Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Woodside Farmhouse Edgecumbe Road St Austell Cornwall PL25 5SW The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Tworkowski Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area
Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to: ï· Put the people who use social care first ï· Improve services and stamp out bad practice ï· Be an expert voice on social care ï· Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information
Document Purpose Author Inspection report CSCI
Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home
Name of care home: Address: Woodside Farmhouse Edgecumbe Road St Austell Cornwall PL25 5SW 0172677401 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): westwood-sharon@btconnect.com Meadowbank Care (St Austell) Ltd Name of registered manager (if applicable) Mrs Sharon Irene Westwood Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection 1 4 0 1 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Woodside Farm House is registered to provide accommodation, care and support for five people with a learning disability. The home accommodates people who may present challenges. The house is on the edge St Austell, and set back from the road. It is within walking distance of the shops and transport from the centre of town. The service has a number of vehicles and provides transport. The accommodation is divided into two flats each with its own lounge, dining room and kitchen, and therefore offers people the opportunity to live in a small group. All of the bedrooms have en-suite facilities. The Registered Provider owns another care home in Devon. The fees at the time of this inspection are 2200 pounds per week, although care packages are agreed on an individual basis, this fee includes all transport though not personal items such as clothing and toiletries. Care Homes for Adults (18-65 years) Page 5 of 29 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home This inspection included an unannounced site visit that took place between 9.45am and 4.40pm. The visit was carried out by one inspector, though the term we is used throughout the report, as it has been written on behalf of the Commission. As part of the site visit we looked around the house, we ate lunch with one of the people who lives at the home, we talked with a relative, and we talked with two of the staff. The manager was present during the second part of the visit. We focused on how the care needs of two of the people at Woodside are met and we looked at their records of care. In addition we looked at the medication system and at the way restraint and challenging behaviour are managed. We also looked at the management of staff, including recruitment and training, and at the way people are kept safe. In addition we received information from the Manager in the form of a annual questionnaire. We also spoke with two of the care managers for people at the home. We sent surveys to all of the people living at the home, and received four back. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well People can do the things they enjoy doing, such as drawing and going out. The house is clean and comfortable. Everyone has their own room. Care Homes for Adults (18-65 years) Page 8 of 29 What has got better from the last inspection The staff are well trained. People are asked about what they think of Woodside Farm House. People are kept safe and can complain if they are not happy. Care Homes for Adults (18-65 years) Page 9 of 29 What the care home could do better Staff need to know how much medication is in the home and when medication is needed. Staff need to know how to help people when they are upset. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 10 of 29 If you want to speak to the inspector please contact Helen Tworkowski CSCI Colston 33 33 Colston Avenue Bristol BS1 4UA 0117930 7110 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 29 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. People who are considering moving to Woodside Farm House can be confident that the staff will know about their needs before they move. Evidence: We looked at the information about one person who had recently moved to Woodside Farm House, and we talked to staff who had been involved in the move. We were told that they had gone to meet the individual and had made an assessment of what the persons needs were. We also saw that there was information on file to show that an assessment had been completed. This included information from the people who had previously provided support. We were told that prior to a move happening a best interests meeting had been held. This had been to agree that the move was both appropriate and to agree the best way of working. Care Homes for Adults (18-65 years) Page 13 of 29 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 people who live at Woodside Farm House are provided with a good level of care and support that provides them with choices. Risk assessments around restraint are not specific and could result in unnecessary harm. Guidance to staff on managing behaviours that challenge is confusing. Evidence: We spoke with one of the people who lives at Woodside Farm House about the care received, a second person did not wish to talk with us, but we were able to talk with a relative. The individual who spoke with us said that he/she was happy living at Woodside Farm House. The relative told us that their son/daughter was treated well and thought of the place as home. As part of this inspection we looked at the records of how care is provided to two of the people at Woodside Farm House. We found that there were care plans, which provided information for staff about how needs are to be met. We found that the care plans were not always signed and dated, so that it was not clear when they were written. We found that there were guidelines about what to do if someone presented
Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: challenges to staff, however these again were not signed and dated. In one case we found that there were three different versions of such a document. We asked one of the staff to tell us which was the current document and he/she was unable to say. We discussed with the Manager the importance of clearly identifying for staff what is the current protocol, and what is an historical document. We looked at risk assessments relating to individuals, and found that these did identify potential hazards,and the things that needed to happen to keep people safe. We found that there were no specific risk assessments relating to individuals being restrained in particular ways. This is important as different restraint methods might need to be used and it is important to show that the individual is taken into account. We were told that any restraint was agreed within a multi-disciplinary framework. We saw that care plans had been regularly reviewed, and as has been noted guidelines had been updated. It is important that where protocols are amended are updated the agreement is updated, and that there is a clear record of this agreement. This is ensure that no one is restrained un-necessarily, and protects both the individual and the staff. We spoke with two Social Services Care Managers about the care provided, one person told us that they had found the service very good and that they had been very supportive. The other person said that they offered a person centred service and were doing very well at providing a service. We talked to staff and the people who live at Woodside about decisions they make and we were told that people could make individual choices about times to get up, go to bed, what to eat. Where choice had been restricted, for example where an individual needed to be accompanied to go out, this had been discussed with the person and agreed through a multi-disciplinary meeting, to be in their best interests. We were shown records of finances, and saw that the people who live at Woodside had access to their own money, and received support to manage their finances. There were very good systems for managing money and there was a clear audit trail. Care Homes for Adults (18-65 years) Page 15 of 29 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The people at Woodside Farm House are provided with a healthy diet, which is to their taste. People are provided with the support they need to make choices about their lives and how they spend their time. Evidence: On the day of this visit there were only two people at home when we arrived, the other people had gone out to various activities. The two people at home also had plans to go out for part of the day. The high level of staffing and the number of vehicles the service have means that people are provided with opportunities to engage in activities in the community and at home. Prior to this inspection the home provided us with information about what they do well, they told us that two people are supported to attend college whilst a third person has just started a work experience placement. When we looked around the house we saw a number of drawings that an individual had done, these were displayed around her room. From our observation we saw that individuals are able to choose how they spend time.The people who live at Woodside
Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: are able to lock their bedrooms if they choose. We ate lunch with one of the people, and she was able to tell us that she chose what she ate. We were told that people are encouraged to help with the cleaning and cooking, though staff do ensure that they provide extra cleaning where this is needed. One person showed us a Christmas cake that she had made and was pleased to be able to have skills and for the staff to be able to learn from her. It is important that people with a learning disability are allowed to show off their skills and not always to be on the receiving end of instruction. The menu we saw showed that people had a varied diet, and that they were encouraged to eat healthily. There was plenty of fresh fruit around. The kitchen and dining areas are clean and domestic in character, and would be places where people could develop domestic skills. We were told how people were supported to keep in touch with relatives. We were told by a Social Services Care Manager that the home had been very supportive in helping maintain family contacts. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and healthcare support
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The people at Woodside Farm House are provide with the support to ensure that their health care needs are met. There are generally good systems in place of managing challenging behaviour, though there needs to be better information about the use of as required medication. The medication system is generally well managed, thought the auditing system needs to be more robust. Evidence: We saw from plans of care that health care needs were addressed. As has already been noted some of the people who live at Woodside may have behaviours which challenge the service and individuals may need to be restrained so that they do not hurt themselves or others. We looked at records and saw that all incidents of challenging behaviour were recorded. Where restraint was used this was also recorded. We were shown records on computer to show that incidents were analysed and consideration was given to was underlying cause of particular behaviours. As has already been noted, we discussed with the Manager ensuring that all of the guidelines are signed and dated. We also discussed the importance of having protocols for as required medications. Such protocols ensure that such medication are given under agreed circumstances. We also discussed with the Manager that all incidents of restraint should be recorded in bound book with numbered pages, as described in the
Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Department of Health Guidelines in relation to this area of care. We looked at the medication system and found that it was generally in good order. However we found that on some occasions there was no record to show why medication had not been given. When we audited the number of as required tablets it appeared that two tablets were unaccounted for. Medication should be readily auditable, and where there are errors these should be investigated. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The people who live at Woodside are protected from potential abuse and have there are good systems in place to address any concerns or issues raised. Evidence: The information provided by the home indicates that there is a complaints and concerns policy. The home advised us that they had received two complaints in the last twelve months, both of which had been responded to and resolved within 28 days. Staff we spoke with said that there was an open culture in the house, and that they would have no concerns raising issues. We received four surveys back from people who live in the house and they indicated that staff always treated them well, listened and acted upon what they said and that they knew who to speak to if they were not happy. Three out of the four people said that they knew how to make a complaint. We were told that the people who live at Woodside Farm House are able to raise any minor or general concerns that they have at house meetings, the last one of these had been held in September 08. We found that appropriate checks had been made of staff before they started work, and that staff received training in relation to safeguarding vulnerable people. There are generally good systems in place to deal with