Inspection on 20/01/09 for Wyatt House

This inspection was carried out on 20th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wyatt House 04/08/08

Wyatt House 27/11/07

Wyatt House 09/03/07

Wyatt House 23/02/06

Wyatt House 24/05/05

Wyatt House 31/08/04

Wyatt House 05/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

CARE HOME ADULTS 18-65 Wyatt House 1 Radford Road Tinsley Green Crawley West Sussex RH10 3NW Lead Inspector David Bannier Unannounced Inspection 20 January 2009 10:00 th DS0000036981.V373405.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 DS0000036981.V373405.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. DS0000036981.V373405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wyatt House Address 1 Radford Road Tinsley Green Crawley West Sussex RH10 3NW 01293 881088 01293 881001 wyatts@caretech-uk.com www.caretech-uk.com Wyatt House Ltd 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) Manager post vacant Care Home 8 Category(ies) of Learning disability (0) registration, with number of places DS0000036981.V373405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 8. Date of last inspection 4th August 2008 Brief Description of the Service: Wyatt House is registered to provide care and accommodation for eight adults who have a learning disability. The people living within the home also have associated challenging behaviour and there are currently eight residents. The service is situated in the village of Tinsley Green near Crawley. The accommodation is on the ground floor and all of the rooms are for single occupancy, six of which have en-suite facilities. The service is set in large grounds, which are easily accessible to residents. The Registered Provider is Wyatt Homes Ltd and the Responsible Individual is Stephen James Unsworth. At present the minimum fee is £1,275.00 per week, and the maximum fee is £2,131.00 per week. DS0000036981.V373405.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. Residents who were considered capable of completing it and staff were sent surveys by the Commission entitled “Have Your Say.” These are designed to enable residents and staff to give their opinions about how the care home is being run. Information received from the AQAA and returned surveys will be referred to in this report. A visit to the care home was made on Tuesday 20th January 2009. This was an unannounced inspection; this means that the provider had no notification of our intended visit. Due to their learning difficulties we were unable to have meaningful conversations with all the residents. However we did speak to some residents and observed how care was provided to them. This gave us a picture of what it was like to live at Wyatt House. We spoke to two staff on duty in order to gain a sense of how it was to work at the care home. We also viewed the accommodation. Some records were also examined. The visit lasted approximately nine hours. Although the manager of the service, who is not yet registered with us, was not available, the deputy manager and the area manager were present and kindly assisted us during our visit. What the service does well: Residents are provided with a range of activities inside and outside of the care home. We noted that residents were kept busy with the routines of their day. They appeared to be active and interested in what they were doing. One resident told us they were looking forward to a session of using trampolines in a local sports centre. There were sufficient numbers of staff on duty to ensure residents are well supported and their needs have been met. DS0000036981.V373405.R01.S.doc Version 5.2 Page 6 Staff meet regularly as a team and individually with the manager and senior staff. They told us they felt well supported by the management of the home. What has improved since the last inspection? What they could do better: DS0000036981.V373405.R01.S.doc Version 5.2 Page 7 Where risks to residents have been identified by assessments, guidance must be drawn up for staff to follow, so they know what action to take to ensure residents are safe. All staff need to be provided with training in identifying different types of abuse and reporting any instances that occur. Broken or faulty equipment, such as washing machines, must be repaired or replaced without delay. 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. DS0000036981.V373405.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000036981.V373405.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A means of assessing prospective residents’ individual needs and aspirations is in place. EVIDENCE: During our last visit we found evidence that there is a Statement of Purpose and Service User Guide in place but as no new service users have been admitted to the home since 2006 we could not assess if the information is suitable for prospective service users. The manager at the time told us that these documents are under review and would be developed in a format that could be more easily understood by people with complex needs. A requirement was made that people must have their needs re-assessed with input from families and other professionals. In response the registered provider has provided us with an improvement plan with up dates in November 2008 and January 2009. The registered provider has advised us that they wrote to those local authorities who are sponsoring DS0000036981.V373405.R01.S.doc Version 5.2 Page 10 each resident in October 2008 requesting that reassessments are arranged for each person. Copies of letters were present on individual care records. As a result reassessments have taken place with regard to two residents. However, the registered provider is still awaiting responses with regard to the other requests. During this visit we were informed that an admission procedure was in place. We looked through this document and note it included the assessment of prospective residents before they admitted. We were advised again that no new residents have been admitted since we last inspected this care home. We could, therefore, not determine if their needs are being assessed before they admitted. For this reason the requirement made could not be determined. Whilst the requirement has been removed, we will review this again during our next visit. DS0000036981.V373405.