Care Home: WCS - Newlands

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Aston Court Nursing Home
• Polesworth Group 70 Long Street
• Breme
• Ravenhurst
• Polesworth Group 64 Long Street

What the care home does well Some resident`s bedrooms are decorated in the way they want it to be and they have things in their bedroom that they like and are important to them. People are encouraged to visit the home on several occasions before they move in. This practice helps people to see if they will like the home and would get on well with other people living there. The staff are friendly and helpful and get on well with the people at the home and support is given for people to keep in close contact with their relatives andfriends. Speaking in a questionnaire, a resident says, "They (Staff) always listen to what we have to say or request." Resident`s files contain a biography of the person`s life history, their enduring interests and relationships. Files provide information on peoples life histories in pictorial format. This helps to make the life histories live and interesting to read. Information collected in this way about residents should help staff to deliver person centred care. Staff have a sensitive, kind and caring attitude towards the people living in the home. Residents were spoken to respectfully by staff and addressed by their preferred names. People living in the home looked at ease when talking with staff and were able to have general conversations as well as talk about their care. All personal care tasks were carried out in the privacy of people`s own bedrooms, showing a proper regard for their dignity. Help is given for people to attend appointments with consultants and for routine checks, such as eye tests and dental check ups, to help them to stay in good health. Suitable procedures are in place to enable people to complain. There have been no complaints about the home since the last inspection. Staff are trained to recognise and report any suspicions of abuse to keep people safe from harm. What has improved since the last inspection? Care plans are in place for people at the home, providing some very good information to help staff to meet people`s needs and to fit in with their routines and choices about the way they want their care to be provided. Overall the home is comfortable and homely. Two new shower rooms have been installed and are equipped to help people at the home to have a shower safely. Staff have received training, which is ongoing, in the use of equipment specially designed for the use of individual residents to ensure their comfort, safety and care needs are met. People living in the home are provided with a varied range of meals, which takes into account their choices and promotes healthy eating and their well being. What the care home could do better: The number and skill mix of staff working in the home needs to be continuously reviewed to ensure that sufficient number of staff working in the home on all shifts. This will ensure that people who live in the home are in safe hands and will have all their health, personal and social care needs met. Residents and relatives say that the home could improve by having more staff, "especially at night". Staff working in the home also say that there could be `more staff so that service users can go out more`. "There are some service users who seem to be lonely and bored and we do not always have enough staff to accommodate this on a daily basis." Current practices in the home do not make it clear as to the lines of accountability and responsibility in the home between nurses and care staff. This could make it difficult for residents to understand the responsibilities of the members of staff working in the home. Staff must understand their roles and level of responsibility and accountability. The cleaning trolley`s containing cleaning products must not be left unattended in the corridor. The trolleys must be locked away when not in use to protect people who use the home from the risk of harm. CARE HOME ADULTS 18-65 WCS - Newlands Whites Row Kenilworth Warwickshire CV8 1HW Lead Inspector Yvette Delaney Unannounced Inspection 1st August 2008 10:00 WCS - Newlands DS0000004267.V369438.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 WCS - Newlands DS0000004267.V369438.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. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Newlands Address Whites Row Kenilworth Warwickshire CV8 1HW 01926 859600 01926 864240 admin@wcsnewlands.f9.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) Warwickshire Home Care Services Limited Manager post vacant Care Home 26 Category(ies) of Learning disability (4), Physical disability (18), registration, with number Physical disability over 65 years of age (4) of places WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Admissions No further service users with both a physical disability and/or learning disability must be admitted. The registration category of physical disability and learning disability (4) relates to the four named service users only. 24th June 2007 Date of last inspection Brief Description of the Service: WCS-Newlands is a single storey care home in Kenilworth. Newlands was first built in 1976 for people with a disability. To accommodate the changing needs of people with varying disabilities, the home has been partially redesigned and refurbished over the past few years. The home provides both personal and nursing care. The emphasis is not on nursing care but on providing personal care, the focus being to encourage the independence of people choosing to live in the home. Carers are known as enablers, the very nature of the word means that they support people to meet their full potential with the aim of hopefully moving back into the community to live full lives. An adjacent two-storey building the home is used as the head office of the company. There is a large car park area at the front of the home. The premises are separated into three living units each having a corridor with bedrooms off, a kitchenette, and an adjacent dining and lounge area. There is also a large communal dining room, entrance hall with a waiting/meeting area, two enclosed courtyards/gardens and large grassed and planted areas surrounding the building. All areas are wheelchair accessible and there are automatic doors and ramps for access. The current placement fees for the home per week are £636 for standard care, £702 for medium care and £768 for high care. In addition to these fees £261 is also charged per week per person for hotel services. Hotel charges include accommodation, meals, laundry and housekeeping. Fees therefore range from £897 - £1029 per week. WCS - Newlands DS0000004267.V369438.