Inspection on 25/07/05 for Wychwood

This inspection was carried out on 25th July 2005.

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

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

Other inspections for this house

Wychwood 09/01/07

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

CARE HOME ADULTS 18-65 Wychwood 38 London Road Southborough Tunbridge Wells Kent TN4 OPX Lead Inspector Debbie Sullivan Unannounced 25 July 2005 15:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Wychwood Address 38 London Road Southborough T-Wells Kent TN4 OPX 01892 353623 01892 535623 www.pepenbury.info Larkfield Hall Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Stephen Richard Shepherd CRH Care Home 4 Category(ies) of LD Learning Disability (4) registration, with number of places Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Bedroom 5 to be available for service users as part of an induction/introduction to service, or emergency placement given risk assessment indicates assessed needs could be met. These placements to be up to 48 hours duration. Date of last inspection N/A Brief Description of the Service: Wychwood was registered in May 2005 as a respite service for four service users with learning disability, one bedroom is equipped to meet the needs of service users with physical disability, a fifth bedroom is available for very short term emergency or trial stays. The house is detached and set back from the main road through Southborough, it has a large garden and a patio area. Four bedrooms are on the first floor, the fifth room suitable for a wheelchair user is on the ground floor. Service users who stay at Wychwood access day care facilities in the week,a variety of activities are offered during evenings and weekends. Local facilities are within easy reach and the centre of Tunbridge Wells is approxamately two miles away. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first undertaken of this service that was registered in May 2005. The inspection took place from 3.40 pm until 6.45 pm at a time when service users were in the property and their views could be sought. Evidence was gained from discussion with the two support workers on duty, two of the four service users present, direct observation and reading of records and other documents and full tour of the property. Wychwood was found to be well run and staff on duty to be confident and service users comfortable with the service. What the service does well: What has improved since the last inspection? What they could do better: Improvements to the environment would increase health and safety in some areas. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 6 Bedrooms are comfortable and well decorated but would be improved by the addition of a desk area and in the main bedrooms beds of a domestic nature. Staff need to be careful to record any special food preferences provided for and to improve vigilance over food storage. Wheelchair users would benefit from being able to access the main garden area. 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. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5. Service users have access to information about Wychwood that is being currently revised and improved upon. Needs are fully assessed prior to respite being offered and visits and trial overnight stays are welcomed. Service users have a signed agreement on their care plans. EVIDENCE: Wychwood has a statement of purpose and service user’s guide, which are available to prospective users and their families. At the time of the inspection both were being revised and in future will include pictorial as well as written information. All referrals to the unit come from Social Services Teams who supply initial information. The manager then undertakes an assessment of need; service users are invited to visit and can choose to have introductory stays of a night or two. A number of service users have transferred to Wychwood from other respite facilities. The fifth bedroom can be used for short-term emergencies or introductory visits; since Wychwood opened in May there have been no such admissions. During the inspection three male service users arrived for respite and another who had already been at the unit for three nights arrived back from his day activities. All settled in well and seemed very much at home, including one service user who had not stayed there before. Care plans include written and pictorial agreements signed by service users at the front of the folders. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 and 10. Service users can be sure that needs and preferences are recorded in their care plans and that they will be consulted on a variety of aspects regarding their stay in respite. Records are kept safely and recorded and handled properly. EVIDENCE: Throughout the inspection it was very evident that choice and consultation of service users is viewed as a very important part of their respite service. Care plans sampled included information about individual preferences regarding personal care, interests and activities. Risk assessments are in place relating to a range of activities such as use of the kitchen, travel and bathing. Risk assessments of those transferred from another service required updating, staff advised this is underway. Care plans are well indexed with information clearly presented and easily accessible. A service users’ meeting is held twice weekly in order for staff to consult about choice of menu and activities; a meeting was held during the inspection as the majority of service users had only just arrived, all were invited to voice preferences and these were recorded and were to be acted upon. Suggestions for meals included chicken curry, spaghetti and pork chops. One service user Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 10 who needed a little help to verbalise choices was gently encouraged and then able to make a contribution to the meeting. The service has topics of the week for staff to think about and discuss themselves; these are on the staff notice board, two recent topics were ‘planning of activities and appointments’; and ‘privacy, dignity and respect’. Choice of activity included bowling and going to the pub and to Hastings. As far as possible a choice of room to stay in is offered. Care plans and other confidential documents are kept in the office upstairs that is always locked when not in use. Service users have access to their personal care plans, which staff assist them to read when necessary. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,16 and 17. Service users have opportunity to choose to engage in activities, which are appropriate and interesting locally and further afield. Choice and independence are encouraged. Choice is given over meals and a healthy diet provided. EVIDENCE: Service users attend various day activity venues; Wychwood has a minibus and transports to day care if other transport is not arranged. One service user was keen to discuss the various centres he attended on different days. Activities suggested at the service users’ meeting and evidenced in care plans and daily record sheets were appropriate and took place in the local community and further afield. One service user spoken with said “ I like to play football outside” and “we choose where we want to go…we go to Hastings for the day”. Discussion with staff on duty, service users and documentation sampled showed that service users are treated with respect and encouraged to be independent. This was evident when new arrivals were given the choice to look Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 12 after their own spending money or for staff to lock it up for safe keeping with the service user signing agreement for this on their care plan. During the inspection the evening meal was being prepared, as well as observing the service users choosing meals for the week menus were inspected which included a variety of healthy meals such as those suggested at the meeting. Where packed lunches are taken to day care these are made up and contents recorded, one service user on a soft diet takes a frozen meal, it is recommended the type of meal also be recorded so variety can be evidenced. Service users have opportunity to go shopping with staff. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20. Service users are able have personal care needs met in the way that they choose. Medication procedures are good and the option to manage personal medication is available. EVIDENCE: Personal care preferences and needs are detailed on care plans. There are two bathrooms on the first floor and the bedroom on the ground floor has an en suite adapted shower room. Bedrooms upstairs are equipped with wash hand basins. Bath temperatures are checked even if service users do not need help with bathing for safety reasons. Medication is kept securely in the staff office, there is a medication cabinet on the wall and a controlled drugs cupboard and a small drugs fridge. It is recommended that a new fridge be purchased, as it is not possible to accurately measure temperatures with the type in use. One service user had chosen to self medicate, this is an option that is risk assessed. Medication recording was inspected on care plans; MAR sheets had been properly completed. If a service user becomes unwell in day care the unit is contacted and staff make arrangements to collect them. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. Service users are protected by the policies and procedures of the service and feel able to air any complaints. EVIDENCE: Wychwood has a complaints procedure that was being updated at the time of the inspection. Details of the current procedure are in text and pictorial format on the notice board in the entrance. This is a very new service and there had been no complaints recorded. A service user spoken with stated that if he had a complaint he would speak to carers at the home or the manager. At the service users meeting staff made a point of asking if the service users knew what to do if they were unhappy about anything during their stay, responses were that they would go to staff. Care staff on duty were very aware of the complaints procedure and to whom to refer a complaint. Staff are provided with Adult protection training and throughout the recording inspected and policies and procedures sampled and discussed it was clear that measures are in place to ensure the protection of service users. A daily staff handover checklist covers items such as recording that medicines of new arrivals have been signed for and transport arrangements for day care checked. As Wychwood has a constantly changing population of service users with different needs, it is to be commended that these extra checks are in place. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30. Service users can access respite in a safe, clean and welcoming environment. The premises and bedroom furniture could be improved upon to increase choice, independence and safety. EVIDENCE: Wychwood provides a comfortable and welcoming environment that is well decorated and clean. The four main bedrooms are spacious with the downstairs room being designed to promote the independence of service users with physical disabilities. At the time of registration in May 2005 it was recommended that the hospital beds in the four main rooms be replaced with divans or other beds of a more homely nature, this remains a recommendation. It is also still advised that bedrooms be equipped with a desk and seating area so that service users are able to spend time at activities needing a desk in peace if they wish to. Shared spaces are of a good size and the lounge dining room is partitioned so that the areas used for eating and for watching TV and relaxing are separate. The large garden is well maintained and used by service users the patio is equipped with new garden furniture. Currently the patio area is only accessible to wheelchair users via a side entrance to the garden as there are steps down Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 16 from the main house, this provides a restriction to the activities that wheelchair users can participate in outside and could make those less physically able feel less included and different. Residents spoken with liked the house; one said, “it is allright, all posh” and that a particular bedroom was his favourite to stay in. The laundry is reached via the patio and is up several stairs, service users can access the laundry with staff although do not use the washing machines, access arrangements could be hazardous in the winter and will need attention. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 and 36. A well-supported and supervised staff group meets Service users needs, staff are clear about their roles and responsibilities. EVIDENCE: Two support workers were on duty at the time of the inspection, this is the usual compliment of staff with the addition of the manager when he is on duty. One support worker sleeps in at night. The manager was not on duty but was on call. As only the manager has access to staff files and records kept securely on the premises these could not be inspected, although a recently recruited member of staff felt that recruitment had been thorough, and confirmed that references and a CRB check were in place before starting work. Staff present were clear about their roles and confident with the service users, service users were comfortable with them one stated “It’s fun here I like the staff and people”. Staff receive regular monthly supervision and staff meetings are held. Induction training is given and includes Manual handling, health and safety and epilepsy. Update training and training on specialist topics is also given. Staff felt well supported by the manager of the unit and enjoyed working there. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 18 There was one staff vacancy which it was hoped could soon be filled pending a successful CRB check. The staff rota was inspected and needs to be amended so that the full names of staff on duty are included. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41 and 42. Wychwood is well managed and service users views are taken into account. Policies and procedures to safeguard service users rights and best interests are in place and the atmosphere is open and inclusive. Increased monitoring of potential hazards would enhance health and safety. EVIDENCE: Some of the unit’s policies and procedures were inspected; these were comprehensive and had been reviewed at intervals mainly being those prepared and used by the Pepenbury organisation. Evidence of regular maintenance checks and testing of fire alarms was read. Records are kept safely and securely and those seen were up to date. Wychwood has an open and inclusive atmosphere and it was very apparent that the service users there during the inspection felt at home and in control of their time there in terms of choices and access to personal records. The health safety and welfare of service users is promoted although during the inspection health and safety issues were raised, these were that the cupboard Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 20 in the laundry containing cleaning materials should be locked, the outbuilding containing electrical gardening equipment should also be locked and two out of date food jars were in the fridge, one of which had been labelled with the opening date. As Wychwood is newly opened, maintenance checks initially undertaken are current and the insurance document is clearly displayed in the entrance with the registration certificate. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 4 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wychwood Score 3 3 3 N/A Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 2 x H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20.1 Regulation 13(2) Timescale for action The registered person shall make Action plan arrangements for the to be recording,handling,safekeeping,s received by afe administration and disposal September of medicines received into the 2005 care home. In that medication needing to be refridgerated be stored in a fridge suitable for this purpose. Action plan The registered person shall to be having regard to the size of the care home and number and received by needs of service users provide in September rooms occupied by service users 2005 adequate furniture,bedding and other furnishings and equipment suitable to the needs of service users. In that bedrooms which have hospital beds have these replaced with more homely beds and desk/table top areas be provided in bedrooms. External grounds which are Action plan suitable for ,and safe for use to be by,service users are provided. In received by September that the area of garden other than the patio be made 2005. accessable to wheelchair users. The registered person shall Policy is in ensure that unnecessary risks to place /staff the health and safety of service to be Version 1.40 Page 23 Requirement 2. 26.1 16(2)( c) 3. 28.1 23.2(o) 4. 42.1 13(4) (c ) Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc users are identified and so far as possible eliminated. In that opened bottles and jars in the fridge must be labelled with the opening date and thrown away after the time advised on labels. 5. 42.3 13(4)(a) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In that the outbuilding containing gardening equipment be kept locked,the cupboard containing cleaning materials in the laundry room be kept locked and measures be taken for extra safety regarding use of steps to the laundry in the dark and bad weather. reminded to label.Action plan to be received by September 2005. Action plan to be received by September 2005. 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. Refer to Standard 9 17.8 41 Good Practice Recommendations The reviewing and updating of risk assessments be continued as a priority. Where a service user takes a frozen meal for lunch to a day centre the type of meal be recorded so that variety can be evidenced. Staffing rotas must show the full names of staff on shifts. Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wychwood H56-H06 S64671 Wychwood V238295 250705 Stage 4.doc Version 1.40 Page 25 - 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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