Care Home: 52 Winchester Road

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What the care home does well The home provides care in a pleasant and well-maintained environment. A well managed supported, motivated, trained and qualified staff team who support residents and work in a manner that recognises resident`s need for personal privacy and dignity. Residents were able to participate in a range of social activities. What has improved since the last inspection? All previous requirements relating to the safe keeping of residents money, staff, supervision and training have been complied with. What the care home could do better: Following this inspection no requirements were made and there were no areas of concern. However to ensure that all residents are able to understand thedaily menu, this should be produced in a format or formats that all residents can understand. Also the health and safety of residents would be improved if all radiators were covered. CARE HOME ADULTS 18-65 52 Winchester Road Four Marks Alton Hampshire GU34 5HR Lead Inspector Peter J McNeillie Unannounced Inspection 23rd May 2008 09:30 52 Winchester Road DS0000011642.V363286.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 52 Winchester Road DS0000011642.V363286.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. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 52 Winchester Road Address Four Marks Alton Hampshire GU34 5HR 01420 564028 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) winchesterroad@ilg.co.uk Iliace Ltd Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2007 Brief Description of the Service: 52 Winchester Road is registered to provide care and accommodation to four people between the ages of 18 and 65 years with learning disabilities. The home is owned and managed by Iliace ltd and is a four bedded detached property situated in the village of Four Marks, a ten minute drive from the town of Alton which has a range of leisure, educational and employment facilities. All service users have their own bedroom, communal space and a large garden, which accommodates an indoor heated swimming pool. Current fees range from £1252 to £1560 per week. 52 Winchester Road DS0000011642.V363286.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, 2 stars. This means the people who use this service experience good quality outcomes. This report was written after taking into consideration a number of sources of information and evidence. These included, the previous report, a site visit to the service, information obtained from examining residents and staff records, personal observations, talks with staff and management, results from an in house quality survey, reports written following visits to the home by a representative of the provider as required by regulation 26, and responses by the manager to a CSCI Annual Quality Assurance Assessment (AQAA) prior to the inspection. This key unannounced visit took place on 23/05/08 between the hours of 09.30 am and 2.00pm. All of the key standards for care homes for younger adults and any previous requirements were assessed. We were to communicate with residents at times with difficulty, we are therefore very grateful to the care staff for their assistance. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? What they could do better: Following this inspection no requirements were made and there were no areas of concern. However to ensure that all residents are able to understand the 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 6 daily menu, this should be produced in a format or formats that all residents can understand. Also the health and safety of residents would be improved if all radiators were covered. 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. 52 Winchester Road DS0000011642.V363286.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 52 Winchester Road DS0000011642.V363286.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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying resident’s diverse needs which ensures residents safety and that their assessed needs can be met that involves residents and/or their representatives in the assessment process.. EVIDENCE: No admissions have taken place since the last inspection. We were informed that there is a corporate admissions policy and procedure that requires that no resident is admitted into the home without a full assessment of need and risk being carried out. The manager or a senior member of the homes care staff carry out the assessment in consultation with the resident or their representative and in tandem with an assessment by the potential residents external care manager. The pre admission assessments of all of the residents were viewed. All of the records seen confirmed that residents were admitted in accordance with the admissions policy and procedure, which included a visit to the home and consultation with other residents. The care assessments were detailed and contained information that included personal care, communication, social and health needs. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 9 52 Winchester Road DS0000011642.V363286.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 good. This judgement has been made using available evidence including a visit to this service. The home has a system of planning and reviewing care which reflects residents wishes, aspirations and diversity. These ensure residents needs are met within a risk management policy and involves residents, residents representatives or relatives in decisions that affect them. EVIDENCE: The previous inspection found: ”Quality in this outcome area was adequate. Care planning and risk assessments have improved since the last inspection but require further improvement to ensure that all the service users care needs are met and risks are minimised.” All of the residents support/care plans viewed indicate that all plans which are reviewed at least monthly and included confirmation that the resident or their representative had been involved in and consulted about the plan. All plans are based on an initial assessment of needs and risk which took into consideration resident’s needs, wishes, choices, aspirations, risks, details of 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 11 any health care professional involved, communication methods, dietary needs and help required with eating and drinking. From the evidence viewed and comments by management and care staff we were satisfied the previous shortfall had been addressed and the care plans had improved Residents right, and the opportunity to take risks is seen as fundamental, however it was clear from records, observations and talking to some residents they would have difficulty in totally understanding the concept of risk and risk taking. Despite this, residents were supported to make decisions for themselves within a risk assessment framework with the help