CARE HOME ADULTS 18-65
Woody Point Station Road Brampton Beccles Suffolk NR34 8EF Lead Inspector
Anna Rogers Unannounced Inspection 4th October 2005 3:00pm Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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 Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Woody Point Address Station Road Brampton Beccles Suffolk NR34 8EF 01502 575735 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) ambercare@brampton.homepcinternet.co.uk Amber Care (East Anglia) Ltd Mrs Karen Ann Palmer Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th May 2005 Brief Description of the Service: Woody Point is a registered care home for five adults with learning disabilities. It changed its category of registration early in 2004, in response to the fact that each of the service user’s living there had reached 18 years of age. The Certificate of Registration for the home now reflects the fact that the home may only accommodate five young adults in the age range 18 – 25 years. Woody Point is a large extended bungalow, set back from the road that runs through the hamlet called Brampton Station. The nearest town to the home is Halesworth. The home is privately owned by Amber Care (East Anglia) Limited. Mrs M Frost was previously the Registered Manager of the home, and is now the Responsible Individual. Each service user has their own bedroom. There are three communal areas for social recreation including a lounge / dining room, a snoozelum, and an activity room with a range of musical equipment, arts and crafts materials, videos and books. A conservatory has been added to the side of the house, and this is used as the laundry. The home does not have designated sleeping-in facilities for staff, as the home employs waking night staff, to cover each night. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out over 3 hours on a weekday afternoon and early evening. There are four service users living at the home and there is one vacancy. During this inspection time was spent with the staff on duty who provide 1 to 1 care for service users and 2 to 1 care for one service user. The inspector was able to meet the service users on their return from their day service/education placements and to observe the interaction between staff and service users. The reader may wish to read this report in conjunction with the report of the announced inspection, which took place on the 25th May 2005. What the service does well: What has improved since the last inspection?
The service user who was admitted to Walker Close (Mental Health Services assessment unit) in April 2005 has returned to the home. It is clear that the staff team are pleased to have the service user back and have clearly undertaken additional training including low arousal training; additional autism training and team building to ensure all staff work together to support the service user. The organisation has supported additional staffing levels and there is a dedicated team working with specifically the service user. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 6 A four weekly activities programme has been developed to provide service users with a wide range of activities based on their individual interests. The activities programme is also supported by ensuring transport and staff qualified to drive the homes’ vehicles are on duty when an external activity has been programmed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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 Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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): None of the standards in this section were inspected during this visit. EVIDENCE: Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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, 9 Service users can be assured that their care plan will identify their needs and that they will be supported to make decisions about their life. EVIDENCE: Since the last inspection one of the service users who had been admitted to Walker Close (Mental Health Services assessment unit) in April 2005 has returned to the home. It was evident that the owners wanted to ensure that appropriate staffing levels were in place to support the service user but also to ensure staff were not attacked and injured and although the staffing level of 2:1 is not supported by the placing authority the organisation has arranged rotas to ensure there is a team of staff assigned to work with the service user on a 2:1 basis. Discussion with staff working with the service user indicated that they have adjusted their ways of working to reduce the pressure and expectations on the service user to complete tasks while encouraging them to make positive choices. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 10 The service users care plan dated 28th June has been developed since their re assessment and there was evidence that this was reviewed on the 3rd August which is well within the recommended six month period set down in standard 6 (6.10). Part of the care plan includes a section on behaviour management and how staff should respond to ensure the service user remains calm and feels safe. One of the other residents care plans was inspected and highlighted the difference in approach to meet the needs of residents for example their was an expectation that they would contribute to the routines of the house including the involvement in domestic chores with an expectation that they would complete the task. The service users at Woody Point are unable to verbally express themselves or to understand the content of their care plan, which is not in a format that uses the picture exchange communication system (PEC system), used by service users to communicate their wishes. However there was evidence that the staff team have included the elements of their care plan onto the PECS board for example their routine and activities, which they can choose from. Picture exchange communication (PEC) boards are located in the lounge and provide residents with opportunities to make choices about how they spend their free time. The inspector was able to observe how the communication board was used. When residents returned from their day services they were shown the board which detailed their routine for example they were encouraged to use the toilet, wash their hands and then have a drink and snack before deciding what they would do before the evening meal. Risk assessments were in place for activities for example when service users are involved in outside activites but it was not possible to see individual risk assessments to support care plans for example, supervision while swimming, use of a trike, trampoline and bathing. This was discussed with the manager following the inspection who explained that risk assessments are incorporated into the individual care plans. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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): 14, 17 Service users can expect to enjoy a lifestyle that reflects their individual needs and interests. EVIDENCE: Since the last inspection a new 4-week timetable of activites has been developed. This is to ensure that service users enjoy a varied programme based on their interests and also to ensure there are members of staff on duty who can drive the vehicles to access activities in the community. The timetable provides opportunities for individual choice as well as one day a week when no organised activity is planned. The day of this inspection coincided with a free day for each of the residents. It was noted that staff discussed again using the PEC board things that service users wanted to do. Two service users opted for a walk, while a third who was tired wanted to “chill out”. The fourth service user has separate carers and when the service user opted to spend time in their bedroom one of the carers stayed near to their bedroom while the other was involved in preparing the evening meal. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 12 Four service users and ten members of staff went on an activities holiday to Bishops Castle for a week in August. A service user was able to express positive views about this holiday. A photo album of the holiday has been put together showing how service users were involved in various activities for example abseiling, canoeing, climbing and enjoying a pub meal. Each photo is accompanied with an appropriate humorous caption. Service users enjoy a well balanced diet. There was evidence in care plans of service users being offered 5 portions a day of fresh vegetables and fruit. Service users have one day a week when they can choose from a variety of ingredients what meal they would like. The menu shows little use of processed foods although there are opportunities for service users to choose ready prepared pies for example on the evening of this inspection service users were having ready made steak and mushroom pies, roast potatoes, peas and sweetcorn followed by rice pudding. Service users have a choice of where they sat for their evening meal. Two were sitting with two staff in the dining room and two were sitting in another dining area leading from the lounge. The meal time was observed to be relaxed and unhurried. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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 Service users can expect that their wishes and preferences will be taken into account when staff are undertaking personal care. EVIDENCE: Care plans are divided into eleven components including morning and bedtime routines and washing and bathing. From the sample seen it is clear that service users preferences are incorporated into the support required. As noted risk assessments are included into the care plan. It was noted at the last inspection that one service user likes to have a bath each evening and enjoys the opportunity to relax in the bath and ‘have a soak’ but indicated to staff that the temperature the hot water (which is within the recommended safe temperature of 43°) is too cold. The manager requested that the temperature is raised and a recommendation to develop a risk assessment was made to support this. However the manager explained following this inspection that no decision has been made to raise the water temperature above the recommended safe water temperature. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 14 As noted each service user has 1 to 1 support at all times. The manager allocates staff to each service user on a daily basis. It was evident from observation that service users are aware of this arrangement and it was observed that when service users returned from their day service provision each member of staff met the service user they were to work with to welcome them home and support them through their routines. Behaviour management guidelines are in place and it was noted from observation that when one service user began to exhibit excitable behaviour the member of staff asked him to sit down and follow a routine that was later confirmed to be set down in their guidelines. The service user responded positively and was then encouraged by his worker to communicate his wishes using the PEC board. Accident records are kept and entries included where staff had been injured during an incident. The content of the accident book and incident records were detailed but a recommendation is made to number the incident to ensure it cross references to the information in the accident book rather than rely on the date of the incident. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users can expect staff to have received training on the abuse of vulnerable adults. EVIDENCE: Staff have all undertaken adult protection training during their induction and foundation training. The Registered Manager is aware that they and the Deputy Manager should update their training and attend a Protection of Vulnerable Adults (POVA) training course. Staff must also be made aware of and have access to a copy of the Suffolk Protection of Vulnerable Adults Inter Agency Policy and Procedures which provides clear guidelines for staff to follow in the event of suspecting or receiving an allegation of abuse. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26, 27, 28 Service users can expect to live in a house that is well cared for and provides privacy. EVIDENCE: There was evidence from observation and confirmed in care plans of service users being supported to use their bedrooms whenever they wish. The staff team are clearly aware of the need to respect opportunities for residents to have privacy while they are in their bedrooms and knocking on their door before entering. Care plans indicate staff awareness that as young adults, service users may need personal time alone to relieve any sexual frustrations. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 17 There are three bathrooms and two separate toilets for use by service users. These facilities are located close to service user bedrooms, and communal areas of the home. Two bathrooms and a separate toilet were seen during the inspection and all were clean. Service users have access to a wide range of communal areas including a spacious lounge, an activities room with music equipment, CD Player and games and a snoozelum. Service users have access to the kitchen with staff support and there is also a small separate dining room. Externally there is a large and well-maintained garden area. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33 Service users can expect to be cared for by a staff team who have been trained to meet their needs. EVIDENCE: The staff team have attended a number of training courses in preparation to having a service user back following a re assessment of their needs at Walker Close. The staff team have attended training at Walker Close titled “Total Communication” also low arousal training (looks at ways of diverting behaviour) additional autism training and team building. A member of staff is scheduled to attend a course titled ‘Trainer Training’ at Kerrison Training Centre, which will enable them to cascade training to the staff teams within the organisation. The manager also confirmed that ‘core training’ i.e. Monitored Dosage System (MDS), food hygiene and fire safety has been updated recently. An application has also been made to Otley College for a course on Quality and Diversity. Staffing levels enable a minimum of one to one care of service users. The staff team on shift were clear about which service user they had been assigned to and were familiar with the service users routines on return from their day services. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 19 There are currently three members of staff on long term sick although one is scheduled to return following a serious accident. One other member of staff is currently off work with a broken ankle. The vacancies are being covered by established bank staff who are known to the service users and are familiar with the organisations policies and procedures. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 20 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): None of the standards in this section were inspected. EVIDENCE: Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Woody Point Score 3 X X X Standard No 37 38 39 40 41 42 43 Score X X X X X X x DS0000059654.V256078.R01.S.doc Version 5.0 Page 22 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 YA23 Regulation 13 (6) Requirement Staff must be familiar with the expectations of the Suffolk Protection of Vulnerable Adults (POVA) inter agency policy, procedures and guidelines for staff. Timescale for action 30/11/05 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 2 Refer to Standard YA9 YA18 Good Practice Recommendations The service should review the information relating to risks in care plans to ensure they provide sufficient information to identify the level of risk. Incident reports should be numbered and cross-referenced to the accident records. Woody Point DS0000059654.V256078.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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