Care Home: Westwinds

What the care home does well The location and layout of the home is suitable for its stated purpose. It is accessible with a pleasant and homely atmosphere. Meals are varied and offer choice, ensuring people receive a balanced and nutritious diet. Staff has an understanding of equality and diversity and have investigated ways in which they can support cultural and religious differences for individuals living within a group setting. Physical and health care is offered in the way service users prefer. The manager is open to constructive feedback, comments and complaints and is fully aware of how the service needs to develop and improve. Staff are valued by service users. Feedback in surveys was largely positive about the service. What has improved since the last inspection? This was the first baseline inspection of a pre registered service. This section is therefore not applicable to the home`s new registration. What the care home could do better: During feedback specific shortfalls in staff training were discussed with the appointed manager. Due to the heavy demands that an increasingly ageing and dependent service user group place on the staff it was also discussed that staffing levels should be kept under regular review to ensure all service users needs are consistently met. Care documentation should be formulated in a timely manner and further developed to better evidence the home`s good practice and to ensure it is person centred. In addition, a review and amendment of the home`s Statement of Purpose and other information documents needs to take place to ensure people have comprehensive guidance and clear information about the service offered at Westwinds. Key inspection report Care homes for adults (18-65 years) Name: Address: Westwinds 48 West Street Reigate Surrey RH2 9DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marion Weller     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 Information about the care home Name of care home: Address: Westwinds 48 West Street Reigate Surrey RH2 9DB 01737277636 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lynda.dance@sabp.nhs.uk Leonard Cheshire Disability Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10 The registered person may provide the following ategory/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Westwinds is a large detached house located in a residential area just outside the town of Reigate, Surrey. The care home is registered to provide accommodation and care for up to ten people with a learning disability in the age range of 18 - 65 years. The home currently provides a service to a predominantly older client group. Leonard Cheshire Disability has recently taken over the ownership and operation of the home from Surrey and Borders NHS Trust Partnership as part of the Trusts planned reCare Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 10 Brief description of the care home provision programme. Leonard Cheshire Disability has made no changes to the homes staff team or the service user group accommodated. All bedrooms for service users are for single occupancy and accommodation is arranged over two floors of the property. Access to the second floor can either be by passenger lift or stairs. Communally the home provides a kitchen, dining area and a living room. There are a sufficient number of bathing and toilet facilities to meet service users needs. There is a large front garden and a secluded rear garden to which people living there have access. There is ample car parking to the front of the home for visitors to Westwinds. The home provides its own transport, which is made available to service users. The fees charged are £1015 per week. Please contact the manager for more detailed information. Care Homes for Adults (18-65 years) Page 5 of 32 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: two star good 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: Westwinds care home was previously owned by Surrey and Borders NHS Partnership. As part of the NHS Trusts Social Care Change Programme the service was transferred to Leonard Cheshire Disability who now own and manage the home. A new registration of this pre existing service was agreed by the CQC on the 2nd October 2009. The purpose of this site visit was to undertake the homes first baseline inspection to judge the quality of service in operation under the ownership and management of Leonard Cheshire Disability. The inspector, who was unaccompanied during the site visit, arrived at the service on the 19th January 2010 at 10:45 am and was in the home for six hours. During the site visit the inspector met with some staff members both communally and in private. The inspector also spoke at length with the appointed manager. It was not possible to obtain a view about the home or their care from the majority of service users due to their level of learning disability and frailty. Judgements were made and based on their Care Homes for Adults (18-65 years) Page 6 of 32 mood, behaviour and information given by relatives, representatives and staff. A number of documents relating to service users were sampled including care plans, risk assessments and medication records. Three staff files, including recruitment and training records were also checked. The inspection report takes into account all the information obtained about the service. This includes any formal notifications, reports, phone calls and letters received and any information concerning complaints or allegations. The manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document gave us sufficient information to provide a reasonable picture of what was happening in the service, and their plans for further development. Prior to the site visit, 20 surveys were sent out by the CQC to ask for peoples views about the service. Disappointingly only 6 responses were received back. The responses were however useful and helped us form a view about the service. No staff surveys were returned to us. During the site visit the inspector looked at how well the service was meeting the standards set by government and has, in this report, made a judgement about the standard of service provided by the home. There were no legal requirements made as a result of this inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 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 9 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users would benefit from information documents tailored to their individual needs. Prospective service users should be provided with all the information they need about the type of service provided at Westwinds to enable them to make a firm decision about whether the service can meet their needs. Assessments of need are made before a service is offered. Improved documentation will better evidence the homes good practice. Evidence: The appointed manager said that any new