menu). People’s hot meal is at lunchtime. There is a three-week rolling menu on display by the kitchen area. Due to people’s needs, this should be in a format, which people can understand. Relatives and staff raised their concerns with us regarding the food and mealtimes at Woodhouse. In people’s plans of care there is some indication of what people like and dislike. Support workers told us that the chef also has this information. Support workers record what people eat in their plans of care. However, the in-house catering audit states that people’s preferences are not documented in their plans, therefore not reflected in the menu planning. The most recent in-house ‘Catering Audit’ stated that ‘a comparable choice of meals is offered at main meal times’. However, staff told us and the menu showed that there is no alternative hot meal provided. If people do not like the offered meal, they are given a sandwich. People are not given choice over their meals. It was observed that for most people, meals are collected by the support worker and given to the person, mainly in their individual rooms. Some people ate in the dining area of one of the lounges. Many people have problems with their bowel movements, continence and weight. Some people have assessed dietary needs, which are not being met. A survey from a relative raised the issue of having to buy specific foods for dietary needs for their relative living in Woodhouse. The manager said that this had been refunded back as it was a mistake. When looking at people’s finances, it was evident that two people had had to buy the same food for their dietary needs. People should be offered a choice of food, and an alternative if the person does not like the main hot meal. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. People’s health needs are not always met. Medication procedures do not protect people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Woodhouse have significant and complex physical and psychological needs. External health professionals are involved in people’s care. Surveys from two general practitioners are satisfied with the overall care within the home. It was observed that people could get up and go to bed when they wished. People wore clothes that suited their personalities, and it was observed how people choose what to wear with support. Some people’s family members bring in clothes for their relative to wear. It was observed that people’s dignity is not always maintained. Details of this was passed to the manager and Company Secretary. This has also been Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 17 discussed at a Safeguarding Adults meeting. Staff must treat people with dignity and respect at all times. It was clear from the surveys that senior members of staff are quick and keen to seek advice and refer people to appropriate services. However, we were also told that advice is not always acted upon. This was also observed during one person’s review with their Consultant Psychiatrist. A letter had been written in February 2008 to change their medication. The letter was in the person’s folder but no one had implemented the instructions. One person is diabetic, which is controlled by their diet. Two support staff told us that not all staff are aware of the consequences of giving them sugary foods. During the handover we sat in on, it was reported that the person’s blood sugar levels was 16 instead of between 4-7. The key standard for medication was inspected by The Commission for Social Care Inspection’s Pharmacy Inspector on 23/07/08. This was carried out due to a number of reasons. The service keeps controlled drugs and other drugs which need specialist storage. Due to the complexity of some people’s needs, there are complex drugs being used. There was one medication error, which had been reported to the manager, but had not been reported it to CSCI. Some staff told us about other medication errors and their concerns with people’s competencies. The ‘Drugs and medication’ section on the AQAA was incomplete. An immediate requirement was made at the last inspection. This was, in the main, met. Therefore enforcement action is not being considered from this visit. Medicines are provided by a local pharmacy using a monthly blister pack system. All medicines are looked after and given by the team leader for each shift. We saw that a large number of keys for the house are kept together. Staff must make sure that only carers able to look after medication can access the medicine keys, this is to ensure that medicines are kept securely. Secure storage for medicines is available on each floor. A medicine fridge is available and records show that temperatures for this are in the safe range for medicines. Daily records of temperature for one medicine room were above 25 degrees Centigrade, which is the recommended maximum for safe storage of medicines. Action is needed to address this to make sure that medicines are stored at a safe temperature. The acting manager has since informed us that the medicine fridge has been moved and the temperature is now acceptable. Some medicines require additional secure storage and this is provided in the home. A register is also available to record the use of these medicines. We saw staff administering some lunchtime medicines during this inspection. Staff checked the medicines administration record sheet before putting out the Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 18 medicines, took them to the relevant person and then returned to sign the medicines administration record sheet when the medicines had been taken. For two people the medicines could not be given immediately and were left in the trolley and given a short time later. During the inspection both people received their medicines and the medicines administration record sheet was signed. However not giving medicine immediately increases the risk that medicines may be left in the trolley and not given, or could be given to the wrong person. It also increases the risk that the required administration records will not be completed. A company medicine policy is available