Inspection on 24/03/06 for Woodhouse

This inspection was carried out on 24th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodhouse 09/06/09

Woodhouse 17/07/08

Woodhouse 20/09/07

Woodhouse 18/10/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Woodhouse Wigton Crescent Southmead Bristol BS10 6DS Lead Inspector Karen Walker Unannounced Inspection 24th March 2006 09:30 Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 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.V283912.R01.S.doc Version 5.1 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.V283912.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Woodhouse Address Wigton Crescent Southmead Bristol BS10 6DS TBA TBA 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 Adrian Peter Smith Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 16 persons aged 18 years to 65 years. May accommodate one named person with a learning disability aged over 65 years. Registration will revert to 18 to 65 years when named person leaves. 27th September 2005 Date of last inspection Brief Description of the Service: Woodhouse Care Home 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 one named person aged over 65 years. When this person leaves the age range the home will revert back to sixteen persons aged 18 to 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 apartments have en-suite bathroom/toilet facilities, a large living area, and optional kitchen facilities. The flats consist of a lounge, bedroom, kitchen and bathroom facilities. Individual accommodation located on the ground floor has small patio gardens. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection as part of the annual inspection process to examine the care provided, and review the progress and actions taken in relation to the requirements and recommendations made during the last inspection conducted in September 2005. The inspector met with the manager and 3 other members of the staff team. Residents were spoken with alongside their relatives if available. Staff members were also observed interacting with residents. 4 residents were case tracked and documentation examined in respect of them, meetings with their key-workers also took place on an informal basis to ascertain the quality of service provision. Other records relating to the management of the home were examined alongside policies and procedures relating to health and safety. What the service does well: What has improved since the last inspection? All of the requirements and recommendations made at the last inspection have been met. Action has been taken to improve one person’s individual accommodation by providing robust furniture. The complaints policy is in place and the manager confirmed that all Complaints are dealt with within the appropriate timescales. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 6 Residents do not have restrictions placed upon them and a team leader confirmed that residents are enabled to be a part of the community. The manager confirmed that the appropriate safety harness is in place to ensure access to the community in the house vehicle. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 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 Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Residents have the necessary information to make an informed decision about where to live. They can feel confident that their assessed needs will be met and care packages reviewed. Residents’ will benefit from access to their personal contracts detailing the terms and conditions of occupancy. EVIDENCE: Through case tracking and the examination of care files it was noted that residents’ contracts were not on file. This was confirmed by the manager who said that these were held at the Trust Head Quarters. The contract must be agreed with each resident stating the terms and conditions of occupancy, what room they will occupy and the fees they are expected to pay. Two residents when asked were unaware of the content of their contracts. There are currently 5 vacancies at this home and the manager and the team leader explained the admissions process. Prospective residents are given the statement of purpose and additional information to enable them to make a decision about choice of home. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 9 There is a detailed admission process in the home that focuses on the needs of the individual as determined through the assessment process. Placements at the home are normally funded through the Health Authority in conjunction with the Social Services department. Detailed assessments from various professionals involved with the individuals are provided with the initial application. Each admission would be on a planned basis and visits to the individual in their home or present placement would be part of the assessment process. Planned trial visits to the home would be arranged in line with the needs of the prospective resident. Each admission package is tailored to meet the needs of the individual and the needs of those already living at the home are also considered. Evidence of individual care plans developed from information gained through the assessment process was seen on file. Personal aspirations, family involvement and health care profiles were included in the plan. Residents are confident that their assessed needs will be met and that staff receive the necessary training needed to support their needs and meet their goals. Training records were examined and sessions found to be varied depending on the needs of the residents. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Residents will benefit from a more detailed care planning record to compliment the Essential Lifestyle Plans already in place. They can feel confident that information held about them is handled appropriately. Residents are able to make their own decisions and choices in everyday life and will benefit from further input into the risk assessment process including the management of PRT. EVIDENCE: The inspector met formally with four residents and discussed their individual care packages. Permission was given to examine documentation in respect of them and key-staff members were spoken with. Where possible relatives gave their view on service provision. It was clear that residents spoken with were aware of some of their goal plans and associated risk assessments. A recommendation is made however to ask residents to sign their own plans where possible. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 11 One resident said, “If I want to I can see my notes”. The Essential Lifestyle Plans (ELP’s) seen were respectfully written in the first person. One new plan was being developed with the resident over a period of time, as there were plans for her to move to a supported living set up. The resident confirmed that the plan detailed her wishes and choices. The lack of ‘care plans’ was discussed with the manager who agreed that ELP’s as a stand-alone document were not sufficient to detail the individualised procedures needed to meet goals and goal steps. The inspector was assured that the Shaw Trust were to be issuing new care planning templates shortly. Progress with regards care planning will remain a theme of the next inspection. Staff members spoken with conveyed to the inspector a good understanding of the residents needs. One resident said, I am happy here and I have friends, I like to help the older people”. She added, “the staff are nice and they are helpful”. Staff members were observed carrying out their one to one supervision of residents and it was noted that for one person the session consisted of listening to loud music. Discussions were held with one team leader and ideas put forward to ensure interactions are positive and beneficial to the resident. Records show that resident meetings take place and residents are also able to join in staff meetings. There was evidence to shown that residents were able to choose and plan their own room decoration and make choices relating to everyday routines. Risk assessments were varied but one seen was not signed or dated thus making it difficult to measure and review progress. The use of Positive Restraint Techniques (PRT) is recorded in some risk assessments but they lack detail as to when or how to use it. This was discussed with both a team leader and the manager. A clear action plan is needed that includes any triggers to a behaviour that may challenge, when to intervene and how. It must also be made clear that a competent member of staff who has received the necessary PRT training can only perform PRT. The manager said that restraint was a last resort and other methods for diffusion were preferred. There is a confidentiality policy in place and a staff member confirmed this was given and explained at induction. Staff members were aware of when they must break a confidence and one staff member said, “this must be done if a resident is at risk or puts others at risk”. Records were appropriately stored and residents knew that their records were confidential. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15,17 Residents will benefit from a much-improved menu with healthy choices of fresh produce. Residents are supported with making and maintaining personal relationships. EVIDENCE: One relative confirmed that she and other family members visited the home frequently and were made to feel welcome. A resident said, “Staff are helping me with my mothers day card, I go home a lot and go swimming with my mum once a week”. A staff member confirmed that residents are supported to visit relatives and friends and are often provided with house transport and staff support. Social gatherings are held in the house especially to celebrate birthdays and special occasions. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 13 Relatives meetings take place approximately every other month and are typically followed by a social get together. This is commendable. One staff member said ‘ we keep these meetings positive and have put a ‘compliments file’ in place to go alongside the complaints file.’ The opportunity was taken to meet the temporary chef and examine the kitchen and menu plans. The days meal of fish was well presented and looked appealing. Whilst it was noted that the menu was somewhat unimaginative and there was no emphasis on fresh produce the manager told the inspector of the positive changes that have and will take place. He now has an arrangement with the local green grocer and butcher and all fruit, vegetables and meat will now be fresh. A pictorial menu book has been started and this will help residents to make an informed input into menu planning. The meal of the day will be displayed pictorially to ensure residents know what they can expect. This is good practice. Other residents spoken with said they preferred to make their own meals in their apartments and confirmed that they could choose the menu. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X EVIDENCE: These standards were fully assessed and met at the last inspection and have not been reassessed. It was noted through records and residents confirmed that health care professionals were accessed where necessary. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X EVIDENCE: These standards were fully assessed and have not been reassessed at this inspection. There are adequate policies and procedures in place to protect residents from any form of abuse or self-harm. The complaints procedure is detailed and provides timescales for action. The organisation has in place a comprehensive training and development programme that includes abuse awareness. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,28,29,30 The environment is a pleasant place for residents to live but would benefit from maintaining a more homely appearance in some rooms. Residents’ bedrooms are suited to their needs and promote independence. Specialist equipment is in place and available to residents. EVIDENCE: The inspector was invited to view a number of residents bedrooms and noted that each reflected the individuals’ personality. One bedroom contained sensory equipment fixed to walls whilst another was quite minimalist. A relative commented, “The rooms are great, a good size and well decorated. There are plans to add a sensory garden especially for ...to use”. Improvements have been made to the garden area, with the addition of colourful sensory decorations appropriate to meet the diverse needs of the residents. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 17 The rest of the environment was pleasantly decorated although the walls were quite stark and the large ‘sun room’ felt empty. The manager has begun to address this issue and wall plaques have been added. Suggestions were made to involve residents in the decoration of walls by contributing their own artwork and paintings etc. This is being considered. There are also plans to make a sensory room available to residents and this will be in place of the ‘keep fit’ room, which is hardly used. The life skills kitchen was in use and it was evident that residents were supported to make snacks and meals of their choice. Staff confirmed the spa room was a favourite with residents. The room was warm and inviting. Risk assessments are in place for its use. There is a hoist available that staff confirm is mainly used to help residents up from the floor when they choose to put themselves there. Two of the staff members are manual handling trainers and all staff are trained in the use of the hoist. Regular equipment checks take place. The home was generally clean and tidy. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36 Residents benefit from an appropriately trained staff team who are well supported through supervision. EVIDENCE: The manager ensures that staff are well trained in order to meet individual resident needs and they up to date with statutory training. This is addressed in supervision sessions and staff meetings. Staff are aware of the supervision policy, which includes the statement, “Continually improve work performance”. Minutes of the last staff meeting were seen and staff confirmed that they were all given the General Social Care Council Code of Conduct. The minutes also detail plans to address ‘good work’ by staff and identify ways in which they can feel valued. After each staff meeting care staff are asked to complete a ‘reflective form’ this is good practice and ensures staff have an understanding of what was discussed and what they can learn from an experience. Formal supervision of staff is taking place on a regular basis. Staff members spoken with confirmed adequate support. One team leader explained support and guidance was received form the manager to ensure consistency in the implementation of formal supervision. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41,42 Residents feel confident that their views are listened to and acted upon and that records relating to them are well written and respectful. The health, safety and welfare of residents is generally promoted however improvement must be made with regards the testing of the fire alarm. EVIDENCE: Residents spoken with were confident that they could make their own decisions within the home and get the support they needed. They were also aware of the rights of residents with regards going into bedrooms uninvited. One resident said, “We had a meeting about how to treat each other”. A team leader said, “there are a number of ways residents can make their views and choices known, meetings, key-workers, team leaders, the home manager etc. Any concerns and requests are fully recorded”. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 20 At the last inspection a requirement was made to ensure all restrictions were recorded with adequate detail as to why the restriction was in place. This was in relation to one person’s use of the house vehicle. The manager explained this was now not an issue and the person had the correct safety harness to enable safe access to transport. The fire logbook was examined and it was noted that the fire alarm testing was not taking place within timescales prescribed by the Fire Brigade. Also call points were randomly tested which meant that one hadn’t been tested for a number of months. It is recommended that fire call bells be tested in sequence ensuring that each is regularly tested. The fire logbook didn’t contain any staff training details. It is recommended that details be kept in the logbook including the date, duration of training and by whom and name of the staff attending. This will ensure ease of audit and show at a glance who needs updated training. Records were generally in good order however it was noted in the communication book that entries have been scribbled out and were illegible. Staff are reminded that this is a legal document and entries must remain legible. Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 21 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 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X 3 X 3 2 X Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 22 NO 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 YA5 Regulation 5(c) Requirement Timescale for action 01/05/06 2 YA9 3 YA42 All residents must receive a copy of their contract and terms and conditions of occupancy. 13(4)(c) Risk assessments referring to 13(6) the use of PRT must be detailed and include triggers, positive intervention techniques, when and how to use. 13(4)(a)(b)(c) Fire alarm testing must take place within timescales dictated by the Fire Brigade. 01/05/06 10/04/06 Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The resident as well as the key-worker/team leader should sign all essential life plans, risk assessments and other documentation relating to them. All should be dated. Historical information should be removed from the care files and stored securely. Make shared spaces more homely in appearance by encouraging residents to contribute their art work/paintings etc. Test call bells in sequence ensuring that each is regularly tested. Plan tests throughout the diary so that is not left to one person. Include staff training details in the fire logbook. 2. 3 YA19 YA24 4 YA42 5 YA42 Woodhouse DS0000044679.V283912.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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. 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