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Work is still progressing with regard to drawing up individualised care plans, which will include residents’ own aspirations and goals. Where possible, residents have been encouraged to make choices about their own lifestyle, with support where needed. Guidance which staff should follow when supporting residents to take risks is not sufficiently robust. EVIDENCE: During our last visit we found evidence that the care planning, monitoring and recording processes were not of a standard that ensures that people’s changing needs are being identified and met. DS0000036981.V373405.R01.S.doc Version 5.2 Page 12 A requirement was made that care plans and risk assessments must be reviewed and updated to ensure that the current needs of service users are being met and staff team have the information they need to safely support people. The registered provider has informed us that, “The manager and team have undertaken work, referring to outside agencies where necessary, in completing this review. Where care plans have been amended this has been communicated to all staff through regular senior and staff meetings. The manager and team will be expected to maintain, and regularly review, such documents with as much involvement of service users as practicable.” During this visit we found evidence that care plans have been developed in respect of three residents. They include information about the resident’s family and friends, their likes and dislikes, personal care needs with regard to their morning and evening routines. Where necessary guidelines with regard to bathing, mobility, continence and activities have been developed. We also noted that the information is also in picture format so that it would be easier for residents to understand. We also found evidence that, where necessary, risk assessments have been carried out for a variety of activities including horse riding, swimming and using public transport. However, such risk assessments are not routinely transferred into guidance for staff to follow so that they know what they should do to meet individual residents’ needs. For example, an assessment has been carried out for a resident who likes to go swimming. But, we could find no evidence of guidance being drawn up for staff to follow to reduce the occurrence of any identified risks when the activity takes place. We discussed this with the deputy manager and the areas manager who agreed to ensure this is shortfall of information is addressed. A requirement has been made, which appears at the end of this report, as this affects the safety and wellbeing of residents. We noted that the care plans for the remainder of residents was still in the older format. We were advised that they would be transferred into the new format by the end of March 2009. We observed staff working with practices and support provided to provided. Discussions with staff on aware of the needs of each resident residents. They demonstrated that care residents were in line with the guidance duty confirmed they had been made fully and how they should be met. Four surveys returned by staff confirmed they are always given up to date information about the needs of residents. One member of staff told us, “Care plans are currently being reviewed and updated.” One survey confirmed this is usually the case. DS0000036981.V373405.R01.S.doc Version 5.2 Page 13 During our visit we noted that some residents were taken out to a local facility where could enjoy a session with trampolines. Another resident was taken out for a ride in the car. Care records we examined listed the activities residents enjoyed. We were also given copies of activity programmes for each resident to look at. We noted that most of the activities are provided for groups of residents. It was not clear if this was because residents had chosen to participate in activities as a group or if they had been arranged in this way by staff. One survey returned by a resident confirmed they can sometimes make decisions about what they do each day. They also told us, “I like trampoline and swimming.” The same resident also confirmed that are able to do what they want during the day, during the evening and at the weekend. We met and spoke to several residents. From our own observations and from care records we examined we concluded that the ability range of residents to communicate and interact with each other and with staff was mixed. Some residents clearly enjoyed meeting with visitors to their home whilst others found it unsettling. DS0000036981.V373405.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a range of activities in which they can take part, including activities within the local community. Residents have been supported in forming/maintaining personal and family relationships. Residents have been provided with a varied and wholesome diet. EVIDENCE: During our last visit we found evidence that the people living in the home do not have opportunities for regular outings and activities. We also found that the home does not provide a stimulating and supportive environment and people’s nutritional needs are not being met. DS0000036981.V373405.R01.S.doc Version 5.2 Page 15 A requirement was made that residents must be supported to access a variety of activities and outings and there must be a programme of in-house resources and activities in place to offer people interest and stimulation. The improvement plan has advised us that “The manager and team are actively developing individual “activity programmes”. These are determined by the wishes and preferences of the service users. The manager is liaising with external professionals and has purchased new in-house materials to better engage with one service user. Service users continue to access a range of external activities which includes horse riding, trampoline and cinema.” During this visit we noted that some residents were taken out to a local facility where could enjoy a session with trampolines. Another resident was taken out for