Care Home: Westleigh

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What the care home does well People who live at Westleigh House have confidence in the care home because it is managed by a qualified and experienced person who has developed her skills over time through training and personal development. People who are thinking of moving to Westleigh are given good information to help them make decisions about the home. The information about the home, what it does and who it is for, is clearly written in plain and clear language so people are helped to understand the information and know what the home provides. This showed us that managers and staff understand the importance of providing people with the information they need to help them choose a home that is suitable for them. Each person`s individual needs are known and their rights to privacy and confidentiality are respected so the support they get from staff is given in a way that meets their needs and maintains their dignity. All the people who live at the home have a care plan that has been written and developed with them so they receive care and support in the way they want and prefer. The atmosphere in the home is relaxed and sociable. People are offered a range of activities in the home and are supported and encourage to explore and take advantage of opportunities for leisure, education and meeting and socialising with other people in the local community. All the people who live at the home told us that they were happy there and their health and welfare needs were met. Some people described the home as excellent and one person told us it was the best place they had ever lived. We could see that the people who live at Westleigh House have good relationships with staff . They told us that they liked the staff and some people told us that the staff were excellent. We could see that there is a strong and consistent team of staff. They are well trained and were recruited through thorough procedures so they are suitable to work with the people who live at the home. Managers and staff are very good at involving people in the day to day management of the home and getting their views on the quality of care, facilities and services provided. People told us that their views were always taken seriously and acted upon. This showed us that the home is run in the best interests of the people who live there. What has improved since the last inspection? At our last inspection we found that the records made for handling money on behalf of the people who live at the home needed improving so managers and staff could show that they were accountable. We could see that this had been done. Records showed that the home had good systems for assisting people with their money so their financial interests were safeguarded. Medication records had also been improved so managers and staff can make effective checks of the stocks of loose medication. Improvements had been made to the information provided by the home so peopleknow what the home does and provides. Some of the information is illustrated with pictures and symbols so more people are helped to understand what the home has to offer. We could see that care plans, assessments and risk assessments had been improved with more information about the person`s strengths and capacity to make decisions so their independence was promoted and they received the right type of support to make informed decisions about their lives. Staffing levels had improved since our last inspection with an additional shift being worked 6pm to 9pm five days each week Monday to Friday. This provided a third member of staff so there was more time to spend with people on a one to one basis. The range of supported activities on offer in the home and in the local community have improved so people are able to do the things they want to do and develop the lifestyle they choose. Choice of meal had been improved because people were able to choose between the options on the menu on the day the meal is served. What the care home could do better: We could see that managers and staff were committed to helping people to develop their skills, identify their goals and and work to achieve them. However, people who live at the home do not have access to the main kitchen and there are no other facilities for people to practice and develop culinary skills. This means that some people`s needs are not always met. We made a recommendation at our last inspection that domestic kitchen facilities are provided. Senior management responded to our recommendation but so far have been unable to provide the needed facilities because of lack of available space. Whilst we recognise the limitations of available space we have made the recommendation again because it is important to the well being of each person that their needs to develop and maintain independent living skills are met in full. None of the people who live at Westleigh House take part in their own medicines management with the exception of the use of inhalers. However, discussion with the manager and senior staff showed that it is likely that some people who live at the home could be helped to take part in their own medicines management if only by degree. We have recommended that managers and staff seek to encourage and support the people who live at the home to play at least some part in the management of their medicines. This is important because it will help people to develop their skills and maintain independence. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Westleigh 109 Walton Road Stockton Heath Warrington Cheshire WA4 6NR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Jones     Date: 0 7 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Westleigh 109 Walton Road Stockton Heath Warrington Cheshire WA4 6NR 01925860584 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : alison109@tiscali.co.uk Warrington Community Care care home 18 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 18 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender. Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 18. Date of last inspection Brief description of the care home Westleigh House is a care home operated by Warrington Community Care that provides a long-term home for people who have suffered, or are suffering from an enduring mental illness. The care home is located in a pleasant and popular residential area of Warrington known as Stockton Heath. It provides spacious and well-maintained accommodation. There are 18 single bedrooms, two of which are being used to provide double accommodation for two people who wish to share. There are four lounges including one which is designated the smoking lounge. Thirteen WCs, three bathrooms and two shower rooms. Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home Information about Westleigh House including copies of the most recent inspection report is made available to each of the people who live at the home and can be acquired by contacting the home on the telephone number given above. Information provided by the registered manager on the 15 September 2009 confirms that fees range from 382 to 438 pounds sterling per week There are no additional charges other than hairdresser, toiletries, and other sundry items charged at cost. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means that people who live at Westleigh House experience excellent quality outcomes. This visit was unannounced. It took place over two days, taking 7 hours and 25 minutes in total, and was done by one inspector. This report will say we when referring to our activities and findings, as it is written on behalf of the Care Quality Commission. Our visit was just one part of the inspection. Before the visit took place we asked the manager to complete a questionnaire that we call an annual quality assurance assessment or AQAA for short. It gives us information about how the home is meeting Care Homes for Adults (18-65 years) Page 6 of 31 the needs of the people who live there and includes plans for future development. We looked at the information that we already had about the home and this, with the information from the AQAA, helped us to form our inspection plan. We checked the records of two people who lived at the home to see what care they receive. We spoke with ten of the people who live at the home and some of the staff who support and care for them and their views were taken into account. We looked at the communal areas of the home, including lounges, bathrooms and toilets to see how the home was decorated, maintained and furnished. We also looked at some policies and procedures to check that these were up to date and provided suitable guidance for staff. What the care home does well: What has improved since the last inspection? At our last inspection we found that the records made for handling money on behalf of the people who live at the home needed improving so managers and staff could show that they were accountable. We could see that this had been done. Records showed that the home had good systems for assisting people with their money so their financial interests were safeguarded. Medication records had also been improved so managers and staff can make effective checks of the stocks of loose medication. Improvements had been made to the information provided by the home so people Care Homes for Adults (18-65 years) Page 8 of 31 know what the home does and provides. Some of the information is illustrated with pictures and symbols so more people are helped to understand what the home has to offer. We could see that care plans, assessments and risk assessments had been improved with more information about the persons strengths and capacity to make decisions so their independence was promoted and they received the right type of support to make informed decisions about their lives. Staffing levels had improved since our last inspection with an additional shift being worked 6pm to 9pm five days each week Monday to Friday. This provided a third member of staff so there was more time to spend with people on a one to one basis. The range of supported activities on offer in the home and in the local community have improved so people are able to do the things they want to do and develop the lifestyle they choose. Choice of meal had been improved because people were able to choose between the options on the menu on the day the meal is served. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Adults (18-65 years) Page 9 of 31 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving to Westleigh House are given clear information and are invited to visit so they can make a choice about the homes suitability for them. They have their needs assessed so they can be confident that their needs will be met when they move in. Evidence: People who lived at the home told us that the information they were given was good. They were encouraged to visit the home before they moved in so they were helped to make an informed decision about the homes suitability for them. The information about what the home provides and who it is for (the statement of purpose and service users guide) were written in plain and clear language so people were given clear and concise information. Both documents had been reviewed and improved since our last inspection so the information was up to date. The service users guide was illustrated with pictures and symbols so people were helped to understand what the home had to offer. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: People can also read past inspection reports and the homes quality assurance reports, news letter and annual report, which all contain the views of other people living at the home to help people with their decision-making. We could see that people who live at the home own and identified with the information provided. They showed us the news letter and annual report which they had contributed to. This showed us that managers and staff understood the importance of providing people who were thinking of moving to Westleigh House with the information they need to help them decide whether the home is suitable for them. We checked the records of two people who lived at the home. We could see that both people had their needs assessed before they moved in so they could be confident that their needs would be met. We could see that their assessments were done with them and their representatives so they would receive care and support in the way they would prefer. If people decide that the home is suitable for them they are given and asked to sign a license agreement so they know their rights and responsibilities. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Westleigh House are actively involved in developing their own care plans so the health and personal care they receive is based on their individual needs. Evidence: We looked at the care records for two people and we spoke with them and a number of others to get their views on the care and support provided. All the people we spoke with during our visit praised the home and the staff for their care and a visiting social care professional told us that staff were committed to supporting people to live the lifestyle they choose. We could see that the people who lived at Westleigh House were involved in the planning of their care and support so they received care in the way they wanted and preferred. Each person had a care plan that had been developed with them and was signed by them to show that they agreed with it. Care plans had been improved since our last inspection with more information about the persons strengths and capacity to Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: make decisions so their independence was promoted and they received the right type of support to make informed decisions about their lives. This showed us that managers and staff understand the importance of