Care Home: Warstones Resource Centre

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What the care home does well What has improved since the last inspection? The home has implemented all seven requirements and one recommendation from the previous key inspection report of 25th September 2007. The Centre has an experienced Registered Manager in post and she is managing the care home well. Conversations with staff, people using the service and their visiting relatives, indicated that the Registered Manager is service user focused, leads and supports an enhanced staff team providing them with improved training and supervision. This style and approach to management aims to pursue future improvements in all aspects of service. One person who lives at the home stated "This place is a lot more peaceful and better organised now". Care Plans seen for people who use the service were informative and gave some indication of how care is to be delivered for each of them. Medication practices have improved and more staff have received training in safe handling of medication. The home has organised staff training on the Mental Capacity Act 2005. The majority of staff have received training in safe working practice topics, dementia care and adult protection and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. It was noticeable that there have been some improvements made to the environment of the home. A rolling programme of redecoration has been implemented, and some of the communal areas have been redecorated. The garden and patio areas at the rear have been improved and made accessible and secure. The Centre`s self assessment AQAA states " We have redecorated in all areas, updated our beds and furniture and ensured our surroundings have improved. We have met all requirements of our last Fire Authority`s Inspection. We have concentrated on updating our staff training and improving our procedures with regard to the Safe Adminstration of Medication". What the care home could do better: CARE HOMES FOR OLDER PEOPLE Warstones Resource Centre Warstones Drive Penn Wolverhampton West Midlands WV4 4PQ Lead Inspector Bhag Jassal Key Unannounced Inspection 16th September 2008 09:10 X10015.doc Version 1.40 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 DS0000035792.V371941.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 Older People. 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. DS0000035792.V371941.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warstones Resource Centre Address Warstones Drive Penn Wolverhampton West Midlands WV4 4PQ 01902-553419 01902 553424 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) www.wolverhampton.gov.uk Wolverhampton City Council Diane Vukmirovic Care Home 26 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (26) of places DS0000035792.V371941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Dementia (DE) 26 Old age, not falling within any other category (OP) 26 The maximum number of service users who can be accommodated is: 26 25th September 2007 2. Date of last inspection Brief Description of the Service: Warstones Resource Centre is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for a maximum of twenty-six people over the age of 50 years. The service serves those people living in the south west of Wolverhampton and is managed by the City Councils Social Services Department. The responsible individual is Mr Brian O’Leary and the registered manager is Mrs Diane Vukmirovic. The Resource Centre provides a range of services to include rehabilitation for older people, respite services for physically frail older people, day care services and home support services. The residential accommodation is provided across three units over two floors comprising of a rehabilitation unit, respite unit and a unit for people with dementia. Bedrooms are single and each unit has a separate lounge, dining area and a small kitchen. A visitors lounge is also available. The Centre provides a passenger lift for accessibility and a fully enclosed garden. The local shopping centre is approximately 500 yards away and there is a bus service to and from the City. People can obtain information about this service from the Statement of Purpose and Service User Guide. Inspection reports produced by CSCI can be obtained direct from the provider or are available on CSCI’s website at www.csci.org.uk DS0000035792.V371941.R01.S.doc Version 5.2 Page 5 Fees charged are based on an individual financial assessment of need, co-ordinated by the social work team. DS0000035792.V371941.R01.S.doc Version 5.2 Page 6 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 the service experience good quality outcomes. This report is on a key inspection, part of which included an unannounced visit undertaken on 16th September 2008. This unannounced visit started at 09:10 am and lasted 9 hours and 35 minutes. The home had 24 places occupied and 2 remain vacant. The judgements made within this report are based upon information supplied by the home, from interviews with staff, people who use the service and their relatives. During the course of inspection the assessment information and care plans were inspected for four people who use the service. Medication administration was checked. Staff records were seen to check staff rotas and training. Various documents were seen in order to check compliance with health and safety legislation. A tour of premises was also undertaken and we observed care practices and interaction between staff and people who use the service. Discussions took place with several members of staff on duty, and several people using the service and two visiting relatives were spoken to throughout the day of inspection. The Team Leader, Ms Suzanne Cash, was present throughout the inspection. The Expert by Experience – Ms Suzanne Webster was also present from 10:00 to 15:00 and took part in the inspection process – tour of the premises and talking to a number of people who use the service and staff on duty. On this occasion all the key Standards of the National Minimum Standards were inspected. Regulation 37 Notifications, concerns and complaints against the home, and Regulation 26 reports received from the care home and an Annual Quality Assurance Assessment (AQAA) had been completed by the Registered Manager and submitted to the Commission for Social Care Inspection (CSCI) prior to this inspection, offering a full overview of the home. These were considered and discussed with the Team Leader. Seven completed surveys were received from four service users and three relatives prior to the day of inspection. We wish to thank the Team Leader, the staff, people using the service and their relatives for their assistance and co-operation on the day of inspection. DS0000035792.V371941.R01.S.doc Version 5.2 Page 7 What the service does well: The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. The home makes every effort to provide people with good care