Care Home: The Windbound

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What the care home does well Individuals are supported by a dedicated team of staff who show good understanding of the needs of the individuals. The service liaises with other professionals in relation to the care of the individuals ensuring a multidisciplinary approach. What the care home could do better: Individuals must be protected by clear records being maintained on the reasons that medication is omitted or administered in the case of as and when required medication to enable this to be fully monitored. Random inspection report Care homes for adults (18-65 years) Name: Address: The Windbound The Windbound Shepperdine Thornbury Sth Gloucestershire BS35 1RW one star adequate service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Paula Cordell Date: 1 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Windbound The Windbound Shepperdine Thornbury Sth Gloucestershire BS35 1RW 01454418274 01454416724 Telephone number: Fax number: Email address: Provider web address: Voyagecare.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharon Alice Snook Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Voyage Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 12 The maximum number of service users who can be accommodated is 12 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability - Code LD Date of last inspection Brief description of the care home The Windbound is a care home operated by the Voyage Group. It is registered by the Commission to provide accommodation and personal care for up to 12 men and women aged 18 - 65 years who have a learning difficulty. People who use the service Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home have a diverse range of needs. The home particularly aims to cater for people who may challenge other services and who may display verbally and physically challenging behaviours. The home itself is situated on the bank of the River Severn. It is in a secluded spot, which would best suit those who prefer a calm and quiet environment. The home has three vehicles, which are used to support individuals to access community facilities. The Windbound was once a public house, which has been converted into three individual flats separated by keypad systems. The home does not have a registered manager. The fees for the home at the time of publishing this report range from GBP1,092 to GBP2,444 per week. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: This was an unannounced random visit. The purpose of the visit was to follow up the requirements and recommendations from the key inspection which was conducted in July 2009 and to monitor the quality of the service provided to the individuals living at the Windbound. The visit was conducted over six hours. An opportunity was taken to look at care records for two individuals and associated documentation, information relating to two staff including recruitment, induction, training and support and a tour of the home. During the course of the visit an opportunity was taken to speak with three care staff, the manager and deputy and five individuals living in the home. Two individuals care records were looked at, as a means to determine the outcome for people living at the Windbound. Care documentation detailed how the person wanted to be supported in all areas of daily living. Clear plans were in place detailing behaviours that challenge including the triggers and the strategies in place to positively support the person. Care was routinely being reviewed every six months, or where needs had changed. Compliance has been demonstrated to a requirement to ensure that plans of care are being reviewed. Care documentation included comprehensive risk assessments covering a wide spectrum of activities both in the home and the community. These had been reviewed since the last visit. The manager said that two Deprivation of Liberty Referrals had been made in relation to the administration of medication for one person and the restrictions imposed in relation to the environment for another. It was evident that the manager was aware of the process and had followed the guidance, ensuring an open transparent service was provided, involving the appropriate professionals and family where relevant. Records were in place detailing the outcome. The manager had a good awareness of the rights of the individuals and promoted a person centred approach and empowered the individuals. Staff described how individuals were being more involved in the daily life at the Windbound including shopping, making drinks and for some preparing and cooking their meals with varying support. One person living in the home said they could choose what to cook and were assisted to prepare most of their meals. From conversations with individuals living in the home, the staff, the manager and the records of menu it was evident that people were choosing what to eat. Each flat prepares a weekly menu and there were two options that individuals could chose from. The service has responded to a recommendation from the visit last July 2009 to ensure there was more choice in relation to menu planning. The manager stated they were planning to develop a pictorial menu to enable more choices for individuals who are non verbal to be actively involved. The manager had introduced a new daily record for each individual enabling staff to record all aspects of the day either with a short sentence or using a tick chart. The daily record included sections on the delivery of personal care, activities in and out of the home, the individuals daily menu and the physical and emotional wellbeing of the person. It was recommended that a section was included for any other comments as some of the sections did not allow for much information to be recorded. However, the records were accessible and enabled a review of care being delivered on a daily basis. Care Homes for Adults (18-65 years) Page 4 of 10 Individuals had activity plans that detailed what activities should be taken place. From reviewing one persons it was evident that the individual had not left the Windbound for a period of a month and the activities completed were similar from one day to the next. However from talking with the individual and asking them what they liked doing they stated I like staying in my room on my own. Staff confirmed they regularly offer the individual activities but these were declined and that the person spent the majority of the time in their bedroom until the home was quieter or at night when the majority were in bed. Staff were seen supporting the person during the visit with activities in their bedroom. From talking with the manager this was being reviewed and discussions were being had with the placing authority. The manager said that much work has been done in this area with the promotion of activities that were meaningful for the person. Staff confirmed this. Staff said that activities were regularly organised in the community, recent trips have been organised to Longleat, Weston and more locally to the garden centre and Thornbury. One person said that the day prior to the visit they had gone out for lunch. Another person said they regularly go to Thornbury to the library or shopping. The manager said that one of the individuals has joined a group in Gloucester to enable them to meet friends outside the home. The manager said that a plan was being drawn up in relation to supporting people to have an annual holiday. Individuals would be shown brochures and given some choice on destination and staff support. Staff spoken with during the visit had a good knowledge of the care needs of the people living in the home and described individuals in a positive manner. One member of staff confirmed they had attended training in autism and mental health and another said that they were aware the manager was organising this training for them. The