Inspection on 25/07/06 for Woodlands

This inspection was carried out on 25th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlands 08/05/07

Woodlands 14/03/06

Woodlands 22/09/05

Woodlands 22/02/05

Woodlands 01/09/04

Woodlands 02/03/04

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 Woodlands Well Park Road Drakewalls Gunnislake Cornwall PL18 9ED Lead Inspector Philippa Cutting Key Unannounced Inspection 25th July 2006 10:00 Woodlands DS0000044246.V298220.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 Woodlands DS0000044246.V298220.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. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Address Well Park Road Drakewalls Gunnislake Cornwall PL18 9ED 01822 832451 F/P 01822 832451 woodlands@regard.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) The Regard Partnership Limited Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 5 people with a learning disability (LD) aged between 16 and 25 years. 14th March 2006 Date of last inspection Brief Description of the Service: Woodlands is an older style detached property set in its own grounds in the rural village of Gunnislake, on the edges of the moor. It is approximately 20 minutes from the nearest town at Tavistock and a further 20 minutes onto Plymouth. Gunnislake has rail & bus connections with the southwest. The home is owned by The Regard Partnership and provides care and accommodation in single rooms for up to five younger people with a learning disability and associated syndromes. It aims to concentrate on promoting independent living & social skills that will enable the service users to ultimately move on to a more independent life, rather than providing a permanent home. To this end high staffing levels are required, with frequent periods of one:one care. Planning permission has recently been granted for an extension to the building. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. It was conducted over two days although part of the second day was spent with Reside, the building & housing associates of The Regard Partnership (TRP), discussing plans for a new build in the grounds of Woodlands. The inspector spoke with the service users, staff and manager, studied records, and toured the premises. She had spoken with the adult learning disability team prior to the inspection and a social worker. A new manager has been appointed and this was the first time the inspector had met her. Two new service users have moved in the home since the last inspection. This is the first time that the home has been at full complement for at least two years. Whether it is the change in the dynamics or coincidental, one of the people who was already in the home is now exhibiting behaviours that are giving cause for concern. The manager has identified that the service needs to be re-vamped and is assessing what this might mean. Consequently few statutory requirements and recommendations are being made following this inspection in the belief that the manager will be instigating changes. Fees start from £1285.50 per week. What the service does well: What has improved since the last inspection? What they could do better: A more imaginative activity programme geared towards practical as well as pleasurable tasks needs to be introduced for the service users. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 6 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. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, Although Woodlands needs to ensure that it carries out its own evaluation of the information provided in order to assess a potential person’s suitability for the home, these standards were judged to be good overall. Producing the service users guide in an alternative format is good practice and helpful for some service users. EVIDENCE: The manager has revised the statement of purpose & service users guide. Copies are displayed in the home. The service users guide has incorporated pictures to help service users understand the text. It includes a clear explanation of the process if a person wants to make a complaint. Information was available on the new service users but this mostly seems to be details gathered from other people who had been involved in their care previously. A copy of Woodlands’ own assessment or how the information had been processed to make a decision about offering a place was not seen but the arrangements that were planned for visits & short stays before moving in was. Specialist services have been sought for the service users as necessary. In some cases this was from the local adult learning disability team and adult social care department or from TRP’s own resource team. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 These standards would benefit from some additional work but in the main were met, with the outcome being judged therefore as good. The advent of two new service users after such a long break should result in a total review of everyone’s care plans as the home’s dynamics have changed. EVIDENCE: The files & care plans of three service users were studied in detail. Files were put together in sections but seemed to contain quite a bit of duplication. A pen picture, likes and dislikes were recorded with goals and interventions. There was an element of jargon such as ‘establishing proactive strategies towards building links with other local organisations’ used rather than a clear English. The aims and objectives of the authority or person commissioning the placement were not stated in the records. There were some reports that were not dated, which diminishes their usefulness. One care plan was written in the first person singular but it was not apparent as to how the details were ascertained as the plan identified communication problems. The service user profile used by TRP was in a file but had not been completed, however there were other notes that supplied similar information. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 10 Where there were restrictions or other contra indications these were listed clearly. Some care plans were signed by the service users but not all are able to do so. The manager said that service users may see their files and the notes that are kept at any time. Entries in the daily log are discussed with service users if they wish. Woodlands helps the service users with their finances as most have difficulty in budgeting if left to their own devices. All transactions are carefully recorded. The home holds regular weekly meetings with the service users and staff where opportunities to express an opinion about things that have happened or things people would like to happen can be voiced. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 On balance the outcome for these standards was judged as poor. The practice did not appear to match the theory. Planned activity programmes were very relaxed and some appeared not to be actioned. If service users are to benefit from their stay at Woodlands a clearer understanding of their contribution needs to be established. EVIDENCE: Personal development is at the heart of the service offered by Woodlands. It states in its statement of purpose that it ‘seeks to provide a safe, secure and positive environment where users of our service can develop their skills and abilities and so achieve a better quality of life’. The inspector looked for evidence of this. By nature of its situation Woodlands does not have many activities or opportunities that are immediately accessible to service users; they have to travel to Plymouth, Tavistock or Saltash to access entertainment, college and day centres etc. People are therefore dependent on the home’s own transport, buses or taxis. There seemed to be little integration into the local small town apart from one nearby animal charity. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 12 The service users are expected to help with the daily tasks in the house, with assistance if necessary. This includes the normal domestic house chores such as cleaning their own rooms, helping with laundry and cooking. A wall chart shows the planned activities for each service user every day. The inspector felt that it was, in many instances, unimaginative. ‘Walk in the woods’ and ‘chill out’ appeared, the latter frequently in some cases; these did not seem to be things that would stimulate and engage the young men especially. If there had been a more specific purpose to a walk, such as a timed trail to increase fitness or bird watching for a twitcher, this would have been better. Staffing difficulties meant that one person was unable to attend an activity session of choice. The inspector noted that some service users did not appear downstairs before 11.15am or 12.45pm. The programme for at least one of these said that the day should begin at 8.0am. There are reasons why programmes are being disrupted at the moment but service users must be receiving a mixed message about how they are asked to participate in their care and what they actually do. The manager is keen to promote a better diet for the service users. She would like to show them that fresh food, properly prepared, would improve their general well being more than quick fix junk meals. To this end the menus are being changed - on the first day of the inspection a barbecue was arranged in the evening with some service users helping to prepare fish dishes. Everyone said afterwards that it had been successful and given people an opportunity to try dishes that they would not otherwise have done. Sitting in a room adjacent to the kitchen the inspector was aware that about midday there were a lot of people in there: she observed one person hanging round the door, one slumped in a chair & one wandering around. Two staff were discussing food for later, one was eating a sandwich and one was just standing in the kitchen. Whilst a kitchen is often the hub of a home this seemed to be excessive given the purpose of Woodlands. It was noisy and there was no active service user involvement. The inspector also noted that one person who has been identified as being underweight had not appeared by 1.0pm and presumably not therefore had any breakfast or other food. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The healthcare needs of service users are well met and the standards assessed as good. EVIDENCE: Personal support is provided for all service users according to individual need. A number need help or encouragement with personal hygiene, this is provided appropriately. People are encouraged, and do choose their own clothes etc. The local health centre and other professions ancillary to medicine meet health care needs. No one is currently undertaking his or her own medication, which is supplied to the home in a monitored dose system. This is carefully recorded and administered. The manager checks the medication administration record sheets regularly and queries any gaps or discrepancies should these occur. There was a discussion about one person for whom ‘prn’ medication has been prescribed and the circumstances and guidelines when this should be used. Staff who handle medication have attended a medication awareness course this year. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 14 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): 22,23 These standards are adequate. The complaints procedure is good but without the evidence that all staff have had PoVA training they are not judged as good as a whole. EVIDENCE: The complaints procedure is set out in the service users guide. It is clear and concise for service users able to understand and use it. The service users did not appear to be nervous of approaching staff if they had a worry but where there are communication problems, peoples’ body language or behaviour may indicate that something is wrong. The home has not received any complaints since the last inspection. A new leaflet has been put together on adult protection and the prevention of abuse. The training records seen by the inspector did not show that all staff had had training in this area. This needs to be checked and rectified where necessary. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 15 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): 24,25,226,27,28,30 The environmental standards were met and are therefore judged as good. The meeting relating to an extensive building programme discussed the need to safeguard service users & staff when work is in progress. EVIDENCE: The environment did not give cause for major concerns. Some service users have moved rooms at their request when there was the opportunity; others have had their rooms decorated in the colour of their choice. Some helped with the decoration. A broken drawer in a chest of drawers was seen in one room, another room had evidence of a hygiene problem that staff were aware of and were discussing with the person concerned. One person chose not to have his room inspected. There has been a problem with furniture, television and other items being broken by a service user. This has caused inconvenience for all the service users although they do have their own televisions in their rooms if they want to watch them there. The kitchen still acts as the main entrance to the home but this was not raised as a problem during an Environmental Health (Food Hygiene) inspection. The redevelopment plan for Woodlands will alter this. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 16 Some of the files have been removed from the office and are now stored in a locked room on the top floor in order to make more space in the cramped office. The office is not satisfactory as it is next to the kitchen making private conversations difficult as voices can be overheard and people need access to money and medication etc. Externally the garden was looking neglected, as the grass was long and not mown. The manager said she recently found a local person to take on the maintenance but he had yet to start. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 17 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): 31,32,34,35,36 The Regard Partnership (TRP) has an active training facility and recruitment system for staff that indicates that these standards are good. However more enthusiasm from staff would be advantageous. EVIDENCE: The staff team is a mixed group by age and gender. Staff have job descriptions for their rôles; a keyworker system is in place for working with service users. Staff have access to the home’s policies and procedures but the manager has said that she feels these need to be redeveloped. Staff ratios have been adjusted recently so that not all service users have one:one staffing at all times but there are still some difficulties in supporting one person whose needs have changed recently. This is under discussion with the purchaser of the Woodlands service. The recruitment process for employing new staff meets the national minimum standards with two references, Criminal Records Bureau checks and PoVA First being sought before anyone starts work. The manager is aware that a new induction programme – Skills for Care - will need to be introduced shortly. A training programme is in place for all staff, organised from TRP’s offices in Plymouth. TRP is making increased use of CD ROMs for training as well as in Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 18 house training sessions. Staff said the CD ROMs were ‘ok’ as they had work sheets to accompany them. Some of the staff with whom the inspector spoke seemed very dispirited about their National Vocational Qualifications courses. They felt they lacked direction and the time scales to finish seemed impractical but the inspector did not ask when they had originally enrolled. The information supplied indicated that some staff had done a Learning Disability Adult Framework (LDAF) course but in response to questions they said it had only been a very basic introduction. Supervision has been restarted having fallen into a lull after the last manager left. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 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): 37,38,39,41,42 As the home is about to undergo a re-evaluation of its service these standards are judged as adequate rather than good. The process of introducing change will need to be embraced by all staff as the regime at Woodlands has become staid. EVIDENCE: The home has a new manager who is experienced in various residential care provisions. She is aware that Woodlands has drifted for too long with the same few service users and the service needs to look at what it does best and which service user group it can best serve. This will include reviewing policies and procedures. TRP has a quality audit document in place with a designated person from the group’s office responsible for conducting this. The records requires by statute are kept as well as other documentation prepared by TRP. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 20 Better arrangements need to be in place for storing items under COSHH – they should be kept locked when not in use – being in the office is not sufficient. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 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 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 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 2 3 X 2 2 x Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA23 Regulation Schedule 2 Reg 19 Requirement The registered provider must ensure that all staff have had training in the prevention of abuse and the protection of vulnerable adults. Timescale for action 31/10/06 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 YA42 Good Practice Recommendations All cleaning substances, etc used in the home should be stored in accordance with COSHH regulations. Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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. Extracts may not be used or reproduced without the express permission of CSCI Woodlands DS0000044246.V298220.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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