Inspection on 02/08/07 for Wren House

This inspection was carried out on 2nd August 2007.

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

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

Other inspections for this house

Wren House 07/07/06

Wren House 04/11/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Wren House 1-3 Wren Avenue Malvern Worcestershire WR14 2QB Lead Inspector Christina Lavelle KEY Unannounced Inspection 2 & 8 August 2007 12.45-5 & 2.30-6.45 nd th Wren House DS0000064834.V342577.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 Wren House DS0000064834.V342577.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. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wren House Address 1-3 Wren Avenue Malvern Worcestershire WR14 2QB 01684 574278 0207 608 3254 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) Royal Mencap Society Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 7th July 2006 Brief Description of the Service: Wren House is operated by the Royal Mencap Society which is also a registered charity. Mencap is one of the largest providers of services for people with learning disabilities in the United Kingdom. There is not a registered manager in post at the home currently and the deputy manager (Ms Gillian Jackson) has been acting up as manager. The Mencap area manager is Ms Sue Harris, who is based at Unit 202, Berrows Business centre, Bath Street, Hereford, HR1 2HE. This home can provide accommodation and personal care for eight adults (men and women). It’s stated aim is to support people with mild learning disabilities and because only one bedroom is on the ground floor the home could not cater for people with very limited mobility. Service users range in age from thirtyeight to eighty and some people have lived at the home for over sixteen years. Wren House is located on a residential housing estate in the town of Malvern. There are shops and facilities and public transport links within walking distance. The property was converted into a care home from three houses in a terraced row. It is owned by Festival Housing Association and leased to Mencap. The house has gardens at the front and rear, including a good sized paved area. People who live at the home have single bedrooms and the room on the ground floor has en-suite facilities. Two other bedrooms have a wash hand basin and there are three bathrooms and two toilets for everyone to use. The home also has two sitting rooms, a dining room, a kitchen, utility room and an office. Information about the home is provided in a statement of purpose document and a service users’ guide. This guide is called “Our Promise to You” and is available in an easy read format. The current fee level for the service is from £505.to £513.02 a week. Service users have to pay for their own clothes and toiletries, social activities, college fees, luxury items, some travel expenses and the cost of the accommodation and transport when they go on holiday. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of the service provided by Wren House. This means all the Standards that can be most important to people who live in care homes were checked. The first visit was made without telling anyone at the home beforehand. Most of the time was spent talking to people who live there and staff. The second visit was arranged at the first visit to discuss how the home is run and any changes made since the last inspection with the acting manager Some people were asked in private about their lives at Wren House and others were spoken with in their sitting rooms. Three of the staff discussed their job, experience, training and support they receive. Surveys about the service were left at the home for the people living there and sent to seven of their relatives and six health or social care professionals who are involved with their care. Only four surveys were returned and their views are mentioned in this report. An annual self-assessment form had been completed before these visits. This asks managers to say what they think their home does well, what it could do better, what has improved and about their plans to improve the service. It also has information about people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All other information received by the Commission about Wren House since the last inspection is also considered such as events affecting people living there. What the service does well: Most people have lived at Wren House for years and say they like it there and get on well with staff. There is an open and friendly atmosphere in the home. Each person living at the home has a care plan they are involved in making. Plans show their needs, likes and dislikes and possible risks. Their plans show staff how to support them to meet their needs and wishes and keep them safe. People living at the home make daily choices about what they do and meals. Their independence is encouraged and they share the cooking and housework. Staff support people who live at the home to take part in various activities they like and to go out and mix in the local community. They make their families welcome in the home and three relatives say the home always keeps in touch. People who live at the home know who to talk to if they are worried about anything and feel able to do so. They choose a keyworker from the staff team they know well and who gives them more individual time and personal support. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 6 Wren House is an ordinary house, which fits in with the local community. It is in a good place for getting to shops and other places in and around Malvern. Mencap check all staff to make sure they should be suitable to work in a care home. Staff receive good training when they are new and to help them know how to meet the special needs of people living in the home and keep them safe What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Wren House DS0000064834.V342577.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 Wren House DS0000064834.V342577.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. An appropriate admission criteria is provided and the home tries to make sure prospective service users are suitable and to involve existing residents in the decision to introduce a new person. However, to safeguard people living at the home, admissions should only take place if staff are confident the service can meet the assessed needs of prospective service users and when all information and views have been shared, debated and agreed by management and staff. EVIDENCE: The required information documents are provided for the home, which include a statement of purpose and a service users’ guide called “Our Promise to You”. The home’s admission criteria is outlined in the statement of purpose. It says people who may like to live at the home would be selected depending on their wish to live there and whether they would get along with other people living in the home, whose wishes would be taken into consideration. Also that referrals would usually come to the home’s manager and then staff, the area manager, community team and other relevant people would make the selection. Mencap reserve the right to say no if it is felt the home is not appropriate to meet their needs. Admissions would involve teatime visits and overnight stays and if they are successful, a six-week trial period. The service users guide also states “We will ensure you live with people who you want to live with and feel safe with”. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 9 The care records of a person recently admitted to the home were examined and the assessment and admission processes followed discussed with staff and the acting manager. It is good that after being referred to the home this person was visited by staff at their current residence and an initial assessment of their needs was carried out. The home also received a referral form and an adult community assessment completed by their funding authority and a care plan from their existing placement, which included a needs and risks checklist. The prospective resident made two visits and spent two nights at the home so they could meet the people living at the home and staff. Detailed daily reports were kept during these visits and written feedback. A weekend stay had been arranged to follow the overnight stays. However the person was then admitted for a seven-day trial and it seems staff and residents were not involved in this decision. Although they did have some concerns that their needs may not be suitably met, the area manager and their funding authority made the decision. It is apparent this person may need more support than the home can provide. Their previous care plan shows they need support and reassurance during the night and Wren House does not have waking night staff. Also their behaviour management plans were not brought to the home until a week after admission. These plans indicate they have more complex needs than existing residents and staff have not received training to help them manage behaviours that may be challenging. It was observed during these visits and service users said they were being affected by this person’s need for staff attention, including at night. The home’s daily reports show staff sleeping in are being disturbed during the night, which is not acceptable especially when are working the following day. A review meeting was soon to be held involving the home and others involved. The acting manager needs to reflect the views of staff and people living at the home as to whether the home can meet the new person’s needs appropriately (and/or they need more staff support) and in respect of their compatibility with existing residents. In the meantime a letter has been sent to Mencap by the Commission in advance of this report to express concerns and to require that urgent action is taken to ensure the home’s admission procedures safeguards people who use the service. It must also be confirmed in writing that based on a needs assessment the home can suitably meet the needs of service users and the assessment of their needs is kept under review. It was also pointed out that the views of staff and people living at the home were not considered before the decision was made about the admission as their criteria promises. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People who live at the home all have a care plan showing their needs, likes and dislikes with risk assessments to minimise safety risks. Whilst they are able to make choices in their daily lives and routines plans should focus more on their personal goals and the support needed to develop their independent life skills. EVIDENCE: A sample of care records was looked at. There is a photograph of each person with personal information about their background, life so far and their family. There is also a list of their likes and dislikes, a description of Wren House with décor colours etc. they have chosen and a house rules document with pictures and simple language. They all have a care plan showing their needs (based on an assessment of their skills) and support they need in relevant areas, such as personal and health care, medication, shopping, cooking and communication. An appropriately person centred approach to care planning has been adopted by the home. This means the people who live there are involved in drawing up Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 11 their own plans and whilst plans seen include their signed agreement for their records to be kept in the office they can look at them whenever they want to. This is good, as individuals should actually own their plans. Plans include a few personal goals with details of action needed and by whom and when. One person’s aims were to reduce their medication and to go out to the pub more often, but how these could be achieved had not been specified. Whilst it is positive the home is now focusing more on individual’s goals they should also be part of promoting a more independent lifestyle. Furthermore when plans are reviewed they should also always reflect if their goals are being achieved with the outcomes detailed and any benefits to each person (or not). People living in the home choose a keyworker from the staff team who gives them more individual support. Keyworkers are also involved in planning and reviewing their allocated residents’ care and are expected to write regular reports that review their support and check if plans reflect their current needs. A formal annual care review meeting is also arranged for everyone who lives at the home. They discuss with their keyworker who they would like to attend their review e.g. their relatives, social worker and day service staff, and invites are sent out accordingly. The home’s guidance states that the review agenda should include progress, points to be raised, keyworker reviews and any future plans. The acting manager says the home intends to arrange more one-to-one keyworker sessions to better reflect their individual wishes, choices, goals and review plans, which is positive but will depend on staff time and continuity. Care planning appropriately includes carrying out risk assessments. The risk assessments seen relate primarily to reducing safety hazards such as boiling water, bathing, going missing, financial management and travelling in a taxi unsupported. Any limitations to an individual’s choice, freedom and behaviour e.g. accessing community and managing their own finances are included. Risk management should again focus more however on promoting an independent lifestyle and this should be developed. The acting manager is aware of the process to ensure any decisions would be made in their best interests when they may not be able to make an informed decision themselves. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People who live at the home are supported to go out and take part in activities they enjoy and to maintain links with their families. With more staff time their opportunities to pursue individual interests in the community could increase. Food provided by the home is what people like whilst staff encourage them to choose more healthy options. Responsibility to share cooking and household tasks is accepted and staff respect their individual needs, rights and abilities. EVIDENCE: Care plans detail each person’s interests and social and leisure activities they prefer such as shopping, going to pubs, the cinema, garden centres, art & crafts, music, watching videos & television, bowling, swimming and using a snoezelen sensory centre. Some of these activities are in-house, although it is good that staff also support and are encouraging them to go out and mix in the local community and several people now go to the local shop independently. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 13 Whilst this is positive plans do not specifically identify social & developmental needs and/or reflect how their needs and interests will be met, which should link in with their activity schedules. One person’s timetable just includes that they spend two days a week at a day service, one day at college and weekends either at Wren House or visiting their family. Activities should also relate to assessed needs and interests and there should be evidence from care reviews that action is being taken to meet them and to achieve any personal goals. The acting manager and staff recognise the importance of enabling people who live in the home to integrate within the wider community and also to engage in friendships outside the home. They would like to be able to offer them more one-to-one keyworker support to facilitate their chosen individualised activities and for personal shopping etc. This depends on staffing levels however and it is hoped when the new manager is in post to incorporate time for this within staff rotas. The proposal to assign one team member as a leisure co-ordinator could also be beneficial so they could seek out new opportunities, find out about community events, arrange outings and help to draw up activity plans. It is confirmed families are made welcome in the home and efforts are made to keep them involved. Most people who live in the home have regular input from their family and one person who doesn’t now has an advocate. Relatives indicate that staff always keep in touch and they are usually kept up to date about important matters; one comments staff are “Very ready to ring me or answer my calls”. One person had a special birthday recently and staff had arranged a party to which all his family and friends were invited. All the staff also came and clearly had made much effort to make it an enjoyable occasion. People who live in the home are encouraged to make choices in their daily lives and take responsibility for themselves to the extent they can e.g. keeping their bedrooms tidy and doing their laundry. Regular house meetings are held when the day-to-day running of the home is discussed and they are all involved in decisions about such as redecorating and holidays. They also choose menus, and are involved in staff recruitment. Daily task sheets are drawn up so they share cooking and household tasks. Staff are aware however that people have different needs and capabilities and treat them as individuals. Issues relating to equality and diversity are covered through staff induction and training. In respect of food provision they are all involved in choosing, shopping, food preparation, cooking and clearing up after meals. Staff have made efforts to improve the variety and nutritional contents of meals and now use recipes and pictures of dishes from magazines to help them choose menus. Information is also available about healthy eating and staff promote using fresh vegetables, fruit, pasta etc. Individual care plans include any special dietary requirements. Breakfast and weekday lunches are flexible (some are packed to take to day services) and they choose what they want to have. The main meal they eat together with staff and the inspector was kindly invite to join them for a meal. This was a very nice social occasion, with a very tasty home made stir-fry. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People living in the home are supported by staff to meet their personal care and health needs. It would help confirm that all their health related needs are being monitored, and preventative as well as routine and specialist health care input accessed to promote their wellbeing, if they all have a Health Action Plan. There are effective arrangements for managing medicines safely in the home. EVIDENCE: Plans show the personal support everyone needs, which for most people is only oversight and guidance, whilst their self-care and independence is encouraged. Keyworkers take part of the responsibility for planning the support needed to promote their good health and wellbeing. Some people have a Health Action Plan (HAP), which is in a user-friendly format, and had been implemented with input from a community nurse. HAPs are recommended by the Department of Health for people who have learning disabilities. They aim to involve them in managing their own health care. Also to ensure any special health care needs have been identified and are being monitored and their good health promoted Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 15 through preventative as well as routine and specialist health care input. This would include emotional needs, such as anxiety and autistic spectrum disorder. It is good the home is planning to implement further Health Action Plans. In the meanwhile records are kept of specific and general health related issues. They include visits arranged to GPs, Dentists etc and to specialists such as a Psychiatrist. It is evident the home appropriately accesses advice, support and treatment from relevant health care professionals if and when needed, such as community nurses and Speech Therapists. One GP indicates in their survey that the home always communicates clearly with them, works in partnership and takes up their advice. They can also see their patients in private, there is always a senior to confer with and staff understand their care needs. They had not received any complaints and are satisfied with the overall care provided. Regarding medication the home has a clear medication policy and procedures. This includes a homely remedies list with guidelines and a protocol for when medicines are prescribed as and when required. Staff arrange six monthly medication reviews for everyone and their plans include a personal medication profile, their photograph, consent to treatment, as agreed with them and staff. It is good that one plan seen includes a picture of the surgery and information written in plain language called “Me & my Medication” which explains the medication they take, why they need to take it and any possible side effects. Medicines are kept and administered to people living in the home using a monitored dosage system, which is only used by staff. Although some people have been risk assessed to take specific medication themselves, such as an inhaler. The home monitors and audits its practices in relation to ordering, administering and medication records and a Pharmacist checks this system regularly. There are suitable storage arrangements in the home and records of administration are maintained appropriately. Staff receive relevant training during their induction and their competence is assessed by management. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. There are frameworks in place for managing complaints and to protect people living at the home. Whilst they are encouraged and feel able to express their views to staff, concerns should also be considered by Mencap and acted on. EVIDENCE: Mencap provides a formal written complaints procedure that is also available in a more suitable format for people with learning disabilities. Staff clearly recognise the importance of enabling people to express their views and make decisions about their lives and the home. This is promoted through resident meetings and keyworkers. There was seen to be an open rapport between people who live in the home and staff and those spoken with know and like their keyworkers and clearly value their support. Most of their relatives also say they know about the complaints procedures and the home has responded appropriately to any concerns they have raised. As referred to in the Choice of Home section of this report however it should be ensured that everyone’s views and concerns are also shared and debated by Mencap management. There have been no complaints made to the Commission, or adult protection issues referred under the multi-agency Protection of Vulnerable Adults (POVA) procedures, since the last inspection. Mencap provides procedures for staff for responding to any suspicion or incidence of abuse or neglect of people living at the home. All staff receive relevant POVA training during their induction and there is a plan for further training. Staff understand their responsibility to protect vulnerable people and to promote their safety and welfare. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. Wren House offers ordinary housing within the local community and provides a stable, safe and comfortable home. Whilst the premises are in a reasonable state of repair and décor the planned move to new build bungalows will benefit people living there and provide more communal space and private facilities. Overall due attention is paid to good hygiene. However staffing levels appear to limit the time available to carry out all routine cleaning tasks and maintain the gardens properly, whilst supporting people who live there to be involved. EVIDENCE: Wren House comprises of three terraced houses converted into one property. It is located on a large residential estate in Malvern town and there are local shops, pubs etc and public transport links nearby. The home and people living there have integrated well and are accepted in the local community. Festival Housing Association own the property and suitable arrangements are in place for repairs, maintenance & safety checks of the home, equipment and facilities. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 18 The general impression of the home is of a well lived in, homely and relaxed environment. However the initial sight of the untidy and somewhat overgrown gardens did not create a very good impression. Also although the kitchen and bathrooms were clean some carpets looked as if they had needed a thorough vacuuming for a while. Staff take responsibility for all the household cleaning and maintaining the internal décor and gardens. They encourage people who live there to be involved and take responsibility for tidying their bedrooms etc and to share tasks in the communal areas. Clearly however some people are more able and willing than others and none are apparently too interested in gardening. One person’s relative thinks they need more assistance to clean their bedroom and to do their ironing. Mencap should consider providing additional help, in particular for the gardens, as it seems inappropriate for staff to spend their limited time trying to maintain them. The home was set up over seventeen years ago and because of this the size of most bedrooms (and the fact that only one has en-suite facilities and two wash hand basins) would now not be in line with the specifications of the National Minimum Standards for new care homes. People who live there also say they would like more space and although their bedrooms are well personalised it would benefit them to have more room for their possessions and for using them as their private space. There is also limited communal space and the dining room seemed cramped at the mealtime when everyone was together. It is good therefore that Mencap’s plan to relocate the home will address these issues. The two new build bungalows proposed will provide all ground floor accommodation with bedrooms that have en-suite toilets and bathing facilities. The new premises will be suitable for people with mobility difficulties and as most of the resident group are over forty and a few are already over sixty any problems associated with ageing that may require space for aids & adaptations etc will be met. One relative comments that “Wren House is a good home but time to move to the new bungalows being built. X loves the idea of no stairs and an en-suite bathroom”. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. People who live in the home are being supported by an appropriately trained and supervised staff team who are committed to providing a good service. Whilst this is so there are issues relating to staffing levels and continuity that impact on the time available for their task and to facilitate individual activities. Mencap operate thorough recruitment procedures, which should help to ensure only suitable staff work at the home for the protection of people living there. EVIDENCE: The staff team comprises of the manager, deputy manager and six care staff. The home also has two relief care staff. The staff team has become more stable recently but there have been recruitment difficulties and whilst agency staff are being used less now staff are still having to work additional hours to cover the home. This is probably also due to the deputy acting up as manager. This report has previously referred to the pressures on staff to offer individual support for activities and maintain responsibility for all the household tasks and the gardens. Given that there are usually two staff on duty