for staff but this is a general policy and not specific to the procedures used in Woodhouse. We have recommended that a policy specific to Woodhouse should be available to staff to make sure that everyone with responsibility for medication is aware of the safe procedures to use in the home. The pharmacy provides printed medicines administration record sheets for staff to complete each month. However some gaps were seen on the medicines administration record sheet where it appeared that staff had put out the medicines to be given but had not signed the medicines administration record sheet to show that they had been given. Medicines had been taken from the relevant blister packs. We saw a notice that asked the staff on duty at these times to complete the gaps in the medicines administration record sheet. One person is prescribed a special shampoo to use. No record had been made that this was used. Staff told us that the shampoo is used twice daily with every shower but no record has been made of this. Action is needed to make sure that staff always sign the medicines administration record sheet when medicines are administered. This is to make sure that people are given their prescribed medicines correctly. If a regular medicine is not given, the reason for this must be recorded. A requirement has been made concerning this. We saw two medicines prescribed with a variable dose but no record had been made of how much was given. Staff said that they always give the same dose. This must be recorded on the medicines administration record sheet so that it is always clear how much medicine has been given. Staff have made some handwritten additions to the medicines administration record sheet. These were generally clear and signed but not checked and signed by a second person. This had been highlighted on some of the staff medication competency assessments we saw. One person had some When required doses of medication added to a medicine prescribed to be given every second night. However there were no clear dosage instructions for this medicine and no information about who had authorised this. Prescribed medicines must be administered according to the doctor’s dosage instructions Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 19 and any changes to prescribed dosage instructions must be authorised by the doctor. We looked at two care plans for emergency treatment of a medical condition. Both had treatment plans in place and available for staff to read. We saw records of when the emergency treatment had been used. On one occasion records showed that a second dose of emergency treatment had been given more quickly that the plan indicated. Staff said that medical staff had advised them to do this. Any changes must be documented in the relevant plan and authorised by the prescribing doctor, to make sure that these medicines are always given safely and the resident’s health is protected. Records are kept of the medicines received into the home. The record book includes some records of stock balances for medicines not supplied in the monthly blister packs. It is recommended that action be taken so that it is clear when medicines supplied in standard packs have been opened. This is so that staff can easily audit the stock and check that it has been given correctly. Record sheets are used to record medicines taken out of the home when people take trips out. Staff said that the community nurses have provided this format. It is not always clear on the form whether staff are recording that medicines have been returned or that they have been administered and action should be taken to clarify this. The acting manager told us that a new company medicine policy is being introduced later this year, but could be adopted earlier. This includes a recording sheet for medicines taken to day care services so that staff will have a record of medicines given there. Staff have received medication training from their pharmacy. We also saw several in-house staff assessments of competency in medicines administration that have been carried out this year. One member of staff has not completed this and the acting manager told us that she is addressing this. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. Not all complaints are dealt with according to the service’s policy and procedure so people are not protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was given to us. It is also included in the service’s Statement of Purpose and Service User Guide in an easy-read format. It states that SHAW will “resolve any complaint as fully and quickly as possible…the investigation must be concluded within 28 days of receiving the complaint and the complainant advised of the final outcome.” Two surveys from General Practitioners stated that they had not received any complaints about the home, and an added comment from a health professional was “team leaders are very receptive and respond accordingly.” All staff who completed a survey stated that they knew what to do if someone wanted to raise concerns. Five out of six relatives confirmed on their survey that they knew how to make a complaint, however, most of the relatives did not feel that the service had responded appropriately. One relative added “I have in the past put in a complaint form, and sometimes I do not get a response so I do not bother now.” We read the complaints and compliments folder. A requirement was made at the last inspection to keep a record of all complaints and action taken. We found a complaint form from June 2007, which still had no resolution. We are considering enforcement action in relation to this. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 21 There are a number of letters of compliments to the staff team and management, mainly from May 2007 – January 2008. We also received complimentary comments in relatives’ surveys. For example “they treat *** as though [he/she] really matters…we always feel welcome…whatever mood *** is in, the staff keep cheerful and positive which in turn makes us happy knowing *** is in the best hands.” Woodhouse’s Protection of Vulnerable Adults policy (now known as safeguarding adults) was given to us. This details the different types of abuse and the procedure for responding to allegations of abuse. The service’s ‘Rights Policy’ states “the home understands that all service users at the home have the following rights: Right to dignity and respect; Protection from abuse or maltreatment...” This policy is not being adhered to. A requirement from the last inspection was for staff to receive training in safeguarding adults. From the training information provided, it showed that staff undertake training in the subject within their induction, and have refresher training annually. There is a copy of ‘No Secrets’ in the staff room on the ground floor, along with the contact number for the Commission for Social Care Inspection. As written under ‘Staffing’, staff have Criminal Records Bureau (CRB) checks prior to starting working. Also under ‘Staffing’, a requirement has been made regarding training people is the use of Positive Response Technique. At present, staff are not trained, therefore, placing people at risk. An incident in May 2008 resulted in the manager making a referral to the local Safeguarding Team. Relevant professionals were involved and strategy meetings were held. This has now been resolved. The manager and deputy keep a folder of current issues, which need to be dealt with. Within this folder, we found three incident reports of abuse dating from 06/04/08; 05/05/08, and 14/07/08. None of these had been reported or acted upon. During the two days, we also observed five cases of bad practice. Details of these were relayed to the manager immediately after the incidents, and we wrote to the Company Secretary about this. These incidences should have been reported to Bristol County Council, and also to CSCI. A requirement from the last visit was to inform us of any incident that may affect the well being of people using the service. This is a repeat requirement and enforcement action is being considered. The service’s policy states that ‘The Home Manager is responsible for making immediate contact with the locality POVA team”. We made a Safeguarding Adults referral to the local Safeguarding Team on the second day of the visit and a strategy meeting is going to be held. The manager also contacted Bristol City Council after we told her to. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 22 Despite staff receiving training about safeguarding adults, the quality and assessment of the training is being questioned. It is advised that the recognised training provided by Bristol City Council be sought. The AQAA states that there is an ‘open culture for whistle blowing’. However, staff told us that they are not confident in talking with the manager about issues within the home or their development. They feel that they will be penalised through the rota system if they complain. Staff also told us that when they have reported and/or talked to senior staff about issues, nothing is done about it. The previous report referred to the need for improvement of people’s reactive strategies. Staff were advised that the information should be expanded. This will be followed up at the next inspection. The service’s policy on ‘Empowerment and Advocacy’ states that “each resident should be enabled to manage their own finances and to give consideration to arrangements that may be necessary in the future.” We looked at four people’s monies held in the home. The amounts held in the individual purses matched the recorded amounts. One person holds a certain amount of money each week which is detailed in their care plan. The majority of people’s monies are held in a joint current account under Shaw Health Care’s name. Two signatories are required to withdraw monies. The manager and deputy are the signatories on behalf of Shaw for people living in the home. Two people have separate accounts. This was discussed with the manager. Some people have large amounts of saved money. People are not receiving any interest on their account. Individual current and savings accounts need to be sought to ensure that their money is safe and can receive the appropriate interest. Records of accounts showed that key workers are allowed to take large sums of money (£50-150) and spend it without people’s consent. Items bought are things like pictures for people’s rooms’; top of the range electric razors, and a mattress topper. The manager must gain people’s consent to spend their money. There is no record of the wishes of the person, or involvement of their family. A requirement was made at the previous inspection for a list of people’s valuables to be kept. One was seen. This will be followed up fully at the next visit. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 23 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, 29, 30 Quality in this outcome area is adequate. People’s who live in this home enjoy private space that is personalised and is of a good size. The shared spaces complement the number of people living in the home. Adaptations are not always made for people with specific needs and so they are not always able to use some of the facilities on offer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Woodhouse is a purpose built home in a residential area. There are local amenities in the neighbourhood and people can access bus routes to the nearby areas. There are gates on the entrance. The home is spacious and light. Areas of the home have recently been decorated and pictures done by people living there are going to be put back up Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 24 on the walls. Colours are bold, which can help people to identify areas of the home. There are eight rooms and eight flats. Rooms are large, all with en-suite facilities. The space requirements were met when the home was registered, and measurements can be found in the service’s Statement of Purpose. We viewed nine people’s living spaces. They were mostly all tidy, clean, and personalised. Some people have access to a personal garden area. Two people’s garden’s well kept. Two people’s have not been maintained. A relative commented