a ride in the car. Care records we examined listed the activities residents enjoyed. We were also given copies of activity programmes for each resident. Activities listed included trampoline, swings and roundabouts, walks to a local park, horse riding and carriage riding, trips to the cinema and bowling alley. One resident goes to a local college. In house activities include sessions of sewing and craft, music therapy, aromatherapy, fun cooking and art fun. There were also opportunities identified in the programme for residents to have individual free time. We were also shown the facilities provided in the home which residents can use. There were adult size swings in the garden and an area for sand play. Inside we found art and craft equipment, equipment for playing CD’s and a selection of games. Whilst we did not meet any relatives or friends of residents during our visit, we noted that care records provided details for each resident of people who are important in their lives. This also included details of the relatives and friends who are likely to visit and how often. There was also guidance for staff to follow to support residents when they have visitors. A requirement was also made that a referral must be made to a nutritional expert to assess the individuals needs of service users and to gain advice on healthy eating and records must be kept of nutritional input for people identified as “at risk”. The registered provider has also advised us that, “The home manager, and area manager, has worked with staff to improve the quality of the menus. Service users are to be weighed regularly. The home manager is to contact a dietician regarding input from local expertise. Service expenditure with regards to food has been increased. Changes have been made to dining arrangements supporting staff to better encourage and monitor meals.” DS0000036981.V373405.R01.S.doc Version 5.2 Page 16 In November 2008 the registered provider advised us that, “The Home Manager has discussed a joint referral to a dietician with a local doctor but they would not refer in this way. The doctor has suggested that we liaise directly for input with the dietician at Crawley Hospital. This has since not proven possible either therefore we have had to submit individual referrals.” During this visit we were given copies of menus to look through. We noted that, apart from Sunday, the main meal of the day was provided in the evening. One day a week, usually on Saturday, a cooked breakfast is provided. The information provided also demonstrated residents have been provided with a varied, wholesome and nutritious diet appropriate to their needs. The care records we looked through included details of residents’ likes and dislikes together with any special diets required. We were given a portion of the midday meal to sample. It was a pasta dish and was nicely presented, tasty and filling. We could find no evidence that any one resident needs to be referred to a nutritional expert. However, it is expected that the care home continues to seek advice from such an expert should this be needed. We were informed that some residents do not like to eat their meals in the company of others. We were also informed that residents are able to eat where they choose. We noted there was sufficient accommodation to allow this. DS0000036981.V373405.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Support and personal care provided takes into account the wishes and personal preferences of each resident. The physical and health care needs of residents have been met. Medication is administered and recorded in a way that protects and supports residents. EVIDENCE: During our last visit we found evidence that service user’s healthcare needs were not being met and the staff team do not have the skills and training to safely support and monitor people. A requirement was made that health care plans must be reviewed and updated to reflect the current needs of service users and referrals must be made to the DS0000036981.V373405.R01.S.doc Version 5.2 Page 18 relevant healthcare professionals and learning disability teams in order to ensure that people’s healthcare needs are being met. The registered provider has advised us that, “ Health care plans have been reviewed and will be kept under review. Referrals are in the process of being sent in regards to epilepsy needs, communication and mobility. Several service users have now accessed health care professionals in regards to individual health issues and recording of information has been improved.” In November 2008 the registered provider informed us that, “Sheets are now in place for the recording of health and Community Learning Disability Team input in care plans to reflect, not only actual appointments, but also other conversations, updates etc. Some referrals are still pending after submission to the positive behaviour team, epilepsy special, Occupational Therapy, speech and language, and others. Some input from the local team has been received already. Foot care is in hand each week, GP involvement has been in line with need, dentistry to be determined through review process, medication training is now done, optician appointments for some have occurred, others to go into community, appointments being booked.” In January 2009 we were advised that, “Appointments have now taken place for health care and are up to date for dentist and opticians etc. Well man and well woman clinic appointments have been booked for all service users. A named resident has been referred to a physiotherapist to aid mobility.” During this visit we looked through a selection of care records. They included information about the health care needs of each resident, particularly with regard to doctor’s appointments, visits to the dentist and the chiropodist. The information also states when they have occurred, the treatment provided and, where necessary further information for staff to follow. We were also informed that, on the morning of our visit, one resident was due to have a health care check at the local surgery. A requirement was also made that the medication system must be reviewed and updated to identify the