Inspection on 24/05/05 for Wyatt House

This inspection was carried out on 24th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wyatt House 20/01/09

Wyatt House 04/08/08

Wyatt House 27/11/07

Wyatt House 09/03/07

Wyatt House 23/02/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Wyatt House 1 Radford Road Tinsley Green Crawley 3 West Sussex, RH10 3NW Lead Inspector Gaynor Moorey Announced 24 May 2005 09:00 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 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 Stationary 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. Wyatt House Version 1.10 Page 3 SERVICE INFORMATION Name of service Wyatt House Address 1 Radford Road, Tinsley Green, Crawley, West Sussex, RH10 3NW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01293 881088 01293 881001 Wyatt House Limited Mrs Caroline Howell Care Home 6 Category(ies) of LD Learning Disability 6 Both registration, with number of places Wyatt House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered as a care for six adults with a learning disability. Date of last inspection 31/08/04 Brief Description of the Service: Wyatt House is registered to provide accomodation for up to six adults that have a learining disability. The service users within the home also have associated changelling behaviour. The home currently has six residents. The service is situated in the village of Tinsley Green near Crawley. Accomodation is provided on ground floor level. All the rooms are for single occupancy and have en-suite facilities. The service is set in large grounds. Wyatt House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standard Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Wyatt House will be referred to as both ‘service users’ and ‘residents’. The inspection was announced due to the last inspection being in August 04 and the need for a detailed discussion with the manager. The actual inspection took place on the Tuesday 24th May 2005 between the hours of 9.00am to 3.10pm. Six residents were accommodated at the home on the day of the inspection. The inspection included a tour of the premises and it’s facilities, with five out of the six residents being in at some point over the inspection. Due to the complex needs of the service users only one service user has any verbal communication and find dealing with new people quite difficult. Although the inspector did not directly hold any full conversations with the service users did spend some time in the home observing practice and care and the relationships between residents and staff. The manager, and two staff had full conversations with the inspector other staff were spoken to generally in the home. Records and documentation inspected included resident files, policies and procedures, staff files and the homes complaints book. Questionnaires were sent out to families/carers and professionals having and working with residents at the home. Some of the questionnaires received did influence which standards were assessed. What the service does well: The home in general has improved in most areas including new appropriate documents for the service users, better care planning and generally settled and happy atmosphere in the home. The home is beginning to maintain a consistent staff team and each service user has two key workers this has allowed residents to develop appropriate relationships with the staff and allowed the staff team to meet the needs of the service users in a comprehensive way that includes activities, clothes, food and personal care needs. The home has implemented a basic training programme for the staff that has improved their knowledge of the service users group and how appropriately to meet the care needs. The staff felt appreciated by the manager and felt that at last there was a team who were working well together. The home’s environment is now generally well maintained inside and out and is decorated to a consistent level with repairs being undertaken on a more consistent level. The home has a good system in place to deal with complaints and any possible incidents of adult protection these systems are backed up by staff training. Wyatt House Version 1.10 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wyatt House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Wyatt House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 5 The home provides good information for prospective service users and their representatives in an appropriate format to make an informed decision about whether or not to move in. The service gathers pre-admission information and assessments in order to make an informed decision as to whether they can meet the needs of a potential new service user and what provision is needed for the person to be appropriately placed. EVIDENCE: Wyatt House has developed a good statement of purpose that outlines the layout of the premises, the homes philosophy of care, and nature of services offered to residents. The home has also developed a guide for the residents that offers the full information that is required by registration. This contains the complaints procedure including the contact details of the Commission for Social Care Inspection. The service has worked hard to produce these two documents so that a full Makaton version sits next to the written word statements. The home has had three new admissions since the last inspection. Each new person has full pre-admission assessments from their care managers and old information from their previous care homes. Each person was visited in their Wyatt House Version 1.10 Page 9 old placement before seeing Wyatt House. An assessment had been undertaken on each potential service user before a placement was agreed to ensure their needs could be met by the home. The three new residents had not been admitted in emergency placements. Each service user has a written contract is set alongside a Makaton version. The contract contains the required statements such as the room they will be occupying and the terms and conditions for this, the facilities within the home and the rights and responsibilities of both parties. The Makaton version is scaled down to basic sentences. The service users have not signed their contracts and they are kept within the residents’ files. The documents can be viewed by the service