of staff who were skilled in communicating with individual residents using methods that were recorded in care plans. This process identified individual risks and how they were to be managed, enabling residents to take part in activities in a safe manner. This was demonstrated when we observed residents using kitchen equipment when preparing their own breakfast and clearing up afterwards un supervised Staff who had a good understanding of the contents of the care plans and risk assessments and were able to explain how the care plan was put into day-today practice. To promote equality and diversity and to ensure that race, gender identity, disability, sexual orientation, age, religion and belief are promoted and incorporated into what they do, in their AQAA the home told us: Service users are supported in accessing the local community including church groups and services should they wish to attend. Plans to hold frequent keyworker meetings are now taking place. Documented evidence of this can be viewed in the home and action plans are attached. We are planning to continue to support the service users to attend events and activities such as a local church group in the local Maltings Centre. We discussed this response with the manager who gave a verbal undertaking to re look at this area and further develop the homes responses to issues of equality and diversity. 52 Winchester Road DS0000011642.V363286.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): 12,13,15,16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social activities, family contacts and the provision of varied and nutritious meals were well managed and reflected resident’s interests and choices. EVIDENCE: The home has developed personalised activities programmes developed for each resident based on their individual interests and choices using the facilities within the home and the wider community. Activities currently available include, swimming, trampolinining, gym, shopping, drumming, cycling gardening at an allotmrnt, day trips attendancea at a local sixth form college for woodwork and church group. At the time of our visit all residents were coming and going as they undertook various activities according to their programmes. The home views residents activities as very important to the individual, consequently, staffing is arranged 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 13 to ensure residents are supported in any activity and whenever possible no activity is cancelled due to lack of staff. During our visit we observed staff interacting with residents in a positive, respectful non-patronising manner. Staff respected resident’s privacy by knocking and waiting for an answer before entering their rooms. Resident’s families and friends are encouraged to visit at any time. Residents who are free to make and receive telephone calls, receive visitors in private and choose who they wish to see, are supported in maintaining family contacts and establish friendships. Residents are also assisted by staff to maintain outside contact by sending birthday cards to family and friends. A written daily menu based on resident’s likes and dislikes was displayed. The home’s staff and management recognised that an alternative to a written menu is of importance for some residents with a learning disability who may find the addition of pictures would be beneficial to their understanding of the meal being offered and assist in them making meaningful choices. At present an alternative method of displaying a menu is not available. The manager gave a verbal undertaking she would ensure that menus are displayed in a format that all residents can understand. Apart from choosing the food they eat residents also assist with the shopping and cooking. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place, ensuring the personal, emotional, health care and medication needs of residents are met. EVIDENCE: Guidelines seen and comments by staff indicated that residents in respect of all aspects of their lives were exercising choice. These would include providers of personal services e.g., dentists, chiropodists and Doctors, staff to assist them, bedtimes, clothes, food, gender of carer, GP, dentist optician and key worker. Records seen indicated that any special medical, health or social care needs would be provided following consultation with the appropriate professional. These might include the local; learning disability team, doctors, district nurses, physiotherapists, occupational therapists, speech and language therapists, and care managers. Records were kept of appointments with all health and social care professionals and included details of any advice and treatment given 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 15 All residents are registered with one of two local medical practices where approximately ten plus doctors are available which allows a choice regarding the gender of the doctor consulted. Medication records confirmed that all prescribed medication , (which was seen to be securely stored) was administered in accordance with a medication policy and procedure by trained staff who confirmed they were aware of and had read the procedure. The record of medication administered to residents and unwanted drugs disposed of were complete and accurate. A procedure that ensures residents can assume responsibility for their own medication was in place. Records viewed confirmed no resident was responsible for their own medication following a risk assessment. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear policies and procedures in place which ensures residents are able to (Through a third party if necessary) and are protected from abuse. EVIDENCE: Following the last inspection a requirement was made that: “An audit must be undertaken of the records of money held for service users. Any discrepancies are to be corrected to ensure service users financial interests are safeguarded”. Prior to our visit a verbal assurance had been given that this requirement had been complied with. We viewed and checked the monies and records relating to all money held on behalf of residents and found then to be accurate and complete .The money seen agreed with the records. We are therefore satisfied the previous requirement has been complied with. A whistle blowing and Adult Protection Policy and Procedure have been implemented to work in tandem with the procedure produced by Hampshire County Council. All staff spoken to demonstrated they were aware of the procedure to follow should they witness or suspect the abuse of a resident. The complaints procedure, which was also included in the service user’s guide included information on how to contact The Commission for Social Care Inspection (C.S.C.I), was seen, as was record of complaints. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 17 CSCI has received no complaints since the last inspection. Due to some difficulties with communication we were unable to ascertain totally whether residents felt comfortable or were able to raise any concerns they had but staff did state they felt comfortable in discussing issues with management on behalf of any resident. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. EVIDENCE: All areas of the home were clean and free from unpleasant odours and obvious hazards. Furniture was comfortable, homely and met residents needs. An assessment (has been carried out) to ensure that any equipment and personal aids required by residents was available. The initial assessments of prospective residents ( referred to in standard two of this report) would consider what personal aids they required and any adaptations the home needed to put into place too meet residents needs. Residents are able to access all parts of the home including the large garden in which there is sited a covered swimming pool. It is understood that it is policy 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 19 that the pool building is locked at all times unless the swimming tutor is present for swimming sessions. Following a risk assessment a keypad system had been installed on the front gate to protect any resident who had been assessed, as being at risk should they leave the home unescorted. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents and all previous requirements had been complied with. EVIDENCE: At the time of our visit the number of staff on duty appeared sufficient to meet the needs of the residents. In discussion with the manager we established that the staff are usually on duty from 7.30am – 3pm two staff plus the manager, 2.30pm - 10pm two staff, 9.30pm -7.30am : one waking night staffsupported by an on call system to management. We were informed rotas are flexible and numbers can change due to the individual needs of the residents. Staff spoken with were confirmed they were aware of their responsibilities, the limits of their authority and who to contact for advice and support during in the absence of the manager via an on call system to external senior managers. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 21 The home has a key worker system whereby a support worker is allocated as the person who will have most contact with the service user and will attend reviews and health consultations. We viewed three staff recruitment and training files, all of which included evidence that staff are employed in accordance with a corporate equal opportunities robust recruitment and selection procedure designed to protect residents This involves the completion of an application form, the signing of a rehabilitation of offender’s declaration, an interview, satisfactory Criminal Record Bureau (CRB), Protection of Vulnerable Adults (POVA) and reference checks. From the evidence viewed and comments made by the manager and care staff we were satisfied the previous requirements had been complied with. Following the last inspection a requirement was made that: “An audit of training required by staff must be undertaken and actions taken to ensure staff receive the training needed to do their jobs.” Records seen confirmed all staff are subject to an in house and corporate induction and compulsory training programme, which involves courses that include first aid, moving and handling, protection of vulnerable adults (POVA), infection control food hygiene, fire safety (including evacuation), handling medication, challenging behaviour. All staff are also expected to undertake a National Vocational Qualification (N V Q) course. Currently 43.0 of staff has been trained to at least NVQ level two with a further 47.0 currently on courses. From the evidence viewed and comments made by the manager and care staff we were satisfied the previous requirements had been complied with. A second requirement relating to staffing was also made. This required that: “Staff must receive supervision at least six times a year to ensure they receive feedback on their performance and have the opportunity to discuss any concerns and training requirements”. From the evidence viewed and comments made by the manager in the AQAA and care staff we were satisfied the previous requirements had been complied with. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 22 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 management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the home are formally sought through their representatives. EVIDENCE: Following a period during which the home has been without a manager, a manager has been in post since January 2008, initially as acting manager and latterly as manager. Registration is being applied for. Care staff informed us that they had regular staff meetings and supervision, felt well supported by the manager who they described as available and approachable and open to ideas that might improve the service. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 23 A quality assurance system was in place and views about the service were sought from service users and their families, external health and social care professionals and staff. The last survey had been undertaken in January 2008. We were informed in the AQAA that” The company is looking in to putting a separate quality and compliance team in place which will be separate from operations, this should provide us with a more detached look at the service the company was in the process. An in house health and safety policy and procedure is in place to ensure the day-to-day safety of staff and residents. Procedures include, weekly health and safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents and procedures to follow in the event of fire (including evacuation) the last in compliance with a previous requirement. As part of the health and safety arrangements and to protect residents, all of the hot water supplies to baths were fitted with thermostatic controls are set at 43 degrees centigrade but radiators had not been covered. During a previous inspection we had been informed by the area manager that risk assessments were in place and the risk to service users had been assessed as low. The inspector was shown the completed risk assessments. No service users at the home were susceptible to epilepsy and had been assessed as being able to move away from the radiators if required. Despite these assurances we would suggest that best practice would indicate that all radiators and hot pipes should be covered. 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 24 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 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 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 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 52 Winchester Road DS0000011642.V363286.R01.S.doc Version 5.2 Page 26 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. 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