staff trained to administer medication and to ensure that the staff team are aware of why they are administering medication to people. The improvement plan also confirmed that, “The medication system is to be reviewed. The home manager is requesting training in the home. Only those deemed competent are to administer medications. The majority of the staff team have now attended the medication training and the manager is planning to deliver the in house assessment as soon as is possible.” During this visit we noted that medication has been securely stored. Records seen had been well maintained and were up to date. Training records seen confirmed that the manager has arranged for staff to receive training in the DS0000036981.V373405.R01.S.doc Version 5.2 Page 19 safe administration of medication. Staff we spoke to who were on duty confirmed this. We were informed that, currently, no resident is considered to be capable of administering his or her own medication safely. We were also shown how staff administer medication to residents. This includes, in some instances, taking medication out of the blister pack in the medication room and putting it into a plastic pot. The member of staff then takes the medication to the resident for whom it is prescribed wherever they may be in the home. Whilst this practice is acceptable we would recommend that the manager refers to guidance issued by the Royal Pharmaceutical Society of Great Britain (RPSGB), and in particular the section entitled “Procedure for Medicine Administration.” We would recommend that the guidance is used to amend the homes’ own procedures to ensure staff are fully aware of the action they should take to ensure medication is transported around the home safely. DS0000036981.V373405.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has set up a system for ensuring residents’ views are listened to. Some work is required to ensure complaints received have been appropriately recorded. Residents are protected from abuse, neglect and self harm. Further training is planned for staff in identifying and reporting instances of abuse and neglect. EVIDENCE: During our last visit we found evidence that the system for recording and investigating complaints does not meet the required standards. We also found that there was a lack of staff training and understanding of safeguarding issues which meant that, along with unsuitability of the environment, people were vulnerable to risk of abuse. A requirement was made that there must be a clear system in place for recording, investigating and feeding back outcomes of complaints concerns and allegations. The registered provider has advised us that, “The home manager has now implemented the registered provider’s own policy and procedure in regards to complaints. The staff are currently reading and signing up to the policy. Clear DS0000036981.V373405.R01.S.doc Version 5.2 Page 21 paperwork to record complaints and actions taken has also been implemented.” In November 2008 we were informed that, “A complaints folder is in use. Staff have read and signed up to the procedure. It reflects the nature and detail of the complaint, the outcome and the actions taken.” In January 2009 we were advised that, “A new service user complaint form has been identified.” During this visit we were informed that a complaint procedure has been drawn up so that residents and their families know how to make a complaint if they wish to do so. We were shown a copy of the home’ service users guide and noted that this included the complaint procedure. We also noted that the text included simple pictures that described the text. We were informed that copies of this document will be given to residents families at a meeting planned to taken place in February 2009. We were also informed the format of this document is appropriate for the needs of residents accommodated. We also looked through the home’s record of complaints that had been received since our last visit. The record included five complaints, the date they were received and the date by which they had been resolved. We were informed that all complaints received had been resolved to the satisfaction of the person making the complaints. Following discussion with the deputy manager and area manager, we recommended that they should ensure further details about each complaint are recorded. The record should include more details of the nature of the complaint, the details of any investigation carried out and its outcome. This would ensure sufficient evidence is available to confirm that appropriate steps have been taken with regard to dealing with any complaint the home may receive. The deputy manager and area manager agreed to ensure complaints are appropriately recorded in future. We also made a requirement that, to ensure that both service users and the staff team are kept safe, risk assessments must be reviewed and updated and the staff team must receive training in safeguarding people in the management of challenging behaviours. The improvement plan informed us that, “The home manager is to review all risk assessments within the home.” As mentioned earlier in this report, we found evidence that, where necessary, risk assessments have been carried out for a variety of activities that residents are involved in, including horse riding, swimming and using public transport. However, such risk assessments are not routinely transferred into guidance for staff to follow so that they know what they should do to meet individual residents’ needs. We discussed this with the deputy manager and the areas manager who agreed to ensure this is shortfall of information is addressed. The improvement plan also informed us that, “Challenging behaviour training has been provided for all staff, including regular agency staff.” In January 2009 DS0000036981.V373405.R01.S.doc Version 5.2 Page 22 we were advised that, “Training for some senior staff has been undertaken on managing change and effective shift leading – others will do this over coming months. A training date that had been set for safeguarding vulnerable adults training in January has had to be postponed to February due to availability.” During