Inspection on 09/06/09 for Woodhouse

This inspection was carried out on 9th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodhouse 17/07/08

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 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Woodhouse Wigton Crescent Southmead Bristol BS10 6DS Lead Inspector Sandra Jones Unannounced Inspection 9 & 10th June 2009 12:00 th Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Woodhouse DS0000044679.V375929.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 Manager post vacant Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Woodhouse DS0000044679.V375929.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. 10th December 2008 Date of last inspection Brief Description of the Service: Woodhouse is operated by Shaw Healthcare (Specialist Services) Ltd, whose aim is to provide ‘the best possible care and related support services for those who are unable to care for themselves without help’. The home provides accommodation and personal care for up to sixteen people with a learning disability aged 18 to 65 years. A variation has been agreed to provide care for two people aged over 65 years. Woodhouse is a purpose built facility, 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. Each person has high ratios of staff support. The people who currently live in the home are supported on a one-to-one or two-to-one basis. 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). Woodhouse DS0000044679.V375929.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 one star. This means the people who use this service experience adequate quality outcomes. This key inspection was conducted unannounced over two days in June 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the home was opened and this information was used to plan the inspection visit. This included the Annual Quality Assurance Assessment (AQAA) and notifications from the home. At the time of the inspection there were eleven people accommodated and five individuals were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. Face to face discussion occurred with three people at the home, the manager, deputy manager and support workers. Interaction between staff and people living at the home was also used to support the findings of this inspection. What the service does well: The people at the home told us that they are asked about the way their care is to be delivered and are told by the staff how things are going to be done. The also said that they are able to make decisions and experience a range of Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 6 activities. These individuals confirmed that they knew who to approach with complaints and the staff knew what to do for them. One relative was asked about the standards of care at the home and their comments indicated that there is continuity of care, they are invited to reviews and are informed about important issues. The staff welcome visitors which can take place in the bedrooms for additional privacy. What has improved since the last inspection? What they could do better: One requirement is outstanding from the last inspection which relates to records of challenging behaviour and six requirements arising from this visit. Risk assessments that include strategies for behaviours that challenge must include staff response to diffuse and divert potential aggressive and violent behaviour with any physical intervention used. This will ensure that there is a consistent approach by the staff to people that present with behaviours that challenge. Care plan must show that people at the home have input into shaping their lives. The manager must ensure that people have a say about the way their care is to be delivered, monthly summaries must plot the progress made and Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 7 for people with sensory needs, care plans must show the way their independence will be maintained with moving around the property. Risk assessments for activities that involve an element of risk need to be further developed. The options available along with the action necessary must be included along with action plans to reduce the level of risk. This will establish that the actions taken are consistent with the level of risk. Protocols for ‘when required’ medications must be clear about the behaviours that can be exhibited before the medication is administered. This will ensure a consistent approach and reduce misinterpretation by staff. Specific training must be provided to meet the needs of the people accommodated. This will ensure that staff have the insight and current good practice guidance to meet the changing needs of the people at the home. Individual supervision must be provided at regular intervals to ensure that performance and development is individually discussed with the line manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Woodhouse DS0000044679.V375929.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.V375929.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (1)& (2) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide must inform people wishing to live at the home about the way their needs will be assessed which ensures the staff can meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide were recently reviewed and defined is the philosophy, services and facilities of the home. It says that the philosophy is to provide a safe and stimulating environment, supported by experienced staff with an awareness of the difficulties and barriers that the individual’s disability and behaviour may present. At present there are five vacancies and depending on the rating of the home, referrals for accommodation will mainly come through referrals from the Local Authority. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 10 The manger was consulted about the way the diverse range of needs that include autism, mental health, behaviours that may challenge, physical and sensory needs are met at the home. We were told that individual’s needs are met by core teams that have specific staff appointed because of their specialism with the area of need. The criteria for admission to the home are listed in the Statement of Purpose with a separate procedure supplementing the listed criteria. It is stated in the organisations policy that assessments in advance of admissions to the home must take place. The policy requires reviewing to include the assessments that would be conducted before the admission. This is particularly important as the home offers accommodations to a wide range of needs. It is therefore important that the manager undertakes a robust assessment of need to determine if the staff have the skills to meet the needs of the people wishing to live there. Introductory visits and trial periods offered before admission are not detailed in the procedure and must be added. This will further ensure that the suitability of the person is assessed before they move into the home. At the previous inspection, it was reported that the homes pre-admission assessment was not adequate. The manager said that admissions to the home are mainly based on the suitability of both parties. An assessment checklist is now in place and will be followed to determine that the skills of the staff can meet the needs of the people wishing to live at the home. The manager explained that the Local Authority would generally make referrals for placements and needs assessments from the social worker must be provided. A homes needs assessment undertaken by the manager or deputy is followed with introductory visits that include four visits with overnight stays and trial periods. Woodhouse DS0000044679.V375929.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (6), (7) & (9) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home must be more involved in the planning process so that they can shape their lives. Care planning must be key to providing consistent and personalised care to the people at the home. EVIDENCE: The manager explained that care plans were reviewed and updated to reflect the individual’s current need and staffs knowledge of their likes, dislikes and routines are evident in the care plans. It was confirmed by the manager that people at the home attend review meetings and completed Quality Assurance questionnaires show that people at the home can shape the life they lead. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 12 Care plans examined are detailed and there is a vast improvement in the quality of the information. There is a pen portrait of the person with their likes. dislikes and daily routines. Support plans are in place for each area of need and mainly focus on personal care, health needs, eating and drinking, relationships and finance. It is evident from the support plans that the actions plans are written with specific knowledge about the way staff believe the care is to be delivered. While there is some evidence that people are involved into the planning of their care, they must have more input into shaping their life. Support plans are monitored monthly, members of staff report on each area of need. However, the information included within the monthly summaries is brief. The purpose of the monthly summaries is to plot the progress made on each area of need so that support plans can be amended where changes occur. For people with mental health care needs, the diagnosis and the way it presents is included in the support plan. Management risk assessments and support profiles are then developed and described are the known triggers, the interventions and the when required medications that can be administered. These are signed and reviewed along with the support plans. We were told by the deputy manager that the keypads in place were disarmed with the exception of the front door and kitchen door. The deputy manager said that other locked areas include the Spa room and COSHH cupboard for safety. Specific risk assessments are in place for individuals that have restrictions placed on freedom. While the use of the keypad to leave the building may be appropriate, the reasons for having them to enter the building in terms of safety of the people at the home cannot be established. A risk assessment for using the door entry system must be undertaken, this assessment must show the options available, the level of risk attached to each option and the actions to be taken to lower the risk. Support plans for people with autism are based around communication needs and intensive interaction is the approach used to engage with the person. As already mentioned, monthly summaries must show the progress made with this method. Members of staff were observed using this form of communication to engage with people that have communications needs. People with sensory needs are accommodated in the home and support plans do not currently show the agencies used to support people to maintain their independence with moving around. Support plans must show how the environment was adapted to maintain the individual’s level of independence with their surroundings. Communication needs form part of the support plans and listed is the way people communicate and for some they are more detailed than others. Support plans do not currently describe the way people make choices, for Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 13 example physical choices. Advocates, IMCAs and Learning Difficulties liaison nurses are used where people need support to make decisions over aspects of their lives. The deputy manager told us about the keyworker system, there are four core teams, which are divided into staffs ‘specialism’ for example, autism, mental health and learning difficulties with the deputy and team leaders leading the teams. Each group has team leaders and senior support workers who act as keyworkers. We spoke to three people at the home and the three staff supporting them about the care planning process. These individuals said that their support files are held in their bedrooms, they are asked about the way their care is to be delivered and staff explained how things are going to be done. Support workers said that in the past support plans were devised by team leaders and the manager but since the appointment of this manager, staff are more involved in the care planning process. Risk assessments and management plans are in place for activities that may involve an element of risk and for behaviours that may challenge. For activities that may involve an element of risk, the level of risk is listed and the seriousness associated with the activity. However, the options considered along with the level of risk attached to the option are not detailed within the risk assessment. It is difficult to determine from the risk assessments that the actions taken are consistent with the level of risk. Risk assessments must include the options considered for each activity with the risks attached and an action plan that reduces the level of risks Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 