Care Home: West Haven

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What the care home does well The needs of people wanting to live at West Haven are assessed prior to their admission to make sure the home can meet their needs. People who live in the home said, "I like living here" and "its nice living here" People who live at the home and staff were seen to be relaxed and comfortable in each other`s company. Staff present as caring and supportive, a relative said "they always seem to me to have the care of each individual in their hearts"People are supported to plan and enjoy their lives inside and outside the home. Records showed that this happens and people spoken with told me that they get help to plan meals, outings and holidays. People who live at the home, staff spoken with and records seen, advised me that staff continue to work well in supporting people to be part of the local and wider community. Surveys returned by relatives told me that people are supported to live full and active lives and to keep in touch with them. One relative said in their survey that "they bring her to visit me and to keep in touch by cards and telephone". What has improved since the last inspection? The service has undertaken and completed all the Fire Safety requirements of previous reports and has installed a sprinkler system throughout the home. This will keep people safe from the risk of fire. The service has organised that a survey is undertaken of the interior and exterior of the premises that will inform the organisation of any remedial work that needs to be undertaken. Records kept by the home, which were identified as needing updating, are now up to date and accurate. This will make sure that staff has correct up to date information to follow. CARE HOME ADULTS 18-65 West Haven 146 Huddersfield Road Dewsbury West Yorkshire WF13 2RW Lead Inspector Mavis Pickard Key Unannounced Inspection 17th January 2008 11.30 West Haven DS0000026332.V357580.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 Haven DS0000026332.V357580.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 Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Haven Address 146 Huddersfield Road Dewsbury West Yorkshire WF13 2RW 01924 461720 01924 461720 westhaven@catholic-care.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Catholic Care (Diocese of Leeds) Mr Peter Simmons Care Home 7 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. When the person with LD (E) is no longer living at the home, the Category of Registration reverts to LD for 7 persons of either sex. 25th January 2007 Date of last inspection Brief Description of the Service: West Haven is a home for up to 7 adults with a learning disability and is owned by Catholic Care [Leeds Diocese]. Bedrooms are situated on all floors, all are for single occupancy. The home is close to public transport links, local shops and pubs, has ample internal and external communal space that provides a safe, homely environment for people who live there. Catholic Care [Leeds Diocese] advises that the fees at the time of this inspection are £656:36 per week. There are additional charges for personal items and hairdressing. The provider makes available information about the home in a service users guide and a statement of purpose. West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced visit to the home, we arrived at the home at 11:30 am and finished at 3pm. During the visit we spoke to people who were in the home, several people who live there and 2 staff members, including the deputy manager who showed me around the premises. I was able to sample records kept in the home including case files, care records, health and safety and fire records. Other information used as part of this inspection process includes notifications sent to the Commission about a range of subjects including any serious illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the care provider and the information requested by us before the visit in a document called an Annual Quality Assurance Assessment (AQAA). This is a new document that is required to be completed by the home every year and is designed as a self-assessment of how the service is running. 8 people who live at the home or their relatives sent back the surveys we asked for, this told us about the service and the experiences of people who live there. I would like to thank people who live at the home, the deputy manager and staff for their welcome to me and for their help with my visit. What the service does well: The needs of people wanting to live at West Haven are assessed prior to their admission to make sure the home can meet their needs. People who live in the home said, “I like living here” and “its nice living here” People who live at the home and staff were seen to be relaxed and comfortable in each other’s company. Staff present as caring and supportive, a relative said “they always seem to me to have the care of each individual in their hearts” West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 6 People are supported to plan and enjoy their lives inside and outside the home. Records showed that this happens and people spoken with told me that they get help to plan meals, outings and holidays. People who live at the home, staff spoken with and records seen, advised me that staff continue to work well in supporting people to be part of the local and wider community. Surveys returned by relatives told me that people are supported to live full and active lives and to keep in touch with them. One relative said in their survey that “they bring her to visit me and to keep in touch by cards and telephone”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. West Haven DS0000026332.V357580.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 Haven DS0000026332.V357580.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): 2. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they move into the home to make sure they get the care they need. EVIDENCE: Many people have lived at the home for many years, surveys received from them and relatives say that people are treated as individuals and that they have their needs met. The deputy manager told us that a person admitted a year ago had little choice about moving as their previous home closed. However they made a choice to move in because they knew someone who lived at West Haven and thought the home would be a good place to live. The deputy manager said that they assessed the individual needs and aspirations of the person considering living at the home, records show that this was comprehensive and included a clear risk assessment. The service records showed that they could meet the individual’s needs and this has been the case. There remains ongoing monitoring and reviews by the West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 9 service and the local authority to ensure that the persons needs continue to be met. Reviews are planned and the person is able to invite who they wish to be present alongside professionals who are involved. This type of social service review is undertaken for most people who live at the home but historically, not all. The deputy manager told me that the service is exploring why some people’s placements are not regularly reviewed and are requesting such reviews for everyone. Records seen during the inspection contained information about individual and group meetings that are held with people living at the home, where staff can find out what residents want and people can plan the type of activities and pastimes that they want to take part in. People plan with staff, holidays and days out on an individual or group basis to suit their needs. West Haven DS0000026332.V357580.