users and families/carers. However due to the severity of the service users disabilities they are not greatly relevant due to levels of understanding and literacy. Although the documents are in place if needed when looking boundaries, rules, terms and conditions as they are a required document. Wyatt House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 There are clear and consistent care plans in place to adequately provide staff with the information they need to satisfactorily meet the needs of the service users. EVIDENCE: There were clear improvements within the care planning system used by the home that clearly laid out objectives, reasons why, how this could be achieved. The plans included activities, contact with families, care needs and general daily life. Each person at the home has a personal centred plan which contains likes and dislikes, a full care plan, an overview which is related to the daily care notes and a monthly review of the care given and changes to each persons’ plan. For some of the service users there extra detailed guidance in such area as meals and bathing. The home have recently been developing a personalised photo book with pictures relating to aspects of the care plan such as activities, food/mealtimes, bathing and pictures of each individuals bedroom this is to enabled the staff to give the service users a clear image of what they are going to do or where they are going to be. Wyatt House Version 1.10 Page 11 The home has developed clear risk assessments in relation to the care plan due to the complex and some times changeling behaviour that the service users present. This is in order to keep both staff and residents safe. Wyatt House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 Meals appear to be nutritionally balanced, nicely presented, and clearly based on service users food and drink preferences, providing them with daily variation and healthy eating options. EVIDENCE: The home complies the menus on a weekly basis on a Tuesday and then shops on a Wednesday. The menu is designed through trial and error and on what works for the service users. The menu and past menus reflect a selection of meals that provide the service users with a varied well balanced diet. The service users were observed sharing a meal of jacket potatoes with toppings and salad. The meal was settled with the service users enjoying each other’s company and the staff were there to support. One service user had helped to prepare the lunch and where possible the residents take turns to help out in the kitchen. Another activity the clients undertake is to help with the shopping. All of the meals are prepared by the staff who have all undertaken food hygiene training. Wyatt House Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 Personal support in the home is offered in such a way as to promote and protect service users’ privacy dignity and independence. The service provides and supports the residents to access both healthcare professionals and specialist services where needed. In order to ensures that the service users receive the appropriate care for their needs. EVIDENCE: The service users within the home have learning disabilities and complex needs, due to the high care needs the residents do depend upon the support of the staff to meet their healthcare and personal care needs. The service has policies and procedures in place for personal hygiene and healthcare needs this is supported by the training supplied to the staff in this area. Within each of the service users files there is a healthcare section that contains appointments for all area of healthcare such as the doctors, dentist and opticians. Other specialist support appointments are listed within these records. Healthcare reports and medical assessments are kept on each service users main file. The residents’ care plans list any specific personal care needs and where a service user may have complex needs guidelines are in place for staff Wyatt House Version 1.10 Page 14 supporting the resident. Each service users has two key workers in order that most of their needs can be met by a member of staff with whom they have developed a relationship. Wyatt House Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Arrangements for protecting service users are satisfactory keeping residents safe from risk of harm and abuse. Complaints are always taken seriously by the home and service users are confident that any concerns they may have are looked and acted upon. EVIDENCE: The home has a detailed complaints procedure that is available in a service ‘user’ friendly format in Makaton. Each service has their own copy of the document that is kept in a file in the main lounge in the service. There have been no complaints received at the Commission For Social Care Inspection since the last inspection. The home has been dealing with a series of issues presented by one of the service users families. Records were in place to document all meetings that had taken place. Appropriate action had been taken in order to resolve the families’ complaints to the home. Although the home does have appropriate formats for the service users it is apparent that the service users have none or very slight verbal skills and all have a significant learning disability. When speaking to staff they had found that training provided by the home such as communication, working with changeling behaviour and issues specifically related to the residents complex needs had helped in detecting distress. But mainly related their knowledge of the service users to the relationships they had built with the residents. The home has a comprehensive collection of procedures for responding to allegations or suspicion of abuse. Staff are trained in dealing with incidents or disclosures from the residents and those spoke to felt confident in how they Wyatt House Version 1.10 Page 16 would deal with any situation that arose. A policy document and training is given to staff in regard to dealing with challenging and aggressive behaviour. Service user care plans and risk assessments include specific guidance to help staff support service users whose behaviour may challenge the home form time to time. Wyatt House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26,27,30 The home is furnished and decorated to a satisfactory standard