Care Home: William Blake House

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: William Blake House Farm Cottage 8 Milthorpe Lois Weedon Towcester Northants NN12 8PP The quality rating for this care home is: Adequate 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: Catherine Perrins Date: 2 2 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: William Blake House Farm Cottage 8 Milthorpe Lois Weedon Towcester Northants NN12 8PP 01327860412/569 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): adminwblakehouse@phonecoop.coop William Blake House Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Learning Disability - up to 3 Service Users. Both male & female 18 - 65 years of age. Date of last inspection 2 3 1 1 2 0 0 6 Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home The home is in a small village near Towcester. Three people with learning disabilities live there. Volunteers also live at the home to support and care for the people with learning disabilities. Some of the volunteers are from other countries and stay for a year to learn new skills. Everybody who lives at the home has their own bedroom. Care Homes for Adults (18-65 years) Page 5 of 34 The home is one of three within the William Blake Community. The William Blake Community believes in Christian values. Fees range from 1817.48 pounds to 2461.42 pounds per week. Care Homes for Adults (18-65 years) Page 6 of 34 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: Adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home The house manager was present for part of the inspection. The house manager for the William Blake community was present during the whole the inspection. An expert by experience worked with the inspector. Experts by experience are people who have experience of using services. We spoke to people who live in the home. Care Homes for Adults (18-65 years) Page 8 of 34 We spoke to volunteers who work at the home. We looked at care plans. These tell staff how people like and need to be supported. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 34 Care plans contain some good information about peoples needs. This helps volunteers support people in the right way. Each person has two key workers. Volunteers have a good understanding of peoples needs. They are good at communicating with people and helping them to make choices. Care Homes for Adults (18-65 years) Page 10 of 34 People have active lives. A volunteer told us that People have a very good life at this home. The food is good and is mostly organic. People are given good support with their health and well being. Care Homes for Adults (18-65 years) Page 11 of 34 Farm cottage is very comfortable and homely. What has got better from the last inspection The medication policy has been up dated. Volunteers receive training before they give people medication. Volunteers have had more training. Care Homes for Adults (18-65 years) Page 12 of 34 What the care home could do better The home needs to have a service user guide to give people who want to move to Farm Cottage. Good records must be kept of peoples money. Care plans need more information about how people communicate. Care Homes for Adults (18-65 years) Page 13 of 34 Medication must be stored safely. Records of medication given to people must be right. Volunteers must have the right checks before they work in the home. If you want to speak to the inspector please contact: Catherine Perrins Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 Care Homes for Adults (18-65 years) Page 14 of 34 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 15 of 34 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 16 of 34 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 have a thorough assessment before moving into the home. They are given good information about the home but not all of this information is currently written down. Evidence: People who may want to move to this home can get good information about the service from the statement of purpose. The home currently does not have a service user guide to tell people about what is like to live at the home. The house manager says that a lot of information is passed on to people verbally when they are deciding if they would like to live at Farm Cottage. There have not been any recent admissions to the home but the house manager explained that the admission process involved a detailed assessment and the person visiting the home to make sure that it could meet their needs. Care Homes for Adults (18-65 years) Page 17 of 34 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 generally have their individual needs and choices very well met. The recording of peoples personal money needs to be more robust. Evidence: Volunteers have good information available in peoples individual plans of care. This helps to ensure that people are supported and cared for in the right way. Information is made easier for volunteers to access by being split into a daily file which contains all the records that are required on a daily basis; an in depth personal file which contains assessments, care plans and risk assessments and a medical file which contains details of medical appointments and information. Care plans contained details of people’s needs and preferences to ensure that staff are able to support people in the way that they wish to be supported. Peoples care plans are reviewed on a regular basis and reviews show that people are gaining independence with, for example, their eating and drinking. Each person has two key workers, this helps to ensure consistency if one person is Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: having time off. Volunteers spoken to had a good understanding of peoples needs. Two of the people who live at the home use very little verbal communication. Volunteers described how they use their knowledge of the person and observation to help people to communicate and to make choices. There is some information in peoples individual plans of care about how they communicate with others although this would benefit from being more detailed to ensure that any new volunteers have all the information that they need to communicate with people. People are supported to be safe without restricting their lifestyles by clearly documented assessments of the risks they face from the environment and the various activities that they do. These cover areas such as swimming, travelling by car, shopping and walking. The home uses a listening monitor to help keep people safe when they are in their bedrooms. The house manager explained that people are aware of the monitor and that it is used sensitively. Although it appears that this is done in peoples best interests there is no record of this being assessed. People are supported to manage their money be volunteers. Each person has their own cash tin where they keep their