Inspection on 30/10/06 for Wycar Leys Care Home (Bulwell)

This inspection was carried out on 30th October 2006.

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

The inspector found 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wycar Leys Care Home (Bulwell) 07/10/05

Wycar Leys Care Home (Bulwell) 19/07/05

Wycar Leys Care Home (Bulwell) 31/03/05

Wycar Leys Care Home (Bulwell) 22/02/05

Wycar Leys Care Home (Bulwell) 24/02/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Wycar Leys Care Home (Bulwell) Snape Wood Road Bulwell Nottingham NG6 7GH Lead Inspector Linda Hirst Key Unannounced Inspection 30th October 2006 10:30 Wycar Leys Care Home (Bulwell) DS0000034961.V318596.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 Wycar Leys Care Home (Bulwell) DS0000034961.V318596.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. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wycar Leys Care Home (Bulwell) Address Snape Wood Road Bulwell Nottingham NG6 7GH 0115 9762111 0115 9762888 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) Wycar Leys (Bulwell) Limited James Robert Steeples Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th October 2005 Brief Description of the Service: Wycar Leys, Bulwell has been converted to provide spacious accommodation for up to 16 younger adults with learning difficulties in a former purpose built residential home for older people. The home is situated in a housing estate with access to local facilities. The accommodation is divided into two units. The ground floor - The Cottage and the first floor - The Homestead - each with separate external access. All of the bedrooms are single and have en suite facilities. Each unit has a dining room and a lounge and there is a sensory room and an activity room in the Cottage and a quiet lounge in the Homestead. There are large enclosed gardens which contain some appropriate activity equipment. There is a mini-bus and a people carrier available for the service users. A good sized car park is available at the front of the building and there is easy access to local transport facilities. The fees range from £1,500 to £2,500 and these are decided on an individual basis, dependent on the needs of service users and their package of care. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 7.5 daytime hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. Only one of the residents who were “case tracked” was able to help by giving a very limited opinion about the care provided. Another refused to talk to the inspector and the third was unable to give their opinion about the care services as a result of high levels of need. Unfortunately no relatives were present during the course of the inspection. Four members of staff and the manager were spoken to as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. 3 service user questionnaires were returned and inspected before the visit to the home. The main areas of concern expressed were around not choosing to move into the home, not having enough information about the home, the cleanliness of the home and one person said they did not know who to complain to. What the service does well: The information given to people before they go into the home is good and this helps them to choose whether the home is best for them. The plans of care are good and they give staff lots of information about how they can help the people living at the home. The service users and their family are also involved in writing the plans. People can make their own decisions about how to live their lives and the staff try and make sure they get their wish. They are also involved in lots of decisions about how the home runs and the manager pays attention to what they say. The people who live at the home have lots of things to do, both at the home and out and about in the community. They are very busy and enjoy the activities they do. The food at the home is good, with lots of choice and people can have healthy things to eat. The way that medicines are handled means that people living at the home are safe and get their tablets in the way their Doctor says. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 6 People are safe at the home, the staff want to keep them safe from harm and they have been taught how to do this. The home is comfortable and if something is broken, the staff repair it quickly. It is clean and tidy even though it gets damaged a lot when people get upset. The staff are very good, they are caring, patient, helpful and kind to the people living at the home. There are lots of staff working at the home and they are taught how to do their jobs well. The manager is very good and makes sure that the home runs well and that the people who live there are safe and well looked after. The home is checked regularly to make sure it is safe for the people who live there and those who work there too. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The service user guide is suitable for some service users. The service is seeking to extend the range of formats to make it more accessible to other service users so they can make choices based on good quality information. The pre admission process and assessment is user sensitive and flexible. It ensures that service users are appropriately placed at the home and that the staff at the home can meet their needs. EVIDENCE: The returned service user questionnaires raised issues of not choosing to move into the home, which was acknowledged to be the case sometimes. One service user who was interviewed said it was decided for her (not by the managers at the home) that she needed to be cared for in a home. Questionnaires also raised the issue of information about the home before admission. There is a service user guide and this is a pictorial document at the moment. Speech and Language therapists have been commissioned to develop the formats the guide can be provided in to make sure that all potential service users can understand it and have information about the home to help them make informed choices. This is evidence of good practice in excess to the National Minimum Standards. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 9 There is a well thought out pre assessment process to make sure that the home is suitable for potential service users and to prepare them for moving into care. The social worker for the potential service user sends copies of any assessments of the person (examples seen on files included Health, psychiatric, clinical psychology and child protection assessments.) If the person is not considered suitable for any reason at this stage (examples given were behaviour issues or compatibility with existing service users) the Social Worker is informed in writing or verbally. If the person is potentially suitable the manager undertakes a thorough assessment of all areas of need, these were seen on all of the “case tracked” service users files. The assessment is then reviewed to ensure the staff have the skills and abilities to meet the service users needs and staff confirmed that extra training may be provided before or after pre admission visits start, giving an example of Makaton training. This is evidence that the service exceeds the National Minimum Standards. Other considerations will be staffing levels and what the service can contribute towards improving the quality of life of that particular service user. Staff said it was usual for the pre admission visits to be frequent and gradually increasing in length of time but always at the pace of the service user. They gave examples of one service user who was visited regularly in Hospital by staff, as he could not attend the home. Various staff visited so that when he arrived at the home he would be familiar with many staff, if not the environment. The staff feel they are given enough information to prepare them for new service users and that this is done both verbally and by them reading documentation. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.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 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care plans are well written and detailed and give staff clear guidance about how to support service users with their needs and the staff follow them. The service users are encouraged to make decisions and participate in the service that they receive to make sure it meets their needs and expectations. Risk assessments are considered and balanced and take account of the service users’ need for independence as well as the need to minimise the risk of harm to them. EVIDENCE: There is a well organised system in place for information and care planning. Each service user has a file for their care plan, a file for personal information, one for Medication Administration Record sheets (MAR), a file for violent incidents and a file for their individual personal allowances. This system allows staff to get quick access to the information they need to help service users and is evidence of good practice exceeding the National Minimum Standards. Each Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 11 service user also has a weekly activity programme and these are displayed in the unit’s office providing evidence that their social needs are properly assessed and provided for. All files are easy to read; well organised and comprehensive daily records are kept on each person, which helps the process of reviewing needs to work well. The plans are person centred, well written and offer clear guidance to staff about how to meet the service users needs. The staff said they have enough information to offer good, consistent care to service users, and other documents such as restraint records indicate that staff have a good understanding of individual care plans and follow these. If there are any changes to the care plan a new one is written and the old one kept which provides evidence that the care plans in place reflect current needs. Staff confirmed that care plans are reviewed with service users by the Team Leaders and that they are told verbally of any changes and advised to read the care plan so that they know how to help the service users. There is evidence on the care plans of service users being involved in planning care and in one case a signature of a service user was seen agreeing to the plans in place. There is a policy on decision making, this was inspected and is thorough and several points are specifically about decision making and participation at the home itself and the evidence indicates this is put into practice. This is evidence of good practice. Staff interviewed said they make sure service users have choices (examples were given about activities, clothes and routines) and they encourage service users to participate wherever possible (examples given were service user meetings, feedback questionnaires and care planning.) The needs of the service users are such that it would be difficult for them to be meaningfully involved with interviewing new staff but they spend time with all potential workers after their interview and their comments are encouraged. This is good practice and exceeds National Minimum Standards. Service user meetings are held once a month and records are kept of the meetings, the last one took place in September and 7 of the service users attended. It is clear from the records that service users are encouraged to say what they want at these meetings. There are a number of service users who do not use verbal speech and may struggle to tell staff what they feel, in these situations the staff try to encourage parents to be more involved in feedback and questionnaires were seen from parents giving feedback about services on behalf of the service users. This is good practice. Each service user has a file documenting their personal allowance and good records are kept of money coming in and going out. The personal allowances Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 12 are kept in individual wallets which are stored securely. The amounts in these were checked and they tally with the balances recorded on the service users’ sheets, the arrangements protect the service users’ assets well. Most of the service users have their own bank accounts, but although these accounts pay interest, the rate is very low and some service users have a reasonable amount of money in their accounts. It is recommended that savings accounts be opened and money transferred