on their survey that their “garden still looks terrible, grass will not grow, lots of overhanging trees, making the room dark…so its no pleasure to sit out.” The flats have a bedroom; a living room; a bathroom and a kitchen. These would be good for people to learn independent living skills. However, the facilities are not used other than for to make drinks and keep personal foods. The manager explained, that the flats are used for people who have complex behavioural needs rather than learning living skills. There are two large, open, light, lounge areas on the ground floor, both with televisions and sofas and chairs. There is an additional smaller lounge area, in between corridors, which is quieter. There is also a garden which is well kept. There is a sensory room, which has a range of lights, cushions, and music. Some people use this occasionally. There is also a hot tub/spa room. There were conflicting views on the usage of this room. Some staff could not remember the last time it was used, some said that it was broken, and some said that certain people use it. One particular person very much enjoys water, but the manager said that they are unable to use the hot tub as the hoist to transfer them into the tub does not go high enough, and three support workers are needed to carry out the manoeuvre. The bathroom facilities offer sufficient privacy for people. However, the majority of the people living at Woodhouse need to use some kind of equipment to have a bath or shower. One bathroom viewed has been adapted to a walk-in shower room to suit their needs. Staff raised their concerns with us regarding people not being able to use their own bathrooms. The majority of people use the assisted bath on the ground floor. Another person uses the shower in the hot tub room. From a review with the person’s consultant psychiatrist, it was established that they would benefit from having a walk-in shower room as they slip off the hoist in the bathroom and using the hot tub room is not ideal or dignified. Their Occupational Therapist has also been involved in their assessment of needs. People are Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 25 unable to use their own bathrooms and so adaptations must be considered in order to improve this situation. Some people have washing machines in their flats, which are used. There is a specific laundry room with facilities to ensure that soiled clothing and bedding is appropriately cleaned. The home was clean and tidy on both days of the inspection. There are two domestic cleaners employed in the home. However. one person’s bath had not been cleaned as there was faeces in the bottom of the bath. The mangers’ and administration office is on the first floor. There is a separate staff room where there are lockers to store personal belongings. There is a team leader’s room on the ground floor, which also has a computer, which can be used by people living in the home. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 26 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 poor. Although people benefit from generally satisfactory recruitment practices, most staff are unqualified and are not fully trained and so people who live in the home may be placed at risk. The staff team are not well supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the AQAA, there is a staff team 94 people, including 16 bank staff, 2 domestic staff and a maintenance person. We spoke with at least ten staff members over the two days of inspection. We found that there is low morale, and they feel unsupported and de-motivated. A handover between staff groups takes place in between shifts so that information about people living in the home is passed on. We sat in on one of these and the team leaders clearly detailed the issues from the night before and that morning. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 27 Staff meetings happen monthly. The manager told us that those staff who are on shift attend the meeting, but those who are not on duty do not tend to come in. Minutes of the meetings were not read. Staff raised their concerns in their surveys about how information is passed on about people living in the home. The AQAA stated that 277 shifts have been covered in the last three months by agency or bank staff. In the last 12 months, 27 staff members have left their employment. There is a high staff turnover. There is a high staff ratio to the people living in the home. Everyone is either supported on a one-to-one basis or a two-to-one basis. Training records were read and copied for us. Induction for new staff takes place over 4 days, between 10am-4pm. This includes the general organisation’s induction, and also all of the mandatory training: Moving and Handling theory; Moving and Handling Practice; Fire Lecture; Risk assessment; Health and Safety; Food Hygiene; COSHH; Infection Control, and Protection of Vulnerable Adults. First Aid is not included in the organisation’s statutory training. Comments from external health professionals, relatives and staff members were both negative and positive. Some people feel that there are some very dedicated staff with good skills and competencies. A comment was “Team Leaders are professional and skilled.” However, some people told us that there is “a large team of unqualified support staff – can result in lack of consistency of approach.” The manager told us about the problems the organisation has had regarding the Learning Difficulties Award Framework, which has now changed to Learning Difficulties Qualification. The AQAA states that 21 people are working towards their National Vocational Qualification Level 2 in care. However, the manager told us that there has been a delay in this, and staff are due to start this autumn. Team Leaders are either qualified nurses or have a relevant qualification. From speaking with staff and reading their surveys, it is clear that staff feel that they are not trained effectively to meet all the needs of the people living at Woodhouse. As written within this report, there are some very complex health needs within the home. According to the staff’s training list, 8 people received specific training in epilepsy in 2005 and 2006; 7 people in dementia in 2006; and 6 people in autism in 2006. No staff have received training in Mental Health needs. A comment from a staff member was that “if they had a better understanding about their job, they may feel more interested and motivated.” Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 28 The manager’s Training Plan for 2008-2009 states that specific training has not been organised but is ‘to be confirmed’. Further, staff working in the home need to have training in ‘Positive response Technique’. The manager is a Trainer in this. However, the training requires two trainers to deliver it. The manager expressed her concerns that she is the only one in the area who can deliver it. There are now two recently qualified trainers in Wales, but there is a massive backlog of staff who require this training. Staff who have received this training need an annual refresher course. From the training lists given to us, it shows that the majority of staff are in need of it, including Team Leaders. A requirement has been made to ensure that staff are suitably and appropriately trained to carry out their job. A requirement from the previous inspection was for documentation to be kept in staffing files to identify that they have undergone a Criminal Records Bureau (CRB) check. The original copy of the check is kept at Shaw HealthCare’s head office. In the seven staff files we read, the person’s front sheet gives the disclosure number of the check. Staff files contained an application form; references, and details of what training has been completed. The manager said that Shaw Health Care have now started undertaking CRB checks every three years, inline with CRB Guidance. Some people’s references did not match with the referees they gave on their application forms. Some people only had one reference, but the previous Area Manager had signed to state that this was acceptable, and some people’s references were from neighbours or friends. The Statement of Purpose states that “all staff receive informal supervision daily and formal recorded supervision sessions from their immediate line manager on an 8 weekly basis. The monthly visit report carried out by the previous Area Manager stated “supervisions remain generally up to date”. We looked at five staffs’ records and found that this was not the case. We were given a copy of the manager’s log of supervisions, which also showed that staff are not receiving regular meetings. Staff also told us that they do not receive supervision regularly. At least three Team Leader’s have not received supervision since August 2007. Many Support Workers have not received any supervision. Further, some people who are supervisors have not had any training in carrying out these meetings with their supervisees. A requirement has been made to ensure that staff receive regular supervision. A recommendation has been made for supervisees to receive training in giving supervisions. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 Quality in this outcome area is poor. People are not benefiting from living in a well run home. Policies, procedures, and records are in place but not always followed to ensure that people are looked after properly. Quality assurance methods are being carried out but the results are not developing the service. People are safeguarded by health and safety procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager, Madelynne Silcock, was present on both days of the inspection. Ms Silcock was registered in June 2007 and is a Registered Nurse for Learning Disabilities. She also has her Registered Manager’s Award. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 30 The new Area Manager started with SHAW Healthcare in May 2008. We also met with the Deputy Manager, who is allocated three days in the office to carry out managerial tasks. Relatives’ surveys and external professionals told us that since Ms Silcock started managing Woodhouse, the service has improved and that both Ms Silcock’s and her Deputy should be commended for their hard work. The manager told us that since February 2008, she has suffered with some illhealth. Senior management need to ensure that the manager is supported effectively to ensure that people’s needs are met and that they are safeguarded at all times. However, staff and external professionals also raised their concerns regarding areas of the management of the home. These have been written in the body of this report, and requirements made accordingly. Staff told us that they do not see their Manager as much as they would like, and that she does not spend time with the people living in the home. The manager agreed with this when it was discussed, and that she would like to spend more time ‘on the floor.’ Staff feel that the manager is not approachable with issues. The home must be managed in line with the service’s Statement of Purpose. A requirement was made at the last inspection to ensure that The Commission for Social Care Inspection is informed of any incident that may affect the well being of people using the service. As written under Standard 23, incidents have occurred which have not been reported. The Annual Quality Assurance Assessment (AQAA) is a legal document, which gives information about the service under each outcome group. It asks what they do well; the evidence; what they could do better, the plans for improvement in the next 12 months. It also gives data and other relevant information about the service. This must be returned to us within the given timescales. It was due back on 25th June. Three extensions were given due to the manager having been absent. However, these were not met. It was returned to us on 18th July. Under Regulation 26, it is required of providers to carry out Monthly visits to the service. We were given the reports from January to May 2008. These are carried out by the Area Manager or another manager of a home within the organisation. We have written to the Provider requesting that these are now sent to us on a monthly basis. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 31 SHAW Health, the registered providers, require their home managers to carry out internal audits to monitor the quality of the home. Copies of the last audits were given to us and have formed parts of this report. The service also has an annual action plan for this financial year. The provider must support the manager to ensure that this plan is realistic and deliverable. Policies and procedures are available in the staff area on the ground floor and manager’s office. A selection of these were read during the inspection, and copies were taken as evidence for requirements. Some polices are not being adhered to. The AQAA gives the dates of when the key policies were reviewed. Records are kept in various parts of the home. Personnel records are kept in a lockable cabinet in the manager’s office. People’s records are kept in their individual rooms (bar one person’s due to assessed needs). Records viewed were up-to-date but not to a satisfactory standard. A requirement was made at the last inspection for fire equipment to be checked regularly and that fire training takes place regularly. The fire logbook was read. It showed that checks are carried out regularly. Staff have fire training within their induction period. Fire drills are recorded and showed that these are done on a regular basis. The service’s fire risk assessment was read and had been updated recently. It should include fire safety measures taken for those with sensory impairments. There are risk assessments in place for the use of cleaning products according to the Control Of Substances Hazardous to Health 2002. Products are kept safely in two locked cupboards. The home does not keep a specific accident book. Managers told us that they write accidents on incident forms. This needs to be in place to meet the legal requirements under The Social Security (Claims and Payments) Regulations 1979 to record accidents at work according to the Health and Safety Executive. This will be followed up at the next inspection. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 X 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 1 33 2 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 2 2 2 3 X Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 33 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA3 Regulation 14(1) Requirement People’s needs must be assessed to ensure that this service can meet them. The care home must be suitable for the purpose of meeting people’s needs in respect of his or her health and welfare. 2. YA19 12(1) People’s health needs must be monitored and action must be taken to ensure that health risks are identified and dealt with at an early stage. Arrangements must be made for the recording and safe administration of medicines in the home: Records must be kept of all medicines administered by staff. Medicines must be given as prescribed by the doctor. If the dose of medicine is variable the amount given must be recorded. This is to safeguard people’s health and ensure that medicines are given as prescribed. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 34 Timescale for action 30/09/08 30/08/08 3. YA20 13(2) 30/08/08 (Outstanding requirement, partly met) 4. YA23 13(6) You are required to ensure appropriate systems are in place to protect service users from abuse. Arrangements must be made to prevent people being harmed or suffer abuse or being placed at risk of harm or abuse. A Statutory Requirement Notice has been issued. 05/09/08 5. YA23 37 You are required to ensure a system to notify the commission of any incidents, which affect the well being of service users in accordance with Regulation 37. Repeat requirement, previous timescale 22/9/07. A Statutory Requirement Notice has been issued. 05/09/08 6. 7. YA23 YA22 13(6) 12(2) 22 People must consent to expenditure of their monies. Keep a record of all complaints and action taken. Repeat requirement, previous timescale 22/9/07. Enforcement action will be considered if it remains unmet. 30/09/08 30/08/08 8. YA29 23(n) People must be provided with adaptations and equipment to use their own facilities within their home. This requirement refers to the 30/09/08 Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 35 arrangements for bathing and using the hot tub. 9. YA35 18(1) Staff must be suitably and 31/10/08 appropriately trained to carry out their job. This requirement refers to the specialist training staff need to be able to support people living in Woodhouse. 10. 11. YA36 YA37 18(2) 16(1) Staff to receive regular supervision and support. The Home must be managed so that the facilities and services, as described in the statement of purpose, are met. 30/09/08 30/08/08 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 YA23 Good Practice Recommendations The registered provider should obtain/investigate advocacy services from independent organisations for those residents in need. The registered provider should investigate accessible, pictorial formats and information for people. The registered provider should ensure that 1) A medication policy specific to Woodhouse should be available for staff. This is so that all staff are aware of the safe procedures to protect the health of people who live in this service. 2) Hand written additions to the medicines administration record sheet should be signed, dated and checked by a second member of staff. Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 36 2. 3. YA6 YA20 3) Action should be taken to make it clear when medicines supplied in standard packs have been opened. This is so that staff can easily audit the stock and check that it has been given correctly. 4. YA32 The registered provider should make arrangements for staff to achieve their National Vocational Qualification Level 2 in care. The registered provider should arrange supervisors to have training in giving supervisions. 5. YA35 Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Woodhouse DS0000044679.V365046.R01.S.doc Version 5.2 Page 38 - 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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