people being able to take control over their lives. Risk assessment is an important part of the homes care planning procedures so the people who live at the home and staff were safe. We could see that risk assessments balanced choice and risk so people were supported to take an element of risk in the interests of living an independent and fulfilling lifestyle. This had many positive outcomes for the people who lived at the home. They told us that they were aware of the risks in everyday life but had confidence in their own abilities and were able to take advantage of opportunities for social interaction and community life to the full, including going out shopping and engaging in community based activities and social events. However, there was some room for improvement. For example, we could see that care plans and risk assessments were reviewed on a regular basis with involvement of the person but one persons care plan and risk assessment had not been revised when their needs had changed. This meant that both the care plan and risk assessment for this person were inaccurate and provided contradictory and misleading information. The manager told us that she was aware that further improvement was needed to make sure that care plans were accurate and up to date. This is to be addressed through one to one supervision for staff and further staff training on care planning where required. We could see that people were involved with the running of the home. They always take the initiative to meet visitors at the front door and welcome them in. They were asked about the quality of meals, standard of care and facilities and services provided on a regular basis through the homes quality assurances processes and they told us that their views were valued, taken seriously and acted upon. People told us that they enjoyed and valued the cluster meetings they have with staff. These are meetings where one of the a deputy managers meets with an identified group of people on a regular basis. Together they discuss any matters that are important to them including the menu and planning future activities and holidays. Minutes of the meetings were available to all people who live at the home. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Westleigh House are supported to make choices about their lifestyle and are offered a range of activities in the home and local community that meets their needs and expectations, so they can live fulfilling lives. Evidence: People who live at Westleigh House told us that they were able to make choices about their lifestyle and said they were happy with the range of activities on offer including the art class, indoor and outdoor bowling, trips out to local pubs and other community facilities such as the swimming baths and cinema. One person showed us an article in the annual report which showed their achievements in art. They told us that Westleigh House was the best place they had ever lived and others made similar comments listing the range of activities that they enjoyed in the home and local community. The atmosphere is relaxed and sociable. Staff tend to remain in the background so as to Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: encourage the people who live in the home to take the initiative to answer the door and welcome visitors to the home. The annual quality survey report showed that staff listen to peoples views and act on what they say. One person told us: I like the freedom of living here as I can come and go as I please. This shows respect for the people who live at Westleigh House and reinforces their rights and the fact that it is their home. We could see that managers and staff were committed to helping people to develop their skills, identify their goals and and work to achieve them. Staffing levels had improved since our last inspection with an additional shift being worked 6pm to 9pm five days each week Monday to Friday. This provided a third member of staff so there was more time to spend with people on a one to one basis. Our observations and discussions with the people who live at the home and a visiting social care professional showed us that care staff had the right skills to help people explore opportunities for leisure, social interaction and occupation in the local community. Goal plans were produced so people get planned and structured support to help them achieve their goals and do what they want to do. For example one of the people who lived at the home had lost confidence to go out into the local community. Records showed that their key worker had developed a goal plan with them so they were helped to gain the confidence they needed to live a more independent and fulfilling lifestyle. People had varying degrees of responsibility to undertake domestic tasks around the home according to their abilities needs and wishes. This is good practice because it helps people retain and develop their domestic living skills. However, people who live at the home do not have access to the main kitchen and there are no other facilities for people to practice and develop culinary skills. This means that some peoples needs are not always met. For example the assessment for one person showed that they needed support to rebuild their lost daily living skills with food and meal preparation and cooking. Staff told us that they were unable to develop a goal plan to meet this persons needs because the home did not have a domestic kitchen that people could use. We made a recommendation at our last inspection that domestic kitchen facilities are provided. Senior management responded to our recommendation but so far have been unable to provide the needed facilities because of lack of available space. Whilst we recognise the limitations of available space we have made the recommendation again because it is important to the well being of each person that their needs to develop and maintain independent living skills are met in full. We have also made a recommendation to explore other ways people could be offered opportunities to practice and develop culinary skills so their needs are met, whilst alterations are made to the premises. Staff support people to maintain family links, friendships and personal relationships. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: People are able to entertain their guests in private if they wish and visiting relatives and friends are always made welcome. Everybody living at the home was happy with the standard of food - in fact most people we asked told us that the food was excellent. Choice had been improved since our last inspection because people were able to choose between the options on the menu on the day the meal is served. Menus seen indicate that a varied and nutritious diet is on offer and special dietary needs, individual likes and dislikes were known and catered for. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and the principles of respect, dignity and privacy are put into practice and promoted so the people who live at the home feel respected and valued. Evidence: Personal health care needs including specialist health care and dietary requirements are clearly recorded in each persons care record file. Care records provide an overview of each persons health care needs and act as an indicator of change in health requirements. We spoke with ten of the people living at the home and all told us that their needs were met in the way they wanted them to be. Most praised the staff for the standard of care provided and some told us that the care was excellent. This showed us that the principles of respect, dignity and privacy were put into practice and promoted so the people who live at the home feel respected and valued. People who use the service were encouraged to manage their own health care. Staff supported them to make and maintain contact with their respective health care professionals. They are able to choose their own GP and have access to all NHS Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: facilities in the local community. A visiting social care review officer employed by Warrington Borough Council described Westleigh House as an excellent home and spoke highly of the staff team and the standard of care provided. Managers and care staff were said to be knowledgeable about mental health issues and understood the importance of people being supported to maintain control over their lives. Staff had benefited from training on the mental capacity act and were sensitive and skilled in their approach. Records showed that they worked in partnership with health care professionals and supported the individual in a person centred way so their health care needs were met. Medicines management and administration was checked. A monitored dosage system was used throughout the home. No errors were noted on medicine administration records. Stock records of medicines provided in their original packages were not kept in the required detail so staff were unable to make stock checks to ensure that medicines were administered appropriately. However one of the deputy managers took immediate action to address this and on the second day of the inspection we could see that appropriate records were being kept. None of the people who live at the home take part in their own medicines management with the exception of inhalers. Discussion with the manager and senior staff showed that it is likely that some people who live at the home could be helped to take part in their own medicines management if only by degree. We recommend that managers and staff seek to encourage and support the people who live at the home to play at least some part in the management of their medicines. Capability and risk assessments should be completed to identify the level of support each person would need to play a part in the management of, or where appropriate take control of, their own medication safely and responsibly. This is important because it will help people to develop their skills and maintain independence. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Westleigh House are able to express their concerns and have access to an effective complaints procedure. There are effective processes at the home to make sure people living there are safeguarded from abuse and have their rights protected. Evidence: Managers and staff have a positive attitude toward receiving complaints and people who live at the home say staff listen and act on what they say. No complaints have been received since our last inspection of the home. People who use the service are supplied with a complaints procedure that sets out how to make a complaint and the action that will be taken by the home in response. Some of the people were unaware of the complaints procedure but all told us that they knew who to speak to if they were unhappy or wanted something to change. We were told that some of the people who live at the home had difficulty reading and understanding documents written in a standard way so staff will go through any such document with them on request. We recommend that the complaints procedure is produced in a variety of ways which may include large print, illustrations, audio and photographs so all people are helped to understand the information. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Westleigh House has good procedures for responding to suspicion or evidence of abuse including a whistle blowing policy so staff know that they can report poor practice. There had been no safeguarding referrals from the home to the local authority since our last inspection at Westleigh House. The manager has provided the staff with training on adult safeguarding procedures so they know what to do if there is any evidence or suspicion of abuse. Information provided by the manager before our visit showed that all staff receive refresher training on safeguarding at least once every two years but staff training records were not up to date so we were unable to confirm this. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained throughout and all people we spoke with told us that the home is always clean and fresh. Systems are in place regarding food hygiene and infection control so people are protected from infection and food contamination. Evidence: Westleigh House is located in a residential area of Warrington known as Stockton Heath. It is a large detached property that has been extended to provide appropriate living space for the 18 people living as one group. People who live at Westleigh House like the way it is laid out. One person said you cannot fault it, it is a lovely place to live. People told us that they are encourage to personalise their bedrooms and are involved in decisions about any proposed changes to the communal areas of the home including decoration, furniture and layout. Information provided by senior management showed that people had been asked whether changes should be made to provide domestic kitchen facilities but there had only been limited interest in this. However, we could see from assessment documentation and discussion with staff that the home was unable to meet one persons assessed needs because of a lack of suitable facilities. Therefore we have recommended that further consideration is given Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: to the provision of a domestic kitchen so people can develop their culinary skills and cook meals for themselves if they wish. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Managers and staff are trained and have gone through thorough recruitment processes so they are suitable and have the right skills to work with the people who live at the home. Evidence: Our observations and discussions with the people who lived at the home and a visiting social care professional showed us that there were enough staff on duty to meet the needs of the people who live at the home. Staffing rotas took account of the changing needs of people so more staff were employed at times of higher demand. Staff numbers had been increased at our last inspection with a third staff member on duty between 6pm and 9pm Monday to Friday. This meant that staff had more time to spend with the people who live at the home on a one to one basis so their personal care needs were met. All the people we spoke with during our inspection were complimentary about the staff and the standard of care they provided. We could see that staff were experienced in caring for people with mental health needs. They carried out their work in good humour and with sensitivity for each persons needs so people always received care in the way they wanted and preferred. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We talked with the manager, one of the deputy managers and one of the care staff about training opportunities and we looked at staff training records. Staff training records were not up to date. However we could see that there was a comprehensive staff training and development programme with opportunities for training in a range of relevant topics. All new staff complete the Skills for Care induction programme. This includes the common induction training standards so all new staff have the skills they need to carry out their jobs effectively and competently. Eight of the homes eleven care workers had achieved a national vocational qualification (NVQ) in care at level three or above and one had achieved level 2 in care. NVQs are nationally recognised qualifications for staff in the care profession. This showed that the home had exceeded the target for a minimum of 50 percent of staff to achieve a nationally recognised qualification in care by a good margin. This showed us that the people who live at the home were safe and had appropriate support because the staff providing their care were qualified and competent. All staff had the benefit of an annual appraisal and a personal development action plan. These help managers and staff to identify what training and refresher training needs to be done. The home has targets for refresher training on important topics so managers can be confident that staff have the skills they need to carry out their jobs safely and effectively. Information provided by the deputy manager responsible for staff training showed that a number of staff needed training on protection of vulnerable people, and moving and handling. However, arrangements were being made to address these training needs. All staff spoke highly of the manager indicating that communication in the home is good. Records showed that they have regular supervision and regular staff meetings so the people who live at the home benefit from a well informed and appropriately supported staff team. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Westleigh House has a qualified and competent management team so people have confidence in the home because it is well managed. People are involved in the running of the home and their views about the quality of care, facilities and services provided are taken seriously and acted upon so they know the home is run in their best interests. Evidence: The manager of the home is a qualified nurse who is experienced in the field of mental health and has developed her skills over time through training and personal development. She has been in post for more than ten years and has achieved the City and Guilds 3251 in advanced care management and the Registered Managers award at NVQ level 4. Staff speak highly of the manager saying she is a good leader, approachable and very supportive. The management structure was suitable for the stated purpose of the home. It included the service manager who was based in Warrington, the manager of the home, Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: and three deputy managers. They led a strong and consistent team of staff who were well trained and well supervised so they were able to meet the needs of the people who lived at the home. Our observations and discussions with staff, the people who live at the home and a visiting health care professional showed us that the manager is person centred and has a clear understanding of what needs to be done to make sure the home is run in the best interests of the people who live there. All staff spoken with were familiar with the concepts of equality and diversity and told us how they recognised and met each persons individual needs through person centred planning. All deputy managers had received training on equality and diversity and plans were being made to offer this to all staff in the next 12 months period. Effective quality assurance procedures were in place. These were based on seeking and acting on the views of the people who live at the home, their relatives and the health and social care professionals who support them. Feedback is actively sought through quality assurance surveys, residents meetings and regular monthly visits made by the care coordinator. The people who live at the home can see the care coordinators monthly report and an annual report is produced following the quality assurance survey. This showed what had been done to address quality issues so people know their views were taken seriously and acted upon. Records showed that the home had good systems for assisting people with their money so their financial interests were safeguarded. We could see that the the health and safety of the people who live at the home, their visitors and staff was promoted. Information provided in the AQAA showed us that installations and equipment were serviced regularly so people were safe. The manager and other senior staff carry out risk assessments so hazards were identified and where appropriate risk assessments and risk management plans were put in place so people were safe. One of the risk assessments seen needed revising because it had not been updated when circumstances had changed. However, the manager told us that she was aware that some more work needed to be done to make sure that care plans were up to date and arrangements were being made to address this. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 11 Steps should be taken to provide the people who live at the home with opportunities to practice, develop and maintain their culinary skills so their needs are met and independence is promoted. Action should be taken to support and encourage people to retain, administer and control their medication within a risk management frame work. Capability and risk assessments should be completed to identify the level of support each person would need to play a part in the management of, or where appropriate take control of, their own medication safely and responsibly. This is important because it will help people to develop their skills and maintain independence. 2 20 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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