Inspection on 04/08/08 for Wyatt House

This inspection was carried out on 4th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wyatt House 20/01/09

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 09/11/2008.

CARE HOME ADULTS 18-65 Wyatt House 1 Radford Road Tinsley Green Crawley West Sussex RH10 3NW Lead Inspector Annie Taggart Unannounced Inspection 4th August 2008 10:30 Wyatt House DS0000036981.V369387.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 Wyatt House DS0000036981.V369387.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. Wyatt House DS0000036981.V369387.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 wyatt@beaconcaregroup.co.uk 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) Wyatt House Ltd Manager post vacant Care Home 8 Category(ies) of Learning disability (0) registration, with number of places Wyatt House DS0000036981.V369387.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 27th November 2007 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 £1,116.68 per week, and the maximum fee is £1,867 per week. Wyatt House DS0000036981.V369387.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 no star. This means the people who use this service experience poor quality outcomes. In order to plan for this unannounced visit, an Annual Quality Assurance Assessment (AQAA) was sent to the manager for completion and satisfaction surveys were sent to service users and professionals involved with the home. The AQAA was returned within the timescales and contained comprehensive information about the services on offer in the home. Five service user and two staff surveys were returned and all were positive about the care and support being provided in the home. The unannounced inspection was carried out on 4th August 2008 and lasted for 4.5 hours. During the visit we spent time talking to service users both in communal areas and in their private bedrooms and we spoke to the staff on duty and observed staff practice and interactions with service users. We tracked four care plans and all supporting documents such as daily records and health plans and we spoke to the staff on duty about how they were aware of the needs and wishes of the people they are supporting. We looked at four recruitment files, staff training files and evidence of supervision and we asked the staff about the training and support they receive. Records for the running of the business were seen and these included complaints and comments, incident and accident recording, health and safety records, Regulation 26 Providers visits reports, fire records and the home’s insurance and registration certificate. The acting manager was present and received feedback following the visit. What the service does well: There is no evidence to support that the home is currently meeting the needs of the people who live there and standards have deteriorated since the last inspection visit. The parent of a service user who was visiting the home said, “ Everything is very unsettled and we never know from one day to the next what the situation is going to be. The company who owns the home have recently amalgamated with another company but there was no family involvement and we were not Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 6 given any information by the home. The manager and deputy have left and the facilities are poor,. I think the staff are doing their level best, they are usually kind but they work long hours and are always changing” What has improved since the last inspection? What they could do better: In order to ensure that the needs of service users are being met and that the home is safely and effectively managed, improvement must be made in the following areas: The care needs of people must be re-assessed with input from families and other relevant professionals involved with the home, care plans, healthcare plans and risk assessments must be reviewed and updated so that people’s physical and emotional healthcare needs are being addressed and monitored. In order to ensure that people have opportunities for outings, activities and access to their local community, there must be sufficient trained staff and drivers available to meet people’s identified needs and the home must also provide equipment and resources to ensure the provision of in-house stimulation and interests for service users. A referral must be made to a nutritional expert to assess the needs of people and to gain advice on healthy eating and records must be kept for people considered to be “at risk”. The medication system must also be reviewed and updated to ensure that errors in medication management do not occur. To protect service users from risk of harm or from all forms of abuse , there must be a clear and accessible complaints procedure in place, risk assessments must be reviewed and updated and staff must receive training safeguarding training and training in the management of challenging behaviour. The home must be kept safe, clean and comfortable as at the present time is it shabby and in poor repair. The necessary working equipment such as tumble driers and washing machines must be kept in good in working order. The need for a complete refurbishment and redecoration of the home must be put in place and the outstanding work on making the driveway safe must be completed as it has been an outstanding Requirment since 31/01/08. Assessments must also be sought from an occupational therapist or other relevant professional to ensure people have the aids and adaptations they need. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 7 There must be sufficient numbers of staff with the skills, knowledge and training needed to support the client group in the home and staff should receive both all mandatory training and training in the specific needs of the people they are supporting. To ensure that the home is safely managed and monitored, a manager with the skills and knowledge and experience to effectively manage the home must be recruited and registered, Regulation 26 Providers visits must be carried out and recorded in order to monitor the home and the staff team should receive regular supervision. Health and safety issues such as outstanding fire safety system work, staff fire training and the lack of a current electrical system certificate must be addressed to ensure that the environment is safe 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. Wyatt House DS0000036981.V369387.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 Wyatt House DS0000036981.V369387.