Care Home: Wilton House

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What the care home does well People who think that they might like to move into Wilton House can visit the home often before deciding whether they would like to live there. The people who use the service told us this and said that they had been helped by the staff to settle into the home.Wilton HouseDS0000072958.V375297.R01.S.docVersion 5.2All people using the service have a written contract; this and other information is provided in easy read pictorial versions. People who use the service can be involved in making decisions about how they are cared for these decisions are recorded in a care plan and these are regularly reviewed. People who use the service told us that they were supported to make decisions about their lives this includes making choices about how they spend their time, whether to attend college or not, choice of décor in the home and decisions about the menus. One person told us ‘ I didn’t want to go to college but I have got a job that I really like, I have made friends with someone who I work with’. Another told us that ‘ I am very busy, I go to a gym where I do all sorts of things and I go swimming and bowling’. The people who use the service appeared to get on well together; one person told us that they liked ‘hanging out with the others, it’s like being a family’. We also noted that people who use the service seemed to get on well with the staff. Routines were seen to be flexible and people who use the service are able to invite visitors to their home. One person said that ‘ I really like the food and we can invite our visitors to come and have a meal with us’. People who use the service appeared well cared for and are supported to access appropriate health care services. People who use the service receive their medication in the way that it is prescribed. People who use the service told us that the felt safe and were happy living at Wilton House. They have easy read information about how to complain and one person told us how they would complain if the needed to but they had not needed to. The home is clean and generally well-maintained people living there told us that they liked the bedrooms that they had chosen and were happy with the communal area. Staff have the right checks done before they can start working in the home. The service has recruited young staff so that they can relate well to the people who use the service and enable them to access social events appropriate to their age. The management are mindful of the need to ensure that the gender of the staff reflects the gender of the people who use the service.Wilton HouseDS0000072958.V375297.R01.S.docVersion 5.2Page 7 What has improved since the last inspection? This is a new service. What the care home could do better: The management need to make sure that the put all of the right information in the booklets that they provide to the people who use the service. The management also need to look at how they admit people to the home and make sure that they keep the right records. The management need to make sure that they only admit people to the home if they meet the terms listed on their certificate of registration. The care plans need to be further developed to make sure that the staff have detailed instruction about how to support people for all of their needs. The management of risk needs to be improved, the management need to make sure that risk assessments are conducted for all of the identified risks and that the assessments contain detailed instruction to staff about how the risks are to be reduced or managed. The management need to make sure that the people who use the service are included in the Electoral Role so that they can participate in elections if they wish to do so. Risk assessments for Medication need to be further developed to include more information about how people are supported to self-administer their own medication safely. The management also need to make sure new staff have all of the right training, knowledge and experience in a timely way. The induction training and Mental Disorder training needs to be reviewed to make sure that it contains all of the right information. The Registered Manager needs to train for the Registered Managers Qualification.Wilton HouseDS0000072958.V375297.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Wilton House 74 Kingsley Road Northampton NN2 7BL Lead Inspector Stephanie Vaughan Unannounced Inspection 5th May 2009 08:30 Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 2 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 Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilton House Address 74 Kingsley Road Northampton NN2 7BL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) TBA 01604 712155 www.mentauruk.com Mentaur Limited Marianne Kimani Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Learning Disability - Code LD (Maximum number of places: 6) The maximum number of service users who can be accommodated is: 6 New Service 2. Date of last inspection Brief Description of the Service: Wilton House is a residential care home registered to provide care to six people with learning disabilities. The service has been designed for people who are ready to move forward who are not yet ready to move to supported living. All rooms are for single occupancy and are fitted with ensuite facilities. There is one lounge/ diner and a small kitchen on the ground floor. It is a period terraced house in keeping with the local community, as such the corridors are narrow and the stairs are steep meaning that the home is unsuitable for wheel chair users. Wilton House is close to local facilities such as churches, shops, restaurants and other leisure facilities. It is adjacent to the Northampton Recourse and is close to the town centre. There are good bus links to the centre of town centre from which rail transport can be accessed. Current fees range from £750 per week to 1575 per week; items not included in