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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs and choices are known and met. Independence is supported by individual risk assessments. Individual decision-making is effectively promoted. EVIDENCE: Records seen during this visit show that staff talk with people who live at the home about what they want in their lives and develop a way to meet those needs and aspirations. Records kept are comprehensive so that all staff understands for example: • • • • • • what people like to be called. what people like to eat and drink. how people spend their time and what people like doing. who should be involved in reviews of their care. their individual health needs and how these should be met. Their arrangements for personal care. DS0000026332.V357580.R01.S.doc Version 5.2 Page 11 West Haven • Who they see as their next of kin or the person they would want to be told if any problems etc should occur. From talking with staff we found that the movement of staff at West Haven is low and the newest staff has been around for several years. Staff knows each person’s likes and dislikes, needs and goals, and these are evident in care plans. The ethos of the home is to support individuals to make decisions and choices about their life and to get the care they need. People are supported to make choices and decisions on how they spend their time. People can keep up relationships with friends, relatives and carers and links with their own community and staff will support people to do this. All people have their own door keys and can access the home independently. Staff are very aware that people who live at the home have some vulnerability but will always encourage independence an example of this might be, should a caller come to the door, it may be a person living at the home who answers. This is something people living at the home choose to do. However staff will always be at hand to ensure people are safe. This means that people have their independence but remain safe. West Haven DS0000026332.V357580.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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The daily routines in the home promote independence, and individual choice. EVIDENCE: Individual choices of food and drink vary, as do dietary needs. People have their own needs and choices, and these are met. Should people wish to have something different from others, this can be arranged. However records show that if there is any concern that a person may not be receiving a healthy diet, the service will check out their concerns with dietary professionals. During this visit we observed a meal being prepared by a person who lives at the home and who was being supported by staff. The person told us me that they always have a healthy diet and from the meal that was being prepared and from evidence of menus this is the case. West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 13 How people spend their day is up to them, some people go out to work or a centre, others will stay within the home or go out shopping supported by staff. It’s their choice. Staff respects the wishes of individuals to be on their own and they can entertain their friends and relatives in their own rooms. People living at West Haven say as do the information on returned surveys and on the AQAA that people live as part of the local and wider community. People are enabled to enjoy a full and stimulating lifestyle with a variety of options to choose from. It is clear from records seen that staff have sought the views of the people and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. From spending time in the home and talking with people its clear that routines are very flexible and people can make choices which should they change can be negotiated and/or accommodated very quickly. West Haven DS0000026332.V357580.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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The systems and procedures followed by the staff at the home make sure that the healthcare needs of people, including medication requirements, are assessed and recorded. People receive personal support in the way they prefer. EVIDENCE: No one at the home self medicates and should anyone need to take medication, staff know this and there are arrangements in place for individuals to take their medication safely and in the way that suits them best. An assessment is in place to show how and when people take their medication. The evidence of this is contained in personal care records and on the home’s medication administration records. Personal plans sampled describe the way people will receive the individual support and care they need. People can expect that their personal care plan West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 15 will change as their needs for support change. This was evidenced within the reviews of personal care plans. Records show that people are registered with a GP although not all with the same practice. They are registered with or regularly supported to visit a dentist and a range of other health care facilities. Should individuals require hospital treatment or have out patient appointments staff will support them to attend and support them to follow any advice given by the specialist. This was evidenced within the care plans in the AQAA and by relatives who returned surveys. West Haven DS0000026332.V357580.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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People say that staff listens to them and that they feel safe in the home. Staff understands safeguarding procedures and are aware of how to respond to concerns, complaints and safeguarding incidents. EVIDENCE: From speaking with the deputy manager, people who live at the home and from records seen, it is clear that people do so in harmony and that challenging incidents are rare, however staff have received training in deescalating or dealing with safely any type of incident that may occur. We saw that the home has polices and practices that safeguard the handling of people’s monies. People know where their personal monies are kept safely. We saw that good records are kept, that receipts are kept and that there is a record of any money spent by or on behalf of people. Appropriate policies and procedures in relation to safeguarding people are in place and staff we spoke with know what they should do should they ever suspect that anyone has been subject to any sort of abuse. Staff are not employed to work at the home before all appropriate checks have been undertaken. West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 17 Policies and procedures were seen that are in place with to safeguard people in relation to confidentiality, fire, emergencies and missing persons. Staff spoken with knew where the policies are and understand them. West Haven DS0000026332.V357580.