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 that people who use the service experience good outcomes. This was a key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Questionnaires were completed and returned by eight people living in the home, a relative and three members of staff, giving their views of the service. An annual quality assurance assessment (AQAA) questionnaire was completed and returned by the manager in time for the inspection, providing helpful information about the home. The inspection included meeting most people living at the home and case tracking the needs of three people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with some of the people that live at the home in addition to care staff and the home manager. A number of records such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the service does well: Some resident’s bedrooms are decorated in the way they want it to be and they have things in their bedroom that they like and are important to them. People are encouraged to visit the home on several occasions before they move in. This practice helps people to see if they will like the home and would get on well with other people living there. The staff are friendly and helpful and get on well with the people at the home and support is given for people to keep in close contact with their relatives and WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 6 friends. Speaking in a questionnaire, a resident says, “They (Staff) always listen to what we have to say or request.” Resident’s files contain a biography of the persons life history, their enduring interests and relationships. Files provide information on peoples life histories in pictorial format. This helps to make the life histories live and interesting to read. Information collected in this way about residents should help staff to deliver person centred care. Staff have a sensitive, kind and caring attitude towards the people living in the home. Residents were spoken to respectfully by staff and addressed by their preferred names. People living in the home looked at ease when talking with staff and were able to have general conversations as well as talk about their care. All personal care tasks were carried out in the privacy of people’s own bedrooms, showing a proper regard for their dignity. Help is given for people to attend appointments with consultants and for routine checks, such as eye tests and dental check ups, to help them to stay in good health. Suitable procedures are in place to enable people to complain. There have been no complaints about the home since the last inspection. Staff are trained to recognise and report any suspicions of abuse to keep people safe from harm. What has improved since the last inspection? Care plans are in place for people at the home, providing some very good information to help staff to meet people’s needs and to fit in with their routines and choices about the way they want their care to be provided. Overall the home is comfortable and homely. Two new shower rooms have been installed and are equipped to help people at the home to have a shower safely. Staff have received training, which is ongoing, in the use of equipment specially designed for the use of individual residents to ensure their comfort, safety and care needs are met. People living in the home are provided with a varied range of meals, which takes into account their choices and promotes healthy eating and their well being. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 7 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. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 8 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 WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 and 5 Quality in this outcome area is good. Written information and contracts at the home ensure that the people living there are clear about their rights and entitlements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the service users guide and statement of purpose are available to people who live in the home and their families. Both documents have recently been updated to include relevant information. The information is sufficient to help people make a choice as to whether or not they want to live in the home. Using pictures makes it easier for the people living in the home to read and understand the documents. One resident commented in their questionnaire that “This home sounded the best out of all the options”. The manager advised in the AQAA that there are plans to develop the statement of purpose and service user guide with the help and participation of people who live in the home. Plans are to produce this information in a variety of different formats and languages. The manager told us that the staff from the home always carry out a thorough assessment of a persons needs before been offered a place in the home. People are encouraged to come to the home to look around. People are invited to stay for longer periods of time so they can see what goes on in the home WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 10 and be introduced to the people already living there. Whenever possible an overnight stay can be arranged. Care management information is received from the placing authority before the home makes any decisions about a placement. The file of a person recently admitted to the home was examined. The file includes information to show that the manager of the home had assessed their needs before moving into the home. Care record show that the person had been encouraged to visit the home on several occasions before they moved in. This practice helps people to see if they will like the home and would get on well with other people living there. This person was considered to have high needs. Records available show that social workers and other care managers from the local primary care trust (PCT) had been involved in the admission process. Follow-up visits had also been carried out to review the success of the placement. The contract is available in the care files examined. The contracts provide details of the terms and conditions for living in the home these include information of the fees payable for living in the home. A placement agreement between Social services, WCS-Newlands and the person admitted to the home had also been signed. These documents showed evidence that the admission had been discussed, identified the persons care needs and the level of care expected to be provided by the home. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 11 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 good. People’s needs are risk assessed, planned for and reviewed so that they receive the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of four people living in the home were examined. The level of information documented within care files has improved. This enables the staff to support residents to meet their individual needs. The care plans covers information based on the assessed needs of residents. Assessments carried out include personal care and hygiene, mobility, eating and drinking, and leisure interests. Care plans although not written in the first person for example I would like they are written to ensure they are centred on individual resident’s needs. This means that the care plan provides information on the persons preferred care routines. This will ensure that people living in the home receive care and support in a way that fits in best with their daily living patterns. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 12 Care files showed that relevant family members or their carers had been involved in the care planning process, helping to discuss their personal likes and dislikes. This support is particularly important as some of the people living in the home are unable to communicate verbally and at times find it difficult to make their immediate needs and choices known to the staff. Meetings are held with people living in the home. Minutes read showed that people talked about activities or events they would like planned. Menus were discussed and people living in the home were asked about foods to be included in planned meals. Care files show that detailed risk assessment had been carried out. Good risk assessments enable staff to support people to stay safe in the home and when out in the community. Care plans and risk assessments showed that they are updated regularly, showing that they are being checked and reviewed to ensure current information, which reflect current individual care needs. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 15, 16 and 17 Quality in this outcome group is good. People are supported to enjoy a good range of activities and to have access to the community. People do not regularly have the opportunity to access the community during the evening, so that they can socialise more. More could be done to improve the environment at mealtimes and make the time more social and relaxing. This judgement has been made using the available evidence including a visit to this service. EVIDENCE: Staff spoken with during the inspection were very familiar with the preferences of residents in their care. Staff were able to discuss the activities residents enjoyed taking part in. Each of the residents files examined contained a biography of the persons life history, their enduring interests and relationships. Both files provided information on life histories in pictorial format. This helped to make the life histories live and interesting to read. Information collected in this way about residents should help staff to deliver person centred care. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 14 A photo board in the main dining room of the home displays photographs of events and activities that have taken place. The photographs show that people living in the home have taken part in various and varied activities and events. Unfortunately as neither the photographs nor the display are dated, it was difficult to confirm when the activities had taken place. Information gained at the inspection from staff and residents identify that the events were not recent. Residents are supported by two activity coordinators and care staff to take part in activities of their choice. The employment of activities coordinators means that care staff are not taken from their care duties. The outcome for people living in the home shows that more one to one sessions and activities are able to take place in the day. People living in the home receive support from staff to go out to places locally such as the shops, into the town centre, local pubs or just for a walk. This support helps to maintain their independence safely. On weekdays residents attend day care services and some residents attend college. Records show that people are supported in courage to be involved in a variety of community activities for example trips out with their families, meals out and other events. Residents speaking in their questionnaire responses said the choice of doing what they wanted to do depend on the amount of staff on duty. Commenting: …I would like to go out in the evening but due to the amount of staff on a late I can’t go out as often as I would like.” Individual records of activity undertaken by residents are documented and photographs are kept in individual files. Examples of activities in peoples records include having contact with the ‘house duck’. … (Resident) spent sometime with me and our house duck, Tallulah, touching her soft feathers and stroking her. … (Resident) seemed to like the duck she was smiling and watching her every move. Other animals are kept in the home for example, birds (some of which belong to one of the residents) and a guinea pig. One of the activity coordinators takes responsibility for keeping the animal cages clean and healthy. The hair dresser was visiting on the day of the inspection. Residents were seen to make their own way to see her, told the hairdresser what they wanted done and also pay for the service provided to them. There is a computer centre within the home. Residents have their own accounts set up on the computers. They are then able to email or send letters to their families and friends. This