the charges are hairdressing, toiletries and personal items such as CDs, clothing and toiletries, all at variable cost. The service intends to display the Care Quality Commission Inspection reports in the main hall way, these are also accessible via the CQC Website at http:/www.cqc.org.uk/ Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience ‘Poor’ quality outcomes. This service was registered in December 2008 therefore this is the first Key Inspection to be conducted for this service. Prior to this statutory inspection, a period of three hours was spent in preparation this comprised a review of the previous registration reports for the service and the manager, the current inspection record and the service history. We have received no concerns complaints of allegations about this service. The service also sent us their completed the Annual Quality Assurance Assessment, which provided us with information about the service and this, was used to inform our inspection activity. We sent out three surveys for the people who use the service and three to staff members to complete to tell us what they think about the service. None of these were returned to us and the Registered Manager told us that they had not been received by the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of nine hours during which the inspector made observations and spoke to the people who use the service, the staff and management. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences were reviewed, including individual plans of care and associated documentation. The Registered Manager was present for most of the inspection. What the service does well: People who think that they might like to move into Wilton House can visit the home often before deciding whether they would like to live there. The people who use the service told us this and said that they had been helped by the staff to settle into the home. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 6 All people using the service have a written contract; this and other information is provided in easy read pictorial versions. People who use the service can be involved in making decisions about how they are cared for these decisions are recorded in a care plan and these are regularly reviewed. People who use the service told us that they were supported to make decisions about their lives this includes making choices about how they spend their time, whether to attend college or not, choice of décor in the home and decisions about the menus. One person told us ‘ I didn’t want to go to college but I have got a job that I really like, I have made friends with someone who I work with’. Another told us that ‘ I am very busy, I go to a gym where I do all sorts of things and I go swimming and bowling’. The people who use the service appeared to get on well together; one person told us that they liked ‘hanging out with the others, it’s like being a family’. We also noted that people who use the service seemed to get on well with the staff. Routines were seen to be flexible and people who use the service are able to invite visitors to their home. One person said that ‘ I really like the food and we can invite our visitors to come and have a meal with us’. People who use the service appeared well cared for and are supported to access appropriate health care services. People who use the service receive their medication in the way that it is prescribed. People who use the service told us that the felt safe and were happy living at Wilton House. They have easy read information about how to complain and one person told us how they would complain if the needed to but they had not needed to. The home is clean and generally well-maintained people living there told us that they liked the bedrooms that they had chosen and were happy with the communal area. Staff have the right checks done before they can start working in the home. The service has recruited young staff so that they can relate well to the people who use the service and enable them to access social events appropriate to their age. The management are mindful of the need to ensure that the gender of the staff reflects the gender of the people who use the service. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The management need to make sure that the put all of the right information in the booklets that they provide to the people who use the service. The management also need to look at how they admit people to the home and make sure that they keep the right records. The management need to make sure that they only admit people to the home if they meet the terms listed on their certificate of registration. The care plans need to be further developed to make sure that the staff have detailed instruction about how to support people for all of their needs. The management of risk needs to be improved, the management need to make sure that risk assessments are conducted for all of the identified risks and that the assessments contain detailed instruction to staff about how the risks are to be reduced or managed. The management need to make sure that the people who use the service are included in the Electoral Role so that they can participate in elections if they wish to do so. Risk assessments for Medication need to be further developed to include more information about how people are supported to self-administer their own medication safely. The management also need to make sure new staff have all of the right training, knowledge and experience in a timely way. The induction training and Mental Disorder training needs to be reviewed to make sure that it contains all of the right information. The Registered Manager needs to train for the Registered Managers Qualification. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 8 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. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 People using the service experience Poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedures at Wilton House are not robust and do not ensure that the service is able to meet the needs of the people who live there. EVIDENCE: The service has a Statement of Purpose, which contains the information specified in schedule 1 of the National Minimum Standards. However this needs to be reviewed to make sure that it includes more specific information about the number, qualifications, including National Vocational Qualification in Care level 2 and the experience of the staff working in the home. However the Statement of Purpose is well laid out and is easy to read. There is also a ‘service users guide’, which is produced in a pictorial easy read version to enable people who use the service to access information about the service. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 11 The service has applied for a Major Variation to the Registration of Wilton House to provide care for people with mental disorder. However they are already providing care for people with these needs. The Statement of Purpose is being reviewed by the Registration Team in line with the current application for variation for Mental Disorder. Although the service does not have an Assessment Policy in place people who use the service are assessed prior to admission to determine if the service can meet their needs. This includes input from a range of health and social care professionals. However the required information is not always completely filled in and is also unsigned and dated. There is an admissions policy which deals with the arrangements that are in place once it has been determined that Wilton House is a suitable placement for the new person. The Registered Manager has been involved in the assessment process once it has been determined that the person is suitable for the home by the Company Director who is a consultant psychiatrist residing in India. During the inspection we found that the management had admitted some people who are clearly out of their existing category of registration. The service has applied for a Major Variation to include this category on discovery that they were only registered to provide care for people with a learning disability. We have held a management review and concluded that we have evidence that there has been a breach in Section 24 of the Care Standards Act 2000. However we have determined that on this occasion we will take a proportionate approach and have informed the service that the people who have been admitted out of category can remain living at Wilton House. The provider gave us a verbal undertaking that they will not admit any further people within the category of Mental Disorder. We have also written to the provider asking that they provide us with a written undertaking not to admit any further people within the Mental Disorder category to the home. People who use the service have several opportunities to visit the home, meet the staff and other residents and sample what it is like to live there at different times a day. The people who use the service told us that the had been to visit the home several times before moving in and that they had been helped by the staff to settle into the home. People who use the service have a contract in place these are available in an easy read pictorial version to ensure that people who use the service are able to read and understand the content. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the 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 who use the service have individual plans of care, which are not consistently robust and fail to ensure that their individual needs can always be safely met. EVIDENCE: We case tracked the three people who use the service, we reviewed the individual plans of care and these showed us that in general they contain the right information to enable staff to support the people who use the service. These are plans of care based on the information obtained during the preadmission assessment and assessments conducted by other health and social care professionals. We contacted one of the health care professionals who confirmed satisfaction with the placement. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 13 There was evidence that the people who use the service are encouraged to participate in the development and review of the individual plans of care. The staff aim to provide person centred support and care and this was evident from the care plans however the care plans still need further development to ensure that they are more detailed cover all aspects of peoples needs and the management of risk. People who use the service told us that they were supported to make decisions about their lives this includes making choices about their activities programmes, whether to attend college, choice of décor in the home and food. Each person has a key worker who provides additional support both in the home and during outings. Weekly meetings are held where residents can make other decisions such as outings and communal activities. There was evidence that the people who use the service are supported to manage their finances. People who use the service are supported to take risks within their daily lives assessments are in place for them to access the local community independently and participate in sporting activities such as swimming. Appropriate information is provided to staff to enable them to support residents to manage their behaviour. However we found information supplied by the funding authority entitled ‘Working with Risk’ this showed evidence of significant risk and there was no risk assessment or care plan in place to manage this risk. We wrote to the Registered Manager requiring the service to take urgent action to address this. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the 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 have control over their lives to enable them to enjoy a lifestyle that promotes choice and independence. EVIDENCE: We case tracked the three people who live at Wilton House and the people who use the service told us that they has good opportunities to access education and employment opportunities. One person said that ‘ I didn’t want to go to college but I have got a job that I really like, I have made friends with someone who I work with’. There is also evidence that people who use the service are supported to obtain benefits and financial support. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 15 People who use the service appear to be well integrated into the local community, one person told us that they has a busy life with their attendance at sporting activities including frequent attendance at a local gym. The service has aimed to recruit staff of a similar age range to enable people who use the service to be supported to participate in activities appropriate to their age such as going to discos and other events involving young people. The Registered Manager confirmed that the as yet the people who use the service have not been placed on the Electoral Role to enable them to vote within the coming European Elections. People who use the service told us that they liked living at Wilton House; one person told us that they liked ‘hanging out with the others, it was like being a family’. All told us of friends that they had made in the local community and during their planned activities. We observed good interactions between the residents and residents and staff. Individual plans of care contain information about resident’s family contacts including their birthdays and other family celebrations. Daily routines are flexible within the constraints of chosen activities and agreed restrictions. During the inspection we observed people being able to rise at a time that they preferred and to spend their time as they chose. People who use the service told us that they are able to receive their chosen visitors in the home and that they had opportunities to invite them to visit and share a meal. People who use the service told us that they were involved in the planning of menus together and that they liked the food that was prepared and that it was of an adequate proportion. We noted healthy fresh produced being brought to the home showing that food is generally home cooked. There was also evidence that people who use the service have access to fresh fruit and are able to prepare snacks and drinks for themselves depending on their ability. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the 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 who use the service have an individual plan of care, which indicates that their health, personnel and social care needs are not consistently addressed. EVIDENCE: We case tracked three people who use the service, their individual plans of care showed the support that staff provide. However these need to be reviewed to ensure that they contain more detailed and specific information about how people are to be supported to maintain their health care and that all of their healthcare needs identified during the assessment process are addressed. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 17 For example one of the assessments indicated that one of the people living there had a medical condition and there was no specific individual plan of care in place to address this. People who use the service are supported to express their personalities and gender in the way that they dress; all were seen to be well presented and appropriately attired. There was evidence that people who use the service are supported to maintain their health care through access to health professionals such as General Practitioners, Dentists and other health care services. Medication systems were reviewed and seen to be in good order supplies are obtained from a local high street chemist and are where possible supplied in monitored dose systems. Medication Administration Records indicated that medication was being given as prescribed and there have been no medication errors at Wilton House. Residents at Wilton House are encouraged to self medicate and systems are in place to enable them to do this safely; They each have a lockable facility in their rooms and the medication is put into suitable containers for the day. However on the day of inspection the containers had been left on an unsecured surface in an unlocked room. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience Poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission and management practices do not ensure that the people who use the service are protected. EVIDENCE: We have received no concerns complaints or allegations about this service. We case tracked three people who use the service they all told us that they were happy at Wilton House and that they got on well with the staff. One person said that they knew how to complain but that they had not needed to. People who use the service have access to an appropriate easy read complaints procedure and this is also included in the Statement of Purpose and Service Users Guide. People told us that they felt safe living at Wilton House and the individual plans of care contained basic risk assessment to ensure that people who use the service are protected when they go out without support. However there was evidence that some risks had not been addressed despite being identified in the information supplied by the funding authorities subsequent to admission. We sent an urgent action letter to the provider to ensure that this was addressed. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 19 Staff have the right checks before commencing work in the home. One member of staff told us that they had limited knowledge in the provision of care for people with Learning Disability and Mental Disorder. They were able to confirm that they had had training on the Mental Capacity Act and ‘a short 2 hour session which covered signs, symptoms, medication and schizophrenia’ with the Company Director. The duty rota indicated that the staff member concerned had been left in charge of shifts. The service is not registered to provide care to people with Mental Disorder however the service has admitted people who require this category. This means that people have been put at risk due to the lack of experience and training of the staff. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the 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 interior of the home is well decorated and well maintained however the garden area requires attention to ensure that the premises are completely safe and accessible. EVIDENCE: The premises are located close to the town centre and provide good access to a range of leisure, retail and transport facilities. It is a period terraced house and as such corridors are narrow and stairs are steep this in addition to the limited communal space means that the home is not easily accessible to wheel chair users, however this is referenced in the Statement of Purpose. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 21 Two of the people who use the service offered to show us their bedrooms, they were both pleased with their rooms and said that they had been able to choose which room that they wanted. They also said that they had been able to choose the colour schemes, décor and furnishings and both were personalised with their own belongings. Both of the rooms were fitted with ensuite shower facilities and appropriate fixtures and fittings including privacy locks. People who use the service confirmed that they had keys to their rooms and front door keys. The communal area comprised a lounge diner with the capacity to seat six people. All areas of the interior of the home were seen to be safe, clean and well maintained. The home has a small rear garden, which includes a decked patio area. However the garden still requires some significant improvement before it can be safely accessed by the people who use the service. This was raised with the management who have now secured a date for the work to be done in the near future which will enable the people who use the service use the garden during fine weather. Arrangements are in place for the people who use the service to do their laundry and become involved in household tasks according to their ability. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People using the 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 lack of training and practical experience may adversely affect the care delivered to the people who use the service. EVIDENCE: We looked at the duty rota this showed that the service employs adequate numbers of staff for the existing number and needs of the people who use the service. This means that there is a minimum of two staff on duty throughout the daytime shifts and there is one sleeping member of staff on duty at night. The service aims to recruit some male staff when the numbers more people are using the service. The staff group are generally reflective of the age of the people who use the service. Most of the staff working in this home have recently been recruited from Portugal, nevertheless they have a good command of the English language and are able to communicate effectively with the people who use the service who are all of white British origin. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 23 We looked at the recruitment practises operated by the service and the staff files were found to be in good order, showing that appropriate references and clearances had been obtained before staff commenced employment in the home. As this is a new service most of the staff are new and have been recruited from Portugal as such none of them have as yet completed the National Vocational Qualification in Care level 2. Staff confirmed that they had undergone induction training that lasted for two weeks. We looked at the induction records, this confirmed that the formal induction period lasted for two weeks and focused mainly on administrative functions. We also looked at staff training and there was evidence that the staff have received training in all of the mandatory subjects including Fire Safety, Basic Food Hygiene, First Aid, Infection Control, Safe Administration of Medication, Safeguarding Adults, Mental capacity Act 2005 and the management of challenging behaviour and de-escalation techniques. It is also noted that majority of the staff training is being provided by external sources. The recently recruited staff have been educated to degree level in aspects of social care. People who use the service told us that the staff were nice and they felt that they were well cared for. However one of the newly recruited staff indicated that they had not had previous experience of working with people with Learning Disability or Mental Disorder and that they had not appreciated that they would be working with this client group at interview. This person was also a key worker for someone with a psychotic mental disorder. The training records did indicate that a training session had been held by one of the Directors of the Company who is also a Consultant Psychiatrist. We reviewed the three page hand out that been provided with the training the staff member told us that the training session had lasted for only two hours. This staff member was a senior carer with Key worker responsibility and in charge of some shifts shift. Two further training in Mental Health topics is scheduled for September and October 2009. All of the existing staff are female and there is one male resident. We spoke to the management about this and were informed of the intention to admit other male residents and to employ male staff as the numbers increased. We spoke to the individual concerned who said that he didn’t mind being the only male in the home and he confirmed that he had male friends living close by. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is not robust which means that people who use the service are not protected nor are their best interests promoted. EVIDENCE: The Registered Manager is qualified to degree level in Social Policy and Criminology and has a Diploma in Social Policy and the Care Sector. She has at least five years of experience of working with people with learning disabilities and has been the Registered Manager at another of Mentaur’s Homes. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 25 However she is yet to commence training for the Registered Managers Qualification, which is a condition of her registration. The Registered Manager is involved in the assessment process for new people coming to live in the home however new people have been accepted to live at Wilton House which is not registered to provide care for people with Mental Disorder. The recruitment of staff from overseas means that the Registered Manager is not fully involved in the recruitment of staff and there is little opportunity for the people who use the service to be involved in the selection of staff. Although staff have induction training and some internal training in Mental Disorder is limited and some of the staff have no previous experience in the provision of this care. Responsible Individual has acknowledged that an error was made regarding the application for registration and has admitted to the service people with Mental Disorder for which they are not registered. The management of risk needs to be improved so that any activities in which the people who use the service participate are minimised. The service is yet to implement formal quality assurance practices but plans to survey people who use the service, their relatives and staff before the end of the year. Meanwhile the senior management team ensure that monthly visits are conducted to review aspects of the service provision. In addition the Registered Manager conducts frequent audits of systems such care plans and medication systems. The Registered Manager also operates an open door policy and people who use the service feel that they are able to raise any concerns or make comments as they arise or at the weekly meetings. All areas of the home were seen to be well maintained and safe. Arrangements have now been made to ensure that the garden area is improved so that it is accessible to the people who use the service. Accidents and incidents appear to be managed appropriately and there is evidence that the service notifies us of events that occur in the home. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 1 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 3 X X 1 X Version 5.2 Page 27 Wilton House DS0000072958.V375297.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4. Requirement The Statement of Purpose must be reviewed to ensure that it contains all of the criteria specified in schedule 1 of the National Minimum Standards. To ensure that people who use the service have access to accurate and up to date information. The preadmission assessment procedure must be reviewed to ensure that people who use the service are only admitted if they are within the appropriate category of Registration. Timescale for action 01/07/09 2. YA2 14. 01/07/09 3 YA3 4. YA6 To comply with the registration categories specified on the certificate of registration. CSA 2000 The management must ensure 21/05/09 Section 24 that the service complies with & CHR the conditions of registration. 2001, 12. To ensure that the service is able to meet the needs of the people who use the service. 14.2 Individual plans of care must be 01/07/09 reviewed to ensure that they provide comprehensive detailed DS0000072958.V375297.R01.S.doc Version 5.2 Page 28 Wilton House information to staff on all of the identified health needs. To ensure that staff have detailed instruction as to how the person needs and wished to be supported. The management of risk must be 11/05/09 reviewed to ensure that appropriate risk assessments are in place to reduce and manage any identified risk to ensure the health and safety of the people who use the service at Wilton House by 18:00 hrs on Monday 11th May 2009. To ensure the health and safety of the people who use the service. 6. YA20 13.2 Risk assessments for the administration of medication must be reviewed to ensure more detailed instruction to staff, including the arrangements that are in place to enable people to self medicate safely. To ensure the safe administration of medication. 7. YA34 19.5 Recruitment processes must be reviewed to ensure that the applicants experience is taken into account when determining their roles and responsibilities. To ensure that the people who use the service are in safe hands ay all times. The staff induction programme must be reviewed to ensure that it complies with current best practice. To ensure that the people who use the service are in safe hands Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 29 5. YA9 13.4 01/07/09 01/07/09 8. YA35 18.1 01/07/09 at all times. 9. YA35 18.1 Staff must receive robust and timely training in the care of people with a diagnosis of Mental Disorder. To ensure that the needs of the current people who live at Wilton House have their needs met. 14/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. 4. Refer to Standard YA13 YA32 YA34 YA35 Good Practice Recommendations Arrangement should be made for the people who use the service to gain access to the electoral role in order for them to exercise their democratic rights The service should ensure that they make arrangements for new staff to undertake National Vocational Qualification in Care level 2. Recruitment practices should be reviewed to ensure that the people who use the service and the Registered Manager are involved at an early stage. Staff who are new to this country should be provided with training in accessing Health and Social Services on behalf of the people who use the service. Wilton House DS0000072958.V375297.R01.S.doc Version 5.2 Page 30 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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. 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. 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