this visit we looked through staff training records and also a matrix of training planned for the future. Staff training records comprised copies of attendance certificates and confirmed staff had attended training in communication techniques, managing challenging behaviours and non-violent crisis interventions. We also spoke to staff who were on duty who were able to confirm they had received the training as stated. We could find no evidence that staff had received training in identifying different forms of abuse and to whom they should report if they witness an event when abuse is taking place. Staff we spoke to also confirmed they have yet to receive training in this area. Whilst we noted that further training planned for the future includes this, a requirement has been made that all staff employed to work at the care home must be provided with such training as this has a direct impact on the safety and wellbeing of vulnerable residents. DS0000036981.V373405.R01.S.doc Version 5.2 Page 23 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have been provided with a homely, comfortable and safe private accommodation in which to live. Some improvements have been made to the communal areas. Further work is required to ensure the premises has been decorated, maintained and furnished to a good standard. Improvements have been made to the standard of cleanliness in the home. EVIDENCE: During our last visit we found evidence that the home does not provide a comfortable, safe and homely environment for the people who live there and there are no aids and adaptations to meet people’s sensory and mobility needs. The following requirements were made: DS0000036981.V373405.R01.S.doc Version 5.2 Page 24 • • • The home must be kept clean and in a good state of repair, service users must be provided with furniture, fittings and fixtures that meets their needs and equipment such as washing machines and tumble driers must be kept in good working order. All areas of the home to which service users have access must be kept safe and accessible, this includes the outstanding work to make the driveway safe being completed. The home must kept in a condition that safely meets people’s needs and advice must be sought from an occupational therapist regarding the provision of suitable aids and adaptations. The registered provider has advised us that, “The Home Manager is requesting new furniture for both communal areas and private bedrooms. The electrical work needed on the property is nearly complete and quotes are being obtained for the installation of keypad locks for main entrances and fire exits. Pest control is now visiting the home regularly. The Home Manager is to request a domestic help for the home. The “Action Plan” has incorporated a complete review of existing facilities and the redecoration and refurbishment of the service by September 2009.” In November 2008 we were advised that, “Group Projects Manager for estates and Development is visiting Wyatt House on 13th November to ascertain how we can improve the use of the space or develop further communal areas. The tumble-drier has been replaced. A larger washing machine in hand. A cleaning programme is in place. Requests are all in for replacement furniture for the lounge, dining room and bedrooms. Evidence of requests are available in the home.” In January 2009 we were informed that, “Soft furnishings and homely items have been purchased by the home in consultation with the service users. These to date have been well accepted by the service users. Maintenance works have been undertaken in the first week of January where further damage has occurred, the same maintenance man will be used for maintenance works now providing a ‘familiar’ face for service users.” On this occasion we visited the private accommodation of each resident, the lounge and the dining room. Those areas of the home seen were presented in a homely and comfortable manner. We noted that the staff have worked with residents to ensure their rooms reflect the personality of residents. We saw items bought on behalf of residents include posters and pictures, televisions, CD players and sensory equipment. We noted that some new furniture has been purchased for use in communal areas and work as started to improve the decoration of these rooms. The area manager informed us that there are plans to rearrange the accommodation so the needs of residents are more readily met. We were informed that there are plans to relocate the dining area and the kitchen facilities. Externally the driveway and gardens were in good order and were available for the residents to use. We saw documentation that confirmed an occupational DS0000036981.V373405.R01.S.doc Version 5.2 Page 25 therapist had been contacted to advise on aids and adaptations for residents. The documentation we saw indicated that, currently, plans are in hand to provide ramps to enable easy access to the premises. We could find no evidence that any one resident needs to be referred to an occupational therapist regarding the provision of aids and adaptations. However, it is expected that the care home continues to seek advice from such an expert should this be needed. We also visited bathrooms, toilets, the kitchen and the utility room. We noted that the washing machine is no longer working. The home has been advised that it cannot be repaired. We were informed that a new machine was on order and should be delivered in the next few days. However, it was not clear how long this would be and what interim arrangements have been put in place to meet the laundry requirements of residents. It is essential the registered provider dopes make such arrangements whilst the washing machine is not available DS0000036981.V373405.R01.S.doc Version 5.2 Page 26 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, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has provided all staff with training with regard to understanding and meeting residents’ needs. However, training in how to safeguard vulnerable adults has not been provided. The home’s recruitment practices and procedures protect and support vulnerable residents. The registered