allows residents to maintain contact with their families and friends at home and abroad. … (Resident) worked on the computer or the first time by the end of the lesson. … (Resident) was able to write a letter with one finger and was thrilled… (Resident) wrote a letter to her WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 15 mum. This practice encourages and supports people living in the home to be involved in life long learning Other activities that have recently taken place in the home include a day trip out to Burford Wild Life Park, an evening at the ‘Waterman’, Exercise to music, painting and crafts, prize bingo and film night. Some residents were seen to have and use their own key to their bedroom door. All residents are offered a key to their bedroom door and documentation was evidenced to show the reason why some residents are unable to or do not want to hold their own key. Peoples religious beliefs are documented in care plans and one resident is supported to attend a church of their choice. A resident is supported in attending an Asian day centre; this enables the person to maintain contact with people of their own culture and beliefs. Relatives and friends are seen to freely visit the home throughout the day. Residents receive visitors in their own bedrooms or in communal areas. Visiting relatives were free to use the kitchenette to make cups of tea, which they said made them feel comfortable and welcome in the home. Staff were observed to be attentive towards residents treating them with respect and thereby maintaining their dignity throughout the day of the inspection visit. At lunchtime the inspector had a meal with the residents. The large dining room has just been a re-opened and the aim is to encourage residents to meet socially and eat together at mealtimes. On the day of the inspection only four residents ate their meal in this dining room. The dining room lacked warmth, it was not an inviting room, dining tables were not attractively set and the condition of some plates and utensils is poor. The standard of service could be compared to the environment expected in a canteen. However the mealtime was a social occasion where those residents sitting in the dining room socialised and chatted together. Examination of the menus and speaking to the residents showed that a varied range of meals are offered. This ensures that peoples preferences are taken into account. Residents spoken with said that they enjoyed their meal and felt that the choices were good. There was sufficient staff available to offer sensitive and appropriate assistance to those people who needed support to eat their meals. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is good. People living in the home are provided with the support they need to meet their personal and health care needs. Suitable arrangements are in place for the safe administration of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care practices observed in this home show that the nursing care needs of residents is not the main focus of the home as the registration of the home would suggest. The ethos of the home is based on a model of social care. The main focus is on delivering personal care to people choosing to live in the home while staff support and encourage them to be as independent as possible and within their risk assessed limitations. Nurses working in the home offer support and guidance on nursing issues for example pressure sore management, dressings, PEG feeding (feeding via a tube directly into the stomach). WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 17 People living in the home looked well cared for, clean and comfortable. Observations during the day showed that the personal care needs of people living in the home are met. The care files of three people identified for case tracking were examined. Care files were standardised, organised and documented detailed information about each person. This should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Written entries were not always signed or a time given to show when they were made. The absence of this information does not support effective audit of care files or the investigation process if complaints are made. In one of the care files it was written…(Resident) hair is very knotty at the back we (staff) have tried to untangle it but it was no use.” There was no further information documented to indicate if any further action was to be taken. During the inspection visit the resident was seen to visit the hairdresser and discussions centred on how the problem was to be resolved. If this action had not been witnessed there would not be any evidence to show that staff had considered how they were going to help the resident. It is important for staff to ensure that care files reflect the action needed to meet people’s ongoing personal care needs to help maintain their well being and self esteem. Risk assessment tools are in place to identify whether residents are at risk of developing pressure sores, poor nutrition or have an increased risk of falls. Care plans to minimise identified risks were available in case files. One resident was noted to be prone to falls when taking trips outside of the home. The persons risk assessment had been reviewed and the level of support needed to help minimise risk identified. Each person’s care file contained a record of contact with or visits by Health Care Professionals. Information in care files confirmed that people living in the home have access to a GP, Dietician, Optician, Chiropodist and Tissue Viability Nurse Specialist. Further evidence of access to health care professionals was documented in the AQAA to say that the home has employed on a consultancy basis the services of two physiotherapists who visit weekly. One of the residents involved in the case tracking process confirmed that they were visited by the Physiotherapist weekly and as a result their mobility had improved. One resident had been visited by a dietician to review their PEG feed regime (a tube into the stomach, which allows nutrtionally balanced liquid feed to be given the person). An agreed plan of care had been written. Practices seen and information in care plans showed that the instructions had been included in the plan of care and that staff had followed the agreed plan. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 18 One persons care files showed that they had two episodes of choking causing their airway to be obstructed. Written information in the files showed that staff took appropraite first aid action, including using resustation procedures and called promptly for emergency medical support. This was an example of good timely practice which promotes the health and wellbeing of the resident. We examined the systems for the management of medicines in the home. A monitored dosage (‘blister packed’) system is used. Residents individual medication is safely stored in locked cupboards in their bedrooms. Other medicines, controlled drugs and as required medication are stored in trolleys, which are kept in locked clinical rooms. A medicines fridge is available in the treatment room with daily recordings of the temperature, which were within recommended limits. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. There are no controlled drugs in the home; however satisfactory facilities are available for the safe storage of controlled drugs (CD) if needed. One of the residents followed through the case tracking process has been prescribed Temazepam (a tablet to help them to sleep). This medication was not being checked to ensure the numbers remaining were correct following administration. This is not a requirement but is considered good practice and would help to prevent the risk of abuse. The home has advised us that they have now started this practice. Nurses employed in the home do not take sole responsibility for the administration and management of medicines in the home. The deputy manager, who is not a nurse, orders the medication for the home. Both nurses and care staff are responsible for the administration of prescribed medicines to the residents under their care during their shift. The medication policy and procedure for the home did not make it clear who would be accountable if there were a medication error following the administration of drugs. Training records available and conversations with care staff confirmed that they had received medication training and have been assessed as being competent to give out medication. The course is linked to Warwickshire College and involves distance learning Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private; residents were spoken to respectfully by staff and addressed by their preferred names. People living in the home looked at ease when talking with staff and were able to have general conversations as well as talk about their care. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 19 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 The quality in this outcome area is good. Suitable procedures are in place for dealing with complaints and staff are trained to recognise and report abuse so that the people living at the home are properly protected from harm. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: A complaints procedure is available in the home and a brief summary of the complaints procedure is available to help people living at home to complain or express any concern. Regular meetings take place involving the people at the home. The meetings give residents the opportunity to discuss anything they would like to talk about. The manager told us that she has an open door policy, where people living in the home can discuss any concerns with her at any time. Seven of the eight people living in the home who responded to the questionnaires said that they knew who to talk to if they were not happy. Comments made said that: “We see the manager first and speak to Anna Read (Home Manager). If we are still not happy enough we fill in a complaints form.” “The carers on all units usually listen to everything I say and if it is anything important or serious they see to it straight away.” There have been no complaints to us about the home since the last inspection. The manager reported there has been twelve complaints made directly to the WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 20 home during the same time period. These have been both written and verbal complaints relating to moving and handling techniques carries out by staff and inappropriate use of a resident’s personal clothing. Records examined show that the complaints have been appropriately investigated and resolved. Staff on duty and the manager confirmed that they are provided with adult protection training to support good practices in the home. This is also verified in the home staff training records. Staff confirmed that they have access to adult protection and whistle blowing policies stored in the homes policy file in the office. There have been two adult abuse allegations at the home since the last inspection. These were appropriately referred to social services for investigation under the local area safeguarding procedures. One of these allegations has been satisfactorily resolved and the other is ongoing The manager also checks and signs the records periodically to confirm they are accurate. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of the resident’s followed through the care tracking process identified that their personal monies were correct. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 21 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, 25, 26, 27, 29 and 30 The quality in this outcome area is good. The home provides homely, comfortable accommodation for people to live in. There is scope for improving the bedrooms of some residents to make their own rooms more personal and comfortable. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: WCS-Newlands provides accommodation for nursing and personal care and support services for up to 26 male and female adults with a physical disability. Residents’ ages vary between 31 and 65 years. On the day of the inspection there were twenty people living in the home nine male and eleven females aged between 35 – 71 years of age. The home is a purpose built dwelling situated in a residential area of Kenilworth near to shops and other local facilities. The home is all at ground floor level and provides suitable wheelchair access and sufficient space for people with disabilities. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 22 Each resident has their own bedroom thirteen of these have separate en suite facilities, consisting of wash hand basins and a toilet. The bedrooms of the residents followed through the case tracking process were viewed with their permission. All bedrooms were furnished with personal items, although not all looked homely and comfortable. One-bedroom had been redecorated and refurbished with input from the resident choosing colours of paint and furnishings. The home was seen to be clean at the time of the inspection. A resident commented that “The home has always been clean, whenever I have come in and stayed for respite.” The manager said in the completed AQAA for the home that the décor and maintenance of all lounge and living areas has improved. Further specialist beds and mattresses have been purchased and two new shower rooms installed. Plans for the future are to have a third shower room and to change an existing shower room into a lounge area with patio doors to the external quadrant of the home. On the day of inspection the floor was being tiled around a newly installed Jacuzzi in one of the quadrants around the home. The manager said that the idea is to build a spa pool with all associated facilities for use by residents to help improve their general relaxation. Photographs were seen of one resident enjoying spending some time relaxing in a Jacuzzi with the support of carers at a local health spa centre. The equipment and shower rooms mentioned by the manager were seen. Some rooms had specific adaptations to support meeting the needs of individual residents. The home is well equipped with assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The home has systems in place for the management of dirty laundry. The laundry is fully equipped and each resident has their own laundry storage box to hold their named clothing following the laundering process. Discussions with residents confirmed that a good laundry service was provided. Care practices observed showed that there are procedures in place to manage the control of infection. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 23 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): 31, 32, 34 and 35 The quality in this outcome area is adequate. Staff are well trained to support them in their work. Robust recruitment procedures are in place to ensure that suitable staff are employed at the home. There is not clarity between the roles of nurses and care staff working in the home so that resident’s are clear about the roles of the different members of staff. The number of staff on duty on late and night shifts do not ensure that residents can have all their needs met. This judgment has been made using the available evidence including a visit to this service. The judgement for this outcome group is good. EVIDENCE: The manager told us that staffing levels have been reviewed to provide more time for one to one interaction between residents and care staff. The usual staffing complement for the home is: Early 1 lead nurse and 9 or 10 enablers (care staff) Late 1 lead nurse and 5 enablers Night 1 lead nurse and 2 enablers WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 24 The above information was confirmed by examining five weeks of the home’s duty rota dated between 29 June and 2 August 2008 and talking to staff working in the home. The duty rotas showed that care staff levels had been increased during the early shift. This means that there is sufficient staff to cover the early shift but staffing levels are reduced by approximately 50 for the late shift and reduced on the night shift. When comparing the level of staffing for the late and night shift with the duty rota at the last key inspection visit the numbers of staff on duty have been decreased by one member of staff on each of these shifts. Staffing levels in the home are supplemented by at least one agency care staff or nurse daily due to absences. The manager told us that the number of agency staff used in the home has reduced. To support continuity of care for residents the same carers or nurses are requested through the agency as far as possible. The manager is supernumerary, although the off duty shows that she occasionally has been counted in the staffing numbers due to absence of staff. There are laundry, catering, cleaning, maintenance and administrative staff employed in the home. For example, • • • • • The kitchen is staffed between 9am and 5pm every day of the week, There are housekeeping staff to cover the laundry and cleaning of the home five days per week, between the hours of 8 and 3.30pm. The home employs a maintenance person. The manager is supported by an administrator, The home employs three activities co-ordinators for 82 hours each week. The information above indicates that care staff are preparing food for residents in the evening, as there is no cover in the kitchen after 5pm. The laundry and cleaning of the home is also covered by care staff after 3.30pm in the week and at weekends when there is no ancillary cover at all. The duty rotas do not show that additional care staff separate to the numbers required to meet the care needs of residents are included on the rota to work in the kitchen during the late shift or to do the laundry and cleaning during the day and at weekends. This would indicate that care staff are taken off the care duty rota to carry out these tasks, therefore decreasing the number of carers available to support residents with their care needs. It was not evident from the outcomes achieved for residents that there is sufficient staff on duty to meet their needs on these shifts. Staff spoken to WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 25 and comments in questionnaires received show concerns about staffing levels, especially in the evening. Comments received from residents say that it is often difficult to go out at night as there are not enough staff to support them. Training records show that 25 out of 29 care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. This means that 86 of care staff in the home are qualified at NVQ level two or above which is well above the National Minimum Standard for 50 of care staff to have this qualification. This should mean that people are cared for by competent staff. The personnel files of three recently recruited staff were examined and both contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and