Care Home: Foxwood

What the care home does well The home provides a very caring approach to the people who live there. Staff are sensitive and knowledgeable about people`s needs and interests. Active efforts are made to maintain links with family and the local community. What has improved since the last inspection? Risk assessments are being done on Dimensions paperwork and are now more structured and more clearly identify how risks will be minimised. Support plans are now being kept under review and up to date. A comprehensive fire risk assessment has been completed. What the care home could do better: There is a need for refurbishment as some areas of the home are beginning to look shabby. Time needs to be spent on sorting out administration shortfalls to ensure the paperwork being introduced by Dimensions is fully implemented. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Foxwood 5 Mill Lane Wolverley Kidderminster Worcestershire DY11 5TR     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: Martin George     Date: 1 3 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: Foxwood 5 Mill Lane Wolverley Kidderminster Worcestershire DY11 5TR 01562852965 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dimensions (UK) Ltd Name of registered manager (if applicable) Mrs Lesley Anne Goodwin 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: 4 The registered person may provide the following category of service only: Care Home Only (Code 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) 4 Date of last inspection Brief description of the care home Foxwood is a traditional two storey detached house in a secluded location in a residential area of Wolverley. The bedrooms are individually decorated and furnished. There is a shared lounge, dining area and kitchen. Local shops and access to public transport are nearby, whilst the home has its own vehicle for people to use locally. The home aims to provide a domestic environment promoting independence and dignity. People receive care and support to live as ordinary a life as possible in the community. This involves staff teaching skills and creating opportunities on behalf of individuals. Care Homes for Adults (18-65 years) Page 4 of 27 care home 4 Over 65 0 4 Brief description of the care home People are encouraged to participate in the running of the home and share in general household activities within their capabilities. The registered manager is Lesley Goodwin. Dimensions (UK) Ltd is the care provider for the service, having registered with the Commission for Social Care Inspection on 1st April 2006. The current fee for the service range from £392.00 per week. Charges which are additional to the fee include personal toiletries, clothing and electrical items such as TV and music centres. Activities not covered by the allowance made by the provider or in the funding authority contract include holidays, major extra outings and hairdressing. 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 unannounced key inspection was carried out by a single inspector between 10:10 and 16:20. As part of the inspection all National Minimum Standards defined as key by the Commission for Social Care Inspection (CSCI) were considered. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about the home through their annual quality assurance assessment (AQAA). Information from the last key inspection report and other information submitted to CSCI prior to inspection were analysed to formulate a plan for the visit and to help us in determining a judgement about the quality of care provided by the home. Care Homes for Adults (18-65 years) Page 6 of 27 On the day of the inspection we spoke to the acting manager, staff and people living at the home. We also undertook a tour of the premises and observed practice, which provided evidence in support of the records we also checked on the day. This approach allowed us to assess how well outcomes were being met for those receiving a service. 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. Pre-admission and ongoing assessments ensure that people have their needs and preferences met. Evidence: All the people living at the home have been there for about 7 years and based on the pre-admission assessments we looked at, albeit completed several years ago, we are satisfied that a multi-agency approach was used successfully to ensure people were being admitted to an appropriate service. There is evidence that these assessments informed the home about peoples wants and preferences, making the placement more meaningful to them. Although it is several years since an admission has occurred the home has a policy of using introductory visits and overnight stays prior to an admission being agreed to ensure the placement is right for the person. The acting manager told us that the welcome guide has been recently updated but unfortunately was unable to find a copy to show us. Each person living at the home has a completed licence agreement, specifying the terms of the placement. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 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. People living at the home are well supported and encouraged to express choice in ways that take account of their disability. Evidence: Although support plans vary in quality there is evidence that they are all person centred, identifying the needs, wants and preferences of people living at the home. There is some work to do to ensure that support plans and health action plans contain the same information so that staff are not misled about current needs, which could potentially affect people living at the home. There are minor shortfalls, such as weight monitoring not always being done monthly. Our observation on the day showed that staff have a very good relationship with people living at the home and constantly try to check what they want, even though the communication abilities of everyone living at Foxwood is extremely limited. The response from people gave a clear indication that they feel comfortable with their Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: carers. Risk assessments are completed for a wide range of things that may potentially leave people in vulnerable positions where they could be harmed. Risk assessments are reviewed and are currently in the process of being changed onto Dimensions risk assessment templates. One of the risk assessments explains why the kitchen is locked while things like boiling the kettle are happening. The Annual Quality Assurance Assessment (AQAA), completed by the manager and submitted to the Commission for Social Care Inspection (CSCI) prior to the inspection, states that people are supported to manage their own finances as much as their capabilities allow. Staff provide support that recognises the disability but also empowers the person to do as much as possible for themselves. Care Homes for Adults (18-65 years) Page 13 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. People living at the home enjoy a lifestyle that respects their individuality whilst ensuring their safety. Evidence: Peoples individuality is recognised and respected by staff. Peoples interests are known about and efforts are made to allow those interests to be met. One person living at the home likes watching football and he can now watch the local team from the conservatory because the trees that previously blocked the view have been cut back. Getting up and bedtimes are flexible. Some people living at the home occassionally get up during the night and staff on sleeping in duties ensure they come to no harm. Staff encourage and support risk assessed levels of autonomy, but the degree of disability Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: means that a high level of support is always available to ensure people are not put in positions of harm. The AQAA states that