Care Home: Westgate

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What the care home does well People who live at the home continue to be provided with a clean, comfortable and homely environment. They are cared and supported by a stable and experienced staff team who provide them with support to develop their independent living skills. Suitable arrangements are in place to ensure health care needs are met. Meal times continue to be flexible and a choice of healthy meals are provided to meet dietary needs and personal preferences. People living at the home are encouraged discuss their care plans and express their views about the service being afforded to them. House meetings provide opportunities for the residents to discuss the day-to-day running of the home with each other and staff. Key worker sessions allow more personal discussions to take about individual progress and personal goals. Staff recognise the importance of keeping in contact with family and friends. They continue to support people who live at the home to maintain positive relationships outside the home. What has improved since the last inspection? The home has made improvements to the quality of its care plans. This includes more detailed information about preferred routines and arrangements for how personal allowances will be managed on behalf of some of the residents. Weekly individual activity programmes have been produced for each person. However, a recent review has identified most people prefer a more flexible approach to arranging activities. A planned programme of individual staff supervision has been implemented and some staff members have attended training in client-centred issues. CARE HOME ADULTS 18-65 Westgate 60 Edward Street West Bromwich West Midlands B70 8NU Lead Inspector Linda Elsaleh Key Unannounced Inspection 3rd & 4th June 2008 09:30 Westgate DS0000004827.V364913.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 Westgate DS0000004827.V364913.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. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westgate Address 60 Edward Street West Bromwich West Midlands B70 8NU 0121 580 0196 0870 609 2435 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) Swan Village Care Services Limited Munish Kumar Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd July 2007 Brief Description of the Service: Westgate is purchased by Minster Pathway in 2006 and continues to operate as Swan Village Care Services. The home is registered to provide personal care for a maximum of seven adults who have learning disabilities. The building is a converted Victorian house situated on Edward Street. A one-way system is in operation and parking is restricted to residents. Westgate has parking permits they provide to visitors. The home is situated within easy travelling distance of West Bromwich town centre. There is access to all local amenities such as a shopping centre, library, college, churches and leisure facilities, which provides service users with the opportunity to lead active lives within the community. The home is accessed via the main entrance at the front of the property. There is one double bedroom and five single bedrooms. There is a long garden to the rear, which contains garden furniture for the use of service users. The dining room/conservatory is a designated a smoking area, during inclement weather. On the second floor, there is a self-contained flat and office for staff use. The home does not provide any lift facilities and therefore would not be suitable for a service user with mobility difficulties. The home should be contacted for information about the current fee range for this service. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This unannounced inspection was carried out on 3rd & 4th June 2008. The purpose was to assess the home’s performance against the key standards in the National Minimum Standards for Care Homes for Adults and report on the progress made to address the requirement made at previous inspection. The inspector’s findings are based on the information received by the Commission for Social Care Inspection (CSCI), examination of relevant records and documents kept at the home and discussions held with people who live at the home, the manager and staff. The atmosphere within the home was relaxed and friendly. Positive comments were received from people who live there. All those who responded to our survey told us they were treated well by staff and liked living at the home. At the time of writing this report no comments about the service have been received from relatives or health and social care professionals. What the service does well: People who live at the home continue to be provided with a clean, comfortable and homely environment. They are cared and supported by a stable and experienced staff team who provide them with support to develop their independent living skills. Suitable arrangements are in place to ensure health care needs are met. Meal times continue to be flexible and a choice of healthy meals are provided to meet dietary needs and personal preferences. People living at the home are encouraged discuss their care plans and express their views about the service being afforded to them. House meetings provide opportunities for the residents to discuss the day-to-day running of the home with each other and staff. Key worker sessions allow more personal discussions to take about individual progress and personal goals. Staff recognise the importance of keeping in contact with family and friends. They continue to support people who live at the home to maintain positive relationships outside the home. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 6 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. Westgate DS0000004827.V364913.