to meet their assessed needs following a care plan. The home has a good key worker system and staff supervision system in place. The home communicates well with the families, friends and representatives of people who use the service and welcomes visitors. People who use the service say they are happy and content with living in a homely and caring place. The seven completed surveys received from residents and their relatives stated that the Resource Centre provides good services and staff are very caring and helpful. The Expert by Experience – Suzanne Webster concluded in her report on the visit as Overall, it is my opinion that Warstones Resource Centre offers good quality of care to those who use the facilities. The Team Leader offers a positive attitude that clearly encourages staff to communicate well with the service users and to be open to suggestions on how to improve care. These components are essential to a good care facility. People who use the service are often vulnerable both physically and emotionally and the Registered Provider and Registered Manager ensure that staff recruited have the ability to carry out personal care services for people sensitively and tactfully. The recruitment of good caring staff is critical to the running of care homes and the Registered Provider and Registered Manager at Warstones Resource Centre undertake this carefully. The Centre has a good staff training and development programme in place. A majority of staff have received mandatory training in safe working practice topics, safe handling of medication, adult protection and safeguarding issues and NVQ Level 2. Thus this training will ensure that the staff have improved their knowledge and skills to meet the changing needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service. The Centres AQAA states Warstones Resource Centre provides a high DS0000035792.V371941.R01.S.doc Version 5.2 Page 8 standard of person centred care. We seek feedback from our service users to assist us to improve our services to meet individual needs and enable people to retain their independence with the focus of returning home whenever possible. We provide a comfortable, well staffed and well equipped environment to assist in that process. What has improved since the last inspection? What they could do better: DS0000035792.V371941.R01.S.doc Version 5.2 Page 9 The home should continue to improve further the detail and quality of daily care recordings. Activities enjoyed by the people who use the service should be consistently recorded, evaluated and incorporated into their individual care plans. People who use the service should have the choice and provision of some social and leisure activities in the evenings including weekends. The Authoritys recruitment processes need to ensure that the requirements within the Regulations are adhered to and also to ensure a consistent, robust approach is adopted across all care services – including at Warstones Resource Centre. Those members of staff who as yet have not received training in safe working practice topics, including Infection Control/COSHH, safe handling of medication, Dementia care, NVQ Level 2, Adult Protection and safeguarding issues must do so as a matter of priority. This training would enable staff to improve further their knowledge, skills and care practices. The Centres self assessment AQAA states As a result of feedback from service users we will look at our admissions procedures to ensure carers wishes and comments are an integral part of our care plans. We will continue to ensure our staff have appropriate training and our building is updated to provide improved bathing facilities for our service users. 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. DS0000035792.V371941.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000035792.V371941.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Everyone receives a full assessment prior to admission to the Centre to make sure that their needs can be met. People assessed and referred solely for intermediate care are helped to maximise their independence and return home. EVIDENCE: The service has a Statement of Purpose and a Service User Guide in place. These documents were not examined on this occasion, however it was stated that the documents have been revised and updated to ensure the documents now meet the amended Care Home Regulations 2001. The Registered Managers Annual Quality Self Assessment (AQAA) states: DS0000035792.V371941.R01.S.doc Version 5.2 Page 12 Service users have a full multi-disciplinary assessment prior to admission to our services. This includes a specialist assessment from Therapists for admission to our Rehabilitation Unit and Specialist Assessments, where appropriate for admission to our Respite care services for people with Dementia. Our referral ensures we gain sufficent information to enable us to meet the needs of someone admitted to our services. Where appropriate we also ensure we are responsive and supportive to the family and carers of our service users. Service users and their families are given the opportunity to visit Warstones prior to admission. We also provide information to other professionals such as Physiotherapists, Occupational Therapists, District Nursing Service and Social Work Teams, who may refer people for admission to our services in emergency situations, which does not allow time for a visit prior to admission. The Team Leader stated that the Co-ordinator of Care continues to ensure, through discussions with Social Work Teams, families and carers and other professionals, our referral process both informs and ensures choice of the right service to meet prospective service users needs. The assessment process was discussed with the Team Leader who demonstrated an explicit knowledge of the assessment, admission and care planning process. Comprehensive needs assessments were available on all four care plans/files examined. The Centre provides a Rehabilitation unit accommodating a maximum of twelve individuals for up to six weeks. A therapy assessment is undertaken to establish their capabilities and individuals are supported to regain as much of their independence prior to their discharge. The care records of four individuals currently using this service were examined and contained detailed assessments in addition to a home visit therapy report. The reports detailed the recommendations to support the person’s transition from the unit to their own home. Discussions held with a service user evidenced that she has found staff on the unit to be very supportive and enabled her to re-gain her mobility. She indicated that she was happy with all aspects of care provided. Visiting relatives of another service user indicated that they were happy with the service provided. DS0000035792.V371941.