links with family are actively supported and discussions with staff and observation of practice on the day of inspection supported this. Arrangements for family contact were being sorted during the visit. One person has additional 1:1 time paid for and this allows for a varied activity programme. This person returned from a mornings 1:1 session during our visit and appeared to have enjoyed the experience. The carer pointed out that the person enjoyed walking and when out and about liked to have a pie, which is one of his favourite things. Involving people in menu planning is very difficult due to their disabilities but staff explained they determine menus based on what people have seemed to enjoy previously. Information contained in support plans informs staff of allergies and food preferences. Care Homes for Adults (18-65 years) Page 15 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. People have their health carefully monitored and receive personal care that protects their dignity. Evidence: There is good quality information about all the people living at the home but due to the need to introduce Dimensions documentation there are currently some discrepancies between information contained in support plans, information in the health action plans and information in the medication folder. Discussions with staff satisfied us that they knew where to find information but there is a need to bring certain records up to date to ensure that people continue to be properly safeguarded and have their outcomes met by well informed staff. The manager needs to ensure that all entries are signed and dated to show which are the most current. The AQAA states that the home is able to access specialist healthcare services when required and records we looked at confirmed this to be the case. Staff have been provided with medication training that means they are able to satisfactorily protect people from harm in this area of practice. Procedures are in place and medication Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: storage arrangements are satisfactory. There is evidence that regular pharmacy audits take place. Care Homes for Adults (18-65 years) Page 17 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. People live in a safe environment where any issues of concern are dealt with effectively. Evidence: There is a complaints procedure that is available in a format suited to the needs of people living at the home. It would be helpful if the entries in the complaints and compliments book were written in an agreed format and if they showed whether the complainant was happy with the eventual resolution. Observations on the day showed a good level of understanding about safeguarding of vulnerable adults. Staff displayed a very sensitive and respectful approach to the people living at the home. They were aware of each persons abilities and vulnerabilities and took necessary steps to protect them from preventable harm. An example of this is mentioned in the AQAA, where it states that the front door is alarmed because some people have no sense of traffic related risks. Staff have received the necessary adult protection training although some refresher training is required to ensure knowledge of safeguarding is kept current. The adult protection policy is up to date but the home needs to acquire Worcestershires adult protection procedures to ensure the homes policy complies with it. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that is kept safe but that is in need of some refurbishment. Evidence: Throughout the home there is evidence of the need for some refurbishment. Although there is nothing which can be said to be in disrepair it is nonetheless disappointing to be told by staff that they have been awaiting refurbishment for some time and have no idea of a timescale for it being done. The furnishings are functional and appear suitable for the people living at the home, even though none of the current group were able to express an opinion. The home is kept clean and free from potential hazards. The bedrooms are personalised and are suited to the needs of the people living there. The AQAA states that there is a lockable safe in each persons room. Hygiene and infection control are maintained to a standard that protects people from preventable harm. We looked at records showing that fridge, freezer, water and cooked food temperatures are monitored to ensure that people are not placed at harm of infection or cross contamination. The food probe is calibrated on a regular basis. Care Homes for Adults (18-65 years) Page 19 of 27 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. People living at the home are cared for by staff who are trained to meet complex needs and provide safe care. Evidence: The home has a very stable staff team, with at least 80 of the team having acquired a relevant professional qualification. Staffing levels are sufficient to provide safe care to the people living at the home, with two staff on duty throughout the day and one on sleeping in duty. Additional staffing is provided to meet specific needs, such as one person who has 1:1 time as part of his support plan. An additional sleep in member of staff is used if there are particular nighttime problems. The organisation is committed to ensuring staff are competent and provides a range of training that equips them with the necessary skills and knowledge. The training records we looked at showed all training that had been completed and included dates for future training events. We noted that not all staff are up to date with their training requirements, but the acting manager assurred us that she was actively following this up to ensure people continue to be cared for by competent staff. Recruitment procedures and practice are suitably robust to ensure that people living at Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: the home are cared for by staff who have been properly vetted. 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. People living at the home are kept safe by effective health and safety monitoring and appropriate management and support to staff. Evidence: The registered manager is currently holding an acting area manager role with the organisation and during this period the deputy is in an acting manager role. Both are qualified learning disability nurses. We were told that an organisational decision has been made to only have one manager in each home. Although there is no indication that this will have any detrimental impact on people living at the home it may affect how well the manager is able to carry out their administrative and quality monitoring responsibilities, which they are already struggling to do. Quality monitoring is done through Regulation 26 monthly visits. The records we saw indicated that although the quality of these visits was good they did not appear to be happening every month. Internal quality assurance processes would benefit from some improvements to show clearly how the manager is monitoring the quality of care and Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: how developments in the service improve outcomes for people living at the home. The manager acknowledged that she needs to be more diligent in ensuring that all staff read and understand information provided to them, such as policies and internal memos, to ensure they are continually performing their duties properly and providing safe care. There is evidence that all necessary health and safety and fire checks are carried out on a regular basis to ensure that people are protected from the risks associated with fire, infection and cross contamination. A comprehensive fire risk assessment was completed in October 2008. 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 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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