residents to Westwinds are admitted to the home following completion of a pre admission assessment to ensure the home can meet the persons needs. The assessment process in place is designed to involve the prospective resident, their family or advocates and any professionals involved with their care and support. The manager said that the assessment also takes into account the needs of the existing residents, to ensure that the home is the most appropriate place for the person to be. In addition, prospective residents are given the opportunity Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: to visit the home so they can make an informed decision about moving in. The homes AQAA records that a new service user was admitted to the home in October 2009. The pre admission documentation for the individual was seen and illustrated that information gained was primarily provided by social care professionals involved with the persons care. The documentation however covered all the areas of support that the individual would need and clearly identified mental health needs which relate to the care of an individual from an older client group, who also has a learning disability. The completed pre admission assessment documentation was therefore considered against the homes current Statement of Purpose and Service User Guide. The provider submitted a Statement of Purpose giving information about the service they would provide at the time of their registration in October 2009. Upon inspection it was seen that the Statement of Purpose does not clearly outline how the service meets the needs of individuals who come into the category of older adults or the specialist staff training needed by people who may suffer from dementia or other types of mental illness associated with an ageing client group, and who may be admitted to Westwinds. It was discussed with the appointed manager that the homes information documents should be comprehensively reviewed to include this information and to accurately reflect that the home predominantly cares for people from an older service user category. This will ensure that prospective service users or their representatives have all the information they need when considering if the home is suitable for them. The service users guide would also benefit from review to ensure it includes all the elements of standard 1.2 in a more user friendly language and format to meet individual need. The section that deals with the homes environment for example is prescriptive about what the person must or must not do and lacks the detail required by potential service users who may be more interested in things like, what will my room be like? Or, will I have enough space? So, this type of information should be in the guide. Care Homes for Adults (18-65 years) Page 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have an individual plan of care. Not all plans of care are sufficiently well developed to evidence the homes good practice and prove that the care plan is used as a working document, which accurately reflects the care being delivered. Individuals are supported to make some decisions in their lives and where possible have a say in how the home is run. People using the service are supported to take assessed and reasonable risks as part of an independent lifestyle. Evidence: Each person accommodated has an individual plan of care. Two of these plans were inspected in detail. The first was a plan of care for a service users admitted 3 months previously. The second for a service user resident at Westwinds for a number of years. Documentation in the first care plan was not well developed and largely contained only the information gained by the service during the pre admission assessment process Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: three months previously. The picture provided of the service user in the plan of care was unrecognisable. Gaps in documentation could however be bridged by the manager and staff explaining to the inspector the care and support they provided to the person. The second care plan viewed was more comprehensive and person-centred and had been designed to enable the individuals health, personal and social care needs to be identified and addressed. The service operates with key workers identified for all the people who use the service. During discussions with staff they were knowledgeable about the needs of the people living at the home and were clear about their role in person centred care and goal planning to promote peoples choices as part of an independent lifestyle. Service users daily record content was variable and dependent on the skill of the person completing them. Content did not consistently reflect the demands of the individual care plan in place. Some daily records are being maintained away from the individuals main care plan file and therefore information held about individuals has the potential to become fragmented, which could cause confusion and result in omissions in care delivery, especially when agency staff are used to cover vacant hours on rosters. This situation also makes auditing the standard of care provided at Westwinds difficult. The appointed manager had a raised awareness that documentation in the first care plan required further development and there was a need to ensure records relating to an individual are not fragmented. The manager spoke of her firm intention to remedy this and other shortfalls in this outcome area to ensure the home can better evidence their good practice. The homes AQAA records areas for improvement in the next 12 months.... Continue to develop person centred plans for best outcomes. Risk assessments had been completed as part of the individual plans of care. The risk assessments seen were well developed and relevant to the individuals needs. They had been kept under review. In addition, they provided clear direction for staff to ensure people were safe, while aiming for improved outcomes for them. Where there were limitations placed on an individuals freedom, decisions had been made either with the agreement of the person or their representatives and had been recorded and an appropriate risk assessment developed. These covered the individual, the activities undertaken, different environments and locations. From observation, discussion with staff and from feedback in our surveys it was evident that people living in the home are offered choices in their everyday lives and are involved as much as possible in the running of the home. A survey respondent Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: records....This is a friendly home and individuals needs are always met wherever possible. Care Homes for Adults (18-65 years) Page 14 of 32 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 use the service are encouraged by staff to participate in activities both within the home and the local community