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have individual plans of care which ensure that their personal, healthcare and social needs can be met. Medication is administered and stored in a manner that safeguards everyone using the service. People who use the service are treated with respect and their right to privacy is understood and upheld. EVIDENCE: The care documentation held on behalf of one person from each unit was examined and provided sufficient information for the delivery of care. Care plans are generated by needs assessments and are shared with the staff team prior to admission and reviewed at the required frequency. All of the care plans examined contained a photograph of the service user and there was evidence that the individuals and their relatives had been involved in developing the plan of care. Staff spoken with considered that they are provided with sufficient information to support the people in their care and had DS0000035792.V371941.R01.S.doc Version 5.2 Page 14 a clear understanding of individual needs. During the inspection, staff were seen to seek guidance and advice from the Assistant Team Leaders when required. One service user stated, “I would recommend this place the staff have looked after me well, the food is very good and the place is clean and tidy”. Service users health care needs were clearly identified on the care records examined. Staff completes a daily journal on each service user with regard to their health and personal care. Multi-disciplinary meetings are held weekly to discuss the needs of individuals receiving a service on the rehabilitation unit to discuss their progress and any action required. Manual handling risk assessments and bathing assessments were available on files examined. None of the people case tracked required treatment for pressure sores. The Team Leader fully acknowledged the need to fully implement Dementia Care Mapping to ensure the quality of service delivery within the unit accommodating people with dementia. All service users appeared well presented and staff were observed to promote dignity and respect throughout the inspection in relation to personal care and appearance. There was a relaxed friendly atmosphere and service users spoken with considered that they are treated well by the staff. The Expert by Experience – Ms Suzanne Webster stated in her visit report that: I was able to talk to 2 men and 1 woman receiving respite care and 4 women and a man in the rehabilitation unit. All responses I received were very positive; all clients felt that their experience at Warstones had been a comfortable and beneficial time. In the rehab unit, I found a very sociable atmosphere. The clients discussed openly how their time on the unit was spent. They spoke very positively about the Physiotherapy and Occupational therapy input. One woman commented that the Physiotherapy input had given her the confidence to return home and to feel safe; she said this type of support had not been offered to her in hospital. All clients felt that the care they received from staff was good; they stated that staff was kind and attentive to their needs. One woman made a very poignant statement, she said ‘I am not the type of person to ask for help but that is not a problem here because staff offer help.’ All clients agreed that staff were available and approachable at all times. The Centre operates a good key worker system, which helps to ensure that the recommendations arising from the care plan reviews are implemented. 4 Care Plans of people using the service were inspected and examined in detail. There was some evidence to show that the goals, aims and objectives were identified and appropriate interventions required to meet the individual needs of people who use the service were also identified. The Team Leader and the Service Manager - Older People Provision and Transformation - stated that the DS0000035792.V371941.R01.S.doc Version 5.2 Page 15 Adults Services are to shortly to review the care plans recording and reporting format. The daily care recordings were also examined and it was acknowledged that the quality and detail of care recording needs further improvement. The Team Leader stated that the care staff will be supported, supervised and appropriately trained to make further improvements. The above points are also acknowledged in the Registered Managers AQAA, which states Although we have a comprehensive Plan of Care for each service user, we need to work more closely with carers to ensure their views are recorded and addressed. We have recognised a need for our staff to improve their record keeping. In order to improve we need to review our service user documentation and then provide some training for staff. The Centres plan for improvement in the next 12 months as indicated in the AQAA is to review Service User documentation and train staff to improve reporting and recording. Discussion with people who use the service showed that the Centre has a good ethos of involving them in all aspects of their life. The care plans that were read were clearly written and included an element of risk assessment. Information from the initial assessments had been written into plans of care. The care plans are reviewed on a monthly basis by senior staff. Care Plans demonstrated that the staff actively promoted the rights of people who use the service of access to the health services both within the home and the community. Appointments are planned or arrangements are made for professionals to visit frail people using the service. Whenever possible continuity of care for the service users’ declining state of health is assured. District Nurses are called upon to assist with clinical help, equipment and advice where necessary. The Registered Manager promotes the key worker system so that relationships between staff and individuals are enhanced. Visitors are able to meet people using the service in their bedrooms, in the lounges or in the visitors’ room on the ground floor. It was observed that people who use the service were being treated with respect and staff were working both professionally and sensitively in meeting individual needs. We spoke at length with several people using the service and all of them commented positively about their care and felt they have everything that they need. Four people who use the service stated that “The carers are very good and kind and they look after us very well”. Two other people who use the service said “The carers are always there to help us”. Generally people who use the service appeared to be content and comfortable. They were complimentary regarding the quality of their lives and care they were receiving at Warstones Resource Centre. DS0000035792.V371941.R01.S.doc Version 5.2 Page 16 There are appropriate policies and procedures in place for the administration of medication. It was noted that the care plans contained a list of current medication. The Team Leader stated that reviews are carried out on a regular basis of all the care plans to ensure that medication details are up to date. Appropriate records are kept of all medicines