behaviour that challenges and to oversee the appropriate use of restraint where needed. Care Homes for Adults (18-65 years) Page 20 of 29 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. Woodside Farm house provides a good standard of clean and comfortable accommodation. Evidence: As part of this inspection we looked around all of the house, and some of the people showed us their bedrooms. The house is divided into two flats, each with its own lounge, dining room and kitchen. This helps ensure that people do not have to live in large groups so that some of the frustrations of group living are minimised. We found that the house was clean and well decorated. Some areas were minimalist, reflecting the needs of the people who live at Woodside. In spite of this the rooms were domestic in character and generally homely. All of the bedrooms reflected the tastes and preferences of the people who lived in them. All of the bedrooms had en-suite bathrooms. The bedrooms were sufficiently large for people not only to sleep in but to sit in, if they chose. All of the bedrooms had door locks to be used if the individual wanted privacy. There are key pad locks between some of the areas of the house, and this is taken into account in care plans. We noted that the some of the corridor areas are confusing, but this does not appear to be an issue for the people who live and work at the Woodside. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The people who live at Woodside are supported by competent well trained and supported staff. Evidence: We spoke with two staff about their work at Woodside. Comments from staff included that it was a lovely place to work, that there was a good team of staff and they were well supported. If there was an incident then they were properly de-briefed and that they were given the training and support they needed to restrain people if needed. We were also told that their was an open culture. One person had recently started at the home and he/she told us about the induction process and shadowing. We were also told that the home has good training. Training courses recently attended included person centred approaches, physical intervention, safe holding, safeguarding, autism and the mental capacity act. When we looked at staff files we found that there were good records of training, and confirmed that staff were offered the training they needed to do the work. Information provided by the home shows that more than half the people have or are working towards national vocational qualifications, including those related to learning disability. We were told that there was one to one staffing throughout the day, and in some cases there is a second person available to drive. At the time we arrived at the
Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: inspection there were seven people rostered to work, including the Manager and deputy who were training, and the handyman/escort. This appeared to be an appropriate level of staffing for the people at Woodside. We discussed with the Manager the issue of whether the staff training in relation to restraint was accredited as recommended by the Department of Health. She explained that they were satisfied with the competence of the trainers, and that the trainers were currently trying to go through the process of accreditation. We looked at the recruitment files of two people who had recently started work in the home. We found that checks on the individual had been made to ensure that the individuals are suited to working with vulnerable individuals. We found that these checks included a criminal records bureau check, checks of list of people who are unsuited to the work, and references from previous jobs. On one of the files we found that a recent reference appeared not to have been taken. We discussed with the Manager the importance of taking recent relevant references, if a reference could not be obtained then the home would need to make a decision regarding employment based on a written risk assessment. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. Woodside Farm House is well managed and provides a safe service. Evidence: The Registered Manager was present during the second half of the inspection at the home. The Manager is well qualified to carry out her role. We were told that the company that runs Woodside Farm House has a positive approach to investing in in staff training and this was evident from what we saw during this inspection. The home is well generally well organised and the needs of the people who live at the home are central to the way it operates. We looked at risk assessments, these documents should help ensure that where risks have been identified they are managed. We saw that checks had been made of the fire system, and that there was a Fire Risk Assessment, (though this needed to be signed and dated). We also saw that there were checks of the water and electrical system. We were shown surveys that had been sent out as part of the quality assurance checks, these were well formulated and were being collated. We were also shown a copy of the a survey that was being used with staff to identify occupational stress.
Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: We were told that representatives of the Registered Provider visit the home on a regular basis and complete a comprehensive report relating to these visits. We confirmed that copies of these reports do not need to be sent to the Commission unless requested, but must be available for inspection in the home. At the last inspection it was noted that the Commission had not been notified of a number of incidents, as is required. Over the last 11 months the Manager has kept the Commission informed of such incidents, known as Regulation 37 notifications. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes ï£ No ï Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set
No Standard Regulation Description Timescale for action 1 6 12 Guidance to staff about how to meet care needs must be clear up to date. 02/03/2009 Staff need to know what they are doing so that they can meet peoples needs. 2 9 13 There must be specific risk assessments relating to individuals being restrained, including any specific holds to be used. 02/03/2009 Any risks need to be managed and minimised to keep people safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 18 Any incidents of restraint should be recorded in a bound
Page 27 of 29 Care Homes for Adults (18-65 years) book with numbered pages. 2 3 20 20 There should be a robust system for auditing stocks of medication. There should be protocols to describe when any as required medication can be given. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk 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.
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