between 7amWren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 20 10.pm, plus the manager working weekdays, the staffing establishment seems rather low to support eight people, only three of whom are able to go as far as the local shop alone. The acting manager confirms rotas are drawn up flexibly to accommodate the needs of people living there, but the scope to do this must be limited by the number of staff available. The current situation where one person needs extra support is clearly affecting everyone but it seems there is no possibility of deploying extra staff during the evenings or for a waking shift at night. Mencap need to review the home’s staffing levels in conjunction with placement reviews undertaken by the funding authorities, as part of this review process is to assess that the needs of people living at the home are being appropriately met by the home and within the agreed fee levels. Mencap provide robust policies & procedures for the selection and recruitment of care staff. Records seen of new staff confirm that a police (CRB) check and two written references are taken up and must be satisfactory before new people are allowed to start work at the home. Copies of relevant documents are held and application forms completed, although the acting manger was reminded that any gaps in an applicant’s full employment history must be explored and a written explanation given. All new staff are required to undertake a probationary period before their employment is confirmed during which they complete Mencap’s comprehensive induction programme in the first six weeks, followed by six months foundation training. They then move onto to an NVQ qualification, although due to staff changes no staff currently have and NVQ and three are working towards one. Staff also complete mandatory heath & safety training and other topics relevant to care e.g. protection and respecting individuals. In the last year they have attended training sessions in autism and dementia and the home is continuing to arrange courses to increase the stff teams’ skills and knowledge. Staff were welcoming and open and appear to be well motivated and work in the best interests of people living in the home to enhance their lifestyles. The acting manager has made efforts to improve communication, which is essential for good team work and staff report that meetings are held regularly and they receive individual supervision. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Appropriate management arrangements are in place overall to ensure that the home is being run properly in the absence of a registered manager. There are systems to monitor and review the quality of the service so that it continually develops for the benefit of ,and as the people living in the home would like. The home’s policies, procedures and working practices promote safety in the home for the welfare and protection of the people living and working there. EVIDENCE: The registered manager recently decided not to return to the home following maternity leave and Mencap plan for the registered manager of one of their domiciliary care agencies operating in Herefordshire to take over management soon. Meanwhile the home’s deputy manager continues to act up as manager. Gill Jackson is suitably experienced and qualified and staff and people living in Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 22 the home are positive about the management input and support. There is a commitment to further developing a more person centred approach to care and the self assessment was well thought out, showing what the home does well, but also identifying areas in need of improvement and how to achieve them. Mencap operate processes to monitor the service quality including the required monthly visits from their area manager when all aspects of the home are checked periodically and a continuous improvement plan is made with actions specified. This should include the views of residents and other stakeholders and so questionnaires have been sent to their families, and day services have helped the people who live in the home complete their questionnaires, about the home, which should be reflected in the service development plan. Regarding health & safety staff training is arranged in all the mandatory topics i.e. first aid, food hygiene, fire safety and moving & handling. It is confirmed staff undertake all the required fire safety checks at the specified intervals. The information obtained from the acting manager further confirms the home has an infection control policy; risk assessments are carried out (including COSHH) and that electrical appliances and the gas & central heating systems are serviced and/or tested regularly. There were no safety hazards identified in the environment during these visits. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 23 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 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 3 X Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 24 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 persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard 1. YA3 Regulation 14 Requirement Accommodation must not be provided at the home until the registered person has confirmed in writing that based on assessment the home can suitably meet the needs of prospective service users. The assessment must then be kept under review. This is to ensure that new service users’ needs and aspirations can be appropriately met and also to safeguard people already living at the home. Timescale for action 08/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA12 Good Practice Recommendations Meaningful activities should be linked to the assessed social and developmental needs of people living in the home and this be included in their plans. Additional staffing support necessary to facilitate more individualised activities and community integration should also be considered. Health Action Plans should be implemented for everyone living at the home. They help to confirm that all their health care needs are recognised and being monitored and their good health and wellbeing promoted. Also to show they are supported to manage their own health through preventative DS0000064834.V342577.R01.S.doc Version 5.2 Page 25 2 YA19 Wren House 3 YA33 as well as routine and specialist health care input. The home’s staffing establishment and staff deployment should be reviewed to make sure that the needs of people living at the home are being appropriately met and there is sufficient time for staff to fulfil all their responsibilities. In particular so there is more scope to offer individualised support for activities and to ensure that tasks related to the household and garden can be carried out satisfactorily. Wren House DS0000064834.V342577.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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