Care Home: Wellhay Resource Centre

What the care home does well Wellhay continues to provide respite and day care provision for people with dementia. There are opportunities for people to experience a range of activities, which ensure that people are motivated and stimulated. Through the "Have your Say" surveys people that use the centre, their relatives and health care professionals made the following comments about what the service does well. The people that use the service said. " The staff are wonderful and hard working, its rare this days to get staff like this WELL DONE", " I like it better in small groups", "Friendly helpful staff, always there to offer help and support" and " It is a pity there are not more homes such as Wellhay, as you don`t feel you are in a home." The Community Mental Health Nurse said that "Caring for and manage people with difficult problems. Also assist carer, relatives to continue to feel part of their relatives care whilst providing respite for them." Relatives made the following comments about the standards of care at the home. " Adaptable, flexible to the individuals", " Provides support-care and friendship enables the person to mix and talk whilst ensuring opportunity to remain in their own home" and " gives a personal and homely atmosphere and a lot of hands on stimulating activities." The manager stated through the AQAA that the service supports Service Users who wish to continue living in their own homes and maintains, their independence, skills and well being. What has improved since the last inspection? The AQAA completed by the manager states that the home has worked positively with all the Community Mental Health Teams in Bristol to provide a service that meets individuals needs for Service Users and their carers living in Bristol. We are flexible and have open lines of communication with these teams. The manager had identified accessibility of information as an improvement for the coming year. Producing accessible formats will demonstrate that there is a person centred approach to meeting needs. Members of staff said that there were changes in shared areas for small groups to undertake activities. What the care home could do better: There are eight requirements arising from this inspection and are based on one suspended and one repeated requirement from previous inspections, three that focus on the premises and three on developing the service. There are two outstanding requirements from previous inspections. The requirement to repair the window frames will be suspended while the future of the centre is unknown. Regarding supervision of staff, the manager mustensure that members of staff receive regular supervision from their line manager, to maintain consistency of care at the centre. Requirements arising from this inspection are based on reviewing the Statement of Purpose and Service User Guide, maintaining the premises for the people that use the service, training and the reintroduction of the Quality Assurance system. The Statement of Purpose must be reviewed to make clear the age range of the people that can be accommodated for respite care at the centre. In terms of the Service User Guide the format must be symbolised with pictures and words to ensure that the people for whom its intended can understand it. While every effort is made by the centre to provide a homely environment for the people that use the service, the premises must be better maintained. The hot water system for providing refreshments and cooking must be safer and more efficient. The flooring in the kitchen must be repaired/replaced to reduce the potential of a risk hazard to the people using the kitchen. The corridors are also in need of attention, the wallpaper is peeling and there are holes in the walls. Mental Capacity Act training must be provided to increase staff awareness on the impact new legislation will have on the way people with dementia are to be empowered to make choices. The Quality Assurance system must be reintroduced to ensure that the views of the people that use the service can reflect the future plans of the centre. CARE HOMES FOR OLDER PEOPLE Wellhay Resource Centre Knole Lane Bristol BS10 6GH Lead Inspector Sandra Jones 4 &7 th th Unannounced Inspection December 2007 09:30 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 Wellhay Resource Centre DS0000037063.V353241.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. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellhay Resource Centre Address Knole Lane Bristol BS10 6GH 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) 0117 3772591 0117 903 8043 brsswel@bristol.gov.uk Bristol City Council Christine Ruth Bryant Care Home 10 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (8) of places Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate 8 persons aged over 65 years of age with Dementia May accommodate 2 persons aged 50 years and over with Dementia Two un-named persons with dementia aged over 50 years may receive respite care at the Centre 7th February 2007 Date of last inspection Brief Description of the Service: Wellhay Resource Centre is run by Bristol City Council. It is registered to give personal support and respite care (for example to support service users who may have been ill or to give relatives a break) for eight people who are over 65 and two people over 50 years. All service users accommodated have a diagnosis of dementia. Wellhay is purpose built and runs a regular day care service for up to 24 people with dementia. The premises are accessible for disabled older people and there are a number of vehicles available for the centres use. A team of mental health and social care professionals supports the centre and meets regularly to discuss service user issues and offer places to them. The centre has its own transport that picks people up and takes them home again each day. The day care service is free. However fees apply for those staying at the centre. The full fee is £584.99 per week and a sliding scale applies depending on service users incomes. The inspection report was seen displayed in the centre and the manager said that relatives say that they also see the report on The Commission for Social Care Inspection’s website. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted unannounced over two days in December 2007 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedure. During the site visit, the records were examined, a tour of the premises was conducted and feedback sought from individuals and staff. The Annual Quality Assurance Assessment (AQAA) was sent to the home for completion, with “Have your Say” surveys for people at the home, their relatives and social and health care professional. The manager returned the AQAA and feedback was received through the survey from nine people that use the centre, ten relatives and one health care professional. Prior to the visit some time was spent examining documentation accumulated through Regulation 26 reports, surveys, the AQAA and notified incidences in the home, (Regulation 37’s). This information was used to plan the inspection visit. The people accommodated at the centre were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the manager, staff and people using the service were gathered through face- to- face discussions. What the service does well: Wellhay continues to provide respite and day care provision for people with dementia. There are opportunities for people to experience a range of activities, which ensure that people are motivated and stimulated. Through the “Have your Say” surveys people that use the centre, their relatives and health care professionals made the following comments about what the service does well. The people that use the service said. “ The staff Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 6 are wonderful and hard working, its rare this days to get staff like this WELL DONE”, “ I like it better in small groups”, “Friendly helpful staff, always there to offer help and support” and “ It is a pity there are not more homes such as Wellhay, as you don’t feel you are in a home.” The Community Mental Health Nurse said that “Caring for and manage people with difficult problems. Also assist carer, relatives to continue to feel part of their relatives care whilst providing respite for them.” Relatives made the following comments about the standards of care at the home. “ Adaptable, flexible to the individuals”, “ Provides support-care and friendship enables the person to mix and talk whilst ensuring opportunity to remain in their own home” and “ gives a personal and homely atmosphere and a lot of hands on stimulating activities.” The manager stated through the AQAA that the service supports Service Users who wish to continue living in their own homes and maintains, their independence, skills and well being. What has improved since the last inspection? What they could do better: There are eight requirements arising from this inspection and are based on one suspended and one repeated requirement from previous inspections, three that focus on the premises and three on developing the service. There are two outstanding requirements from previous inspections. The requirement to repair the window frames will be suspended while the future of the centre is unknown. Regarding supervision of staff, the manager must Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 7 ensure that members of staff receive regular supervision from their line manager, to maintain consistency of care at the centre. Requirements arising from this inspection are based on reviewing the Statement of Purpose and Service User Guide, maintaining the premises for the people that use the service, training and the reintroduction of the Quality Assurance system. The Statement of Purpose must be reviewed to make clear the age range of the people that can be accommodated for respite care at the centre. In terms of the Service User Guide the format must be symbolised with pictures and words to ensure that the people for whom its intended can understand it. While every effort is made by the centre to provide a homely environment for the people that use the service, the premises must be better maintained. The hot water system for providing refreshments and cooking must be safer and more efficient. The flooring in the kitchen must be repaired/replaced to reduce the potential of a risk hazard to the people using the kitchen. The corridors are also in need of attention, the wallpaper is peeling and there are holes in the walls. Mental Capacity Act training must be provided to increase staff awareness on the impact new legislation will have on the way people with dementia are to be empowered to make choices. The Quality Assurance system must be reintroduced to ensure that the views of the people that use the service can reflect the future plans of the centre. 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. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 8 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 Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 9 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): (3) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. There is an effective admissions procedure in place, individuals staying at the centre and their relatives can be reassured that the staff will have the skills and resources to meet the needs. The Statement of Purpose must be reviewed to ensure people are informed of the age range of the people that can be accommodated at the home. EVIDENCE: There is a prepared Statement of Purpose, which describes the admission procedure for the home. It confirms that admissions are based on full assessments and purports to take emergency placements. There is a Terms and Conditions of residency and describes the way the home will meet the needs of the people accommodated. The deputy manager said that the intention is to make information more accessible, it was further stated that the Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 10 Service User Guide would be reviewed and symbolised with pictures and words. This will ensure that people for