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 Westgate DS0000004827.V364913.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): 1, 2, 3, 4 & 5 Quality in this outcome area is adequate. A Statement of Purpose and Service User Guide is produced by the home. Some of the information in these documents need to be updated and copies issued to all interested parties to enable people to make an informed choice about where to live. The home has suitable procedures in place for assessing the needs of prospective service users and arranging for them to visit. People who use the service do not have a signed agreed contract/statement of terms and conditions with the home that informs them of their entitlements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current people living at the home have been resident for more than two years and each has their own bedroom. There have been no admissions during the last 12 months. Since our last visit the home has produced a procedure for emergency/short notice admissions. The manager informed us this procedure has been discussed with staff. The minutes of this meeting are available. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 9 The manager has reviewed the home’s Statement of Purpose. A copy of the Service User Guide is provided to each resident in a pictorial format. Information provided about what is/is not included in the fees is confusing. For example, the Statement of Purpose states the fee includes “...Basic toiletries …” and the Service User Guide states “You will have to pay for things like, …Personal toiletries”. The records of the personal allowances managed by the home on behalf of some residents show toiletries have been purchased. The manager informed us the home provides general items such as products for cleaning and for toilet products such as soap for wash hand basins communal toilets. The Statement of Purpose should be amended to accurately reflect what is/is not included in the fees. The manager stated that a copy of the Statement of Purpose is available to anyone who requests it. However, comments received in the surveys from relatives and/or other stakeholders stated they were not been provided with a copy. The manager is advised to be more pro-active in ensuring information about the home is provided to all interested parties. The home has a checklist for its assessment process. This includes providing prospective residents with opportunities to visit and stay at the home before making a choice about where they wish to live. The people who live at the home have various needs and training in specific areas of care is provided to staff, such as managing epilepsy and diabetes. Two residents are identified with having limited communication skills. We observed staff using different methods for interacting with these residents. Training records show two staff members have received training in speech & language. We discussed the need for a consistent approach in communicating with these residents and the manager is advised to give more consideration to staff training in this area. There are copies of the contract agreements between the home and the funding authorities. These are in need of updating. The Service User Guide includes a Service User Agreement template, but this has not been completed with the individual resident and/or their representative. Westgate DS0000004827.V364913.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, 8 & 9 Quality in this outcome area is adequate. People who live at the home are confident staff are aware of their assessed and changing needs and personal goals. However, the care plans do not always reflect fully how some of these needs are to be met. Risk management strategies are in place to keep people living at the home safe from harm. Staff supports individuals to take risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the files for three service users and each contained a document entitled “All About Me”. This document provides information about how the individual’s communication skills, their likes and dislikes and how they usually respond in different situations. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 11 Care plans cover different aspects of residents’ personal, healthcare and social needs and identifies the different levels of support they require. For example, one resident has limited vision and communication skills and another manages their own personal care and travels independently. The manager told us care plans are reviewed twice a year. We looked at the last two review records for one resident. The funding authority arranged the review that was held in March 2007. This meeting discussed changes in the person’s care needs as identified by the home. The next review was held in September 2007. The resident, their relative/representative or a representative from funding authority, did not attend it. There was no supporting evidence about why these people were not present. The manager and deputy told us the home has increased the staff hours to ensure the needs of this resident are being met. The funding authority cancelled meetings arranged for January 2008 and the home is waiting for a new date. A review for another resident took place in October 2007 and was attended by their funding authority. The outcome shows “consideration is to be given to preparing the resident for supported living”. The resident told us s/he did not attend the review and staff are aware they wanted their “own place”. The manager told us the funding authority cancelled the meetings planned for January and March 2008. We discussed with the manager and deputy the need to implement more suitable arrangements to ensure care plans are regularly reviewed with the resident and/or their representative and significant professionals. The home also needs to ensure care plans are updated and any