received, administered and leaving the home. Random sample of medication and administration sheets were seen at the inspection and there were no discrepancies. All the medicines are stored in the managers office and kept under lock and key. Daily checks are taken of the temperature of the medicines in the refrigerator and the managers office. There are no controlled drugs used by any service user at the Centre. However, there is a facility to store securely and safely in a lockable metal cupboard in the managers office. Medication rounds were observed during the inspection. Staff were seen to administer and record when medicines had been given. The Team Leader stated that all staff responsible for administering medication were appropriately trained in safe handling of medication. The Centres AQAA received prior to our visit states that We have made the following improvements since the last key inspection -: • With guidance and assistance from the local Pharmacist and our Standards Development Officer we have made considerable improvement in the reciept, storage, administration and disposal of Medicatuion, to comply with CSCI Pharmacy Inspectors requirements and our Safe Administration of Medication Policy and Procedures. • Staff have been trained and assessed as competent to administer medication. Five staff remain to complete training and our night Staff need to have an assessment of their competency to administer medication. Staff competency is reviewed regularly. • We have implemented new documentation for assessment of the need for Bed Safety Measures, Self Administration of Medication and Covert Administration of Medication, seeking advice, where appropriate, from other professionals and the Standards Development Officer to ensure we maintain and protect the rights and dignity of service users who lack the capacity to make their own decisions. • We have undergone an Infection Control Audit, carried out by Wolverhamptons Infection Control Team. As a result provision of additional Infection Control equipemnt and advice has been received and implemented to maintain even higher standards of Infection Control. We have taken part in additional health and well-being initiatives in partnership with the local Health Authority, including control of MRSA and received training by the Infection control Team in handwashing techniques and other good infection control practice. DS0000035792.V371941.R01.S.doc Version 5.2 Page 17 One service user suggested through a survey received by us The Centre can improve by the staff having less distractions whilst giving out medication in the dining rooms DS0000035792.V371941.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to exercise choice with regard to social and leisure activities at the home. Activities provided meet the needs of the people using the service. Relatives and friends are encouraged and assisted to maintain contact with the people using the service. The food at the home is of good quality and choices are always available. EVIDENCE: The Centres AQAA states Service users in our residential units have individual plans of care to meet their own personal needs. This includes their preference for getting up in the morning and going to bed at night. Meal times are flexible, although most people on a unit tend to eat together, especially at lunch time. Warstones has lounges and dining areas on all units. The lounges have television, radio and DVD players. Service users are encouraged to sit together and engage in social activity throughout the day. DS0000035792.V371941.R01.S.doc Version 5.2 Page 19 Warstones has a large Day Care Centre which service users are welcome to use during their stay. The Day Centre has regular Bingo sessions, art classes and an Internet Café where service users can learn to access and use the Internet. A hairdresser is available on Wednesdays and Thursdays. . Some of the Day Centre staff are trained to deliver gentle exercise classes. Board games and cards are available and staff are trained in the production of ceramic pieces for decoration. Some of the staff on our Meadowfields - Dementia unit are trained in Sonas a specialist activity which includes music, touch and taste activities for people with dementia. This is complemented by Life History work for individual service users. Warstones has a Service Users Committee which meets once a month to discuss any issues regarding services and make suggestions about any changes service users may wish to have with regard to the building and delivered services. A local church provides a simple service in the Day Centre once a month for all who wish to attend. Warstones has a large Rehabilitation Garden with raised flower beds and a patio outside of the Day Centre. There are seats and benches and other garden furniture throughout the gardens. The Warstones provides an activities programme in accordance with everyone using the service, their choices, preferences and capacities in relation to – social, leisure and cultural interests. People using the service, who were able to give opinion, were very complimentary about the activities provided, and particularly the Bingo sessions. People who use the service are enabled to enjoy a full and stimulating life style with a variety of options to choose from. A record of activities participated in is kept and photographs of major events displayed in the Centre. However, the activities enjoyed by the people who use the service need to be evaluated, consistently recorded and incorporated into their individual care plans. The Expert by Experience states in her visit report thatMost of the social activities offered to clients staying at Warstones are dependent on what is timetabled for the Day Centre. Clients are informed of all activities and supported to attend if they wish. Activities offered weekly include, painting, computer work, whist, yoga, bingo and Tai Chi. Although these activities are offered, only one client I spoke to chose to go to the Day Centre during her stay. Clients from the Meadowfields unit attended the bingo session today accompanied by a member of staff. I wondered if some activities could be made available to the units in the evening as well as in the Day Centre. DS0000035792.V371941.R01.S.doc Version 5.2 Page 20 When asked about trips out of the unit, all clients stated that this was possible if arranged with the staff. Activities outside of the unit are offered regularly but more often declined. During my visit it was very apparent that the Rehab unit for clients with physical frailties and the Respite unit were occupied by clients enjoying their stay and using their time to rest and enjoy each others company. The communication between staff and clients on these units proved to be excellent with clients being fully aware of activities available, what their choices were and how to access staff support. The Respite unit for clients who have Dementia appears to be providing good care. I