and are well supported to maintain contact with their family and friends. They will benefit further when plans recorded by the manager to improve outcomes are realised. Service users are offered a healthy nutritious diet and enjoy their meals. Evidence: The people who live at Westwinds are offered a range of daily activities. The homes AQAA records.....service users each have a weekly activity timetable which is flexible. This includes Us-in-a-Bus, aromatherapy sessions, sing and sign sessions, involvement in Tandridge music project, one to one time with support staff and art and craft sessions. Records show that service users go out regularly for shopping trips, to have meals out and to visit the theatre or cinema. The manager records her Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: intention to make further improvements in this outcome area for people living in the home and says.....we shall source even more individual and meaningful activities and arrange weekend outings and activities. Westwinds have access to transport which is shared with another of the providers homes. The manager spoke of organising day trips for service users to take part in. These include visits to the coast, garden and shopping centres and other local attractions. One survey respondent records when asked what the home could do better? ......Arrange more person centred meaningful activities, provide more direct social contact between service users and staff and give more respect for residents individual choices. Some of the comments correspond with service development plans recorded in the homes AQAA by the appointed manager. The home supports service users to maintain family links and friendships. The manager said some relatives visit for birthday celebrations and at Christmas. Family members are invited to reviews to encourage their involvement in decision making and the appointed manager said they ensure that relatives and representatives receive regular telephone updates. Routines of daily living were observed to be as flexible as possible and take into account the complex and relatively high support needs of the people currently living at Westwinds. The appointed manager said service users help as much as they are able with the chores around the house and have access to all communal parts of the home. Some service users access the kitchen and laundry room with staff support. The AQAA records that service users are now making more use of their own bedrooms. These have been redecorated and personal items such as televisions and music systems updated. The manager and key workers support service users to open their mail. The staff on duty were knowledgeable about the needs of individuals within the home and in particular knew how to support service users with specific religious and cultural requirements. Care documentation also contained relevant information to ensure that peoples diverse cultural and religious needs could be met in the context of a group home. The home has a menu plan and records meals eaten by service users to monitor the provision of a healthy diet. Service users are involved in planning their meals, assisted by the introduction of a pictorial menu. Care support staff undertake the cooking duties. Training in food handling and food hygiene is regularly arranged for staff. The homes AQAA records.......There is a varied balanced diet offered and the menu, which has been viewed by the dietitian, is on display. Service users are encouraged to take Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: part in planning the menu via pictures. Some service users enjoy helping with the weekly grocery shopping at the supermarket. Care Homes for Adults (18-65 years) Page 17 of 32 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. Service users receive personal support in the way they prefer and they can be confident that their health care needs will be met in full. The service needs to further develop care documentation to better evidence good practice and to ensure that all staff are trained in specialist areas to clearly demonstrate they can meet the needs of all the service users accommodated. Evidence: Individual service user plans for the most part provided clear evidence that the people who live in the home receive the agreed levels of personal care and support they require. One individual plan of care however required significant further development, as detailed earlier in this report. Weight records for one service user who had lost weight over a period of three months did not evidence the actions taken by the home to secure the individuals health and welfare. It was clear from discussions with the manager and staff that appropriate action had taken place however and the situation referred to the individuals GP. It was recommended to the manager that shortfalls in care plan development, record keeping and the current fragmentation of service user records are addressed without delay. Terminology used in daily records and in care Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: plans should also be reviewed to ensure that practice does not breach standards of respect and dignity when caring for adult service users. For example, an audio device placed in a service users bedroom at night to protect their welfare, was consistently referred to as a baby monitor. All service users moving and handling risk assessments were seen to be comprehensive and had been regularly reviewed. The home also has health action plans in place for each service user and individuals had access to a range of appropriate health professionals to maintain good health. All service users attend annual health checks. Staff spoken with were aware of the health care needs of service users and supported them when attending the GP and other medical appointments. People who live at the home are largely unable to attend to their personal needs without advice and prompts. Support is offered as and when appropriate. The homes AQAA records increasingly high levels of dependency. The service users group is mostly made up of older people whose primary care need is a learning disability. Observation showed their support and supervision needs can be very demanding of staff time. Records also evidence that a service user has a diagnosis of dementia. Not all staff could evidence they had received the required training in supporting people with dementia or had received awareness training in the ageing process and the Department of Healths national minimum standards relating to the care and support of an older service user group. All service users bedrooms are for single occupancy and there are enough toilet and personal care facilities to guarantee their availability and privacy. The homes AQAA records......Staff learn to understand peoples care preferences by good communication and observation. Personal care is carried out with respect to privacy. The home has a robust policy for the safe storage and administration of medication. Staff receive comprehensive training and until they have satisfactorily completed the course they are not permitted to handle medication to fully protect service users from any potential for harm. The arrangements viewed for the storage, administration, record keeping and return of medicines are largely fully compliant with National Minimum Standards. The home has periodic audits by a pharmacist, to ensure practice conforms to best practice standards. It is recommended however that staff record the administration of topical medicines to service users to better evidence their good practice and to ensure that prescribed topical medicines are not left on view in service users rooms. The manager said that all service users have access to a lockable place in their bedrooms as standard demands. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Care Homes for Adults (18-65 years) Page 20 of 32 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. There are systems in place to ensue that residents are protected from abuse and they can be confident that their concerns and complaints will be acted upon. People using the service will benefit further when minor shortfalls in the complaints procedure are addressed and it is included in the service user guide for reference. Evidence: The homes complaints procedure is made available to service users, their relatives and other people visiting the home. It is also produced in a pictorial format to better meet the needs of the people who live in the home. The majority of residents have difficulty with communication and therefore staff rely on their skills of observation, monitoring and their knowledge of known behaviour patterns to inform them of a service users level of satisfaction or unhappiness. The homes AQAA records the service has received no formal complaints in the last 12 months. Some minor review of wording should be undertaken to the homes complaints procedure to reflect that the Care Quality Commission can be involved at any stage of a complaint, but the Commission is not a complaints reconciliation service. The quality of the service provided is the responsibility of the provider and concerns and complaints should be raised with the home in the first instance. The homes complaints procedure should better reflect this viewpoint. The complaints procedure would also benefit from the inclusion of clear timescales for the resolution of complaints and the contact details for the local Social Services Department. Social Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: services hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. Survey respondents raised no concerns about the how the home deals with complaints or concerns raised with them. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff induction and staff NVQ training have elements of adult protection and there has also been protection of vulnerable adults training for staff. This training is ongoing. The manager states that more update training for staff is planned for 2010/11. Staff spoken with had an understanding of adult safeguarding and protection procedures. The Manager stated any allegation of abuse would be referred to the concerned agencies without delay. The AQAA records one safeguarding investigation involving a service user accommodated in the last twelve months. This is now closed. Criminal Record Bureau checks have been obtained for all staff. The appointed manager is aware of her obligations with regard to ensuring the safety of residents and protecting them from abuse. Care Homes for Adults (18-65 years) Page 22 of 32 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. Service users live in a comfortable, safe and homely environment that meets their needs. Attention is being paid to good standards of hygiene and infection control measures are in place which safeguards service users from any risk of harm. Evidence: The accommodation at Westwinds presents as a comfortable and welcoming. The home is well maintained and attractively decorated throughout. Communal areas and a number of service users bedrooms were viewed and found to be bright, airy and comfortable. Bedrooms reflected the personality and interests of the occupant and had sufficient space to display personal possessions, store clothing, sit and relax and provided service users with a comfortable bed. The premises were well lit, clean, and hygienic and odour free with good attention being paid to infection control measures designed to protect service users, visitors and staff from harm. The homes AQAA records......There are procedures in place for hygiene and infection control. Staff effectively use personal protective equipment. There is a cleaning schedule carried out by the night staff and a walk through handover takes place each morning. We also employ a part time cleaner during the day time. Anti-bacterial products are used throughout the home. All staff receives health and safety and infection control training. Infection control laundry bags are used which Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: go directly into the washing machine when staff have to deal with soiled clothing or bedding. Information received prior to the visit indicated that safety and maintenance certificates were in good order and up to date. This was a base line inspection of a previously registered home and as such the appointed manager appropriately records in her AQAA improvements made to the homes environment in the last 12 months.....New carpets have been laid in the communal areas on the ground floor. New dining room and lounge furniture has been purchased. New garden furniture has been purchased and white goods, i.e. cooker and two fridges. A ramp has been installed to the rear and side of the property to allow wheelchair access to all entrances and automatic door closers have been fitted to fire doors. Care Homes for Adults (18-65 years) Page 24 of 32 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. People living at Westwinds benefit from a competent and motivated staff team who know them well. They will benefit further when identified staff training shortfalls are addressed. Staff are robustly recruited to ensure service users safety and protection. Evidence: Staff spoken with evidenced a good understanding of service users needs and preferences. Throughout the site visit they were observed to be respectful and caring toward the service users. It was evident that staff had received mandatory training in safeguarding adults, fire procedures, food handling, food hygiene, moving and handling, health and safety, first aid and managing medication. Specialist training courses, designed to meet service users specific needs are also arranged. There was no evidence however that all staff have undertaken training in