Care Home: 7 Wychwood Close

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 7 Wychwood Close 7 Wychwood Close Sonning Common Reading RG4 9SN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Lough     Date: 2 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 7 Wychwood Close 7 Wychwood Close Sonning Common Reading RG4 9SN 01189722678 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jenny.pearce@new-support.org.uk Dimension (NSO) Ltd Name of registered manager (if applicable) Mrs Jennifer Pearce Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home 7 Wychwood Close is a three bedroomed house situated in a quiet residential area in Sonning Common. It is close to shops and other amenities. It provides residential care for up to three adults with learning disabilities, both under and over the age of 65. All those being supported are admitted on a permanent basis. Their physical independence is decreasing as they become older and the home cannot be fully adapted to meet these needs. Therefore, the home cannot currently guarantee to be a home for life. This is being addressed and those being supported are to be given more suitable accommodation. Community and Social Care purchase all the places at the Care Homes for Adults (18-65 years) Page 4 of 27 care home 3 Over 65 0 3 Brief description of the care home home. The home is run and managed by New Support Options Ltd, a not for profit organisation established in 1989 and part of the New Dimensions Group. New Support Options Ltd has a wealth of experience in providing services for those with learning disabilities and operates in West Berkshire, Hampshire, Surrey and Norfolk, in addition to Oxfordshire. The fees for this service are #641.18 per person per week. The home contributes towards costs for clothing and some holidays. Service users purchase their own toiletries, magazines, hairdressing and some outings. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in January 2008. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service were consulted about their opinion of what it was like to live in the home during the visit to the service. Care Homes for Adults (18-65 years) Page 6 of 27 From this visit it was found that the requirements made previously had been met. There was one area of concern identified during this inspection and one requirement was made to reflect this. A small number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough assessment of need process can be carried out prior to an individual being offered a place in the home. Evidence: The residents currently residing in the home have been living together for a number of years, and the staff at the home have not been required to carry out an initial assessment of need process for some time. The service does have the required information, document tools and procedures in place should the need arise. The policy and procedures for this involve providing opportunities for prospective residents to visit the home and the occupants before a decision is made to move in. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records show that for the people supported in the home their care planning is detailed, reviewed regularly, and amended to reflect any changes in their needs. The risks to their wellbeing and to others are identified and detailed strategies are in place to reduce or eliminate them. Personal choices and decision making is recorded throughout the care planning records. Evidence: The records for two of the residents were reviewed to see what the home has in place to inform and instruct staff of how to meet the need of the person concerned. Both records show that each person has an Essential Life Style Plan that is generated with the involvement of the individual. Their personal preferences, daily routines, and any risks to their well being or others is identified and clearly documented with detail information given to staff of how to achieve them. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: The concerns in regard to the weak content of some of the risk assessments that were seen at the last inspection process have now been rectified. The documents now show that there is good detail, better guidance to staff and clear instruction of how staff are to reduce or eliminate any risks identified. The records also show that there is a regular programme of review for all parts of the care plan and that the person concerned is involved in any changes carried out. The records for risk assessment also include a vulnerability analysis and behaviour management monitoring which assist staff to care for the individual on a day to day basis. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported to continue with their lives as they wish. They are also assisted to maintain their relationships with family and friends and given the opportunity to be part of the community they live in. They are provided with suitably nutritious meals and encouraged to be involved with the planning and preparation for them. Evidence: The care planning records show that each individual is supported to continue with their chosen lifestyle and interests, where they are able. They also have friendships and companionship with the people living in the sister home, 60 Wood Lane, who they meet regularly as staff and residents undertake activities across the homes. Through discussion with the manager it was apparent that she has already identified Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: that the needs of individuals are changing as they become less physically able to participate and is continuing to explore what they can offer to maintain their interests. Each resident has an individual plan of activity both inside and outside the home. However, personal preferences to remain at home are also listened to and acted upon. Previously some of the residents have been able to go on short holiday breaks or trips of which the individual has been helped to make records of the events in their own care plans. Residents are also encouraged to be included with the running of the home, where they choose too. Small household tasks such as food preparation, some dusting, and tidying are part of this involvement. Additionally, they plan and carry out the food shopping with staff should they wish. From information provided it could be seen that the residents are assisted to attend and enjoy any events or activities going on the local community. They are enabled to access the local shops and amenities when they wish. Relationships with families and friends are supported and often they are invited to join in any significant event or activity going on. The menu planning for individuals and the shopping required for home is carried out every Wednesday when residents sit down together to discuss what they would like to do. Individual dietary preferences and needs are incorporated and alternative meals are always available, should they wish. Staff continue to encourage residents to be involved with some of the meal preparation as to ensure that they keep active and maintain some of the practical skills required to be independent. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff who support the people living in the home ensure that their health and personal care needs are met. There are safe medication practices carried out in the home. Evidence: The manager and staff provided some information about what individuals need for help with their personal care, which was reflected in the care planning records that were reviewed. The health care needs are including in the care planning with records showing plans of action of how to achieve meeting them and any involvement of a specific health care practitioner when they occur. Monitoring tools are used if necessary if an area of health is assessed as being at risk. There is also documentary information about the comprehension of, and the agreement to treatment that the individual has given, as to provide staff with guidance on the persons understanding of their healthcare needs. Individuals medication is recorded in the persons care plan and the MAR(Medication Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: Administration Record) charts provided confirmation that they receive them as prescribed. What they could do to improve the record keeping is to keep samples of the staff signatures as to be able to audit and monitor the records more thoroughly. All staff received medication training as part of the core training programme. None of the current residents undertake any self-administration of medications. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that their concerns will be listened to and acted upon. There are suitable strategies in place for staff to protect the people they support from possible abuse or harm Evidence: The residents living in the home are provided with a copy of the complaints process that is included in their care records that they keep in their rooms. The format of the documented process is variable depending on the needs of the person concerned. The review of care planning for individuals that were looked at, included staff asking if there are any concerns of worries that the person may have. Residents are also given the opportunity to speak to the providers representative during the regular monthly quality monitoring visits. The manager provided information that there had been no complaints received by the service during the last twelve months. The commission has not been in receipt of any information or complaints about the home. Staff are provided with information and training in regard to safeguarding the people Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: they support from possible harm or abuse. The topic is included as part of the initial induction training and is revisited periodically as to keep staff informed of changes in legislation and remind them of best practices. The staff have also been provided with training in regard to the Mental Capacity Act 2005, and further is planned with a focus on the Deprivation of Liberty safeguards. The home has not had any adult protection concerns since the last inspection of the service. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is kept comfortable, homely, and is generally maintained well. The kitchen area has the potential to put residents at risk from the inability to maintain a high standard of cleanliness and safety. Evidence: The home continues to be kept in a good decorative order, and remains homely and comfortable for the three people that live there. All the residents were present in the home during the inspection visit and they appeared to enjoy the private space of their rooms and the communal areas. One person was content to remain in their room, another was enjoying the evening television in the sitting room. The planned refurbishment of the upstairs bathroom has been carried out, making it a more pleasant and practical facility for the residents who use it. Other intended refurbishments that the manager outlined at the last inspection have not yet taken place. The proposed decking for the garden has been halted as to ensure that the facility will be appropriate for one of the residents. They are investigating Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: alternatives as to minimise the possible risks to the individual concerned. The other major change to the environment was a planned refurbishment of the kitchen that, as yet, not been carried out. From what was seen, the kitchen is in quite a poor state and is close to being unsafe for the preparation of food and could potentially put residents at risk. Particular areas of concern are, the damaged worktops, cupboard, and drawer doors, one has a panel missing. The lino flooring in this room is damaged and beginning to come away from its fixings in several areas and could cause a trip or fall to residents as they pass through regularly, to the utility and bathroom beyond. Overall the kitchen presents a difficult problem for staff to maintain good standards of cleanliness. Its general condition may limit residents using it and therefore prevent them retaining some of their independence and practical skills. The concerns about the state of the fabric and fittings of the kitchen were discussed with the manager, who equally expressed that improvements were overdue. Generally the home appears to be kept to a good standard of cleanliness and adaptations have been obtained to meet the changed needs of the individuals living there. This includes handrails in the bathrooms and raised toilet seats. The raised toilet seat in the downstairs bathroom appeared to be ill fitting and staff on duty quickly checked the safety of the seat during the inspection. The matter was referred back to the manager who gave information that the matter would be rectified as soon as possible. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported by a trained, and consistent, team of staff employed. Evidence: The homes management and staffing provision is run in conjunction with the sister home, in Wood Lane, a few hundred yards on the main street through Sonning Common. From information provided by the manager the permanent staffing levels have improved, although they continue to use regular staff from the bank team of support workers and those who work in the organisations day services. At no point do the service use agency staff, therefore residents, are supported by a familiar consistent team of people they know well. On average bank staff provide approximately thirtyseven hours per week to support the residents in both services. The duty rota is recorded showing staff working across the two homes with a pattern of long shifts including sleep ins for some. Usually there is one staff member on duty at all times. The detail of the rota is fairly complicated and for good practice they should ensure that the full name of the member of staff is recorded. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Three recruitment and employment records of staff employed in the home were reviewed as to establish what the quality of the processes carried out. The records provided information that the required checks for Criminal Records Bureau, and references are carried out before the new member of staff is employed in the home. There was also evidence of the residents involvement with preliminary meetings with prospective new staff. Copies of some of the records are kept within the home, others are held at the providers central office in Berkshire. The service uses a summary document to show that the necessary information has been obtained. However, care should be taken to make sure they are used effectively. There is a core induction programme for all new staff. The manager provided information that the process has been updated, with established staff included in revisiting topics in, Our way of working. The manager provided information about the level of qualification attained by staff and number of those undertaking training to achieve them. One member of staff has achieved an NVQ Level 3, four staff an NVQ 2. There is a regular programme of supervision carried out with staff, including monitoring the medication practices carried out. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run effectively and safely and continues to strive to provide support and lifestyle that is in the best interests of the people who live there. Evidence: The service is led by an experienced manager who has been working in her current position for a number of years. In addition to being a registered nurse, she has also undertaken further training to enhance her role. This includes an NVQ 4 in management and since the last inspection a number of topics relevant to managing and training the team of staff she supports. The manager continues to divide her working time between the two registered services and providing support to an individual service user in the community. She is also included in the scheduling to provide personal care and support across the two homes. Despite the minimal designated time for completing her management responsibilities, the home appears to be run well. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The service has several methods of formally consulting with the residents in regard to the services provided. This is carried out in the regular reviews of care with individuals key worker, the annual reviews with other health and social care professionals, and during the monthly visits to the home by the providers representative. The concerns that copies were not available in the home of these regular quality assurance monitoring visits(Regulation 26), that were raised at the last inspection visit, have now been rectified. These documented visits also provided evidence that other records and the general running of the home were areas that are assessed on a regular basis. The strategies and information made available in the home for safe-working practices did support that sufficient measures are in place. The deficits in the condition of the kitchen are potential areas that will reduce the general standard of good practices in the home. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The kitchen area should be kept in a fit state and suitable for purpose. You should ensure that the food preparation area is suitable to maintain good food hygiene practices to protect the people living there. They should also be in a safe condition for residents to use with the risks of harming themselves eliminated should they use the the facilities unsupervised. 30/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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