suggested to the Team Leader that the use of pictures may prove helpful as well as words to indicate the toilet and bathroom areas, she acted on this suggestion immediately and pictures were placed appropriately on the unit. The Team Leader was very accepting of suggestions to improve the clients experience while on the unit. The staff use reminiscence work and are planning to have more visual activities around the unit to encourage communication and a more homely environment. We observed people using the service were seen sitting in the lounges chatting to staff and visiting relatives and in other communal areas within the Centre. Two people who use the service stated that they preferred to sometimes sit quietly in their bedrooms and the staff respected this. After lunch time a number of people who use the service were watching television. The people using the service spoken to stated that they were in regular contact with their family members and friends, and spoke about their visitors’ involvement and interest in their care matters. The visitors’ book kept in the Centre showed a considerable activity. People who use the service also keep contacts with the local community – for example, local church services, pubs and shops. Five people who use the service told us that they are happy with the care and social activities offered by the Centre. They further added “the Centre provides a good service and the staff are very caring and they are pleasant”. The Centre also provides some indoor activities, including festive and birthday parties. The staff told us that service users relatives do take them out to local shops. Other outings also can be arranged if service users wished to go out shopping or to local pubs. The Team Leader stated that the people who use the service were positively encouraged and helped to exercise their choices, and control over their lives and daily living, subject to risk assessments in terms of safety, security and capacity to make certain decisions. The Team Leader also stated that a close liaison is maintained with the relatives and representatives, where the people using the service are not able to make certain decisions. The relatives of people using the service and their representatives are informed of the availability of Advocacy Service based at the local Age Concern. The Age Concern also has an office at Warstones Resource Centre. DS0000035792.V371941.R01.S.doc Version 5.2 Page 21 Several people who use the service told us “The Centre is very good and its peace and quiet here”. “The food is very nice well cooked and tasty”. The consensus of people using the service was the range, quality and choice of food provided was very good and the home catered for those people using the service, who have individual preferences and medical needs. The Team Leader stated that the menu is changed regularly in consultation with the people who use the service. This is usually done in accordance with seasonal changes as well. Menus seen displayed in the main kitchen appeared balanced and provided choice. Service users spoken with were very complimentary about the meals provided which was also confirmed in the surveys undertaken as part of the Centres quality assurance. Meals are prepared and cooked in the main kitchen and delivered to each of the units in hot trolleys. Tables were seen nicely laid and people requiring assistance were appropriately supported. The kitchen is well equipped and kept clean and tidy. The catering staff are trained in food safety and hygiene matters. DS0000035792.V371941.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is clear Complaints Procedure in place, a copy of which is made available to people who use the service and their relatives. This should ensure that any complaints made are listened to and acted upon. The home has an Adult Protection policy and procedure in place to protect people who use the service from all forms of abuse. EVIDENCE: The Centre has a good Complaints Procedure in place, which is referred to in the Centre’s Service Users’ Guide and in the Statement of purpose. There is a system of recording concerns and complaints. The AQAA completed by the Registered Manager states “Warstones Resource Centre has a comprehensive compliments and complaints procedure which complies with Wolverhampton City Councils Policy and Procedure. When dealing with a complaint timescales are adhered to and outcomes of any investigations are dealt with appropriately. Service users and their families are made aware of the Compliments and Complaints Procedures through information leaflets and the Service Users Guide. DS0000035792.V371941.R01.S.doc Version 5.2 Page 23 Service users are also made aware of the address and contact number of the Commission for Social Care Inspection. Adult protection is an integral part of the ethos and practice of managers and staff at Warstones. We recognise the importance of respect, support and protection of a service users right to make decisions about their own well being and life style. Where individual members of staff or the service fails to maintain this standard we recognise that failure and ensure we learn and improve our practice from any comment or complaint. Where adult protection issues arise we take advice from the Standards Development Officer and Adult Protection Unit to resolve identified issues. Warstones works within Wolverhampton City Councils framework of Adult Protection and Safeguarding Vulnerable Adults from risk of neglect or harm. The Commission for Social Care Inspection (CSCI) has not received any complaints about the Centre. However, the Centre has received four complaints, which were dealt with promptly by the Centre. There was one adult protection/safeguarding referral made during the last 12 months, which was dealt with in accordance with Wolverhamptons multi-agency adults safeguarding procedure. The people, who use the service, when asked, were certain of how to formally make a complaint but they said they would quite happily talk to one of the staff or the Manager. The Centre also has good policies and procedures in place regarding restraint, dealing with aggressive behaviour and prevention of abuse, which includes whistle-blowing policy. The Team Leader stated that adult protection and safeguarding issues are discussed during induction training and supervision meetings. The Team Leader also stated that a majority of staff have received formal training in protection of vulnerable adults and those who as yet have not received this mode of training will do so as a matter of priority. The Centres AQAA states the improvements made in the last 12 months are as below:• Fifteen of our Rehabilitation Assistants have received training in Recognising and Reporting Vulnerable Adults. The Manager has received training in Deprivation of Liberty. • Through our Complaints Procedure, Regulation 26 reports and Service Review we have recognised issues regarding delivery of service