dementia or awareness training in relation to the ageing process, or the demands placed on the home by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. As mentioned throughout this report, the home is providing a service to an increasingly older service user group. Service users will have additional needs to those for which the home is primarily registered. It is therefore recommended that this shortfall is addressed to ensure that the diverse needs of service users continue to be met. The manager spoke of her firm intention to address Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: this issue. The homes AQAA records that the home exceeds the 50 standard for NVQ qualified staff, which is clearly to the benefit of the people living at Westwinds. There are a number of staff vacancies to which the manager is hoping to recruit. Substantive staff are undertaking additional shifts to cover vacant hours on the staff rosters, which provides for greater continuity of care to the people accommodated. New staff are subject to a 6 monthly probation period. During this time the appointed manager said they receive a structured induction and mandatory training. The induction checklist viewed reflected Skills for Care competency elements. There appeared to be sufficient staff on duty to meet the needs of the service users on the day of the site visit. The home has a full compliment of 5 full time and 2 part time staff. The duty roster evidenced a minimum of three members of staff rostered for duty each day shift. This number is inclusive of the manager. There is two waking night staff. Due to the heavy demands that an increasingly dependent service user group place on the staff group, it was discussed that staffing levels should be kept under regular review. The appointed manager said that there is flexibility to roster more staff to meet peak periods and special needs. There are clear lines of accountability in the home and staff are aware of the demands of their role. The AQAA records that staff are familiarising themselves with the new providers policies and procedures and the providers expectations of them. Evidence kept in the home indicates robust recruitment procedures for the protection of service users. All staff found to be appointable are required to have at least two satisfactory references and all gaps in employment are now being effectively explored, with responses recorded and checks made on the information provided. It was also clear that staff are POVA checked prior to employment and also have a satisfactory enhanced CRB check. Care Homes for Adults (18-65 years) Page 26 of 32 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 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 going through significant change. The new provider and appointed manager have robust plans for the future which put the best interests of service users at the heart of developments and improvements to the service. Service users will benefit from identified shortfalls being addressed to secure their welfare and to ensure their needs are consistently met. There is clear evidence that the health, safety and welfare of the service users is being promoted. Evidence: Leonard Cheshire Disability now owns and manages Westwinds. The service was registered with the CQC on the 2nd October 2009. It was noted at the point of registration that the service did not have a registered manager in post. Leonard Cheshire Disability gave an undertaking to ensure that an application to register a manager would be submitted within three months of the homes transfer of ownership. On the day of the site visit the inspector was informed by the homes acting manager that she had been appointed to the managers post the day before, with an effective date of the 18th January 2010. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Our records show that the newly appointed manager had been effectively managing the service unregistered for a number of years prior to the new provider taking over responsibility. As an application to register the homes manager had not been received by the CQC within the three month period agreed, it is now a priority that the provider organisation fulfils their stated intention of making application, to both confirm the appointed managers fitness and to evidence their responsibility for service outcomes. The appointed manager gave a firm assurance that an application to register would be forthcoming. The home has quality assurance monitoring systems in place. The CQC has also received survey responses from some family members of the people who live in the home and external care professionals. A survey respondent records.....I want to extend a big thank you to the staff for all their hard work. Another records.....This is a friendly home and individuals have their needs met wherever possible. Monthly regulation 26 visits are conducted; the most recent reports were viewed. There was also evidence of minutes taken at monthly staff meetings. The CQC received the appointed managers completed Annual Quality Assurance Assessment (AQAA) on time, which indicates that Leonard Cheshire Disability provides a range of policies, and procedures, which have been brought to the staffs attention. The AQAA records.....We need to adjust to new procedures relating to the home with regards to the change in ownership. We plan to do this with regular communication with our new line management, cascading information to service users, families and the staff team. Substances hazardous to health (COSHH) were stored securely and appropriately. Internal health and safety checks have been completed regularly and a thorough health and safety assessment of the home has been undertaken by the new provider organisation. The report outcomes were not available to the inspector on the day of the site visit. The acting manager provided information to indicate that records and certificates and identified systems are in place for routine service and maintenance arrangements for the environment. During feedback some specific shortfalls in staff training were discussed with the appointed manager. Due to the heavy demands that an increasingly ageing and dependent service user group place on the staff group it was also discussed that staffing levels should be kept under regular review to ensure all service users needs are consistently met. Care documentation should be formulated in a timely manner and further developed to better evidence the homes good practice and to ensure it is Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: person centred. In addition, a review and amendment of the homes Statement of Purpose and other information documents needs to take place to ensure people have comprehensive guidance and clear information about Westwinds. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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