14 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): This is what people staying in this care home experience: (12), (13), (15), (16) & (17) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for people to experience community activities. However, there are little opportunities for learning activities and independence living skills. EVIDENCE: Activities form part of the care planning process and for each person there is a goal plan, which includes the individual goals ranging from independent living support, in-house and community activities and improving the environment. A weekly activity plan is devised and staff record whenever these activities have taken place. Opportunity charts are completed by the staff and show that opportunities exist for in-house and community activities. The manager told Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 15 us that an activities coordinator is employed to develop activity programmes and to compile history books with each person. However, there is little evidence that people are making progress with their identified goals. Three people were consulted about the way they spend their days. One person described their daily activities which included cooking and going out to the pictures. We were also told that that in September they are attending college. Another person told us that they enjoy listening to music, cooking, drawing and going out on the bus. Support workers were asked to comment on the way people are supported to be independent and treated as individuals. Staff told us that people are given choices and they endeavour to take people out on community activities. These include clothes shopping and visiting the local shops. The arrangements for visiting are included in the Statement of Purpose and Service User Guide, which says that visiting, is open. The importance of maintaining contact with family and friends is recognised and commits to supporting people with keeping links with relatives. The people at the home told us that their visitors are welcome and private visits are conducted in bedrooms. One relative gave feedback about the standards of care observed at the home. This relative told us that they are invited to review meetings; they can read care files and make comments in the daily reports and are informed about some important health issues. It was also confirmed that visiting is open and visits can be conducted in bedrooms for additional privacy. The Service User Guide commits to personalised living where people have a say about shaping the lives they lead. The rights of the person are listed along with the way people can expect to be treated by the staff. It is easy read, with simple formats and pictures so that it can be understood by those people for whom it’s intended. The Privacy and Dignity policy is included within the Statement of Purpose and states that these rights underpin the homes and organisations philosophy. The rights of people at the home are part of the staffs induction, which ensures that staff know about the rights of the people at the home. Staff gave examples that show people are treated with respect. The comments from people at the home indicated that the staff respects their rights. Their comments included that the staff pull curtains before providing personal care and they knock before entering bedrooms. Comments were sought from the manager about the way people supported with living skills. The manager told us that there is an expectation that people participate in household chores. However, the manager recognised that people Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 16 are not participating in household chores. While there are activities taking place, people at the home must be empowered to be more independent. Information about healthy living and daily pictorial menu choices are on display in the dining room, it is symbolised with pictures and words. A chef and senior cook are employed by the organisation to prepare meals and they told us that they seek the likes and dislikes of the people accommodated to devise healthy balanced diets. It was further stated that where people have limited likes, they are tempted to increase the variety of food. The menus examined show that people have a continental style breakfast prepared by the staff in the skills kitchen, a cooked lunch and tea. We were told that there is a four weekly rolling menu, which change with the seasons. The range of food held in the kitchen confirmed that people have a varied diet. At a recent Environmental Health inspection, the home was given five stars for their food safety. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (18), (19) & (20) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs of the people at the home are adequately met. Medication protocols must be more detailed to ensure they are not open to staff’s interpretation. EVIDENCE: Personal care is part of the care planning process and as previously mentioned in this report, information is detailed and there is evidence that staff have specific knowledge of the person. More detailed information from the individuals about the way their care is to be delivered and reviews summaries need to show the progress made with the assessed needs. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 18 Health files are separate from support files and are held in the office. Personal and professional details, medical history, appointments and risk assessments are included. Personal details give and overview of the persons current health and prescribed medication. Medical sheets show that people access the Community Learning Disability Team (CLDT), other health and social care professionals and NHS facilities, for example, dentist. Within the medical sheets there is a section for staff to report on the outcome of the health visits. Consultations sheets are more detailed and state the current medical history along with the actions to be taken as a result of the visit from health and social care professionals. Correspondence from these professionals shows that people access specialists. However, there is no clear audit on the way that their advice is actioned by the staff. For example, the way Speech and Language guidelines are put into action. The Barthel model of assessing the individual’s ability to maintain their independence is used to provide the necessary assistance needed from the staff. The persons level of dependency is assessed through their ability with