whom it’s intended can understand the guide. The Statement of Purpose must be reviewed to clarify the age range of the people that can be accommodated and the Service User Guide must be symbolised. “Have your say” surveys from eight people that have respite said that they received enough information about the home before their short-term placement. Their comments included “ We visited the home and met the staff”. Regarding contracts one person said that contracts are not provided because it’s short term placement and another said that a contract was provided. The deputy manager on duty explained that referrals are city wide through the mental health team and stated that the admission process for the home consisted of introductory visits. Although two week and long-term stays are available, weekly stays are generally encouraged because it prevents bed blocking and a 1:6 week placement can then be provided. At the time of the inspection visit, one person was accommodated as an emergency respite placement. The case file of the person at the home was examined and the pre-admission assessment from the social worker was in place. “Have your say” surveys were received from relatives and four people said that the home always kept them informed to help make decisions about the home and four said it was usual. A relative said through the survey “ I can always ask questions and receive helpful positive responses. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 11 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) & (10) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There is an effective care planning systems in place so individuals can benefit from receiving an individualized and consistent service. There is sensitive and prompt support for their personal and health care needs from a skilled staff team. Medication systems are safe. EVIDENCE: The deputy manager said that the care coordinator provides the initial assessment of needs for the person wishing to stay at the home. Home support plans are then developed at the home, with keyworkers monitoring the plans monthly and a review of needs six months after. The person, their relatives, attends review meetings, with social and health care professionals that have input into the care of the person. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 12 The person currently accommodated was admitted the day before as an emergency and as this person was previously accommodated social workers needs assessments, support plans, daily reports and records of administration were already in place. Running reports inform the staff about the recent admission and reports described behaviours observed and activities undertaken. The deputy manager said that the keyworker would be updating this person’s information. It was explained there is an expectation that keyworkers seek from the person their likes, dislikes and preferred routines about the way the care is to be delivered. Background histories are sought from the relatives to increase staff’s insight into the person. A member of staff with key working responsibilities was consulted and explained that staff are allocated specific individuals for staff to undertake the role of keyworker. The role consists of seeking background histories from relatives and the person so develop support plans. Support plans are then devised from the information received from the person, needs assessments and the family. The person accommodated at the home said that the staff assist with meeting their needs. Eight “Have your say” surveys from relatives state that the home always meets the needs of their relative and one said it was usual for the home to meet their relatives needs. The Community Mental Health Nurse that responded through “Have your say” surveys stated that individuals health care needs are usually met. “Have found clients care needs identified and met by the service in a positive way” was the comment made to support their response. The people at the home are able to communicate verbally and usually body language and behaviours are used to establish decisions made by the person. It was stated that there is a wide variety of activity groups including music and dancing to assist with communication. The deputy manager explained the arrangements in place for medical attention that may be needed by the people at the home. The deputy said that for individuals that are local and in respite, their local GP’s are used if necessary. There are separate arrangements for people in respite that live outside their GP’s boundaries. It was explained that temporary registrations with local GP’s is requested for people that need medical attention during their stay. Patient summary sheets are requested from GP’s before admission to the home to ensure medical histories are known. A patient summary sheet for the most recent admission was received and held in the case records. The member of staff consulted said that medical advice is consistently followed because information is passed on through handovers and running reports. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 13 Manual Handling profiles are completed for each person and assessments are based on the persons level of independence. The level of the persons understanding and physical impairments are also considered within the profiles. The arrangements for Privacy and are detailed within the Statement of Purpose. It confirms that through leadership, induction, supervision and facilities, members of staff know that they must respect the individuals rights. The deputy manager said that bedrooms are single and lockable and when requested keys are provided. Regarding measures that may be considered restraint, the deputy said protective clothing is only used when requested by the person or family and bedrails are not used. It was further stated that where specialist equipment is needed support from the rapid response and district nurse is sought before using any equipment that is considered as restraint. The member of staff on duty gave the following examples on the