personal money. Senior volunteers hold keys to these tins. All transactions are recorded in a personal cashbook for each person, however these records do not include a running total so it was not possible to check whether the money in the tin corresponds to the records in the book. The house manager explained that the totals in the cashbook are calculated monthly. This system means that if errors are made with people’s money it may not be noticed until up to a month later which may be too late to identify how an error occurred. Care Homes for Adults (18-65 years) Page 19 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People enjoy fulfilling and active lives within a caring community. Evidence: People are able to enjoy a good range of activities such as swimming, going for walks, music / singing, gardening, art and craft, going to local pub, going for a Jacuzzi at nearby spa and listening to the radio. The home has a people carrier to enable people to go out to their activities. One person has his own laptop enjoys playing computer games, writing e-mails and using the internet. One person told our expert by experience I like the radio, listening to cds and playing the keyboards. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: A volunteer told us that People have a very good life at this home. People contribute to the running of the home for example helping with the food shop, helping to clear table after supper and helping to mow the lawn. On the day of inspection volunteers and service users were having a house meeting to discuss the running of the home. Volunteers say that these meetings take place every week. People were seen enjoying their lunch, which consisted of sausage, rice and vegetables. Volunteers told us that people have the best food, and that everything is organic. Volunteers eat with the people who use the service. Our expert by experience observed that (someone) gets to choose what he eats and he eats good food and fruit. Discussions with volunteers show that they have a good understanding of peoples dietary requirements and that they receive training and guidance to assist them to cater for the specific requirements of one individual. People are given support to maintain friendships and relationships with their families and friends. This is done through visits and sending cards and gifts for special occasions such as birthdays. The house manager explained that volunteers accompany people to family events such as weddings and to go on holiday with their families if they need the additional support. Our expert by experience told us that one person told him that they celebrate their birthday with friends from the community by having cake and drinks. The William Blake community is based on Christian values. Our expert by experience told us that people are always given the choice to go to church. Care Homes for Adults (18-65 years) Page 21 of 34 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 . Peoples personal and health care needs are generally very well met but peoples medication is not always accurately accounted for which puts peoples health at risk. Evidence: Volunteers are able to access good information about peoples health and medical needs from their individual plans of care and medical files. Records included details of how to monitor peoples specific health issues, how to support them to maintain good health and action to take if they became unwell. Volunteers received advice and training from health professionals such as a diabetic nurse. Records show that people benefit from the involvement of a range of health and social care professionals such as hospital consultants, general practitioners, occupational therapists, specialist nurses, dentists, opticians and podiatrists. This ensures that peoples full range of health and personal care needs are addressed. The home uses complimentary health care where appropriate. This is recorded on peoples files and records show that it is discussed with their families. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Volunteers receive training in the administration of medication and the house manager stated that two staff always administer and record all medication given. The house manager stated that stock checks are carried out on the medication. Medication is stored in a metal lockable cabinet that is secured into an alcove in the kitchen. This needs to be reviewed to ensure it complies with the latest guidance from the Royal Pharmaceutical Society of Great Britain. Two people have their tablets dispensed in sealed blister packs containing the correct dose for each day and time. The third person does not use this system and has his medication administered directly from tablet containers. A spot check was carried out on the medication and found that the totals on the medication recording sheet did not balance with the total number of tablets. There was also no balance recorded for some paracetamol tablets, which are given as required so it was not possible to check whether the total for these was correct. All entries on the medication recording sheets were signed appropriately to say that medication had been given as prescribed. Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a robust complaints procedure but omissions in some of the working practices in the home put peoples safety at risk. Evidence: One person told our expert by experience that they are happy living in the house, it makes me feel safe. The complaints policy was viewed, the address for the Commission for Social Care Inspection needs to be updated within the policy and the contact details of each persons funding authorities need to be made available. The home has not had any complaints or allegations made since the last inspection. Volunteers showed an understanding of the complaints procedure and how to keep people safe. Some issues in relation to keeping people safe have been noted elsewhere in this report. In particular concerns about keeping peoples money safe, ensuring that medication is accounted for and making sure that all staff having the required pre recruitment checks to make sure that they are safe to work with people with learning disabilities. Care Homes for Adults (18-65 years) Page 24 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People enjoy a high standard of accommodation that is clean, comfortable and very homely. Evidence: Farm cottage is an attractive period cottage that has been extended to provide spacious and comfortable accommodation for the people who live there. The furnishings and decor are of a high standard and the property is very clean and well maintained throughout. The communal areas consist of a large lounge with two comfortable seating areas, a large kitchen and a conservatory / dining room. There is a separate laundry room. The cottage has the feeling of a family home with plants, pictures, ornaments and books adding to the homely atmosphere. Volunteers share the communal living space with the people who use the service. People were observed relaxing in the lounge. People have their own bedrooms that they have made personal with their own belongings and effects. Bedrooms seen were spacious and comfortable giving people plenty of person space to relax. Specialist equipment such as bath chairs have been provided to help people with daily living. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: People have the use of a large attractive rear garden that is enclosed. Volunteers told us that people enjoy sitting in the garden and often have meals outside when the weather is warm. People who use the service are encouraged to contribute to the maintenance of the home for example helping with the gardening. Care Homes for Adults (18-65 years) Page 26 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from caring and sensitive support from a committed team of volunteers but the recruitment process is not robust and cannot guarantee to make sure that all volunteers are safe and suitable to work with people with learning disabilities. Evidence: Volunteers show a good understanding of peoples needs and preferences and were seen to support people in a caring and sensitive way. Our expert by experience observed that The volunteers relate well with the residents and the community spirit is high. Volunteers receive support from an external consultant. She told us that the volunteers generally work well as a team. Taking volunteers on a for a years placement at a time means that there is a regular turnover of volunteers however volunteers explained that much effort is put in to ensure that the people receiving a service have consistency in the way they are cared for. This is done by having a long handover period where new volunteers work alongside experienced colleagues to get to know the people who use the service really well. Volunteers receive a good induction and ongoing training to ensure that they are able to support and care for people in the right way. The house manager says that the core Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: team of volunteers have all completed or are working toward an NVQ in care. Senior volunteers undertake NVQ level three or four. Records of the recruitment process were viewed and showed that not all of the required checks had taken place prior to people taking up their positions as volunteers. One person only had one reference and there was no record of checks being made to ensure that another person was safe to work with people with learning disabilities prior to them starting at the home. This check has since been done but it appears that the person worked at the home for nearly four weeks before the check was completed. Volunteers say that they do not directly support people who use the service until the results of their recruitment checks are known. Care Homes for Adults (18-65 years) Page 28 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is managed in the best interests of the people who use the service but recording systems are not adequately robust to reflect the quality of the service provided. Evidence: The home does not currently have a registered manager as the previous manager has recently left. The house manager explained that a meeting was being held the day after the inspection to look at this issue. The home holds weekly meetings with volunteers and people who use the service to discuss how the home is run and to seek feedback from all involved. The house manager explained that the home has good relationships with the families of the people who use the service and regularly get feedback from them about the home. The home is very well maintained and there was evidence that some safety checks are carried out such as checking electrical equipment. The house manager explained that fire checks are also carried out and equipment such as the bath chair are regularly serviced however records of this were not available. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: None of the radiators within the home had covers and there was no record of the potential risks to people should they fall against a hot radiator having been assessed. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes  No  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 Description 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 Description Timescale for action 1 1 5 A service user guide must be 03/02/2009 available for people who may want to move into the home. To give people information about what it is like to live there. 2 7 17 Accurate records must be kept of all money held on behalf of service users. 05/12/2008 So that the monies can be checked to ensure that they are correct and prompt action taken should any discrepancies occur. 3 20 13 The storage of medication must be reviewed to ensure 06/02/2009 Care Homes for Adults (18-65 years) Page 31 of 34 it complies with the latest guidance from the Royal Pharmaceutical Society of Great Britain. This includes ensuring the cupboard meets the requirements for storing controlled drugs. To ensure that all medication including controlled drugs can be stored safely. 4 20 13 Accurate records of peoples medication must be maintained including medication administered, totals received and the number of tablets left. 05/12/2008 To ensure that people receive their medication as prescribed. 5 34 19 All required pre recruitment 05/12/2008 checks must be carried out prior to volunteers working in the home. To ensure that volunteers are safe to work with people with learning disabilities. 6 37 8 The registered provider must 06/02/2009 appoint and register a manager for the home. To ensure that the home is managed effectively. 7 42 13 Safe working practices must be promoted through required risk assessments and health and safety checks. These must be documented. 06/02/2009 Care Homes for Adults (18-65 years) Page 32 of 34 To ensure the health and safety of everyone who lives at or visits the home. 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 6 Individual plans of care should contain detailed information about how individuals who do not have verbal communication communicate with others and make their wishes and choices known. Individual plans of care should include a written assessment showing that any invasion of a persons right to privacy is done with their consent. If someone does not have the understanding needed to be able to consent records must show that the situation has been fully assessed as being in their best interest. 2 7 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk 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 © (2008) 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. 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