and is kept clean and tidy ensuring that the residents live in a homely, bright and well kept environment, which suits their lifestyles. The service has risk assessments in place to ensure the home is safe and to minimalize any risks to the service users. EVIDENCE: Wyatt House has historically had environmental issues due to problems with the support offered by the company in regard to timescales of when maintenance is undertaken once it had been reported. This has resolved itself and the home now has regular support. However Environmental Health have questioned the experience of the maintenance man and his qualifications to be working in a care home after witnessing some unsafe practice. The home was inspected by the Fire Department in April 2005 and was found to have satisfactory fire systems. The home has adequate communal areas for the amount of service currently in the service. The communal areas consist of one large lounge where the residents also take their meals. There is another small room which is used by one service user who at times needs to be away from the other residents. The Wyatt House Version 1.10 Page 18 bungalow is surrounded by large gardens that are accessible to the service users. The home was found to be clean, tidy, hygienic and free from any odours or smells. All of the resident bedrooms were seen to be personalised to some degree. Each of the rooms has received some form of upgrade since the last inspection such as decoration, flooring/carpeting and furniture. However the home does need to address the damp problem within a majority of the bedrooms. All of the bedrooms have some en-suite facilities either a full bathroom with a shower or bath or a toilet with hand washing facilities. For those residents without full bathroom there is adequate provision in the home. The toilets and bathrooms are clean and tidy. Wyatt House Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 The assessed needs of residents are met by the numbers and skills of staff deployed at the home. The home maintain good records and supports and trains the staff to ensure that the residents have all of their needs met and to ensure that they are protected and safe. EVIDENCE: Within the home there has been a settled staff team for the last 9 months. There is a mix of staff from various ethnic backgrounds. The team has a good gender mix that is positive for the service users as four are male and two are female. The home has good staff records and through the recruitment procedures maintains two references and a CRB check on each member of staff. Although through archiving the system the manager realised that two staff employed before her arrival did not have CRB checks. The manager has now amended this situation and is awaiting a reply from the Bureau. The home also undertakes to check staff through the POVA system evidence of this was seen on the staff files. Staff receive both a job description and contract at the beginning of their employment. Part of the recruitment process is a three-month probationary period. The system in place helps to ensure the safety of the residents. The Wyatt House Version 1.10 Page 20 records and the staff spoken to confirmed the system is in place and used for all potential new employees. There is clear evidence of the training programme in place at the home. The staff spoken to confirmed that regular basic training had been offered and undertaken. All the newer staff had undergone an induction programme this had been recorded and kept within the staff files. Currently there are only three people in the staff team including the manager and assistant manager that have any NVQ qualifications this has been an issue in previous reports. The manager is aware of the requirement for NVQ training and has said the company is hoping to offer this over the coming months. The staff spoken to stated that they felt fully supported by the management team. Supervision has not always been on a regular basis within the home but records indicate that this has changed over the last six months. Currently no appraisals have been completed these are set to happen over the next six months. Wyatt House Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 The home has a quality assurance system in place that involves consulting those involved with the service including the service users’. The home has undertaken a full programme of quality assurance. However the home has not assessed the evidence from the survey and does not have a development plan in place so although the survey has finished it has not yet benefited the service users or helped to assist in the development of the home. EVIDENCE: Within the homes there is a quality assurance system in place that includes questionnaires appropriate for the service users, families/carers, professionals and staff. A full survey has been undertaken and evidence was seen some of the questionnaires especially from parents/carers contained both positive and negative comments. The service has not yet used the findings of their survey to influence practice in the home or as a part of a development plan for the coming year. The home does need to use the results of the survey otherwise it indicates that the service is not using input from those living, accessing services and working there. Wyatt House Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 x x 3 Standard No 11 12 13 x x x Standard No 31 32 33 34 35 Score x x x 3 2 Page 23 Wyatt House Version 1.10 14 15 16 17 x x x 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x Wyatt House Version 1.10 Page 24 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 ST35 Regulation 18 Requirement The company needs to ensure that NVQ training is offered to all established staff as part of their on going development. The home needs to implement a new development plan that includes and uses the findings from the recent quality assurance survey. Timescale for action 30th August 2005 30th August 2005 2. ST39 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard ST36 Good Practice Recommendations The manager to ensure that the staff all undergo an appraissal over the coming seven months. Wyatt House Version 1.10 Page 25 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wyatt House Version 1.10 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!