satisfactory references were obtained before staff started working in the home. Robust recruitment practices safeguard people living in the home from the risk of abuse. One recently employed care assistant confirmed that pre employment checks were made before they started working in the home. They told us they had an induction period when they were not in the ‘working numbers’ but ‘shadowed’ an experienced care assistant. A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. Staff have attended training on person centred approaches to care and practice. This training looked at the differences between the medical and social model of disability and the outcome these differences make upon a person. This should support staff to give person centred care to people living in the home, which meets their individual care needs. Other training attended include equality and diversity, brain injury and applying pressure bandages for people with leg ulcers. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 26 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): 37, 39, 41 and 42 The quality in this outcome area is good. Suitable quality assurance systems are in place and overall appropriate measures are in place for maintaining a safe environment for the people that live at the home and the staff that support them. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: The Registered manager holds the Registered Managers Award and is a qualified (second level) nurse with 8 years experience as a nurse working with Warwickshire Care Services. These qualifications are necessary to equip managers to carry out their role. Two and a half of these years involved working at WCS-Newlands working as a Care Manager. She has been appointed as the Home Manager and has applied for registration with us. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 27 A recently employed member of staff explained how the manager also observes his practice and provides constructive feedback as part of his development. Records of staff meetings and unit meetings confirm that staff are provided with opportunities to discuss care practices and other matters that are will help to run the home effectively. Information provided by the manager as part of the inspection process indicates that all essential Health and Safety maintenance checks are being carried out at the home. The fire safety log was examined and contained evidence to confirm that fire alarms and lights are tested at the correct frequency and fire equipment being properly serviced. The fire alarm was tested on the day of the inspection and a fire risk assessment completed in March 2008. Suitable arrangements are in place at the home for treatment of water for the prevention of Legionella. It was observed, however, during the inspection that the cleaners had left two cleaning trolley’s containing cleaning products unattended in the corridor. It was determined that the cleaner had gone for a break. The trolleys were safeguarded at the time of the inspection and action put into place to review the training of the cleaners on the safe storage of chemicals and current procedures for the storage of cleaning trolleys. The home’s Quality Assurance file contained evidence that management reviews the service provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. Incidents and accidents that happen in the home are recorded and were available for examination. The manager completes a monthly accident audit to analyse any patterns that occur. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 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 3 26 2 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 2 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 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 3 X WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 29 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. 1. Standard YA33 Regulation 18 Requirement Staffing levels must be reviewed to ensure that sufficient numbers are on duty at all times. Attention should be given to peak times of activity in the home, which includes: • • During the evening to assist residents with eating their meals. Where two members of staff are required to transfer a resident using appropriate and safe moving and handling techniques. Ensuring that care staff do not have to spend undue lengths of time undertaking non-caring tasks, especially in the kitchen, domestic and laundry areas. Supporting residents to go out in the evenings/night where this has been assessed as safe for them to do so. Timescale for action 30/11/08 • • This will ensure that residents care needs can be met safely at all times. WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 30 2. YA42 18 The standards of health and safety management within the home must be improved. So that the home is kept free from hazards. Particular attention must be given to ensuring that: The cleaner’s trolley is not left unattended at any time. 01/08/08 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 YA14 Good Practice Recommendations It would be good practice to label display boards showing activities/outings that have taken place in the home with the date and year to help people living in the home to remember and recall special occasions in their life. The layout, presentation and décor in the large dining room should be reviewed to provide an inviting and comfortable environment for residents to enjoy their meals. This should include a review of the plates, cutlery and utensils provided for the use of residents. Staff should ensure that care plans provide details of the action to be taken to meet all identified problems related to a resident’s personal care. This will mean that other staff are made aware and ensure the well being and self esteem of people living in the home The roles of nurses and care staff working in the home should be clearly defined. This will ensure that staff are clear about their level of responsibility and accountability towards people living in the home and maintain resident’s safety. 2. YA17 3. YA18 4. YA31 WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 31 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 WCS - Newlands DS0000004267.V369438.R01.S.doc Version 5.2 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!