action identified is followed up in a timelier manner. One person is not in contact with any relatives and receives support, when needed, from an external advocate. The manager told us a briefing session has been held with staff on the Mental Capacity Act. Staff said they would benefit from further training in this area. Monthly meetings are held with each resident and her/his key worker. Records are kept of each meeting. We looked at the minutes of meetings for three residents. Two contained brief information of comments made about issues such as activities and meals. The other was more detailed and included discussions held with the resident about her/his progress in following a healthy eating programme. One of residents told us how much s/he enjoys meeting with her/his key worker and feels staff are supporting them to prepare for a more independent lifestyle. We discussed these meetings with the manager, deputy and a member of staff. They all stated the quality of the recording did not clearly show the range of issues discussed and the resident’s participation in these meetings. The manager said effective recording will be discussed with all staff and minutes of these meetings will be more closely monitored. Daily records show how residents have spent their day and the support provided by staff. With the exception of the detailed recordings of support provided to one resident to follow a healthy eating programme, the other daily recordings we saw did not make direct reference to the individual’s plan of care. The key workers use these recordings to monitor care plans. A review of Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 12 the quality of recordings is advised to enable care plans to be monitored more effectively. Residents have regular ‘house’ meetings where they are able to express their views about the day-to-day running of the home and issues associated with communal living. This is reflected in the minutes kept of each meeting. We saw information reminding staff to ensure a resident’s wardrobe was locked at all times. The deputy explained the resident’s shaving kit had to be locked away to prevent him harming himself. A risk assessment is available in the resident’s file. However, such action also prevented the resident from accessing other items. No safety concerns were identified about the resident having access to other items in his wardrobe. The manager agreed to provide a suitable secure facility in the resident’s room for his shaving kit. One resident told us s/he has a bus pass and travels to unescorted. S/he also has a mobile phone and keeps in contact with the home to let them know where s/he is and what time s/he will be returning. Staff told us they would implement the home’s missing person procedures if the person is more than two hours late contacting them or they are unable to contact her/him. This information is not recorded in her/his care plan or risk assessment. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. People that live at the home are supported to follow their preferred routines, access education facilities, participate in social activities and maintain contact with family and friends. The home continues to provide people who live at the home with a choice of healthy meals that meet their dietary needs and individual preferences. The home has yet to make suitable arrangements to ensure the dining room remains a smoke free environment at all times for the comfort of people who do not smoke. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During weekdays some people who live at the home attend day centres or colleges. This provides them with opportunities to develop practical and social Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 14 skills. One resident told us s/he had recently enrolled in literacy and art courses and makes their own way to and from college. S/he has a computer in her/his bedroom and told us staff are always available with advice and assistance when required. Two residents are interested in gardening and proudly showed us their plants. Another resident enjoys regular trips to the local shops with staff to buy items for themselves and the home. We were told the individual weekly activity programmes was not proving successful with the residents, as they would often changed their minds about what they wished to do. This is reflected in the records. Residents are now consulted about activities on a daily basis and enjoy a trip to a pub as well spending time at home listening to music. The home does not have its own transport and therefore, is not always able to respond to some impromptu activity requests. The manager told us the company is considering the home’s request for access to a vehicle. Residents are consulted about holidays and/or short breaks. These are discussed in residents meeting and during one-to-one meetings with their key worker. The home has an allocated budget for each person that can be spent throughout the year. Staff supports people living at the home to maintain positive relations with family and friends. One resident told us s/he regularly uses public transport to visit her/his relatives. Relatives and friends are welcome to visit the home at any reasonable time and invited to join in some of the activities. The home as a smoking policy that states: “…Residents who wish to may smoke in the lounge or outside within the porch area of the rear exit of the building…”. The Service User Guide informs residents they may smoke in the conservatory during inclement weather. Pictorial information about smoking is displayed in the home. The staff and residents are aware of the new smoking legislation. Individuals who wish to smoke were observed going into the garden. However, they are reluctant to do so in inclement weather. The manager stated that following our last visit