to our users and sought to improve and implement change as a result. • We have implemented new documents and procedures for the assessment of the need for Bed Safety Measures as part of the Care Services Policy and Procedure Manual. DS0000035792.V371941.R01.S.doc Version 5.2 Page 24 The Centres plans for improvements in the next 12 months included in the AQAA are:– • A further six Rehabilitation Assistants will receive training in Recognising and Reporting Vulnerable Adults in the next six months and staff will be identified in the Training Plan from March 2009/10 to continue the process of updating staff in Recognising and Reporting. • Two managers will receive training in Deprivation of Liberty • An interactive DVD training package will be made available to all staff to view My Decision Today Your Decision Tomorrow which supports the Implementation of the Mental Capacity Act 2005. Several people who use the service told us that they are satisfied with the service provision, feel safe and well supported by staff that have their protection and safety as a priority. DS0000035792.V371941.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good providing a homely, clean and secure place to live. EVIDENCE: Warstones has a safe, well maintained and clean environment. It is surrounded by gardens. The Rehabilitation Garden is enclosed and has raised beds and seating areas for service users to use. Facilities at Warstones includes - a large Day Care Centre, lounges and dining areas and sufficient bathing and toilet facilities on each unit, including toilets for disabled service users and high low baths with chair hoists. Specialist equipment such as moving and handling aids, and hoists to assist with DS0000035792.V371941.R01.S.doc Version 5.2 Page 26 transfers and bathing are used, where appropriate, and indicated through the Moving and Handling Plan of Care assessment. The entrance to Warstones has a security code and the reception area is staffed between the hours of 9.00 am to 5.00 pm. Entry to the building outside of these times is gained by use of an intercom to the Duty Office. Visitors to Warstones are required to sign the Visitors Book for Fire Safety reasons. Warstones has an Aid Call system in all units and bedrooms to enbale both service users and staff to summon assistance, particularly in an emergency situation. Fire Safety checks are carried out each week and regular checks are made on emergency lighting systems and Fire Safety equipment. Warstones building and surrounding environment is maintained by means of an Asset Management Plan. Warstones has regular checks made with regard to Legionella and has had an Asbestos Survey carried out, which is consulted prior to any major work being undertaken on the fabric of the building. The Centre have policies and procedures in place with regard to infection control, COSHH and food Safety. The home has a rolling programme of redecoration to maintain good standards. During the tour of the premises, it was noted that the bedrooms are “personalised” by most of the people using the service. All the requirements from the last Fire Safety Officers Inspection Report dated 9th April 2007 have been implemented, including an additional fire door in the longer corridors of the Respite and Rehabilitation Units and the fitting of door closures to all bedroom doors. Staff are being trained in the Centres revised evacuation procedures and personal evacuation plans are also being developed for individual service users. Staff are undertaking Fire Safety training through a video and workbook. Eight members of staff and all managers have undertaken a formal Fire Safety training, including Fire Marshal training. The Rehabilitation Dining Room has been redecorated and new flooring has been laid. Parts of the corridors along the units and Meadowfields unit have been repainted. The bedroom doors in Meadowfields have been painted in a variety of bright colours, and the corridor walls have been painted with a neutral colour and facilities rooms - such as the kitchen and sluice have been painted in a muted colour. The colour scheme has been designed to assist service users with Dementia to visually better identify their own room and other areas of the unit. On advice from the Therapists, the Centre has purchased variable height chairs for the units and profiling beds for the Respite Unit to assist service users to maintain their independence and improve their well-being. DS0000035792.V371941.R01.S.doc Version 5.2 Page 27 As part of the improvements from the recent Infection Control Audit the Centre has purchased additional equipment, including soap and paper towel dispensers for each room, alcogel and holders for each room where additional Infection Control procedures may be required for individual service users, and a colour coded system of aprons, mops and buckets that comply with National Health Standards of Infection Control. New signage has been provided to inform all staff and other health professionals of the colour requirements of care and cleaning equipment. All rooms have new commodes that are compliant with current Infection Control policies and replace the previous chair commodes which are not considered suitable for good infection control. The Centre has purchased a new washing machine for the laundry. The gardens have been tidied and the border to the front of the building relandscaped. The Centres AQAA states the improvement plan for the next 12 months, which will include:• The refurbishment work on two of the bathrooms. • The bathroom in the Respite Care unit is being updated and altered to a shower room. • The Rehabilitation bathroom will also have a walk-in shower. • The Rehabilitation Unit Dining Room will be refitted with a new kitchen area. • The Centre is to purchase additional cupboards for the sluices. • Wolverhampton City Council, in partnership with the local PCT is evaluating a new system of cleaning service user rooms, in order to further improve our infection control standards. It is hoped these units will be purchased and available for use in next year. During the day of our visit, the Centre was found to be clean, tidy and free from any unpleasant odour. It was also noted that the bathrooms on the first floor were being refurbished. The home has good policies and procedures in place regarding infection control/COSHH. However, it was noted from the staff training records that a majority of staff have undertaken training in infection control and those members of staff who as yet have not received this mode of training will do so shortly and as a matter of priority. It was noted that all new members of staff received induction training and they are made aware of the dangers of cross-infection. DS0000035792.V371941.R01.S.doc Version 5.2 Page 28 DS0000035792.V371941.