manager was able to demonstrate that many of the staff had attended this training and further dates were being organised for the newly recruited staff. Medication was reviewed. The medication has been moved from the staff room to a designated office space in one of the flats. Appropriate storage was available including a medication fridge. The storage was well organised with records maintained of the fridge temperatures. Records were in place in relation to medication entering the home, administration and disposal. Staff were completing daily and weekly audits on the medication system and maintaining records of stock. Compliance has been demonstrated to two requirements relating to medication. However, it was noted that for one person medication had been omitted for a period of two weeks but there was no record of the reason why. The manager stated that usually there is a section on the reverse of the Medication Administration Record but this had not been included on this months record. This must be addressed to ensure that the reasons is clearly recorded and monitored. Staff were aware of the reason they were omitting the medication but if unfamiliar staff were involved then this could potentially put the individual at risk. There were clear guidelines in place for the reasons for as and when required (PRN) medication and a homely remedy agreement from the prescribing doctor. Care plans included information about the medication prescribed for each individual and how they were being supported with the administration. However, this was kept in the main office and not with the medication administration record. Good practice would be for a copy to be kept with the administration record as this would assist unfamiliar staff with the process. Staff were unable to locate a file containing a medication profile for each person Care Homes for Adults (18-65 years) Page 5 of 10 which detailed the medication they were prescribed, protocols and specific information relating to each medication prescribed in respect of side effects or contra indications. This had been seen on previous visits. During the last visit a number of requirements were made in respect of the environment. This included a refurbishment programme for two of the bathrooms, to ensure privacy in one of the bathrooms and to replace broken bedroom furniture. Compliance has been demonstrated to all the requirements. Two bathrooms and one ensuite have been refurbished to a very high standard. Nine out of the ten bedrooms have been redecorated and new furniture has been purchased where appropriate. Curtains have been purchased for two of the bedrooms and a lounge area. One person spoke positively about how they had been involved in choosing the colour scheme, new furniture and curtains for their bedroom. Another positively commented on the refurbishment of their ensuite. The manager said that future plans for the environment include redecoration of the last bedroom and making other areas more homely within a risk assessment framework. It was evident there was a commitment to ensure the Windbound was homely and a pleasant place to live. All areas seen were clean and free from odour. Individuals were observed moving freely around their individual flatlets. Two out of the three flatlets had access to a garden area overlooking the river Severn which individuals could access at all times. Much work has been completed on the grounds of the Windbound including development of the old car park into small garden areas for each flat. From talking with staff and the manager it was evident that the individuals were being consulted on what they would like to see happen in these areas. Suggestions included a rock garden, quiet seating area and purchasing ornaments. There was evidence that regular meetings were taking place. Since the manager has taken up post in November 2009, there has been two staff meetings, a senior and night care meeting arranged. Minutes of the meetings were recorded including the topic and any agreed actions. The manager had also organised house meetings for the people living in the Windbound demonstrating that individuals were consulted on the menu planning, activities and choice of decoration. Recruitment information was seen for two members of staff, which demonstrated a rigorous process had been completed. Evidence was provided that staff were in the process or had completed an in house induction. In addition Staff complete the Learning Disability Award Qualification. Compliance has been demonstrated to ensure staff complete an induction within a suitable timescale. The manager said a recruitment initiative has taken place to ensure that the staffing numbers were appropriate to the people they support. Staffing has been reduced in light that occupancy levels have been reduced by two people. Staff spoken with during the visit and the manager indicated that the home was adequately staffed to ensure that individuals needs are met. The manager said that the minimum staffing levels was five but evidence was provided that in fact the majority of the time there were six staff on duty not including the manager. At the time of the visit the manager said there was one home support worker vacancy and the plan was to recruit a core bank staff that cover staff absences. From talking with the manager and looking at records it was evident that sickness levels have been reduced over the last three months. This was being monitored by the manager and the area manager. Care Homes for Adults (18-65 years) Page 6 of 10 The manager had developed an action plan relating to staff training and where there were gaps, training had been arranged for staff. As evidenced in discussions with staff, the manager and the diary. Evidence was provided that staff had attended training in mental health and autism and further training was booked for staff that had recently been recruited. Staff confirmed they had completed training in adult protection. The manager confirmed that this was completed during induction with further training organised with the local Council. Compliance has been demonstrated to a previous requirement. One member of staff said that since the new manager has been in post more direction has been given to them in relation to their role and training. They said this was not made clear when they had first started back in the Summer of last year. Staff spoken with during the visit spoke positively about the management support and the changes that had taken place. The manager was confirmed in post in February 2010. She started work in the home in November 2009. A deputy manager has also been appointed to assist with the management of the home. Much progress has been made since the last visit and significant improvements have been noted in the planning of care, communication and support with the staff team and the environment. It was evident that further improvements were ongoing in relation to activities for the people in the home and training for staff as identified in the annual quality assurance assessment and from talking with staff and the manager. What the care home does well: 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 2. Care Homes for Adults (18-65 years) Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 10 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, 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 1 20 Staff to complete the carers notes on the reverse of the MAR sheet in respect of any omissions including the reasons so that this can be monitored. Each person to have a medication profile kept in the medication room containing information about their prescribed medication including the reasons why they are taking it, the side effects and protocols for as and when required medication and any support needs they may have. 2 20 Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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