personal hygiene, mobility, eating and drinking and communication. The individual’s level of dependency is then identified through the total score given to each task, for example, 35-40 low dependency. A waterlow risk assessment is completed for each person and depending on the score, a risk assessment is completed. Manual handling risk assessments were reviewed, they are ongoing and there is evidence that health care agencies were used to reassess risk assessments. We were told that physiotherapist’s visits are requested where they are ongoing needs. Three staff were consulted about the systems in place to ensure individual’s health care needs are met. Staff told us that the body language of people with communication needs is used to monitor their health and people living at the home are accompanied on health care visits. Handovers and daily reports are used to ensure that medical advice is pass information from shift to shift. A monitored dosage system is used to administer medications and the records of administration sheets show that staff sign the records after administration and use appropriate codes to record the reasons for not administering the medication. Medication profiles are held in support plans and describe the purpose of the medication, its side effects and compatibility with other drugs. When required protocols included in the profiles would benefit from more detail, as currently it’s open to staffs interpretation on when these medications are to be administered. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 19 A record of medications no longer required is maintained and signed by the pharmacist to indicate receipt of the medication for disposal. Woodhouse DS0000044679.V375929.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (22) & (23) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home can be reassured that their concerns are taken seriously and acted upon and they are protected from abuse. Risk assessments for people that may present with aggressive and violent behaviours must be more detailed to ensure their rights and best interests are protected. EVIDENCE: There is symbolised Complaints procedure on display in the entrance of the home, the main lounge and included in the Service User Guide. The records of complaints were examined and there were no complaints recorded since the last inspection. The home has received three letters of compliments since the last inspection about the skills of the staff. Three people at the home were asked if they knew whom to approach with complaints and did they feel safe at the home. Three people told us that they would approach the staff with complaints and they felt safe. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 21 Feedback was sought from three staff about complaints and their responsibility towards safeguarding people from abuse. Members of staff told us that complaints would be passed onto team leaders. Their comments also indicated their awareness of the procedure and their responsibility to record complaints. In terms of the Safeguarding Adults from abuse, the staff knew the factors of abuse and the expectation that they report poor practice. The Safeguarding Adults policy specifies the factors of abuse and describes the actions to be taken. There was one safeguarding referral made about alleged abuse, which the home was asked to investigate. The WhistleBlowing policy makes it clear that staff that report poor practice will be protected. While the purpose of the policy is to allow staff to report poor practice without reprisals, the consequences for staff that do not report poor practice is not included. The WhistleBlowing policy must tell staff that they may be subject to disciplinary procedure if they witness poor practice and dont report it. We were told that a positive approach is used, where no one is judged by the behaviour they present and working with individuals when they present challenges to reduce the number of episodes. Diffusion, diversion, re-directing and safe working distances is the approach used for people that may exhibit aggressive and violent behaviours. It was further said that physical intervention is at a last resort and staff attend Positive Response Training (PRT) that is specific to the person. At present the staff may use PRT on two people for personal care and medication and a multidisciplinary team signs PRT guidelines in place. However, the techniques to be used and the intensity and times are not included in the risk assessment strategy. The manager must ensure that risk assessment strategies for people that may exhibit aggressive and violent behaviour include the techniques to be used, the intensity and the length of time that can be used on the person. Two people at the home consulted confirmed that at times they can become angry. They said that ‘walk away’ was the instructions given whenever people became aggressive and/or violent. Members of staff said that they attend PRT training and the approach is guiding people to diffuse the situation. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (24) & (30) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Woodhouse provides a homely, comfortable and safe environment for people at the home. EVIDENCE: Woodhouse is a purpose built home in a residential area. It is close to shops and other amenities and people can access bus routes to the nearby areas. There are gates on the entrance and car parking spaces at the front of the home. The home is spacious and light, is tastefully decorated and pictures by people living here have been hung on the walls. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 23 There are eight rooms and eight flats. The flats have a bedroom, living room, bathroom and a kitchen: this is potentially very useful in enabling people to learn independent living skills. Rooms are large, all with en-suite facilities. We meet some people in their own rooms or flats during our visits and rooms were clean and tidy. People are supported to personalise their rooms by choosing colour schemes and having many personal items, pictures and photographs, which help with the homely feel. Some people have their own small garden, and everyone who lives here can use the communal garden area when they wish. There are large, open, light, lounge areas on the ground floor, both with televisions, sofas and chairs. There is an additional smaller lounge area, in between corridors, which is quieter. The spa is fixed and the spa room re-decorated. It is hoped that by improving the décor, and encouraging staff, that service users may make better use of this facility as it is clear that some people enjoy hydrotherapy or swimming. Some people have washing machines in their flats, which are used. There is a laundry room with facilities to ensure that soiled clothing and bedding is appropriately cleaned. The home employs people to clean the home and work in the laundry. It is not clear how much service users are involved in keeping their home clean and tidy. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (34), (35) & (36) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported by better trained staff, further training must be provided to ensure staff have the skills to meet the individuals changing needs. EVIDENCE: The manager said that there are no staff vacancies, the home rarely relies on agency staff and bank staff are only used to cover sickness, training and annual leave. The personnel files of the two most recently employed staff were examined and the completed application forms require full employment history, the names of two referees and disclosure of criminal background. Written Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 25 references are authenticated and Criminal Records Bureau checks obtained are held in the files supporting a robust recruitment process. The homes training records show that there is an induction programme for new staff and statutory training that includes Moving and Handling, Food Hygiene, Infection Control, Safeguarding Adults, Health and Safety is attended. Specific Dementia, Epilepsy, Eyes and Hearing training was provided and attended by 26 staff. However other specialist training that includes Autism and mental health training is outstanding. The manager must ensure that staff attend specialist training to ensure they have the insight and skills to meet the diverse range of needs that people at the home have. The manager told us that while vocational qualifications is encouraged, less than 50 of the staff have NVQ level 2 and above. The records supervision show that staff are having more individual’s supervision. The practice of core team supervision continues and the deputy explained its purpose. We were told that staff are coming up with ideas, there is more ownership and staff are more challenged. The manager recognises that the home must move away from group supervisions to more individual supervision. In future supervision will follow a set agenda and an action plan will be devised from each supervision session to be followed-up at subsequent sessions. Members of staff consulted gave feedback about the arrangements for supervisions. The staff told us that group supervision occurs regularly and they understand that individual supervision will be taking place more regularly. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (37), (39) & (42) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is strong leadership and people at the home benefit from the ongoing monitoring of standards. EVIDENCE: Comments about the style of management used were sought from the manager. We were told that a clear, honest approach where only excellent Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 27 staff are employed is used so that standards of care can be exceeded. It was also stated that the skills base ensure that staff can meet the needs wants and aspiration of the people at the home and the staff have worked hard to improve the quality of care. In terms of maintaining consistency the manager told us that supervision, audits and evaluation of records ensure that the home is moving forward. The people at the home told us that the staff are ‘ok’ and they know what to do for them. The comments from staff about the leadership style used were sought from three staff who told us that an approachable style where the manager is open to suggestion is used. It was also stated that the management style ensures that people needs are met and since the appointment of the manager, there is closer monitoring of staff and people have more choices in particular meals. The rotas were examined and during the day, with the exception of one, there is 1:1 staff support throughout the day and five people have additional hours for activities. At night there are eight staff rostered to support the people at the home. Management presence is maintained by the manager, deputy and team leaders who rostered on every shift. There are systems in place which are designed to support health and safety within the home. The fire risk assessment in place shows that the potential for an outbreak of fire is assessed and appropriate action taken to reduce the level of risk. Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 3 x 3 x x 3 x Version 5.2 Page 29 Woodhouse DS0000044679.V375929.R01.S.doc 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 YA6 Regulation 15 Requirement a) The manager must ensure that people have input into their support plans. b) Monthly summaries must plot the progress made in the care plans. c) Support plans for people with sensory needs must show the way their independence with moving around the home is maintained. Risk assessments must detail the options considered with the level of risk attached and the actions that must be taken to reduce the level of risk. People at the home must have better opportunities for independent living skills training. Protocols for ‘when required’ medications must be specific about the times and the behaviours for which the medication is DS0000044679.V375929.R01.S.doc Timescale for action 30/10/09 2. YA9 13 30/08/09 3. YA12 12 30/10/09 4. YA20 13 30/08/09 Woodhouse Version 5.2 Page 30 prescribed. 5. YA23 13(7)13(8) Incidents of challenging behaviour, together with staff responses, must be clearly recorded. This must include restrictive physical interventions, if these are used. This will ensure clear records are maintained for each individual and promote their welfare and safety. This requirement is repeated from the previous inspection. 6. YA35 18 Members of staff must attend specific training to ensure they have the knowledge and skills to support people appropriately. Members of staff must receive individual supervisions as recommended by NMS. 30/11/09 30/08/09 7. YA36 18 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodhouse DS0000044679.V375929.R01.S.doc Version 5.2 Page 31 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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