Care Home: Wellington House

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What the care home does well The service has a commitment to consult with all service users about their lives. There is a good, equal relationship between staff and the people they support. Everyone has a person centred plan so people are getting the support they need to lead the lives they want. People are getting out and about a lot more. They are shaping the way they want their home run and changes are coming about because people are being listened to. There is a large staff team, meaning that when people need staff to support them, it is possible. People know that if they speak up, or tell staff they have a problem, something will get done about it. Relationships are supported discreetly and sensitively. The home is well run in service users best interests. The manager has lots of experience and has nearly completed a Certificate in Person Centred Support at the Tizard Centre, University of Kent at Canterbury. What has improved since the last inspection? Service users have `Person Centred Plans`. They are all having a say in who helps make decisions that effect them. They are tracking their own goals, which are based on their wishes, hopes and dreams. Restrictions have been reviewed, like the kitchen and laundry being locked. Service users now have keys to these rooms and to the front door so they have more control over their environment. People are leading the lives they want through person centred planning. Because of this incidents of problem behaviour have dropped and community presence has increased. People are developing their independent skills and confidence due to good support and person centred planning. Some people are able to go out on their own now and do more in the way of cooking and cleaning and are taking more responsibility for their lives. A common room for service users has been created from a staff office. There is a pool table and games and facilities to make hot and cold drinks. Service users are having the support they need to take more control of their health and medication. The manager and activity coordinator have nearly completed a year long course `Certificate in Person Centred Support` This means that they have more knowledge about latest research and good practice relating to service users needs. What the care home could do better: Service users experience some good and excellent outcomes. The challenge is for the staff to continue supporting people to grow and develop and live the lives they want. Service users should be consulted to see if they want to include weekends on activity planners so they know they have choices and opportunities.Service uses should be consulted to see if they would like a microwave oven or other cooking facilities in the common room. CARE HOME ADULTS 18-65 Wellington House 371 Dover Road Walmer Deal Kent CT14 7NZ Lead Inspector Kim Rogers Unannounced Inspection 29th April 2008 09:30 Wellington House DS0000023123.V361095.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 Wellington House DS0000023123.V361095.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. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellington House Address 371 Dover Road Walmer Deal Kent CT14 7NZ 01304 379950 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) wellington.house@robinia.co.uk The Robinia Care Group Ltd Miss Sharon Anne Head Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 12 People with learning disabilities over 18 years of age. Date of last inspection 19th April 2007 Brief Description of the Service: Wellington House is a large detached house in the village of Walmer. The home is registered to provider personal care and support for up to 12 younger adults with learning disabilities. The home is situated on the main Dover to Deal road, with local public transport services, and a variety of shops and a public house nearby. A car parking area is situated at the side of the house and there is a small secure garden to the rear. All the clients in the home have their own bedrooms, with bathrooms and toilets facilities in close proximity. Communal facilities comprise of a lounge/dining room, and lounge on the ground floor and a small quiet room situated on the first floor. There is also a kitchenette on the ground floor with pool table and tea and coffee making facilities for service users. Storage areas and the laundry room are situated in the basement of the home. The current fee for the home is about £1,900 a week. For more information about the fees and what is included please contact the Provider. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 29 April 2008 between 9.30am and 2.30pm and is part of the key inspection. The Registered manager, Sharon Head, service users and staff assisted with the process. Service users gave face-to-face feedback. Two service users showed the inspector their rooms and other parts of the home. Organised and spontaneous activities were taking place throughout the visit, and observations formed part of the evidence collected. The inspection process consisted of information collected before and during the visit to the home. Records were sampled including assessment and person centred plans, medication and activity records. The inspector also made observations. The manager completed the AQAA (Annual Quality Assurance Assessment). This gives information about how the home has improved and how the home intends to improve. The AQAA was well completed and gives good evidence of improvement at the home. Service users said ‘Staff help me to be independent so I can get my own flat’ ‘I did not know how to cook when I came here, I cook a lot now’ ‘I have a key to the laundry now’ The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. What the service does well: The service has a commitment to consult with all service users about their lives. There is a good, equal relationship between staff and the people they support. Everyone has a person centred plan so people are getting the support they need to lead the lives they want. People are getting out and about a lot more. They are shaping the way they want their home run and changes are coming about because people are being listened to. There is a large staff team, meaning that when people need staff to support them, it is possible. People know that if they speak up, or tell staff they have a problem, something will get done about it. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 6 Relationships are supported discreetly and sensitively. The home is well run in service users best interests. The manager has lots of experience and has nearly completed a Certificate in Person Centred Support at the Tizard Centre, University of Kent at Canterbury. What has improved since the last inspection? What they could do better: Service users experience some good and excellent outcomes. The challenge is for the staff to continue supporting people to grow and develop and live the lives they want. Service users should be consulted to see if they want to include weekends on activity planners so they know they have choices and opportunities. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 7 Service uses should be consulted to see if they would like a microwave oven or other cooking facilities in the common room. 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. Wellington House DS0000023123.V361095.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 Wellington House DS0000023123.V361095.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 and 2 People who use the service experience good outcomes Information about the home is produced in different formats so people have the information they need to make a decision about the home. People know that their needs and future goals will be assessed to make sure the home can support them properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective service users are given lots of information about the home, including a newsletter produced by service users and staff. This helps people make a decision about moving in. Trial visits and stays are arranged individually to meet peoples’ needs so they get a feel of what life is like at the home. All service users now have a detailed baseline assessment, which they have had lots of say in. This has established each person’s hopes and wishes for their future, as well as support requirements. Prospective service users have a very detailed assessment that will form their basic care package. An assessment was sampled and showed that the service user was fully involved and kept at the centre of the assessment process. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience excellent outcomes Person centred approaches put service users in the ‘driving seat’ for all consultation and planning, decision-making and risk taking. People are achieving their goals and living the lives they want due to good support and person centred planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have been fully consulted in the development of their person centred plans. Plans are all individual so they mean a lot to the people who they are for. Circle of support meetings have been arranged, and outcomes very clearly documented. Some people have had support to chair their own meetings. Each service user has a key worker and person centred planning facilitator whom they meet with regularly to review their plans. This ensures that staff know if people are achieving their goals and if they are getting the right support. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 11 Positive behaviour support plans have been developed with service users where necessary. This means that staff use positive approaches to manage problem behaviours and with staff being more proactive incidents have reduced. Associated risks have been assessed with individuals with much more focus on enabling people and giving them more control. Risks are being reviewed regularly to be certain that only absolutely necessary restrictions are imposed. Service users are having more freedom and problematic behaviours are seen differently as a consequence of this new approach. Levels of incidence have significantly dropped since the last key inspection. One person has moved to more independent living as part of their plan and more people have that goal of moving on. This is being supported by staff and some more people will be moving on this year. The AQAA says that they plan to improve by supporting service users to move onto more independent living if they wish. The home is also looking into a new assessment to measure current choices people have. The plan is then to increase choices. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 People who use the service experience excellent outcomes Service users have real opportunities to develop and have the lifestyle they choose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are considerable improvements to service user lifestyle. People are making really meaningful decisions, and these are presented in a way that they truly understand. People can learn and maintain their life skills. For example, people now access the kitchen regularly and have developed their cooking skills. As a consequence of reviewing approaches to lifestyles, relationships between staff and service users have improved. There is a more equality. Service users are happy with the changes, environmental restrictions have dramatically reduced and the level of aggressive incidence has dropped significantly. People have much more control over their lives. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 13 Each person has a weekly activity planner covering Monday to Friday that they have been involved in developing. Staff said ‘there is much more emphasis on meaningful activities like work experience and college now’. Staff said service users like going to boot fairs and shopping at places like Lakeside and Bluewater at weekends. The home has a vibrant and happy atmosphere, and a real ‘buzz’ about it. Service users are now more involved in the day to day running of the home and therefore have more responsibility and ownership. For example, even though there is a menu most people cook for themselves and choose what to cook. Service users are all involved in planning and preparing meals and food shopping. Some people have jobs and some are furthering their education. The AQAA says the home plans to support more people to get a job or work experience. Training is also being arranged in food hygiene and first aid. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience excellent outcomes. People have support they need to take control of their personal care and health and medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported in the way they want, and this is spelt out in the person centred plan. Everyone has a health action plan that they have been involved in developing. This easy read document helps service users take more control over their health. Staff support people to understand it, and make sure that people see the doctor etc when needed. Some service users now make their own doctors appointments giving them more responsibility and control. During the visit, some health care appointments were taking place. The staff make referrals for specialist health care support when needed. Medication administration records and systems are easy to use and show no errors, storage is safe. Staff support service users to learn how to administer their own medication and some people now have control over their medication keeping it securely in their rooms, giving a sense of pride and achievement. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 15 All is clearly risk and development plan assessed. There are plans for more service users to have control over their medication. Staff have training in health matters, specifically relating to service users needs and medication. The medication policy has been reviewed since the last inspection. The AQAA says that they plan to improve by continuing to monitor health needs and supporting independence. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes. Service users know that their complaints will be listened to and acted on. Service users are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users said they feel safe and know who to talk to if they were not happy about something. Service users said staff would sort it out for them. Regular meetings with key workers and person centred planning facilitators give service users opportunities to speak out. There is a complaints policy and procedure, which has some, symbols and pictures making it more accessible. The AQAA says that the procedure is available in other formats. There is a policy on whistle blowing and safeguarding vulnerable adults; both have been reviewed since the last inspection. Staff attend training in safeguarding so they know how to recognise and respond to possible harm and abuse. The manager is aware of her role and responsibilities regarding safeguarding adults. The use of restrictive physical intervention has stopped with staff using more positive person centred approaches to supporting challenging behaviours. This has reduced the number of incidents and has improved people’s quality of life. Service users are having support to develop money skills so they can take more control over their money and finances. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes. Service users live in a clean safe home that is well maintained. Service users now have a real say about the home and have control over the environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in very good decorative order and has comfortable furniture throughout. Two service users showed the inspector their rooms that are highly personalised making them feel like home. Service users said they have support to clean their rooms and now do their own laundry. Access to the rear garden is now unrestricted for all service users. Consequently, people are using the area more, and this has added a broader dimension to the home. The garden has been improved since the last inspection. A common room has been created from the old staff office. There is a pool table and games and tea and coffee making facilities. Although there is no water supply there is a water dispenser. This has increased communal space for people and given the home another area for people to enjoy. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 18 A shower room has been refurbished since the last inspection and the AQAA says there are plans to do some planting in the garden and continue with the maintenance and decoration programme. A housekeeper is employed and all communal areas are clean and tidy throughout. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good outcomes Service users can feel certain that the staff team will understand and support their needs, and that staff have had all the necessary safety checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and senior team have provided staff coaching. It has focused on the well-being and decision making opportunities provided to service users. This has had really positive outcomes for service users as opportunities have opened up, anxiety and aggression has decreased. Staff meetings and supervision sessions are regular giving staff support and forums for open discussions. Team building days have also been introduced. Changes in care planning has allowed newer staff to get to know the people better in a shorter time period – which removes stress levels for service users. Training is more focused around service users needs and person centred support. The staff team can therefore meet the current service users specific needs. Staff numbers are provided to meet service users planned activities, which may mean in one morning, there could be 10 staff on duty. Recruitment Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 20 processes are solid and gather all the data necessary to make sure service users are protected. The AQAA says they plan to introduce observation to the supervision and appraisal process. They also intend to involve service users more in the recruitment of new staff. Training on the Mental Capacity Act is planned so staff have awareness of service users rights and issues relating to consent. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience excellent outcomes. The home is run in service users best interests, reflecting the lifestyle they want. Service users know their health and safety will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has improved the service significantly, which has improved outcomes for service users. She has embraced person centred approaches, learnt how to apply them, and is enjoying seeing how well service users are responding to this level of consultation. The manager has nearly completed the ‘Certificate in person Centred Support’ so is up to date with latest research and good practice relating to people’s needs. Service users are having meetings and bringing their own matters to the agenda. Personal plans are drawing out each person’s aspirations, which are Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 22 being incorporated in the overall development plan for the service. Visits by the responsible individual from the organisation are taking place and now have more of a focus on outcomes for service users. Quality assurance systems have been improved by using questionnaires more effectively to get peoples’ views about the service. The company carries out regular audits of various areas of the service including training. There is a range of forums enabling service users to give their views about the service. Improvements have been made based on service users’ views. The AQAA showed that all safety checks are confirmed as in date. Incidents and accidents are well recorded, analysed and action taken to prevent future occurrence. There are plans to support service users to carry out some of the health and safety checks so they are more involved and have more responsibility. The AQAA shows a good understanding of equality and diversity issues and gave good evidence of why the home is good value for money. The manager, who completed the AQAA has awareness of what needs to improve and how to do it. She has identified barriers to improvement and has strategies to overcome the barriers. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 4 X 3 X X 3 X Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations Consult with service users about adding weekends to activity planners and about providing a microwave oven or other cooking facilities in the common room. Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wellington House DS0000023123.V361095.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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