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Warstones Resource Centre is staffed by well-trained and experienced group of staff to meet the needs of people who use the service. There are adequate recruitment procedures in place to protect people who use the service. There is a good training programme in place that ensures staff are competent to do their jobs. New members of receive structured induction training. EVIDENCE: Warstones is staffed with adequate numbers and skill mix of staff, although the Centre currently have four Rehabilitation staff vacancies and a vacancy for an Assistant Team Leader. Staff rosters are prepared six weeks in advance to allow managers to cover for planned absence and vacancy. The staff group includes mature, experienced and young staff. Throughout the inspection, staff were seen to interact positively with people who use the service. Staff considered that they are provided with adequate information to support the needs of the people using the service. Service users and visiting relatives spoken with were very complimentary about the staff. It was reported that more than 50 of care staff now hold NVQ Level 2 qualifications. DS0000035792.V371941.R01.S.doc Version 5.2 Page 30 The team consists of a Registered Manager, a Team Leader, a Care Co-ordinator, four Assistant Team Leaders, forty-three Rehabilitation Assistants, several domestics and four kitchen staff. It was reported that the current staffing ratio is a minimum of seven staff across three units, which was an accurate reflection of the staff rota seen during the inspection. The service has vacancies for four Rehabilitation Assistants and one Assistant Team Leader. It was also reported that the Centre has not recruited any new staff since the last inspection due to budget implications, therefore permanent staff have been covering vacant hours. However, the Team Leader stated that we have now obtained permission from the senior management to advertise externally to recruit four Rehabilitation Assistants vacancies. All staff have an individual Learning and Development plan to ensure their training needs are met and their skills are updated. Warstones meets the requirement of staff trainning in NVQ level 2 in Care. A majority of staff have now been trained and their competencies assesseed for the Safe Administration of Medication. All staff are trained using a variety of training such as on site approved video and workbook, local colleges and by the Adult Services own in-house Training Section All members of staff have received a Staff Handbook and the General Social Care Councils Codes of conduct and practice for social care workers and employers. Staff receive regular supervision and have a yearly Employee Performance Review. Any issues regarding staff behaviour or performance are dealt with in accordance with Wolverhampton City Councils Disciplinary, Grievance and Capability Policy and Procedures. The Centres staff training matrix indicates progress since our last inspection of 25th September 2007. The Team Leader stated that the staff have been trained in the following topics-: • Safe handling of medication, • reporting and recording, • safeguarding vulnerable adults, • Health and Safety (CIEH), • NVQ Level 2 in care, • Moving and Handling, • Hoisting, • Infection Control, • Fire Safety and • Food Hygiene. The Centre have created the Training Matrix to control and monitor staff training, in conjunction with its yearly Training Plan. DS0000035792.V371941.R01.S.doc Version 5.2 Page 31 The Team Leader stated that no new staff have been recruited since July 2007, therefore personnel records were not examined on this occasion. A review of staff personnel files was undertaken by two Regulation Inspectors at the Civic Centre (Human Resources Section) on 9th July 2007 and again on 21st May 2008 and a selection of files held for staff employed in care homes and domiciliary care services were examined. A number of shortfalls were identified in the recruitment procedures, as well of the documentation required was not readily available. Managers acknowledged our findings and demonstrated a commitment to improving the Councils recruitment processes further to ensure that the requirements within Regulations are adhered to and ensure a consistent, robust approach is adopted across all services. There is a staff training and development programme in place. In addition to the mandatory training (see NMS OP38) staff also would benefit from training in adult protection/safeguarding issues, Mental Capacity Act 2005, equality and diversity, and physical aggression/challenging behaviours. Staff confirmed that training is provided and there are many opportunities to improve themselves for the benefit of the care of people using the service. All newly redeployed/transferred staff received their induction training in accordance with the Skills for Care standards and specifications. A survey returned to us by a service users relatives states that The staff at Warstones Respite unit – Meadowfields are outstanding – very caring and helpful – always looking out for my mothers best interests. People who use the service commented that they feel safe with staff caring for them and they felt that the home employs people that are capable of carrying out their care duties. DS0000035792.V371941.R01.S.doc Version 5.2 Page 32 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home is run in their interests. Financial interests of people using the service are safeguarded. The home promotes the health, safety and welfare of people who use the service. EVIDENCE: The Registered Manager – Diane Vulmirovic is qualified in both practice and management of care and has over 20 years experience in care provision. She holds the Registered Managers Award, NVQ Level 4 in Care, a BTEC Diploma in the Management of Care Services. She holds overall responsibility for the care services provided through Warstones Resource Centre. DS0000035792.V371941.R01.S.doc Version 5.2 Page 33 The Centres AQAA states Warstones has clear levels of responsibilities at all levels of management andaare well defined and reinforced by good leadership skills, regular formal supervision, informal meetings, Team Meetings and Employee Performance Reviews. Warstones produces a Service Plan yearly, which seeks to achieve a level of development for the services it delivers, which complies and agrees with the Service Plan for Older People and Adult Care Service in Wolverhampton. Service users financial interests and welfare are safeguarded. Service users valuables and money are safeguarded. Each bedroom has lockable facilities for this purpose. Warstones has a robust safekeeping system for those service users unable to manage their own finances or valuables. Financial records and administrative procedures relating to the handling of monies of three people who use the service were inspected and were found to be well ordered and maintained. All the money belonging to to people who use the service is kept in a safe and under lock and key. All records relating to staff and service users are completed and