a request was made to the company to arrange for a sheltered area to be provided, but no action has yet been taken. The home’s smoking policy, service user guide and statement of purpose needs to be revised to ensure the rights of non-smoking residents are protected and a suitable designated area provided for those residents who choose to smoke. The risk assessments for residents who wish to smoke was last reviewed in June 2006 and will need to be updated. Throughout our visit we observed residents following their individual routines and helping with some household tasks. One resident was preparing to do her/his own laundry. The home has had a new washing machine and the resident told us staff had shown them how to use it. We also saw a ‘prompt sheet’ on its use had been produced for them. A staff member told us the Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 15 resident was good at following written instructions. Another resident was seen laying the dining table ready for the evening meal. The menu for the day is displayed in pictorial form in the kitchen with the choice of two options. Each week staff and residents plan the menu for the following week. The records kept of meals taken show, where requested, alternative meals are also provided. All the residents we spoke to told us they enjoyed the meals and are able to dine at time that suits them. The records show five staff members have attended training managing diabetes. 90 of the staff team hold a Basic Food Hygiene certificate. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. People who use the service receive support from the home to meet their personal and healthcare needs and in a way they prefer. The home has good systems in place for managing medication on behalf people living at the home. The home should review its recording systems to demonstrate more fully how they support individuals to manage their own medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided to us by the home identifies two residents who require varying levels of support with personal care. Staff told us all people living at the home have good mobility. They are aware of individual personal preferences of those who require support with bathing and dressing. Residents we spoke with told us they choose their own clothes and staff are available to offer advice, when requested. We observed good interaction between staff and Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 17 residents. Staff respects residents right to privacy and dignity. They address individuals by their preferred name and do not enter bedrooms without knocking. The files we looked at contained information about keeping healthy and a health care checklist for routine and specialist appointments. The records show residents are supported to access community health care services, such as the general practitioner, dentist, optician and chiropodist. The GP for one resident advised a healthy eating programme and is monitoring her/his progress. Specialist support is also sought, such as speech and language and occupational therapy. The home works with health care professionals to produce individual healthcare action plans. Since our last visit the home has produced a healthcare flowchart for supporting a resident to communicate her/his feelings and make their own informed decisions about their health care. The medication policy and procedures were last reviewed in July 2007. A list of individuals authorised to handle medication is kept in the medication folder with a sample of their signature & initials. Two are no longer employed by the home and one is on extended leave. This list needs to be updated. The manager told us six staff members are currently undergoing training. There is a suitable storage facility for medication. The records kept for receiving and disposal of medication were found to be in good order. We looked at the medication administration record (MAR) sheets for three people living at the home and seen to be completed appropriately. However, the list of medication kept in individuals’ files needs to be kept updated. The manager is advised that where it was necessary for handwritten entries to be made, for medication prescribed outside the normal repeat cycle, these should be witnessed and signed by a second member of staff to reduce the risk of recording errors. We looked at records for one resident who part-manages her/his medication and discussed this arrangement with the resident and two staff. Staff orders the medication and the resident collects it from the pharmacist. The resident has her/his own lockable facility to store the medication. Staff we spoke said the resident was gaining in confidence, but still needed their reassurance. The resident told us they were aware of possible side affects associated with the medication. The arrangements for managing, supporting, monitoring and recording medication should be detailed on the individual’s care plan. The manager told us the home has a good relationship with the pharmacist who makes routine audit visits. They are currently working together in developing new protocols and formats for “as required” (PRN) medication. On the rare occasion medication is given to one resident’s relative, for example if they are going out for the day. The manager is advised to discuss the home’s practice with the pharmacist to ensure suitable arrangements are in place. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 18 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 & 23 Quality in this outcome area is good. People who live at the home are encouraged to express their views and are satisfied with how staff responds to suggestions and concerns raised by them. The home has suitable procedures and systems to ensure the safety and well being of residents is promoted and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received by the home and none have been reported to Commission for Social Care Inspection (CSCI). A copy of the home’s complaints procedure is produced in written and pictorial formats. Residents have a copy of document in their bedrooms. People we spoke to told us they knew whom they would speak to if they had any concerns or worries. Staff told us regular meetings enable concerns to be identified and addressed at an early stage. There have been no reported adult protection issues and no concerns were identified during this visit. Safeguarding policy and procedures are available in the home. Staff told us they were familiar with these and were confident in reporting any concerns that may affect the safety and welfare of the people who live at the home. Training in abuse awareness and the protection of Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 19 vulnerable adults is provided for staff. The manager told us four staff members have not yet received this training, but courses were being arrangement. The personal allowances for some residents are managed on their behalf by the home. Staff explained how they encourage individuals to make their own choices when they are out shopping together. There are good systems for recording transactions and suitable facilities available to ensure their money is kept safe. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is good. The people who use the service are provided with a homely and comfortable environment in which to live. Attention to cable management in bedrooms will ensure the individual’s safety is fully more fully protected. There are suitable procedures and systems to ensure a good standard of cleanliness is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home have freedom of access to communal areas such as lounge, dining room and, subject to a satisfactory risk assessment, the kitchen and laundry. The garden can be accessed via the side door by the laundry area. However, residents normal choose to use the patio doors in the dining room. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 21 Since our last visit the hall, stairs and landing have been re-decorated. The manager told us he is waiting to receive a 12 month programme for work to be carried out in maintaining the building following a recent visit by the company’s maintenance officer. The replacement of the settee and redecoration of the lounge was identified by staff as a priority for this year. Residents are able to choose what colour they wish their bedrooms to be decorated. Their individual personalities and interests are reflected by the personal belongings they have on display. One resident has a number of electrical appliances and equipment in her/his room, such as TV and computer. Some of the cables were trailing loose on the floor. To reduce the risk of accidents occurring the home needs to ensure good arrangements for cable management are included in its environmental checks. The home does not employ ancillary staff. Suitable procedures are available for care staff to follow to ensure the home is clean and comfortable. Residents are encouraged to participate in some domestic tasks and keep their own rooms clean with support from staff. Staff told us they felt residents benefited from not having designated domestic and catering staff because the carrying out of the majority of tasks included the residents. This enabled them to develop their independent living skills. Training has been provided to some staff in infection control. The home received a positive report of the recent visit made to the premises by the Environmental Health Agency. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 & 36 Quality in this outcome area is good. A stable and experienced staff team provide the care and support the people living at the home need. The staff team are supported to carry out their duties through regular team meetings and a planned programme of supervision. The safety and well being of service users are protected through the home’s policies and procedures for the recruitment of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home continue to be supported with their care by a stable staff team. The rotas show suitable staffing levels are maintained to meet residents individual care needs. There is a designated person in charge of each shift. Staff presented themselves as confident in their roles and understood what is expected of them. Suitable procedures are in place for the recruitment of staff. We looked at the recruitment records for two staff. These contained satisfactory criminal record Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 23 bureau checks (CRBs) and references. These were obtained prior to the person commencing employment. Newly appointed employees are provided with a period of induction and arrangements made for them to complete the Skills for Care course. The NVQ Level 2 Certificate (National Vocation Qualification) is held by 95 of the staff team. Training is recorded on a matrix that shows ‘at a glance’ each individual’s training needs, courses booked and completed training. Staff who we spoke with told us training opportunities within the home are good. Arrangements are being made for some staff to attend training refresher courses. Since our last visit the manager has improved arrangements for providing regular planned supervision sessions for staff, for which records are kept. Staff told us they find these sessions useful especially having the opportunity to discuss their own practice and training needs. The manager and deputy told us they are developing staff support systems by implementing an annual appraisal system in the near future and training and development plans will be agreed with each member of staff. Staff meetings include team discussions about policies and procedures and care practice issues for which minutes are produced. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 24 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 & 42 Quality in this outcome area is good. People who use the service benefit from living in a home. It has a registered manager who is supported by a deputy and experienced and stable staff team. The home’s has not yet fully implemented its quality assurance system. However, people living at the home are confident their views influence the changes made to the service for their benefit. The home has suitable policies and procedures to promote the safety of people who live at the home. However, to ensure their safety and comfort is more fully protected appropriate arrangements must be made to ensure bedrooms remain free of trip hazards and the dining room is kept a smoke-free zone at all times. This judgement has been made using available evidence including a visit to this service. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has the relevant experience required for working in a residential setting with this client group. He is supported in his role by deputy and receives regular visits from his line manager. Monthly visits are also made to monitor the home’s performance. A report on the findings of the visit is produced and a copy provided to the manager. The home consults with people living at the home on a one-to-on basis and at group meetings. The residents are asked periodically to complete pictorial surveys about the quality of the service and are supported to do so by staff. The manager is advised to consider a more independent method for supporting people to express their views in this way. Surveys are also sent to other people who have an interest in the home such as relatives and health & social care professionals. The manager reported this response was poor. This was evident in the number of responses seen for March and October 2007. Nevertheless, comments about access to information and provision of activities appeared in some of the responses and needs to be addressed by the home. During our last visit we discussed improvements to be made in the home’s quality assurance system such as publishing results of surveys and providing interested parties with a copy of an annual development plan for the service. The manager stated this would be focussed on more fully during this year. Policies and procedures are available to staff on safe working practices and training in health & safety issues are provided to staff. Records are kept of inspections and servicing of appliances and equipment. The home carries out its own regular checks on the environment. The manager is advised to review the home’s management systems for observing practice and monitoring records to ensure areas that may affect the safety of residents are being addressed appropriately. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 2 4 3 5 2 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 3 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 12 (1) (a) Requirement To ensure proper provision is made for the welfare of the person who travels independently details of the arrangements agreed must be included in her/his care plan and risk assessment. Details of all arrangements for supporting an individual to manage her/his own medication should be clearly detailed in their care plan. Timescale for action 19/09/08 2. YA20 13 (2) 19/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA3 YA5 Good Practice Recommendations The Statement of Purpose should be amended to accurately reflect what is/is not currently included in the fees and issued to interested parties. Staff should receive training to meet the needs of individuals who are identified with limited communication. People who live at the home should be provided with a copy of their contract/statement of terms & conditions DS0000004827.V364913.R01.S.doc Version 5.2 Page 28 Westgate 4. 5. YA6 YA7 6. YA7 7. YA9 8. YA16 9. 10. 11. 12. YA20 YA20 YA39 YA42 agreed with the home. The home should improve its arrangements for reviewing care plans with residents, and significant people in her/his life, at least once every six months. Daily recordings and minutes of key worker meetings should be more detailed to reflect how individual’s are to be supported to make decisions and participate in the planning of their own care. Additional training for staff should be provided on the Mental Capacity Act to promote confidence in supporting individual’s to make informed decisions and, where necessary, to make appropriate decisions on their behalf. A lockable facility should be provided for storing items considered to be a risk to an individual’s safety that does not restrict him from having access to his other belongings. The dining room should be a smoke-free area at all times to ensure the comfort of people who choose not to smoke and more suitable arrangements made for people who choose to smoke. The home’s smoking policy, associated information should be amended to reflect the new arrangements and, were applicable, individual’s risk assessments updated. Details of staff authorised in the safe handling and administering of medication should be kept up to date. Hand written entries on MAR sheets should be witnessed and signed by a second member of staff to reduce the risk of recording errors. The quality assurance system should include the publishing of results from surveys and an annual development for the service. Management monitoring systems should be reviewed to ensure areas that may affect the safety of residents are being appropriately addressed. Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westgate DS0000004827.V364913.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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