provider has ensured the staff team are supported and regularly supervised. EVIDENCE: During our last visit we found evidence that the staff team do not have the knowledge, skills, training and support to safely care for and support the people currently living in the home. DS0000036981.V373405.R01.S.doc Version 5.2 Page 27 A requirement was made that there must be sufficient numbers of staff on duty at all times that have the skills, training and knowledge to safely and effectively support the needs of the client group living in the home. The registered provider has informed us that, “Staffing levels have been increased. Management behaviour training has recently been implemented and a further training plan is being developed. Recruitment is targeting experienced, competent staff to join the service and the Company has recently implemented a pay increase to try and attract experienced support workers and senior support workers.” In November 2008 the registered provider informed us, “Recruitment is ongoing, some progress has been made including a Home Manager and Deputy Home Manager. Continuity of regular agency staff is maintained in the absence of a full staff team.” In January 2009 the registered provider advised us that, “A further 2 pay increase has been awarded to staff salaries, effective from 1St December 2008.” During this visit we were informed that recruitment of permanent staff continues to be difficult. We were also informed that, currently, there are seven full time vacancies in the staff team. The registered provider has identified the difficulty is due to severe competition in the local recruitment market. In the meantime, the care home continues to rely heavily on agency staff. We were informed that the registered provider has taken appropriate steps to ensure the same agency staff are used so that the care provided remains consistent and continuous. We were given copies of staff rotas to look through. They included a period of two weeks before our visit, the week of our visit, and the week afterwards. Rotas indicated that from 7.15am to 2.15pm each day there are six staff on duty. From 2pm to 9pm each day there are five staff on duty. From 8.45pm to 7.30am each night there are two awake staff on duty to provide for the needs of residents. In addition, there is one member of staff who is identified as being on call in case of emergencies. After looking through a selection of care records and observing a part of the morning routines we concluded there were sufficient staff on duty to provide for residents’ needs. We also examined the recruitment records of two staff who had been appointed since we last visited. We found that all the required information and checks were in place to ensure vulnerable residents have been protected. This included two written references, proof of identity and criminal record checks (CRB). Surveys returned by staff confirmed their employer had carried out checks, such as CRB checks and references, before they started work. We also looked through staff training records. They confirmed that staff have received, or are in the process of receiving, mandatory training such as health and safety, first aid, food hygiene, fire awareness. However, as identified in an earlier section of this report, we could find no evidence that staff had received training in identifying possible instances of abuse and how they should be DS0000036981.V373405.R01.S.doc Version 5.2 Page 28 reported. In addition staff have received, or will be receiving in the near future, training in providing care to someone with epilepsy and understanding autism. Staff we spoke to were able to tell us the training they had received. Surveys returned by staff confirmed that they had received induction training, training which is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. One member of staff told us, “We also respect each resident’s dignity, privacy and culture.” We also made a requirement that, in order that the staff team are monitored and supported in their care practice, they should receive formal supervision at least six times a year. The provider’s improvement plan states that, “The Home Manager has initiated regular ongoing supervision for seniors, it is envisaged this will be rolled out to all staff once seniors trained and competent to do so. This will take shape as recruitment improves. However, informal supervision does take place on a daily, informal basis. Staff also receive group supervision through staff meetings that are held monthly.” During this visit we found evidence that all staff have been receiving, and are scheduled to receive supervision from a more senior member of staff on a monthly basis. Staff we spoke to confirmed the supervision they had received and also confirmed they felt well supported by the management team. Four surveys returned by staff confirmed the manager meets with them regularly to give them support and to discuss how they are working. One member of staff told us, “We have a new manager who has just started on 1st December 2008. We hope he will be giving us support and discussing with us how we will be working.” One survey confirmed the manager often meets with them. We were also shown minutes of a staff meeting that was held soon after the new manager and deputy manager were appointed. The meeting’s primary purpose was to introduce the new manager to the staff team. DS0000036981.V373405.R01.S.doc Version 5.2 Page 29 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, 41 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Work is required with regard to how the home is managed to ensure the care home is well run. The registered provider has set up a system for seeking the views of residents and their families but this has yet to be implemented. The registered provider has taken appropriate steps to ensure the health, safety and welfare of residents and staff have been promoted. EVIDENCE: DS0000036981.V373405.R01.S.doc Version 5.2 Page 30 During our last visit we found evidence that the home had not been well managed or monitored. Health and safety issues also needed to be addressed to ensure the safety of both service users