maintained appropriately, in accordance with Wolverhampton Councils Policies and Procedures. Warstones has, along with other Resource Centres for Older People undergone a restructure of their management team, to one Team Leader and four Assistant Team Leaders. The restructure has led to a re-evaluation of management responsibilities and has improved day to day contact of managers with staff and service users. The Care Co-ordinator role has been reduced to two posts to cover the four Resource Centres for Older People. Along with the introduction of a new City Direct system, there has been a period of review and bedding in new systems. Managers have been trained to use the new Care First system. The Centre has developed a ten week shadowing opportunity for Rehabilitaion Assistants to gain insight and knowledge in the management role of Assistant Team Leaders as part of their personal development programme. Four staff have had the opportunity to take part in this scheme so far. Two members of staff have completed a positive action programme. A new parttime Team Leader has been recruited. The newly appointed Team leader is currently undertaking a 13 weeks induction programme. The Centre is to recruit to a vacant Assistant Team Leader post. All staff are currently having their CRB checks renewed. Observations made and discussions with people who use the service and their relatives and staff have indicated that the Registered Manager is very approachable and she operates an ‘open door’ policy. People who use the service, who could express themselves stated that they are happy to approach DS0000035792.V371941.R01.S.doc Version 5.2 Page 34 the manager and staff with any problems they might have and were confident that they would respond to them appropriately. Equality and diversity for people who use the service was seen to be promoted throughout the home within the assessments, care plans, menus and activities. Equality for staff is promoted through the opportunities for training at all levels. It was noted that the home has a Quality Assurance monitoring system in place. Quality Assurance takes place throughout the service in both a formal and informal manner. Meetings and day-to-day contacts all provide records to show that satisfaction is at the heart of the service for people who use the service. Surveys were carried out for the year 2008. A report on the result of the feedback from people who use the service and their relatives will be prepared by the end of October 2008. The comments received were generally very positive. In addition, stakeholders’ survey was also carried out and the feedback was also positive. Notes of recent meetings of the Service Users Committee at Warstones were provided, which included details on the social and leisure activities and improvements to facilities provided at the Resource Centre. Visits as required by Regulation 26 are undertaken and a report on the visit conducted on 12th May 2008 was seen. However, the reports for the recent visits were not readily available. The self - assessment (AQAA) forwarded to CSCI prior this inspection was detailed and reflects both the strengths and areas of improvements for the service. The Centre keeps records to show that health and safety of people who use the service is promoted and protected. The Centre has good health and safety policy and procedures, and staff were aware of their responsibilities regarding these issues and a number of staff have received training in these issues. All safety systems and equipment are regularly checked and well maintained and records of all tests/checks are kept up to date. The staff training records showed that a majority of staff have received their mandatory training in safe working practice topics, e.g. moving and handling, food hygiene, first aid, health and safety and fire safety. The Team Leader stated that all those members of staff who as yet have not received this mode of training will do so shortly. They will also receive training in Adult Protection/safeguarding issues, safe handling of medication, Infection Control, NVQ Level 2, Mental Capacity Act 2005 and Dementia care. People who use the service spoken with were very complimentary about the Registered Manager and staff in the home. Many of them knew who they were by name and looked at ease in their presence. DS0000035792.V371941.R01.S.doc Version 5.2 Page 35 DS0000035792.V371941.R01.S.doc Version 5.2 Page 36 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 DS0000035792.V371941.R01.S.doc Version 5.2 Page 37 Are there any outstanding requirements from the last inspection? NO 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. 1. Refer to Standard OP18 Good Practice Recommendations Staff should be provided with training in safeguarding adults to ensure they are familiar with the process of recognising potential abuse and the formal referral process. It is recommended that the social and leisure activities enjoyed by people using the service should be consistently recorded, evaluated and incorporated into their individual care plans. The people using the service should be consulted about what they would like the Centre to provide in terms of a range of social and leisure activities in the evenings in the respective units. It is recommended that the detail and quality of daily care recording should be further improved in order to ensure that staff are aware of the importance of recording all the DS0000035792.V371941.R01.S.doc Version 5.2 Page 38 2 OP12 3. OP7 information regarding the well being of people using the service, and all entries made by staff are always cross – referenced to care plans. 4 OP30 The Registered Manager should ensure that all those members of staff, who as yet have not received training in adult protection from all forms of abuse or harm, Dementia care, equality and diversity, and Mental Capacity Act 2005, should do so in order to safeguard, and fully meet the needs of people using the service. The Registered Manager must ensure that all those members of staff who as yet have not received mandatory training in safe working practice topics, including Infection Control/COSHH and Fire Safety do so as a matter of priority in order to ensure the safety and protection of people using the service. The Fire Drills for staff should be held on a regular basis in accordance with the Fire Authoritys recommendations in order to ensure safety and well being of all people using the service. The Registered Manager should take appropriate action to ensure that the essential programme of maintenance, redecoration and refurbishment of bathrooms and other communal areas are completed. This is to ensure that people live in a comfortable and safe home. 5. OP38 6. OP19 DS0000035792.V371941.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000035792.V371941.R01.S.doc Version 5.2 Page 40 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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