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 outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. Because of the quality of the service being offered and the diversity of service users assessed care and support requirements, the home is not meeting people’s needs. EVIDENCE: 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 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. We were told that referrals had been made to adult services for two people to be re-assessed and looking at safeguarding records, talking to the acting manager and observation on the day of the visit showed us that the people living in the home are not compatible. Wyatt House DS0000036981.V369387.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 8 and 9 Quality outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. The care planning, monitoring and recording processes in the home are not of a standard that ensures that people’s changing needs are being identified and met. EVIDENCE: There is no evidence in records that service users have been recently reassessed and the manager told us that because of the number of incidents and people needing one to one observations it is clear that the home is no longer meeting all service user’s assessed needs. Care plans have recently been reviewed and updated but are still not “person centred” and do not give clear information to the staff team on how each person needs and wishes to be supported. Files are over full of paperwork making it very difficult for staff to find the information they need to safely support people. There is a high use of agency staff but no précis of care plans in place for them to easily become familiar with people’s needs. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 11 Risk assessments were out of date or did not clearly identify how risks are being minimised and monitored and this was especially the case for dealing with challenging behaviour. Assessments and observation showed us that the people living in the home have complex needs and often express themselves through unique behavioural communication but there was no evidence in care plans or records of input from community learning disability teams or other specialists to work with people to devise behaviour management plans or to train the staff team. The acting manager told us that there had been some input from a Speech and Language therapist but this had been withdrawn as the plans the therapist made were not put into practice by the staff team. During the visit we saw that when people began to display some difficult behaviours, some of the staff on duty became anxious and abrupt in their manner towards service users and there was very little actual personal interactions with people. Care plans also say that people have a key worker who works closely with them to identify changes in their needs and ensures that they receive the care and support they need but as there is high turnover of staff and a very high use of agency staff in the home, this is not happening. Care plans identify that some people understand Makaton sign language and all of the service users have verbal communication difficulties but apart from the acting manager there was no evidence that staff had attended any form of communication training and there were no visual aids or other forms of communication aids in the home. Daily records are poorly written and did not reflect the care and support actually being given to people and were not all up to date. Wyatt House DS0000036981.V369387.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 14 15 16 and 17 Quality outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. The people living in the home do not have opportunities for regular outings and activities, the home does not provide a stimulating and supportive environment and people’s nutritional needs are not being met. EVIDENCE: For each person living in the home there is a daily activity plan in place that identifies activities to be undertaken both in the home and in the community. Records showed us that this is not happening and the acting manager told us that this was because of a lack of trained staff and drivers. When looking at daily records we saw regularly recorded under the “activities undertaken” part, “ no unit vehicle driver present”, “ no driver and staff inadequacy, “ not sufficient staff” and “due to no driver on this am, shift replaced with various in-house activities”. There were no records as to what the in-house activities were. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 13 The whole of the home is very spartan and we saw no equipment for activities other than some paints and paper that people were being supported to use in the garden. There is no sensory equipment even though one person is identified as being registered as partially sighted and in the communal areas we saw no music equipment, resources or evidence of any craftwork undertaken by people and nothing to catch people’s interest or provide stimulation. Activities such as bowling, going for a walk, carriage driving and the cinema were recorded for some people but these were very sporadic and for one person we saw no outings or activities recorded in the past month. The acting manager told us that this was because of the person’s high health support needs but no other in-house activities or one to one time had been recorded for this person. During the afternoon a reflexologist came in and spent time treating people and she told us that she came to the home weekly. The acting manager said she was aware of the lack of outings, equipment and sensory aids for people and said that she had made a referral to an occupational therapist to try to address this. A menu was in place in the kitchen but for the week, apart from Sunday when there was a roast lunch with fresh vegetables and one day when there was fish and chips, all of the lunch and main meals were rice dishes, pasta dishes or pizzas. We asked the acting manager if this was service user’s choice but she said that she thought it was because most of the staff team come from differing ethnic backgrounds and found English type meals difficult to cook. This is also not being helped by the kitchen being very small and cramped with no ventilation. The menu for the day of the visit was tortilla wraps or pitta bread with chicken or tuna and jacket potatoes as an alternative. When the meal was served every service user was given a roughly cut up jacket potato with some cheese and a large amount of baked beans. We asked if this was the service user’s choice and were told that the staff member working in the kitchen had decided that everyone would have this meal. We observed lunch being served and saw that one person kept pushing the meal away without eating any; the staff member gave it back to the person who again pushed it away. The staff member then said, “ you don’t want it then, I will take it back to the kitchen”. At this point another staff member said, “ Oh he won’t eat it like that it has to be mashed”. The staff member then mashed the food and put it in a bowl and the service user then accepted