Care Home: The Wheelhouse

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What the care home does well Service users needs are met by staff who have an in depth understanding of the service users individual ways of communicating their needs. Service users are given a healthy and balanced diet, and we saw that they have choice over the food they are given. We could see from records and discussions with staff and how residents presented that their emotional needs, and health care needs are met. Service users are supported to have an active and varied social life with many opportunities to be included in the local community. Opportunities exist for service users to further their educational and occupational activities. Staff are enthusiastic and are safely recruited for the jobs they do. They have a good rapport with service users and through comment cards and discussion with the inspector confirmed that the manager of the home is very supportive and approachable. Comments were made by staff such as "I believe the service provides a homely sensitive environment for the service users". What has improved since the last inspection? Since the last inspection a new registered manager has been working at the service. There were no requirements from the last inspection. Work has been carried out to redecorate the lounge and dining room and new furniture has been purchased. Staff continue to receive ongoing training and work is being carried out to find more ways for service users to express their views. What the care home could do better: There were no requirements following this inspection. The manger needs to continue to send in notifications of any incident that take place in the service, which may affect the service users. CARE HOME ADULTS 18-65 The Wheelhouse 15 Old Roar Road St Leonards-on-sea East Sussex TN37 7HA Lead Inspector Kathryn Emmons Key Unannounced Inspection 12th March 2008 11:00 The Wheelhouse DS0000021268.V348605.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 The Wheelhouse DS0000021268.V348605.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. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wheelhouse Address 15 Old Roar Road St Leonards-on-sea East Sussex TN37 7HA 01424 752061 01424 752061 the.wheelhouse@craegmoor.co.uk 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) Ferguson Care Limited Anthony Burgess Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is five (5) Service users must be aged between eighteen (18) and fifty (50) years on admission 9th August 2006 Date of last inspection Brief Description of the Service: The Wheelhouse is registered to accommodate five adults with learning disabilities, however only three males are resident at the present time. The property is a two storey-detached house located in a residential area on a private road on the outskirts of Hastings. The property is owned and managed by Craegmoor Healthcare. The service users accommodated have very complex needs, and all service users have very limited communication skills. They communicate their needs by using picture symbols and non verbal gestures which staff are able to understand. Current fees for the service are from £1225.00 per week. The Wheelhouse DS0000021268.V348605.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 star. This means the people who use this service experience good quality outcomes. A visit to the service took place on 12 March 2008. This visit was unannounced and took place over 3.5 hours. The registered manager was present during the visit and was able to assist the inspector. Care received by two service users was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Staff were spoken with and the care they provided was observed. We received a completed self-audit document completed by the registered manager, to provide information before we did a site visit. We also looked at how the provider makes information about their service, including CSCI reports available to prospective service users. During the visit we spoke with a member of staff and the manager and observed the care given to two of the service users. What the service does well: Service users needs are met by staff who have an in depth understanding of the service users individual ways of communicating their needs. Service users are given a healthy and balanced diet, and we saw that they have choice over the food they are given. We could see from records and discussions with staff and how residents presented that their emotional needs, and health care needs are met. Service users are supported to have an active and varied social life with many opportunities to be included in the local community. Opportunities exist for service users to further their educational and occupational activities. Staff are enthusiastic and are safely recruited for the jobs they do. They have a good rapport with service users and through comment cards and discussion with the inspector confirmed that the manager of the home is very supportive and approachable. Comments were made by staff such as “I believe the service provides a homely sensitive environment for the service users”. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Wheelhouse DS0000021268.V348605.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 The Wheelhouse DS0000021268.V348605.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 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users, relatives and people who place service users at the service can be confident that their assessed needs can be met by the service. Contracts are in place so all can be clear on what service they can expect to be offered. EVIDENCE: We could see from looking at care files that service users had contracts in place. Since the last inspection no new service users had been admitted to the home. There is a vacancy at the service and the manager explained how prospective service users have been assessed and what the process is for preparing to admit someone to the home. The statement of purpose and service users guide are two documents which provide information to anyone considering moving into the home and the people who are supporting with placing the service user at the home. These are updated regularly. The manager said that any new service user would need to be able to fit in with the three current service users as they have lived together for many The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 9 years. The pre admissions process is very in depth and covers all aspects of the prospective service users needs so that if a place is offered in the service the manager can be confident that all staff have the skills and knowledge to meet the new service users needs. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Written records and staff skills and knowledge provide service users with confidence that their needs are known and are able to be kept safe. Regular reviews of needs provide staff with detailed information to provide the correct level of support. EVIDENCE: We saw care files for two service users. Both of these contained written assessments care plans and risk assessments. It was clear what the service users needs were and how these were going to be met. We could see that where possible the service user had been involved in their plan and when this was not possible information had been sought from relatives and friends. The care plan was in picture format to enable service users to be more aware of the content of the plan. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 11 Staff enable service users to make choices as much as is possible. During the visit we saw examples of this such as choosing what to have for lunch from using picture symbols, which were on the wall in the dining room. We were told that service users are able to choose their own clothing when they go shopping and this is another way in which service users express their individuality. The organisation holds meetings for service users called “your voice” which are chaired by service users from other services within the organisation and are used to empower service users to express their choices and to be supported to make decisions. The manager is working with service users to gain their views so they can be involved in these meetings. The Wheelhouse DS0000021268.V348605.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. Service users have a varied and balanced diet and are able to have their choices catered for. Service users are able to participate in community activities. Purposeful activities are provided and service users enjoy these. Service users are able to receive friends and visitors into their home. EVIDENCE: We could see from care records and daily entries in personal files of service users how they spend their days and what activities they are involved in. Staff told us how they support service users to go to the cinema, swimming, shopping and out to pubs and local parks and café’s. The detail in the care notes also recorded how the service user had expressed their enjoyment in the activity. This is important as service users are not able to say if they enjoyed the activity or if they would like to try something new. At The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 13 the previous inspection the manager at that time has said she was exploring the possibility of service users having employment opportunities. This had not currently happened and the new manager is looking at possible ways this may be able to take place. The manager discussed how service users have contact with family and friends and what arrangements are in place for possible trips to take place. The pre inspection information we received gave a list of all the activities service users had been able to participate in, these included going to a pantomime and activities in the local community. Staff told us “the service offers a wide range of activities to ensure that service users are well incorporated into the community. “ Needs are met without hesitation or question”, and “We are currently expanding their activity choices which will be a positive improvement when completed”. We saw staff supporting service users at lunch time and staff discussed the type of meals provided for service users. A varied diet is offered and service users were seen being able to choose from snacks offered at lunchtime. A Key worker system in place and we could see from daily records and review records the input key workers have. In respect of equalities and diversity one of the service users key worker is a member of staff who comes from the same country of origin. This means that the key worker has a good understanding of the cultural needs of the service user and is able to assist staff to implement these needs. The Wheelhouse DS0000021268.V348605.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): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are met and risk assessments are in place, and identify risks and how these will be minimized. Medication arrangements are good. EVIDENCE: We looked at the medication arrangements for the service users. Staff who give out medication have been trained to do this and understood the importance of giving the right medication at the right time. There is a medication policy in place. Medication records we saw had been signed and completed correctly. Detailed risk assessments are in place and where a service user was not able to undertake a specific task without support an explanation was recorded. This shows that the staff have the skills to balance the service users rights to make choices alongside the potential risk this may expose them to. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 15 We could see from looking at care records and speaking with the manager that service users are supported to attend local doctors and dentists, a chiropodist visits the service. Due to the complex needs of the service users and their anxiousness of interacting with health care professionals the manager is working towards liaising with healthcare professionals so a planned approach can be made to enable service users to have the opportunities to have a full health check. We could also see that service users have had regular opticians visits. From speaking with staff and reading the in depth content of the care notes we could see that staff are very clear on how to support service users to have their needs met. The interactions we saw between staff and service users were valuing. The Wheelhouse DS0000021268.V348605.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. Service users and other people involved with the service can be confident their concerns will be listened to and acted upon. Staff are trained in safeguarding adults procedures and service users are protected from harm. EVIDENCE: We saw the complaints procedure on the wall in the hallway this gave correct details. We could see that staff had the skills to assess if service users seemed concerned or unhappy. A complaints log is maintained and the manager confirmed there had been no concerns or complaints made. We spoke to the staff member on duty and they were given safeguarding adult scenarios, which they were able to answer appropriately. Staff spoken with said they were confident to challenge the manager if they thought a decision was not in the best interest of the service users. An up to date safeguarding adult policy was in place. Staff confirmed they had received training in safe guarding adults procedures we also saw the staff training plan for the year and saw that training had been planned and taken place. The manager told us that all staff had criminal record checks in place before they were offered a position within the service. We saw these in the staff files we looked at. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 17 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. The home is clean and tidy and provides service users with comfortable surroundings, which they are able to personalise. EVIDENCE: A tour of the premises was undertaken. All areas were clean and tidy and in good repair. The lounge has been redecorated and new furniture purchased. Part of the lounge is a sensory area with different textures on the wall and a light, which makes relaxing shapes, and colours on the wall. The manager said that currently the service users do not want to use this area for a sensory room and further ideas are being explored as to what this area can be used for. Window restrictors have been fitted to the upstairs windows to keep service users safe We saw gloves and aprons in the bathroom and kitchen to minimize the risk of cross infection. A kitchen gate is in place at waist height in the The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 18 doorway leading from the kitchen to the dining room. This is so that service users do not run into the kitchen placing themselves and staff at risk. The gate is low enough so that service users can view what is happening in the kitchen. A maintenance person is employed at the service and a record is maintained of all work, which needs to be carried out. There is a large garden to the front and back of the home and service users are able to move around the home freely. We were given permission to look at two service users bedrooms these had been personalised by the service users and one of the bedrooms had a full wall sized mural depicting a scene of their country of origin. Another service user had personalised their room with pictures and personal possessions. Pre inspection information evidenced that all servicing of equipment such as the heating system and fire safety system had been carried out within agreed timescales. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Enthusiastic and trained staff cares for Service users. Recruitment records show that staff have been safely recruited. EVIDENCE: We looked at the recruitment records for 3 staff. We could see that all staff had had the necessary recruitment checks undertaken including a (CRB) Criminal records Bureau check and written references. A new member of staff working at the time of the visit spoke about how they were recruited and confirmed what we had been told by the manager and what we had seen in records. A training plan was in place for all staff and we saw that courses and training had been booked for protection of vulnerable people, basic food hygiene and health and safety. The manager told us that he was looking into providing deescalation technique training for staff. This would enable them to defuse any potentially aggressive or harmful behaviours the service users may present The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 20 with. Staff told us they had received an induction and support to study for National Vocational Qualifications in Health Care (NVQ’S). One of the comment cards said, “The training is always evolving to meet new policies etc. The manager meets with me regularly, we have reviews of our working roles and practices and we have this every month.” Discussion with a staff member included talking about upholding service users rights. The staff member was very clear on service users rights to be treated as citizens and have opportunities available to them. We also had a comment card back from staff, which said, “ I feel the service offers equality, diversity and support that all individuals require or need”. We saw from staff files, and the staff we spoke with said, they had a contract of employment and a job description. This enables them to be clear of their job role and what is expected of them. We saw that staff meetings take place and opportunity is available for staff to discuss any issues and minutes show what action has been taken. Since the last inspection the manager has returned the night duty staff level to waking staff so that service users needs can be met overnight. There are always at least two staff on duty during the day and the manager. The staffing levels are regularly reviewed to ensure there is sufficient support for service user when they go out into the community. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 21 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): 36, 37,38 and 39 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is well run by a competent and trained manager. Service users are encouraged to express their opinions. Supervision sessions enable development and training needs for staff to be identified. Checking of equipment and servicing of house systems keep service users and staff safe. EVIDENCE: The registered manager is Mr Tony Burgess who was approved for registration a short time before this inspection visit. Mr Burgess is a registered learning disability nurse with an extensive work history in caring for people with learning disabilities. Staff we spoke with and comment cards we received all stated that the manger was “really easy to get on with always finding time for The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 22 you and will listen to any ides or suggestions you have” and “makes you feel part of the team”. Staff supervision sessions take place every eight weeks and records are maintained of these. One staff member said “As well as supervision we are given time with the manager to ensure we are comfortable with our roles and make sure we are kept up to date with training “. Another comment received was “Manager always ensures that we are well informed about all of our service users and we are able to go over any queries”. A quality assurance programme is in place and part of this consists of the monthly visits from an area manager of the organization. In addition to this the manager undertakes a monthly audit of one main area of the service and reports the findings back to the organisations head office. Yearly the organisation visit the service to carry out a full audit. Service user relatives and stakeholder questionnaires are also sent out and a report is produced on the findings and this assists with the services business plan. We saw from records that an incident had occurred in the home, which we should have been informed about. The manger had completed a form but this was sent to the organisations head office where a decision is made as to whether we are told of incidents or not. The manager agreed that we would always be sent the completed forms as well as a copy being sent to the organisations head office. From pre inspection information we received we could see that all testing of equipment had been carried out regularly to keep staff and eservice users and visitors to the service safe. The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 X 5 3 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 24 no 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 The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI The Wheelhouse DS0000021268.V348605.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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