into them to attract a better return on service users’ money. All residents pay the mobility component of their Disability Living Allowance to the company that enables them to use the minibus, people carrier or if they are using public transport or taxis the company pays this for. These arrangements form part of the contract that service users or their representatives sign on admission. The care plans have good assessments of risk which balance service users’ rights and their need to be safe, examples seen covered areas such as aggression, destructive behaviour and mental health issues. The staff interviewed said that they feel all risks are properly assessed, kept under review and said they are not put in difficult positions by having inadequate information. There have been several instances where restraint has been used since the last inspection, but good records are written about what happened, why and there is an analysis of what could have been done better to avoid the need for restraint in the future. An examination of the records suggests that staff are very honest in their records, even if it indicates they have not fully followed the care plan. Staff confirmed that they are told to write exactly what happened so all staff can learn from this and better ways of responding can be identified. Records show that all but one member of staff has had training on restraint, de-escalation and breakaway techniques and the staff said that staff couldn’t be involved in any restraint unless they have had the training. They also said they work well and support each other as a team to make sure they and the service user are safe and protected. They feel they are a “strong,” well trained team with the resources to deal with most difficult situations. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 13 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 in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live busy and fulfilled lives and enjoy a wide range of community and home based activities and leisure interests that are age appropriate and broaden their experiences. Service users are encouraged to maintain family contact and form relationships but the service provision for their sexual needs requires improvement. This is to make sure that service users are supported and safe and that staff understand the best way to respond to their needs. Routines are flexible and service users can lead their lives in a way that meets their individual needs and preferences. The food is of a good quality and service users have a varied and interesting diet which promotes healthy eating. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 14 EVIDENCE: Three service users currently attend college at Stonebridge Farm, but none of the others do any paid or unpaid work. Each service user has an individual activity plan in place; these were inspected to check that the range of activities was appropriate to the needs of the people living at the home. Activities provided in the community include swimming (and a group of service users went swimming on the day of this inspection), bowling, shopping, going to activities centres, dinner out, bus trips (again a group of service users went out on a trip during this inspection) and going to the pub. Staff interviewed confirmed that many of the activities are based in the community and that these are visited regularly. It is clear that the service users get plenty of opportunities to use community resources locally and further afield. Staff said that the correct staffing levels are always maintained during trips out and they never feel inadequate staffing levels compromise their safety or that of the service users. In house activities include using the sensory room, hair, nails, aromatherapy, hand massages, using the activity room, doing housework, cooking and learning daily living skills with staff support. During the inspection several service users were observed using the garden and its equipment either as quiet time or just to relax. Service users were also seen relaxing with staff, two sat with laundry and catering staff on their break and one was washing the minibus with a member of staff. Staff members said that it was pleasing to see service users busy and occupied and they feel the service users get real enjoyment from experiencing new things. They said that if service users want to do anything new it is arranged and staff are always asking if there is anything new they would like to try. Family and friend are welcomed and their visits and feedback encouraged using feedback forms. The service user interviewed said she likes telly and she said she had been swimming on the day of the visit. She said her mum visits on a Sunday and she likes to see her and watches TV with her. The policy on service users’ sexuality and personal relationships was seen and was comprehensive, dealing with issues of capacity and consent well. There are clearly issues around service users sexuality (examples of which were evidenced.) Although issues of sexuality are considered on the initial assessment forms, they are not fully incorporated into the care planning process and this is recommended to make sure that the care plans cover all areas of need properly and that any needs for specialised advice or services are identified. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 15 Staff interviewed said that no-one accesses contraceptive services at the moment and they don’t actively discuss safe sex with service users. That said, they demonstrated quite good levels of awareness about service users’ sexual needs, they understand issues of capacity and consent and believe in service users’ rights to express and enjoy their sexuality. They gave good examples of how they respond to inappropriate sexual expression, talking to service users and helping them understand they should go to their bedroom if they want private time. There is one situation which they are struggling with and it is clear that specialist advice and support is needed to ensure that staff are properly trained, that good guidance is available in care plans for staff and that above all service users are given their privacy and dignity in relation to issues of sexuality. Each individual has their own routine and this is important to them as many have Autistic Spectrum Disorders and struggle with flexibility. The staff said there are no restrictions on service users’ personal liberty and that they live their lives in a way that suits their needs and preferences. They said they make sure they knock before they enter bedrooms (and this question is asked on the service user feedback forms to check it is being done.) Staff were observed knocking on bedroom doors when a tour of the building was done. Observations during this inspection would suggest that service users have space and flexibility when at home to spend their time as they wish. Lunch was observed in the cottage to check that service users are receiving a varied diet and have choices about what they eat. A group of five service users sat together at the table in the dining room, some people prefer to eat earlier or later if they do not like noise and this is encouraged. There are two choices every day; one is a healthy eating option, being salad and pitta bread on the day of the visit. The other option was a cooked breakfast which most of the service users had chosen. Fruit or yogurt is available for desert. A record of the food and drink residents have is kept in their care plans and these demonstrate that service users have a varied diet. The resident interviewed said the food was “ok” and she liked chicken. The staff said that the food is very good and that they will try and get anything the service users want. The cook said that she has no problems with her budget and can order whatever the service users want. There are fresh deliveries three times a week at the home and the kitchen was very well stocked with food, especially fresh fruit and vegetables. The evidence indicates that residents have a good, varied and healthy diet. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are assisted with personal care according to their preferences and staff are very aware of issues of privacy and dignity. Service users’ health care needs are fully assessed and provided for well. Medication storage, administration, recording and disposal is well managed and service users get their medication as prescribed by their GP. EVIDENCE: The policy of the home is that male staff help male service users with personal care tasks and only female staff assist females to make sure that they are comfortable and safe. The staff confirmed that this is followed through in practice. They demonstrated a good understanding of issues of privacy and dignity and gave examples of how they help people with personal care tasks to illustrate this. This is good practice. The staff group is varied and skilled and includes female and male staff, they are also mixed in terms of their ethnicity and race which is beneficial to Black service users in terms of understanding needs and feeling connected to their ethnic origin. The care plan for one Black service user was inspected and it Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 17 contained advice on hair and skin care, although no specific services or activities were arranged within the Black community for the person. If this is an area which has already been explored it should be documented. The staff interviewed said that in terms of personal care they ask service users how they would like to be helped. An example was given of one person who likes a bubble bath and her legs and armpits shaving which staff do for her, as she likes to be pampered. The records show that female service users have annual well women and well men health checks to make sure they are well and healthy. The dentist and chiropodist do home visits and this works best for the service users and they have annual appointments with the optician, although no-one wears glasses. The staff interviewed said that service users’ health is well catered for, if any specialist help is needed it is accessed straight away. They were clear about when to call in the GP or take people to the Hospital to maintain service users’ health and wellbeing. All of the service users are registered with a speech and language therapist as they all have varying degrees of difficulty communicating and expressing themselves. A private psychiatrist visits the home every week to assess service users, make sure their mental health is well cared for and assess whether any would benefit from other input such as clinical psychology. One service user sees a Community Nurse, one sees a physiotherapist and another sees an OT, two have been referred to a dietician. The evidence clearly demonstrates that the health care needs of service users are properly assessed and provided for and where there may be lengthy delays private contracts are set up to make sure people are seen quickly. The systems utilised indicate that this service exceeds ther National Minimum Standards in maintaining service users health and welfare. Medication storage was checked to make sure it is secure. There is a locked cabinet in each unit, a medication fridge and a separate locked storage for controlled drugs. Medication records are properly maintained and show what medication service users have taken and when. The controlled drugs are counted down and the tablets tally with these records which shows they are handled safely. The last pharmacy inspection was in September but no recommendations were made for improvement. Senior staff generally administer medication and records show they are given training from People’s College in addition to that provided by the home’s pharmacist. All staff are assessed before they are allowed to give out medication to make sure they understand how important the role is and their responsibilities. There was a recent incident of mal administration of medication, an internal investigation was held and the staff involved were disciplined. These records were inspected and provide evidence that the manager takes the administration of medication seriously. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 18 The staff interviewed were not responsible for medication but said it is taken very seriously at the home. They gave an example of one service user who would only take his medication from a particular member of staff, but the person giving out the medication stood beside him and made sure the service user had taken the tablet before signing the record. Staff said the medication is never left with staff or service users for it to be given later as this would be too dangerous. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is not appropriate to the needs of service users and they are not clear about how to complain. Complaints are properly recorded and investigated. Service users are protected from harm and abuse by staff who are aware of the issues and trained to understand their roles and responsibilities. EVIDENCE: There have been no complaints made to the Commission for Social Care Inspection since the last inspection about the service, though two have been made directly to the home, suggesting people trust that complaints will be properly investigated without referring to external agencies. The complaints procedure is displayed but this is a written document, and given that none of the service users can read it is not surprising that one expressed confusion about how to complain in the service user questionnaires. A signs and symbols version should be developed and given to each service user and it is also recommended that making complaints be raised with service users and their relatives directly. Staff interviewed showed a clear understanding of how to deal with complaints and the process to be followed. “Niggles” are not recorded, but dealt with there and then where possible (e.g. missing laundry). Staff members said they encourage service users and relatives to be open and honest with them. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 20 The complaints record was inspected and provided evidence that complaints are properly recorded and investigated, it is not clear however if complainants receive formal responses to complaints made, if this is not the case it is recommended as best practice. There have been no allegations of abuse since the last inspection. The staff interviewed showed an excellent understanding of what constitutes abuse of service users. Although they had never had any allegations disclosed to them personally, they were clear about their obligations and responsibilities to report. They were also very clear about their responsibility to blow the whistle on any bad practice and said the managers have made it clear to them they can also go directly to the Commission for Social Care Inspection if they have any concerns, suggesting an open organisation. They said have had training on issues of abuse and would have no hesitation in reporting bad practice, their main priority being the safety of service users. The service user who was interviewed made no comment about issues of abuse, she said she gets on “ok” with staff and other service users. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, properly maintained and it is made homely for the service users living there. It is clean and good hygiene practices are followed. EVIDENCE: A partial tour of the building was completed (including a sample of bedrooms) to make sure that the home is safe, well maintained, comfortable and homely. The building gets a great deal of wear and tear because of the needs of the service users, but a new maintenance man has been employed and it is evident throughout the building that work is being undertaken to repair and improve facilities. Staff interviewed said that they are all responsible for reporting anything needing repair or replacement and they said that now they have a new maintenance worker matters are resolved very quickly. There is a dining room and comfortable lounge in both units, shared sensory and activities rooms, and a quiet lounge in the Homestead. Staff commented it Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 22 would be nice to have an activity room in the Homestead and plans for this are already afoot. The bedrooms seen were highly personalised and all are single with en suite facilities and underfloor heating. The service user interviewed said she likes her room, though she said she would like something to play tapes on. This was reported to the manager, who agreed to look at this as a possibility. The staff acknowledge that the building gets a lot of wear and tear because of the needs and behaviours of some service users but said they try whenever possible to personalise the service users’ bedrooms where they often spend time. The home was relatively clean and tidy, considering the use it gets, and good hygiene practices were observed in the laundry area. The kitchen was very clean and well organised and the last visit by the Environmental Health Officer raised only minor issues. The staff feel there are enough domestic staff to keep the home clean and fresh. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 23 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels are appropriate to the high level of needs that service users have and the staff team is cohesive and supportive meaning that service users are well cared for. The recruitment procedure is robust and offers good levels of protection to service users from staff who may potentially abuse them. Staff are well trained and properly supervised to check that they are competent to undertake their roles. EVIDENCE: The staff feel they are a “strong” team and said there is a clear management and support structure. They said that they feel confident that someone within the team can deal with virtually any situation which arises. Records show that each member of staff is formally supervised a minimum of once a month by staff who have been trained in undertaking supervision. The service user interviewed said the staff are “ok” and appeared to have a good relationship with staff. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 24 Staff were observed to be respectful with service users and they clearly understand issues of personal space. The staffing levels are well above the minimum required and appropriate to the needs of the service users; in many cases individual staffing contracts are in place with the placement funders. Staff interviewed said these are always honoured. Staff interviewed said they had to complete an application form, be interviewed, supply two written references and have a returned CRB check before they could start work, thereby making sure service users are protected. The evidence collected from staff records confirmed that the recruitment process is robust and protective. New staff work super numery for 8 shifts and after that they are closely assessed by a team leader throughout their induction. Each member of staff is employed for a probationary period and is assessed at the end before being made a permanent staff member. The arrangements to protect service users from staff who may potentially abuse them are appropriate. Staff who were interviewed feel they have access to lots of training and only have to mention a need to team leaders and this is taken up with managers, for example staff were given training in Makaton when it was identified that this was how a potential service user communicated. Staff files provide confirmation that good levels of training are provided to make sure the staff are confident and competent in the roles they undertake. Staff said that all but one staff member have had training in restraint and breakaway including de-escalation techniques. They said no-one is allowed to get involved in any incidents involving restraint unless they have been trained, if they are present when an incident becomes difficult they must summon help and leave the room. The staff members said that they are assaulted on occasion, but said that they get very positive support from colleagues and managers after any incidents. They are encouraged to be honest in their recording and assessment of incidents involving restraint so they can learn and do things better to avoid restraint on the next occasion. They said restraint is always the minimum for the shortest time possible. Restraint records are completed after every event. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 25 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is competent and runs the service well. The quality assurance systems are thorough but do not evidence that service user comments are responded to. The home meets Health and Safety requirements and keeps good records to prove service users and staff are safe at the home. EVIDENCE: The manager has recently been registered with the Commission for Social Care Inspection and assessed as being a fit person to manage the home. He has achieved the Registered Managers Award which helps develop the skills a manager needs to run a service well. His job description covers all of the areas he is responsible for and helps him run the service. Staff said the manager is Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 26 very good and fair. They said there was an open door policy with all managers and staff views and suggestions are taken seriously and often acted upon. They feel the home is well run. The service user said the manager was ok and that she thought the way the home was run was, “very nice.” “I like it here.” Quality Audits are undertaken once a month. These were seen and were thorough documents, showing full assessments are done on the service to improving the quality for the benefit of service users. Service user and relative comments are collated every six months. Those completed for “case tracked” service users were seen and these were mainly positive. However when issues were raised there was no action plan to address them. The purpose of quality audits is to improve services taking account of the users’ feedback. It is recommended service user and relative comments be collated and action plans developed to bring about any improvements in response to comments made. Staff said service users are encouraged to express their views both informally with staff and formally via service user meetings and quality audits. Often they can’t complete the questionnaires so parents fill them in instead but they said that any suggestions made by service users are acted upon. They knew audits were monthly but didn’t know if results were published, they are told if there is a specific issue they have to improve or work on. Health and Safety servicing and testing records were inspected to make sure that residents are safe within the home and protected from harm. Suitably qualified people do all servicing and testing at the correct intervals. Accident and restraint records are well maintained and clearly document what led up to the events. The health and welfare of service users and staff is well protected. Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 27 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 3 2 X 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 X X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 2 X X 3 X Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 28 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 YA15 Regulation 12(3) Requirement The registered person must ensure that service users’ sexuality is properly assessed and plans of care developed to guide staff in how to respond appropriately. Timescale for action 30/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA1 YA7 YA15 YA18 Good Practice Recommendations Different formats for the service user guide should be developed. Accounts attracting a better rate of interest should be introduced for service users with savings. Specialist advice and counselling should be sought regarding issues of sexuality. Activities for the person identified within the Black community should be explored, if this has been done, or none are available it should be documented in the care plan. Complainants should be formally informed of the outcome of their complaints and evidence kept of this. A signs and symbols version of the complaints procedure should be developed and given to each service user. Service user and relatives’ feedback should be collated and action plans developed in response to any issues raised. DS0000034961.V318596.R01.S.doc Version 5.2 Page 29 5. 6. 7. YA22 YA22 YA39 Wycar Leys Care Home (Bulwell) Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Wycar Leys Care Home (Bulwell) DS0000034961.V318596.R01.S.doc Version 5.2 Page 30 - 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!