and the staff team. As we were concerned that the home was not meeting people’s needs we made the following requirements: • • In order that the home is effectively managed and monitored a manager with the required skills and experience must be recruited and registered. There must be a system in place to seek the views of service users, families and other people involved with the home. Regulation 26 providers’ visits must be carried out and recorded in order to ensure that the home is being regularly monitored. The home must be kept safe and promote service users’ independence. This includes liaising with the fire department regarding the outstanding fire safety work, staff receiving fire training and a current electrical certificate being in place. • The registered provider informed us via their improvement plan that, “As an interim measure, an experienced manager has been seconded to Wyatt House whilst recruitment is ongoing. Additional management support is being provided on a weekly basis.” In January 2009, the registered provider supplied us with an update to their improvement plan. It stated, “A new manager has started. The previous experienced manager undertook a thorough handover and is still involved each week providing advice and support.” We noted that the new manager of Wyatt House had been appointed in December 2008. During this visit we met the deputy manager, who had been appointed at the same time as the manager, and the area manager of the organisation that owns the care home. We were unable to meet the new manager as he was on annual leave. We were informed that the manager would be submitting an application to register with us in due course. We were given minutes of recent staff meetings to look through. This showed that the manager and deputy manager had met with the staff team for the first time on 4th December 2008. Following discussion, we were advised that, prior to the appointment of a permanent, the home had been managed by an experienced manager of another care home owned by the same organisation. We noted that the name of this manager appeared on residents’ care records. We were advised that this person had been working on making improvements to care plans. We found evidence that work is being carried out to ensure the care home is well run. For example we saw records of staff meetings, staff training and staff supervision. However, we also found evidence that improvements are still needed. For example, care plans must include guidance for staff to follow to DS0000036981.V373405.R01.S.doc Version 5.2 Page 31 reduce or eliminate identified risks to residents when they participate in activities. All staff must be receive training in identifying and reporting abuse. Faulty or broken equipment must be repaired or replaced promptly. In January the registered provider’s updated improvement plan told us, “The quality and performance team will circulate a questionnaire by the end of February 2009. After feedback on the forms from external customers the format is to be slightly changed to make it more user friendly.” During this visit we were shown copies of the updated questionnaires that were going to be sent to service users and their families. We were also shown questionnaires that were also going to be sent to other stakeholders such GP’s and residents’ care managers. We were also told about a meeting that was planned to take place in February 2009 between representatives of the registered providers and the families of residents. We were informed the purpose of the meeting was to issue the new service user’s guide and to discuss the future plans for Wyatt House. The registered provider’s improvement plan, which had been updated in November 2008 confirmed that, “Regulation 26 visits are monthly and on file – outcomes and actions are included. This includes discussion with internal and external customers and staff.” During this visit we saw copies of the reports of such visits carried out by representatives of the registered provider. The reports we saw included all the necessary information required by current legislation and confirmed that they had been carried out at appropriate intervals. The registered provider’s improvement plan, with updates in November 2008 and January 2009, confirmed that the following work had been completed: • Electrical test done – awaiting certificate. • Fire checks in line with Regulations. Remedial work that was identified has been forwarded to the Estates Manager for action. • Fire training was completed on 15th December as planned • Fire authority has postponed their visit to 21st January. During this visit we were shown documentation that confirmed maintenance work that has been completed. Gas and electrical equipment, electrical appliances have been checked and maintained regularly. detection equipment and other fire appliances have also been checked maintained. the and Fire and We also found evidence that a programme of training provided and also planned for all staff includes training in health and safety issues, fire prevention, manual handling and first aid. This will ensure the safety and wellbeing of residents and staff. DS0000036981.V373405.R01.S.doc Version 5.2 Page 32 DS0000036981.V373405.R01.S.doc Version 5.2 Page 33 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 X 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X X X 2 X X 3 X DS0000036981.V373405.R01.S.doc Version 5.2 Page 34 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13 (4) Requirement Timescale for action 31/03/09 2 YA23 13(6) Where risks to residents’ health and safety have been identified, care plans must include guidance for staff to follow so that they know what to do to reduce or eliminate that risk. All staff must know how to 16/04/09 identify all forms of abuse and know the procedure for reporting any instances of abusive practices, to ensure vulnerable residents are adequately protected. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000036981.V373405.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000036981.V373405.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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