the meal and ate it all. This was immediately fed back to the acting manager as an example of poor practice and a lack of understanding of service user’s needs as had the second member of staff not intervened the service user would have gone without a meal. Care plans show that some people have difficulty with eating and swallowing and need pureed meals and supplements. The staff member carrying out the Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 14 cooking did not have a knowledge of people’s nutritional needs and told us that when meals are pureed, it is all put in together. The pureed lunch looked unappetising and no drinks were served to service users with the meal. There is evidence in care plans of people’s nutritional needs being assessed but they are then not monitored and recorded even though records show us that some people have high nutritional support needs and one person has recently been recorded as losing weight. In one person’s care plan it was recorded “ has lost 5lb in the last month but no choking, needs to eat a balanced diet”. There is no evidence to show how this is being carried out or monitored. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 15 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 outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. Service user’s healthcare needs are not being met and the staff team do not have the skills and training to safely support and monitor people. EVIDENCE: In the AQAA we were told that Health Action Plans had been completed for service users and that their healthcare needs were being met. We saw during the visit that although the plans had been completed they did not reflect the current healthcare needs of people. Examples of inadequate recording are that in one section of the plans where people’s needs have been assessed, for several people it says, I can “probably” hear well or I can “probably” see well, without any evidence of how this decision was reached. Although a number of people living in the home suffer from severe epilepsy, the plans and risk assessments for dealing with this have not been recently reviewed and updated, guidelines for staff responses are poorly recorded and monitored and there is no evidence of people regularly being supported to attend epilepsy clinics. For some people a plan and risk assessment has been written regarding the use of invasive medication to be administered within a short time of a seizure being identified. The manager told us that because of Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 16 the high use of agency staff without the skills and training to carry this out the guidelines could not be followed especially at night so instead an ambulance was called. People living in the home have complex needs and often communicate through behaviour but there is no evidence of the home working with learning disability teams or other professionals to assess people, implement behaviour management plans and train the staff team. The acting manager told us that she has identified this as a priority and has booked training to be carried out on 15/8/08. There is evidence in safeguarding meeting minutes and from records that there are high levels of anxiety and people exhibiting difficult behaviours in the home and both service users and the staff team are at risk of being hit or injured. Some people are also recorded as being a risk to the public, which means that they need highly skilled and trained staff to support them in the community. As there is a high turnover of staff and often agency staff on duty there is no evidence to show that people are being safely supported. We saw forms in care plans that recorded visit to doctors and other healthcare professionals but these had very few visits recorded and some people’s sheets were blank. The acting manager said she could not be sure if people were regularly attending healthcare appointments or if the staff team were failing to record visits. There are policies and procedures in place regarding the storage and administration of staff and the acting manager told us that only staff who have attended training administer medication. We saw certificates of training with the local pharmacy in the training files. There is a monitored dose system in use and medication is safely stored in a locked room. Medication was generally well managed and medication recording sheets (MAR) were up to date but the list of authorised medication handlers was out of date and recently prescribed medication such as antibiotics had been hand written on service user’s MAR sheets without written authorisation being received from the doctor or an explanation of why the medication was in use being detailed on reverse of the MAR sheets. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 17 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 outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. The system for recording and investigating complaints does not meet the required standards and because of a lack of staff training and understanding of safeguarding issues and the unsuitability of the environment, people are vulnerable to risk of abuse. EVIDENCE: The home has a complaints procedures but this was not displayed and there was not an accessible format in place to support service users communication needs. We saw the complaints book but this was not in a format where complaints are recorded and showed evidence of timescales for investigations and how outcomes are fed back to complainants. One recent complaint from a parent is currently being dealt with by the acting manager, who told us that she is aware that the complaints recording system needs reviewing and updating. Two safeguarding referrals have recently been investigated by West Sussex Safeguarding team and two further safeguarding alerts are awaiting investigation. We saw from training records that all staff have not attended safeguarding training and from talking to the staff on duty we found that they were not aware of the procedures to follow should they suspect any form of abuse had taken place. An example of this was when asked what they would so if they heard a service users being shouted at by a colleague, the staff member Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 18 replied that, “I would take the person to one side and ask them not to do it again”. We saw one agency staff member whose attitude to service users was very abrupt and this was fed back to the acting manager. Also a regular member of staff, who although kind in their attitude towards people, never called any service user by their name but called them “young woman”, “young man” or “ missy”. This was also fed back to the acting manager as evidence of a lack of recognition of individuality, respect and dignity for people. During the visit service users were going into other people’s rooms and recorded incidents show that more vulnerable people are at risk from being hurt by other service users but there was no system in place for people to be able to lock their rooms safely. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 19 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 25 27 28 29 and 30 Quality outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: The home is a large detached bungalow situated in it’s own grounds in a rural area. There are automatically controlled gates to the front entrance of the property and a large, high fenced, secluded garden with swings, chairs and tables to the rear. There is a large lounge area that is very spartan with just leather chairs and sofas a couple of pictures on the wall and a dresser being used to store files, the walls also need decorating as they are dirty, scuffed and marked. The dining room is also very bare with tables and chairs but no homely additions. Throughout the communal areas of the home it is very bare and impersonal and does not feel homely, lived in, comfortable or welcoming. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 20 Bathrooms and toilets are also in need of updating and we saw broken toilet seats, holes in walls, and all bathrooms and toilets need decorating and updating. There are no aids and adaptations such as handrails or grab handles anywhere in the home even though some people are assessed as having mobility and sensory needs and there was also no specialist bathing equipment. The kitchen is small and does not have enough work surfaces to adequately cook and dish up food for eight people, there is no ventilation and there was a musty, unclean smell. In the laundry, which is very small with no ventilation we saw that the tumble drier was broken and one of the washing machines is also broken in the front but still in use. There were piles of dirty clothes on the floor and the whole garden was covered in wet clothes on lines, bushes, chairs etc trying to get it dry as the weather had been very wet. A service user’s mother showed us new clothes she had recently bought that had been ruined in the wash as they were white and had been washed with dark clothes. The person said that she had also bought the service user a clothes airer to dry her clothes on individually as they are always being ruined but she said that the staff did not use it. She also showed us that clothes are not being ironed and observation of the way other people were dressed confirmed this. Service user’s bedrooms had been personalised with their belongings, where they would allow this and some were attractive and well decorated but most were in need of refurbishment and we saw broken bed bases, poor quality, worn bedding, curtains hanging off windows, holes in plaster and old broken and worn furniture in rooms. One service user has their own self-contained lounge and bedroom but the door between the two rooms, which is a fire exit door, had no handles and both rooms needed redecorating and refurbishing. We saw in letters from the fire officer showing that there are still outstanding works from 25/10/06 to make the fire evacuation system safe and the acting manager told us that she has asked the Registered Providers for finances to complete the work. A Requirment made at the last two inspection visits for the driveway of the home to be repaired and made safe has not been met. The acting manager told us that she has carried out a full environmental audit of the home and is aware that it needs completely updating and refurbishing. The acting manager showed us copies of the audit, which identifies that, the electrics system in the home is not working properly and that the fire evacuation system is unsafe. We were told by the acting manager that a referral has been made to an occupational therapist regarding provision of aids Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 21 and adaptations and a request has been made to the registered providers for some new laundry equipment. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 22 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 36 Quality outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: The acting manager told us that the home was having real difficulties with recruiting staffing and said that this has been historical with the home with a high turnover of staff. The manager and deputy manager have left and there has recently been a safeguarding alert, when two senior staff walked out leaving the home’s staffing levels unsafe. The manager told us that emergency staff had covered the shift but the level of agency staff being used has now needed to be increased. The home is currently trying to recruit new staff to the team and during the visit we heard people telephoning for application packs. There were five support workers plus the acting manager on shift all day and we were told that at night there are two people awake. From looking at the support needs of service users, for example two people are assessed as needing one to one attention at all times, this level of staffing does not currently meet people’s individual and diverse needs. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 23 There is a very high use of agency workers and the staffing rota showed us that usually there is usually two permanent staff on duty each day, with numbers being made up from agency workers. Staffing rotas and discussion with the staff on duty also showed us that staff regularly work a double shift which is thirteen and a half hours and we were told by a staff member that this is stressful because agency staff are not aware of the complex needs of service users and the regular staff have to support and monitor them. Records show us that because of the lack of skilled and experienced staff, people’s individual needs, especially in respect of activities, medical needs and one to one observations to ensure safety are not happening. An example of this is a risk assessment that has been put in place for one service user identified as going into other people’s rooms and causing injury. The risk assessment says that at night, one staff member must stay at all times near this person’s bedroom door but then goes on to say if that staff member is called away to deal with another service user or deal with an emergency then a senior manager must be called. This was discussed with the acting manager who agreed that in practice the risk assessment would not work, as people often need two people to assist them during the night especially with epilepsy management. All of the people on shift were from differing cultural backgrounds and had English as a second language. Observation during the day showed us that communication between service users and staff was not effective and the staff on duty did not display the skills needed to support people with complex needs or show an understanding of people’s needs and wishes. There is a robust recruitment process in place, we saw the records for four staff members and saw that an interview process had been undertaken, references had been taken up and current Criminal Bureau Checks (CRB) were in place. In the four files we saw evidence that new staff receive an induction in line with Skills for Care but not all staff had attended mandatory training such as health and safety, manual handling and infection control. There was no evidence that staff had attended training in gaining knowledge to provide care for the specific client group being supported by the home, for e.g. challenging behaviour, learning disability, supporting people with sensory difficulties, Autism awareness and epilepsy management. There was also no evidence that the staff team receive regular supervision and support or that their care practice is monitored. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 24 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 and 42 Quality outcomes for service users in this area are poor This judgement has been made using available evidence including a visit to this service. The home has not been well managed or monitored and health and safety issues need to be addressed to ensure the safety of both service users and the staff team. EVIDENCE: The acting manager, who has experience in learning disability services, has been seconded from another home in the group and she told us that she has only been working in Wyatt House for one and a half weeks. The manager told us that she is very aware of the shortfalls in the quality of care in the home and has been given the task of “turning it around”. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 25 There is no evidence that the home has been run in the best interests of service users, as there is no evidence to show that people’s needs are currently being met. There is a system in place for managing service users monies and each person has a cash wallet and cash book in use and receipts are kept of any expenditure carried out. We looked at the records for three people and found them to be correct. While looking at the finance books we saw that a service user had been charged for drying clothes in a launderette and asked the acting manager if this was a proper use of people’s monies as the home had been supplied with a tumble drier, even though this was broken. The manager told us that this had been an error of understanding on the part of an agency staff member and she would see that the service user was reimbursed. We looked at Regulation 26, Registered Providers visits and saw that there are only two dated 16/4/08 and 11/5/ 08 on file in the home. The acting manager said that others would have been carried out but there was no evidence of this. The manager also told us that the Registered Providers have a quality assurance system in place and that surveys had been sent out to families and professionals but there was no evidence of this in the home. The parent of a service user who was visiting the home told us, “ my daughter has lived here for five years and managers and staff just come and then are gone. They need to get a good manager, deputy and staff team in place that will stay so that some consistent care can be provided for people”. We looked at records for the running of the business and this showed us those records in the home around health and safety issues are inadequate, with monitoring of the safety of the home for e.g. water temperatures not being completed, the electrical certificate out of date, fire system requirements out of date and records show us that the staff team do not have up to date fire training. Concerns about the current provision of service being offered to service users was discussed with the acting manager who told us that she was prioritising areas that have a direct influence on the safety of people and that she was asking for investment in the home from the Registered Providers. Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 26 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 1 3 X 4 X 5 X INDIVIDUAL NEED AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 1 26 X 27 1 28 1 29 1 30 1 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 x LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 1 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 x X X 1 X 1 1 x Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA2 Regulation 14-(1) Requirement To ensure that the home can meet the changing needs of service users and that the service user group is compatible, people must have their needs reassessed with input from families and other professionals. 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. Service users 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. 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”. Healthcare plans must be reviewed and updated to reflect DS0000036981.V369387.R01.S.doc Timescale for action 01/09/08 2. YA6 15.-(2) 01/09/08 3. YA14 16.- (2) (m) and (n) 01/09/08 YA17 4. 16.- (2) (i) 01/09/08 5. YA19 13.- ( 1) (a) and 01/09/08 Wyatt House Version 5.2 Page 28 (b) 6 YA20 13.-(2) 7. YA22 22.- (1) (2) and (3) 13.- (6) 8. YA23 9. YA24 16.- (1) and (2) (a) to (g) 10. YA24 23.- (2) (0) 11. YA29 23.- (2) (a) (b) (c) (d) and (p) the current needs of service users and referrals must be made to the relevant healthcare professionals and learning disability teams in order to ensure that people’s healthcare needs are being met. 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 There must be a clear system in place for recording, investigating and feeding back outcomes of complaints concerns and allegations. 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 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. Outstanding from 31/01/08 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 DS0000036981.V369387.R01.S.doc 01/09/08 01/09/08 01/09/08 01/09/08 01/09/08 01/09/08 Wyatt House Version 5.2 Page 29 of suitable aids and adaptations. 12. YA32 18.-(1) (a) to (c) 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. 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. 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 and 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. 01/09/08 13. YA36 18.-(2) 01/09/08 14. YA37 8.- (1) 01/09/08 15. YA39 26.- (2) and (4) 01/09/08 16. YA42 13.-(4) (a) to (c) 01/09/08 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 Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 30 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 Wyatt House DS0000036981.V369387.R01.S.doc Version 5.2 Page 31 - 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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