way individuals rights are respected. It was stated that knocking on doors before entering, seeking permission to deliver care, providing discreet personal care. The Annual Quality Assurance Assessment (AQAA) completed by the manager states that there would be a reintroduction of 6 monthly assessments of care workers competence to administer medication. Members of staff consulted during the inspection confirmed that they received medication training to ensure safe administration of medicines to the people at the centre. It is the policy of the home to only accept medications dispensed by a pharmacist into a monitored dosage system or original packages. Within the medical summaries, medications prescribed are listed which is used to cross reference medications received during the admission process. A Medications folder is available to the staff, which generally lists medications regularly administered at the home, their purpose and side effects. Medications administered by the staff are recorded and the name of the medication, directions and running balances are detailed. The records show that staff sign the records soon after medications are administered. A record of medications returned to the family is maintained and included is the name of medications, date returned/disposed, quantity and signature of the person. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 14 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) & (15) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There are good support systems in place for individuals to lead active and interesting activities. A better system of providing hot water for cooking and refreshments must be found, as the present system is not suitable. EVIDENCE: “Have your say” surveys from three people at the home state that activities always take place, two said it was usual and two said it was sometimes. Their comments included “ Some people like very different activities that they would join” and “As there are only a few things I enjoy, it’s not always easy to cater for me”. The resource centre provides respite and day care to people with dementia and the aim is that each person in the unit has the opportunity to participate in an activity. The deputy said that there is more than one activity is taking Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 15 place in any one time. The activities organised varies with the abilities of the people and the levels of staffing in place at the time. A record book of activities undertaken is maintained and generally quizzes, music, arts and crafts are organised. The member of staff on duty was consulted about activities provided at the home. It was stated that part of the care workers role is to provide in-house activities. Puzzles, board games, crafts and music are favourite in-house activities. The arrangements for visitors is included within the Statement of Purpose and states that visitors are welcome at all times and phone contact is also possible. Five relatives stated through the “Have your say” surveys that the home always helps their relative to maintain contact. The deputy explained that the purpose of short-term care is to provide respite to carers and for this reason visits to the home from relatives is unusual. Within the contract of residency, individuals are informed that personal possessions can be taken into the centre. The deputy said that individuals are encouraged to have small personal items during their stay. There are lockable facilities in bedrooms for individuals to have a secure place to have personal possessions. It was noted during the inspection that the person in respite has personal items in their bedroom. Individuals at the home are restricted from entering the kitchen, a member of staff on duty said that indivdials must be supported in the ktichen and laundry. A member of staff explained that three meals and refreshments are served at the centre. It was stated that meals are provided for people on respite care and day care service. Catering staff said that the managers develop the menus with their support. For example, meals not eaten is feedback to the managers for changes. There is a wide variety of fresh, frozen and tinned foods which reflect the menus in place. A record of the individuals preferences and disliked meals is kept in the kitchen. For example, the size of the meals and condements AQAA states that menus are varied throughout the year and if there are any specific dietary needs or preferences these are recorded and the cooks informed. A record of the food provided is maintianed, with changes of menus and reports of the levels of satisfaction of meals provided. “Have your say” surveys from five people state that the meals at the home are always good and three people said the meals were usually good. One person made the following comment about the food at the home, “ The cook is really very good, we really love the food.” The person at the home said that they had eaten some of the meal provided. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 16 It was noted during the inspection of the kitchen that some repairs are needed. The flooring needs repair because the joints are separating and may cause a trip hazard to staff. The water heater broke and staff are using an urn. However, the urn cannot be used at all times. A better system of providing hot water must be provided. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 17 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): (17) & (18) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Individuals can expect their concerns to be listened to and to be protected from abuse. EVIDENCE: The Bristol City Council Complaints procedure is used at the home. While the procedure is available in other languages, large print and Braille, a symbolised procedure with pictures and words is not provided. The Complaints procedure must be written in a format for the people for who is intended. This will ensure that they can understand the procedure. There were no complaints received at the home since the last inspection and nine letters of compliments. Complimentary letters are to thank the staff for the delivery of care to relatives previously accommodated at the centre. “Have your say” from five people at the home state that they know who to approach with complaints and they know how to make a complaint. Two people indicated that they usually knew whom to approach and they know how to make complaints. The nine surveys from relatives indicated their awareness of the complaints procedure and that the home always responds Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 18 appropriately to their complaints. One person stated, “Minor issues have always been addressed.” The staff on duty were consulted about the way individuals are supported to make complaints. It was stated that families consult with keyworkers to discuss concerns and the individuals behaviour and expressions are used to determine if the person is not happy about something. The person will then be supported to follow the complaints procedure in place. The deputy manager said that the Whisltblowing, Code of Conduct and “No Secrets” policies and procedures show the commitment towards safeguarding individuals from abuse. While the procedures set the approach, the implications to staff that witness poor practice and do not report it is not specified within the Whistleblowing policy. The deputy also said that all staff had attended Safeguarding Adults training. Feedback was sought from staff about their responsibilities towards safeguarding adults. The member of staff confirmed that Safeguarding Adults training was provided and was aware of the their responsibilities to protect individuals from abuse. There were no outstanding Safeguarding Adults referrals. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 19 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) & (26). Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. The centre must be better maintained for individuals to benefit from living in a comfortable environment. The centre is clean and free from unpleasant smells. EVIDENCE: Wellhay is a Local Authority provision attached on one side to another Local Authority care home for older pople. The accommodation is arranged on the same floor with level access into the home, ten single rooms, dining room and a number of lounges all on the same level. The AQAA states that steps were taken to implement a program of Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 20 redecoration this year, we have refurbished the bathroom. The music and activity room have changed locations to provide Service Users with more space to participate in activities. All the corridors have hand rails and we have a toilet specifically built to enable wheelchair users to use. The centre has two lounges which includes a T.V. lounge, dining room and shared spaces for activities. Smaller domestic shared space is also provided for hairdressing, music, housekeeping and crafts. This ensures that people have the opprotunity to join in activities or for private use Outdoor space is secure so that people can go into the garden and remain safe within the grounds of the home. People at the home that want to go into the garden can use a number of internal exists. It was noted that the paths are in need of attention. Assisted baths and showeres with toilets are available in sufficient numbers for the people accommodated at the time of the inspection. Keypads that restrict individuals access out of the home, into the kitchen and office area are used. There are exits into the garden and the deputy said that people that want to leave the home through the front entrance are coaxed away. Care Cordinators would be contacted because it may be an indication that the home is not able to meet the needs. During the tour it was noted that some bedrooms were locked and it was explained that empty bedrooms are always kept locked and only when requested by the individual. There is an outstanding requirements about repairing the window frames. This requirement will be suspended while the future of the home is unknown. However, there are a number of repairs that must be actioned in the meantime. Corridors have peeling, ripped wallpaper and holes in the walls which require attention. Seven “Have your say” surveys from the people at the home state tha the home is always fresh and clean. Comments made include “ Very comfortable and homely” and “Excellent”. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 21 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) & (30). Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. Individuals are supported by a competent, qualified and skilled staff team. Supervision must be more consistent for all the staff and staff must attend training that will have impact on the needs of the people at the home. EVIDENCE: The AQAA states that the induction processes will be reviewed to ensure compliance with current standards. To review the care staffing levels and increase the number of care hours. The deputy manager said that there were no new staff employed at the home since the last inspection. It was then explained that the home is currently short listing for two vacant posts and there is a 32-hour care officer, two 20hour waking night staff and two ancillary vacant posts. A personnel file was examined during the inspection and contained copies of two references and notifications of Criminal Records Bureau (CRB) checks. The deputy said that application forms are held in the HR. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 22 The staff rota shows that four staff are rostered to work 8:00-1:00, staffing levels then increase from 1:30 pm when three additional staff are rostered until 5:00. From 5:00 pm the staffing levels fall from 8 staff to 4 staff, with two staff awake at night in the premises. Catering and ancillary staff are also employed to work at the home. Agency staff are used to cover short falls and on the day of the inspection five staff were on duty. “Have your say” surveys from six people at the home state that the staff are always available when needed and one stated it was usual for the staff to be available. One person stated “ Very helpful/caring/supportive” The deputy manager said that staff have annual personal development plans meetings where training needs are identified. Members of staff must attend statutory training that consists of Medications, Equalities, Manual Handling, Safeguarding Adults, First Aid and Food Hygiene training. Members of staff are currently attending Equalities courses to ensure that statutory training is kept up to date. Records show that staff have attended Safeguarding Adults training and updates on Manual Handling and Food Hygiene since the last inspection. Dementia training will be taking place on 13/12/07 for all staff, it was stated that Dementia Voice would be facilitating the training. Mental Capacity training must be considered, as changes in legislation will have an impact on the people at the centre. It was stated that Mental Capacity Act training is to be attended in the New Year. The deputy manager said that vocational qualifications are encouraged for the staff. It was stated that care officers have either completed or are undertaking NVQ level 3 and night care assistants are undertaking NVQ level 2. The home is operating above the NMS of 50 qualified in NVQ level2. A member of staff on duty said vocational qualifications are encouraged at the home and had already completed NVQ level 2 and was undertaking level 3. Six “Have your say” surveys from relatives state that the staff always have the right skills and experience to look after people properly and two said it was usual. Comments made by relatives include “Staff are wonderful treat everyone as if they were their own parents”, “Excellent very caring people” and If they haven’t they are doing a good job.” The Community Mental Health Nurse stated through the survey that “ Have not found a problem at all. Have been impressed by skills and experience of the staff.” Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 23 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) & (38). Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Individuals can expect to live in a safe environment and can be re-assured that standards will be the subject of ongoing monitoring. Quality Assurance systems must be reintroduced. EVIDENCE: Members of staff have Development Training Profiles that lists the training attended and describes the aim of the training completed Within the files are supervision mimutes and generally supervision is from the line manager. The manager suprevises the deputy managers and they supervise care officers. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 24 Supervision occurs monahtly and the manager diaries the sessions in advance. Records of supervision were viewed and for some people records show that supervision is monthly and focus on the person, care planning, peformance, workloads and training. A member of staff on duty said that supervision is six weekly and focuses on support plans, concerns, training needs and performance. Feedback was sought from a member of staff about the way the manager maintains consistency at the home. Staff said that staff meetings, supervisions and training are the systems in place that maintain the standards of care at the home. It was also confirmed that suggestions made by staff are taken on board and where appropriate acted upon Six “Have your Say” surveys from people at the home state that staff always act upon what they say and one person said it was usual. Quality Assurance from an external company has not taken place this year. It was stated that because of changes withing the team, the Annual Quality Assurrance audit has not taken place. Fire Risk assessments in place include the management of the premises where the frequency of checks and practices of fire training and evacuation are evaluated. The steps to be taken by the staff to ensure that people at the home can be assisted to leave the premises in the event of a fire must be included in the assessments. The AQAA stated that a review our fire safety procedures and risk assessments will take place in line with current regulations and departmental policy. The manager also ensures compliance with other associated legislation. Contractors visit the home annual to check equipment , aids and systems to ensure the people at the home are safe to live in the environment. Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 25 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 2 x 3 x x N/A 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 x 17 3 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 23(2)(b) Requirement The outsides of all window frames must be repaired and revarnished. (Suspended until the future of the home is known). Timescale for action 31/12/08 2. OP1 6 3. OP36 18(2) a) The Statement of Purpose 31/03/08 must be reviewed to make clear the age range of the people that can be accommodated at the centre, b) The Service User Guide must be symbolised with pictures and words to ensure the people for whom its intended can understand it. Staff must have 1-1 supervision 31/01/08 at the frequency laid down in the employer’s relevant policy. Repeated from previous inspection A better system of providing hot water for cooking and making refreshments must be found, The kitchen flooring must be repaired/replaced to prevent a trip hazard. The corridors are in need of repair and redecoration. The DS0000037063.V353241.R01.S.doc 4 5 6 OP19 OP19 OP19 16 (g) 23(2)(b) 23(2)(d) 28/02/08 30/03/08 30/05/08 Wellhay Resource Centre Version 5.2 Page 27 7 OP30 18(1)(c) (i) 8 OP33 24 hole must be filled and peeling wallpaper repaired/replaced. Staff must attend Mental Capacity Act training to ensure the implications of new legislation to people with dementia The Quality Assurance system must be reintroduced. 30/06/08 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Wellhay Resource Centre DS0000037063.V353241.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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