Care Home: West Dean

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What the care home does well West Dean is a well established home that provides a positive environment for residents who need support whilst at the same time encourages independence. A resident commented that she was made welcome when admitted to this home and that she has found the staff to be supportive and very good. She also confirmed that she is encouraged to be independent, being in charge of her own finances and personalising her room, whilst having the freedom to go out when she wishes. Past visits found that residents can come and go as they wish and are in control of their lives and have space to be alone or mix with other residents/the community as they wished. The manager and care staff were seen to be good at developing positive relationships with individual residents. What has improved since the last inspection? What the care home could do better: The provider needs to address fully the requirement to undertake reviews of the quality of care at the home and inform people of the outcome of those surveys undertaken. All carers must have up to date photographs as part of their procedures for carryout robust recruitment checks. CARE HOME ADULTS 18-65 West Dean 77-79 Yarborough Road Lincoln LN1 1HS Lead Inspector Doug Tunmore Unannounced Inspection 5th November 2007 10:00 West Dean DS0000002396.V353388.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 West Dean DS0000002396.V353388.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. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Dean Address 77-79 Yarborough Road Lincoln LN1 1HS 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) 01522 568248 westdean@unitedhealth.co.uk www.unitedhealth.co.uk United Health Limited Mr John Warriner Care Home 16 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (10) of places West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2006 Brief Description of the Service: West Dean is a care home providing personal care for 16 residents who have a learning disability or mental health need. West Dean is not registered to provide Nursing care. The home is a large detached property located on a steep hill on one of the key routes within the City of Lincoln. The home is set back from the main road, within its own grounds and garden. There is access to the front of the home through the main entrance, which has a number of steps. There is also access to the rear of the home by way of the parking area, which is set on a steep slope. The property has four floors. There are two selfcontained flats on the ground floor. These are used as pre-discharge facilities, which support residents who are choosing to move into the community. The home is one of a group of homes owned by United Health PLC. The home has a flat rate of current charges, which is £361.00. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key visit was unannounced and took into account any previous information held by the Commission for Social Care Inspection (commission) including the homes previous inspection reports, their service history and the homes Annual Quality Assurance Assessment form hereafter in this report referred to as AQAA. The site inspection consisted of case tracking a sample of two residents records and assessing their care. The commission sent out surveys to the provider and five residents surveys were returned and four carers surveys were returned. The inspector spoke with one of the residents and two others showed the inspector their rooms. The inspector also spent time with the manager and a carer. A partial tour of the home and a review of a sample of the records were also included. What the service does well: What has improved since the last inspection? What they could do better: West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 6 The provider needs to address fully the requirement to undertake reviews of the quality of care at the home and inform people of the outcome of those surveys undertaken. All carers must have up to date photographs as part of their procedures for carryout robust recruitment checks. 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. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 7 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 West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 8 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): Standards 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider carries out care needs assessments with other agencies and prospective residents to ensure the home can met their needs and aspirations. EVIDENCE: A previous inspection carried out on the 14/11/06 evidenced that the home had a prospective residents care needs admission form. It was also found that visits were made to the home before admission for some new residents and where this was not possible a visit made by staff from the home to the individual before admission to undertake an assessment of needs’. We looked at two resident’s files who were being case tracked and found that they contained a letter confirming that the provider could meet prospective residents needs. The manager stated that he visits all prospective residents prior to admission. He also said that there have been one recent admission to the home. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 9 The providers AQAA states that ‘the statement of purpose is given to all prospective service users terms & conditions. Full assessments of needs are carried out, visit to the home by prospective service users, and were possible over night leave arranged’. All five residents surveys returned to the commission showed that they had wanted to move to this home and they had enough information about the home before they moved in. We found that resident’s files contained a written document of their terms of conditions of occupancy with the provider. All those people who live in this home have a service users guide. One resident stated that she had been admitted from hospital to this home by her social worker. She also confirmed that the staff were very kind and she was made welcome. West Dean DS0000002396.V353388.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): Standards 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have care plans in place, which reflect their care needs and those risks undertaken as part of their individual lifestyle. EVIDENCE: A review of all information available prior to this inspection and a previous key visit carried out in November 06 at this home evidenced that residents had an individual care plan. This visit found that, improvements had been made to care plans and now provide evidence of action plans, which identified those residents who need support in maintaining their independence within the home and the type of support, which was being offered to meet this need. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 11 One resident seen confirmed that she was aware of her care plan and was involved in the planning of her care since she was admitted to the home. On a pervious visit a resident stated that he had attended reviews relating to his care. Other resident’s files seen evidence that they are actively involved in their care plans. However, The manager needs to make a file note indicating those residents had declined to sign their care plan. The providers AQAA shows that, ‘every residents care is based on their own individual needs and requirements this is set out in their personal files care plans and risk assessments’. Resident’s surveys showed that three felt that they make decisions about what to do each day, one felt he/she usually did and one felt that he/she sometimes made these decisions. All residents were also found to have a risk assessment separate to, but linked to their individual care plan. Previous visits confirmed that regular house meetings are held in which residents are empowered to raise any issues and discuss the running of the in September 07. We found that resident’s files showed who the key worker was for that particular resident. West Dean DS0000002396.V353388.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): Standards 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in appropriate activities within the home and local/wider community. Residents are also encouraged to maintain family relationships and to develop relationships with other residents with support as they wish. The home provides a varied and balanced nutritious diet for residents. EVIDENCE: A previous key visit to this home evidenced that residents are encouraged to develop practical life skills as part of their overall care plan. Additional care staffing hours are to be provided for staff to support residents with social activities linked to care plans. Resident’s files showed that residents are given opportunities for personal development and engage in leisure activities of their choice. One resident commented at a previous visit that he is independent and West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 13 retains links with his brother and sister with whom he meets for weekend lunches. A second resident said that she has a boy friend who she visits regularly and hopes to move out into the community and be independent in the future. The manager confirmed that one resident has now left and supports herself in the community. A resident confirmed that she could go out when she wants as long as she informs carers when she is planning to return. She also sated that she cleans her own room and launders her own clothes. Previous visits have found that residents attends the Shaw trust, another attends cookery lessons, one does voluntary work for Strut and another attends to the garden at the home. Evidence was also seen in files that resident’s social workers are involved in finding suitable activities or voluntary work for their clients. The manager stated that residents are encouraged to be independent, and clean their own rooms and go shopping. Three residents showed the inspector their rooms and it was found that support was given for some residents in order to maintain their independence and in one instance prepare for living on her own. Care plans had been updated to ensure that care staff are aware of the needs of individual residents. The providers AQAA shows that the home, ‘maintains & promote independence, residents rotas for assisting in the kitchen & attending to their own laundry & daily living tasks’. This document also states what they could do better with, ‘liaising with external agencies to promote residents activities outside the home’. Residents were observed throughout the inspection, coming and going freely and undertaking activities of their choice. Residents confirmed that they felt well supported. Resident surveys reflected that four felt that carers listen and act on what they say and one felt carers usually did. A resident informed the inspector that the food is very good and we get a variety of meals. West Dean DS0000002396.V353388.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): Standards 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health care needs of residents are fully documented and they are encouraged to make their own appointments to see health care workers. Residents care plans show those residents who are able to safely administer their own medication. EVIDENCE: A previous key inspection found that each resident has a named key worker. This system helps to ensure consistency in care provided, whilst promoting good working relationships between a named member of staff and a resident. Care plans seen at this inspection evidenced that all health related needs are recorded and staff support residents to attend GP and other health care appointments within the community. One resident at a previous visit stated that he had been to the dentist on the day of that inspection and also attends West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 15 the opticians and his GP when he requires theses services. Only one resident has been assessed for administering his own medication and has a lockable facility in his room where medication is stored. We viewed a self medication risk assessment and found it had been signed by a resident confirming that he was aware of the risks and was prepared to self medicate. One resident stated that she does not take any medication. Some residents at the home also require support with medication. There are policies and procedures for recording all aspects of administering medicines. Records of medication given were seen and found to be up to date at the time of this inspection. The manager and trained care staff administer medication to residents. The manager confirmed that training in the administration of medication would be undertaken on the 19/11/07. The last pharmacist visit was undertaken on the 26/04/04. West Dean DS0000002396.V353388.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): Standards 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are empowered by the homes complaints procedure. The home takes the protection of residents seriously, and acts to support and protect residents. EVIDENCE: Previous key inspections found that the manager encourages residents to talk about any concerns they may have and has set up residents meetings to enable greater opportunities for those living at the home to air their views. The providers AQAA evidenced that there have been no complaints made at this home since the last inspection. However, information in the homes service history held by the commission shows that a complaint has been made. The manager commented that this complaint has been resolved and all documentation is held at the main office. Previous visits have found that there is an up to date copy of the policy, procedure and guidance relating to the protection of adults. This visit found that training in safeguarding vulnerable adults has been undertaken in 2004, 2006 and 2007. Staff were found to be aware of what action should be taken if a resident raises concerns regarding abuse. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 17 A resident stated that ‘she feels safe’ and she has no need to make a complaint. Resident’s surveys showed that all five knew who to speak to if they were not happy and four knew how to make a complaint. The providers AQQA states that, ‘observation feedback from staff and residents, display prominently complaints procedure and complaints form and the use of the suggestion box, complaints procedure and complaints form are displayed, all residents aware of this’. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 18 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): Standards 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Externally and internally improvements have been made to the home for the benefit of people living here. The home was found to be clean and tidy with residents taking a pride in their rooms. EVIDENCE: Those residents who showed the inspector around the home were proud of their rooms in which some four had been fully redecorated since the last visit. The manager stated that there is a rolling programme and he hoped that all rooms would be redecorated in time. He also commented that hallways are to be decorated before Christmas. Other comments were that a resident who made a negative comment about his carpet would have it replaced in the near future. It was observed that rooms were reasonably clean and tidy with one resident now receiving support with managing the contents of her room. This inititave West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 19 is now part of her care plan and agreed with the resident as to how this is to be addressed. The home currently employs a cleaner who works twenty hours a week. Residents confirmed that they help clean their own rooms and many are selfsufficient. One resident stated that the home is clean and there are no unpleasant odours. Resident’s surveys overwhelmingly stated that the home is always clean and tidy. All rooms are numbered for each resident and residents have their own keys to their rooms. Observation made at this inspection was that residents could come and go to their rooms as they so wish. This visit found that the area at the back of the house has been landscaped and a table has been placed in the grounds for the use of residents. It was noted that the front garden has been grassed over and shrubbery planted giving an attractive aspect to the front of the home. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 20 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): Standards 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust recruitment practices are in place to protect those residents who are vulnerable. Staffing levels are satisfactory to meet the resident’s needs. EVIDENCE: The last key inspection dated November 06 found that the home was adequately staffed, with staff, who demonstrated experience and competence to care for the current group of residents. Through the checking of staff files and discussion with the manager, it was confirmed that a recruitment policy and procedure is in place to ensure that the team is balanced and provides appropriate physical, and social support for all residents. This inspection found that adequate checks are ongoing although three care workers don’t have a current photograph. The manager stated that he would contact the commission West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 21 by the 09/11/07 to confirm that all carers have an up to date photograph on file. Care staff surveys showed that the employer had carried out appropriate checks before they started work. One carer recently employed said that she had undertaken the homes recruitment process and confirmed that references and criminal record bureau checks were acquired prior to starting work at this home. It was noted that her personnel files was not available and was kept at a sister home in which staff work between the two. The manager commented that each worker in the home has been given the General Social Care councils pack relating to the registration of care workers and the philosophy of the Care Council for all social care homes. A carer stated that she had undertaking the homes induction training, which included fire procedures. The providers training plan was seen and found to be up to date. The training record identified that the manager and care workers who had undertaken training in 2006 and 2007. Information received from the home in their AQAA evidenced that the home has three carers currently working towards a National Vocational Qualifications (NVQ) in the care or residents. The manager stated that training is to be arranged for February 2008 for staff, which is related to caring for those people with a learning difficulty. A carer commented that there is enough staff on duty to care for residents at this home. One carers survey mentioned that there should be more staff on duty. A resident at a previous visited stated that ‘if there are problems staff are always around and cope with it. I am quite happy, I was born down the road’. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 22 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): Standards 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager provides leadership to carers in everyday care issues. Quality assurance audits of residents are not carried out. Risk assessments are available regarding residents windows so as to ensure their safety. EVIDENCE: The registered manager has experience in working with clients who have a wide range of social care needs. This includes people with physical or mental health care needs or who are elderly mentally infirm. The manager has NVQ West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 23 level 3 in mental health care and is currently undertaking the registered managers award. He has also undertaken training as required. It was found that the provider does not conduct an in-house quality assurance check or report based on the views of residents as to how this home is managed. The manager evidenced that he has produced a questionnaire for resident and that a newsletter would also be in operation in which results of surveys will be reported. He confirmed that no surveys had been undertaken since the last inspection. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence in the providers AQAA which showed that fire alarm, fire drills and emergency lighting checks are carried out. Staff also undertake fire training as part of the homes initial training and as a regular training event. Past visits have found that certificates were available showing that gas safety inspections have been carried out, electrical wiring checks, and portable electrical equipment checks. Risk assessments are also available for windows on the first floor, which do not have window restrictors. The manager confirmed that all incidents have been reported to the commission as required. West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 24 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 x 2 3 3 3 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 3 34 x 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 X 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 2 X X 3 x West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 25 Yes 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. 1. Standard YA39 Regulation 24 (a)(b) Requirement The provider must establish and maintain a system for reviewing at appropriate intervals the quality of care provided at the care home and inform service users of the outcomes of any survey undertaken. (Timescale of 23/02/07 was partially met and a second timescale has been set.) Timescale for action 13/02/08 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 West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 West Dean DS0000002396.V353388.R01.S.doc Version 5.2 Page 27 - 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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