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): 24 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users live in a clean and comfortable home. EVIDENCE: It is clear from touring the building that the home provides an environment that is comfortable, well maintained and clean. People spoken with said they liked living at West Haven. Some of the people who live at the home who we were able to speak with during the visit showed us their private accommodation and told us that they are able to personalise their rooms, that they chose the way in which they are decorated and furnished. One person said that their room had been decorated to their choice, whilst they had been on holiday and that they came back to a lovely ‘new’ room. West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 19 Another person showed us a special chair that they had received as a Christmas present. All private rooms seen are bright, well maintained, comfortable and individualised. The shared areas provide a choice of communal space with opportunities for people to meet relatives and friends in privacy outside of their own rooms. There is a large pleasant dining room where all people can, if they wish take meals. This room is awaiting a new carpet, residents are deciding presently the colour and style they want. The deputy manager said that this would be completed very soon. Some parts of the communal area’s seating presented as dated and in need of thorough cleaning, refurbishment or replacement. There was a discussion with the deputy manager about this being addressed as part of the maintenance budget as soon as is practicably possible. Throughout, the home is clean and hygienic. A previous concern about minimising cross infection advised that the service needed to provide individual towels in communal toilet areas. The deputy manager said that paper towels are now being used However, the deputy manager said that one person in particular has difficulty with using this type of towel. There was a discussion that cotton towels could be made available following appropriate risk assessments. West Haven DS0000026332.V357580.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): 32, 34 and 35. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are supported in their individual and joint needs by competent well-trained staff. People are supported and protected by the home’s recruitment policies and procedures. EVIDENCE: Records show that the service has appropriate recruitment policies and procedures and ensures that its staff are trained and updated in a range of care related topics. The roles and responsibilities of staff are clearly defined and understood, these are based on accurate job descriptions. The deputy manager said that she has worked at the service for 3 years and is one of the most recently recruited people, this shows that retention of staff is good. West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 21 Staffing levels reflect the needs of the people living at the home, and rotas are flexible to fit around the lifestyles of individuals. Key workers have specific allocated time to spend with individuals. The service does not employ agency workers. This means that people are supported by people they know and trust. Staff were seen to have the skills to communicate effectively with people living at the home. Records relating to staff meetings are used for consultation, training and the involvement of staff in the development of the service. The deputy manager confirmed to me that the staff group are a ‘happy bunch’ and that people who live at the home and staff get on well together, staff spoken with agreed. The information received from relatives and people who live at the home say that staff are always helpful and that they make live happy at the home. West Haven DS0000026332.V357580.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): 37, 39 and 42. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a well managed home and are confident that their views are listened to and acted upon. EVIDENCE: The registered manager was not on duty during this visit, however the deputy manager and staff who were on duty were seen to respond to people who live at the home in an open and transparent way. The service has sound policies and procedures, which are evidenced as being reviewed and updated, in line with current thinking. This means that management and staff have guidelines to work from that put people who live at the home first. West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 23 The deputy manager says and records show that staff receives regular supervision and have meetings where all aspects of the service can be discussed. The health and safety and fire safety records were found to be of a good standard and are routinely completed. The organisation’s management visits the service regularly and the Commission receives a copy of the report. This means that we know how that the service is safe and comfortable for people who live there. Records show that work identified at a previous fire service visit and the last inspection has now been completed; a fire sprinkler system has been installed. All staff has undertaken comprehensive fire safety training and will be regularly updated. The Commission has received a copy of the up to date fire risk assessment. We saw that the cellar area that was not very safe and which was used to store a freezer that people, who live at the home had access to. The freezer is now been stored in another place more easily accessed by people. This keeps people safe. People who live at the home now have no reason to access the cellar, which is now only used by staff. An up to date risk assessment for staff that use this area is in place and safety equipment has been made available for staff. West Haven DS0000026332.V357580.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 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 2 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 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 3 X X 3 X West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The organisation should ensure that the planned replacement of the dining room carpet goes ahead without delay. This will ensure a more domestic and comfortable environment for people who live at the home. The organisation should consider the thorough cleaning, refurbishment or replacement of settees and armchairs in communal areas as soon as is practicably possible so that people who live at the home have a more hygienic and pleasant environment. 2. YA24 West Haven DS0000026332.V357580.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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 Haven DS0000026332.V357580.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. 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