Care Home: Wimbourne House

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What the care home does well The people living in the home benefit from a service that has experience in supporting people who have enduring mental health issues and offers a professional and supportive environment for them to live. Many of the residents living in the home have had placements that have previously broken down, but choose to stay in this home. The AQAA prepared by the home stated that "we have a non-judgmental approach to all of our residents and care is delivered irrespective of race, ethnicity, sex, gender, background, religion, sexual orientation or belief. This was confirmed during the inspection process. The home has good working links with health care professionals including the mental health service that enables the people living in the home to be supported with their healthcare issues. The people living in the home all feel able and comfortable to express their views on how the home is working and anything they need or want to happen.The home operates professional policies and procedures including those relating to health and safety and medication. These help to safeguard the residents. The home is maintained on an ongoing basis and provides a homely and clean environment for the residents. The home is well located to enable the people living in the service to access local shops and other amenities. What has improved since the last inspection? The home has met the requirements from the last inspection. This included providing a member of staff who co-ordinates activities, ensuring all staff had a completed contract of employment, checking that all staff had the necessary permission to work in the country, supporting staff to receive training paid for by the company, providing more health and safety training and providing the manager with training so he can complete staff supervisions. In addition, medication returned to the pharmacist is correctly recorded. Environmental improvements have also included the provision of a new oven, repairing kitchen cupboard doors and providing a washing machine of an appropriate specification to meet the needs of the residents. To improve health and safety the home has completed the fire evacuation plan and completed a maintenance check of electrical installations. The home has also identified some additional improvements that have taken place. These include empowering the residents to increase their levels of independence, meeting the residents equality and diversity needs, improved written documentation in the home and increasing the frequency of monitoring the medication charts to ensure their accuracy. CARE HOME ADULTS 18-65 Wimbourne House 16 Wimbourne Road London N17 6HL Lead Inspector Jane Ray Key Unannounced Inspection 23rd September 2008 09:30 Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wimbourne House Address 16 Wimbourne Road London N17 6HL 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) 020 8493 9947 020 8801 0620 Mr Kwame Adusei Mr Kistnasamay (Chris) Thandrayen Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 4 22nd January 2008 Date of last inspection Brief Description of the Service: Wimborne House is located in a residential area close to Bruce Grove, in Tottenham where there are a range of local shops and easily accessible public transport. The home is registered to provide residential care for four people with a mental disorder. The registered provider, Mr Kwame Adusei, owns a number of similar small homes in this area. The home is an ordinary house, on a domestic scale and fits in well with the surrounding area. It has four bedrooms one of which has en-suite facilities, as well as a separate bathroom and shower room. There is a shared lounge, kitchen and dining area and a rear garden. The home has a small team of staff and staffing levels vary according to the needs of the people living in the service. The home also has a part-time cleaner. The organisation’s brochure states that it specialises in supporting service users who may have a forensic history or may be on the supervision register and that the aims are to respect the resident’s privacy and dignity, maintaining and promoting personal identity and the right to choose. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 5 Fees charged at the home range between £700 and £1000 per week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place on the 23 September 2008 and was unannounced. The inspection lasted for four hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to two of the current residents. Neither of the residents chose to speak to the inspector. The inspector was also able to spend time talking to the manager as well as the one care staff who were working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a self-assessment questionnaire (AQAA) prior to the inspection. The inspector also received seven completed surveys completed by 2 residents and 5 staff members. What the service does well: The people living in the home benefit from a service that has experience in supporting people who have enduring mental health issues and offers a professional and supportive environment for them to live. Many of the residents living in the home have had placements that have previously broken down, but choose to stay in this home. The AQAA prepared by the home stated that “we have a non-judgmental approach to all of our residents and care is delivered irrespective of race, ethnicity, sex, gender, background, religion, sexual orientation or belief. This was confirmed during the inspection process. The home has good working links with health care professionals including the mental health service that enables the people living in the home to be supported with their healthcare issues. The people living in the home all feel able and comfortable to express their views on how the home is working and anything they need or want to happen. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 7 The home operates professional policies and procedures including those relating to health and safety and medication. These help to safeguard the residents. The home is maintained on an ongoing basis and provides a homely and clean environment for the residents. The home is well located to enable the people living in the service to access local shops and other amenities. What has improved since the last inspection? What they could do better: A few areas for improvement were identified at this inspection. Some staff training needs had to be met including ensuring all staff who administer medication had completed medication training and also providing training on safeguarding vulnerable adults for all the staff. Some staff also need refresher health and safety training and the manager also needs to ensure all his mandatory training is in place. It was also recommended that the record of what the residents eat was maintained so that, their diet can be monitored to ensure it is healthy. It was also recommended that residents are supported to check their weight each month to monitor any changes. Another recommendation was that a standard agenda is prepared for supervisions to help stimulate discussion and ensure Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 8 this time is used effectively. Risk assessments should also be prepared for staff working on their own in the home that reflects the changing needs of the residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wimbourne House DS0000010779.V372195.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 Wimbourne House DS0000010779.V372195.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 4 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will have access to information in an appropriate format to tell them about the home. EVIDENCE: “We welcome residents to our home by providing a relaxed, homely environment. Prospective service users are provided with information about the home, they meet the director/manager once the referral has been made and are given the opportunity to spend some time at the home before making their choice of whether to move in. Once admitted, staff spend time getting to know the resident and through discussion and a comprehensive assessment, we work together to determine their needs and goals, hence, their plans are formulated”. (Extract from the AQAA prepared by the home) Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 11 “In building a therapeutic relationship with each individual resident we learn how to respond to their individual needs”. (Extract from a survey completed by a member of staff) The service has an updated statement of purpose and this was inspected and was satisfactory. The home provides prospective and new residents with a copy of this document to give them information about the service. We looked at the assessments for the three current residents. All the residents have assessment information provided by appropriate care professionals. An experienced mental health nurse from the organisation that runs the home, also completes their own assessment. Residents are also supported to complete a diversity and equal opportunities form that gives them the opportunity to inform staff of their preferences in all aspects of their lives. Since the last inspection a resident moved to the home and was able to visit the service as part of this process. Another future resident is planning to move into the home and has made six visits already as part of this process. The current needs of the people who live in the home were discussed with the manager and care staff. They have very specific individual needs linked to their mental health. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with skill and sensitivity. The residents were observed to be very much at home and communicate when they wish to do so with the staff team. Wimbourne House DS0000010779.V372195.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: “As stated in our statement of purpose, residents are supported to take measured risks which are felt to be important to the service users personal development and to promote their independence. For any activity where a resident is deemed to be at risk of harm, individualised risk assessments are undertaken and regularly reviewed to minimise risk. Based on the individual Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 13 assessments made of each residents physical and psychological needs, a comprehensive care plan is devised”. (Extract from the AQAA prepared by the home) “We support residents to live the life they choose. However in the instance where their behaviour is detrimental to their health or puts others at risk, we must intervene, put the necessary plans in place and discourage the behaviour”. (Extract from a staff survey) We inspected care plans for the three people currently living in the service. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The care plans had all been reviewed on a monthly basis by the key-worker. All of the residents had been supported to have a CPA meeting with their care team. All of the residents had signed their care plans. Each resident had a named key worker. The staff were asked about their role as a key-worker and this showed that the support they provided included helping to organise activities, helping the resident to clean their room, meeting for a key-worker session and updating care plans. We read the risk assessments for the same three people who live in the service. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. Risk management plans gave clear guidance to staff. Each person living in the home had individual behavioural guidelines as part of their care plan and risk assessments and these were clearly written and gave appropriate guidance to the staff. We observed the people living in the home and their interaction with the staff. It was positive to note that they felt very comfortable making decisions about what they wanted to do and able to ask the staff for support where this was needed. The staff were also very aware of consulting the residents about all aspects of their daily lives. The manager said the resident meetings take place monthly but the last recorded meeting took place two months previously. It was however observed that in such a small home, the residents tend to tell the staff what they want on an individual basis. Wimbourne House DS0000010779.V372195.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): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the homes are supported to develop their daily living skills and are also enabled to follow their own routine. The home supports the residents to enjoy a range of activities based on their individual interests. Inadequate records meant it was not possible to tell if the residents were being supported to eat a healthy and nutritious diet. EVIDENCE: “We work with each resident to pursue structured/ unstructured activities on a daily basis to promote their independence, improve their skills, build their confidence and to keep them occupied”. (Extract from the AQAA prepared by the home) Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 15 The staff talked about how the residents were developing their independent living skills. Everyone is encouraged to clean their room with support as needed. Two of the residents will occasionally help the staff to prepare their evening meal. None of the residents are willing to help with the shopping but they each prepare a list of the food they want the staff to buy on their behalf. The residents are all able to go out independently and use public transport. They choose where they want to go and who they want to see. The activity coordinator said he regularly offers the residents opportunities to participate in activities but they prefer to go out on their own. One resident did attend a course to prepare for greater independence but this course has now finished and he has not chosen another one. One of the residents in the home is a practicing Muslim and chooses to regularly visit the mosque and eat a halal diet. The other two men choose not to practice their religion. One of the current residents has regular contact with his relatives and goes to visit them. Another resident has occasional visits from his family. One resident has lots of friends who he goes to visit whenever he wishes to do so. The staff explained that whilst they ensured each resident took their medication at an agreed time they did have flexibility around the times they went to bed or got up. We were able to observe people spending time in their rooms if they wanted to do so. The residents have their own keys to the front door and bedroom. The staff explained that each week the people living in the home individually choose their food for the week ahead. The staff explained that the residents prepare their own breakfast and lunch. In the evening the staff will speak to the residents and ask them what they want to eat and help them prepare a hot meal. The record of what the residents had eaten was not maintained and so it was not possible to establish if they had received a healthy and nutritious diet. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. Whilst systems are in place to enable the residents receive the correct medication some staff need training in this area. EVIDENCE: “Each resident is approached and treated as an individual with their privacy respected and dignity maintained. Personal & healthcare support are given to all clients in a variety of ways depending on the individual. Although residents are encouraged to carry out as much of their daily routines independently, we provide them with the necessary assistance. Consistent support is given in all aspects of their lives whilst helping them to maintain their independence and control over their lives. Our speciality lies with caring for individuals who have Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 17 a forensic history, challenging behaviour and/or drug related problems”. (Extract from the AQAA prepared by the home) “Medication is administered by staff and all medication charts are checked thoroughly on a daily basis to prevent the risk of mistakes occurring” (Extract from a staff survey) We observed during the inspection that the residents attend to their own personal care, but where some prompting is needed this takes place in a sensitive and encouraging manner. We also observed that the residents were all dressed in an appropriate manner, although one person had a tee shirt that appeared worn. The manager explained that this resident, purchases his own clothes and they try to encourage him to buy new items. We looked at the healthcare records for the people living in the home. Everyone was registered with the GP and had regular health checks. Everyone had been encouraged to visit the dentist and optician and where the resident had refused this was recorded. All the residents had input from the local mental health care professionals. The staff understand the importance of monitoring each persons mental health and contacting the care professionals if there are any issues to address. The residents have been supported to check their weight on a monthly basis, although this had not been recorded for the previous month. We looked at the medication, administration records and staff training records. The home uses a blister pack system. The medication is stored in a medication cupboard in the office. The temperature of the medication cupboard is monitored and this is at a satisfactory level. The medication administration records record when the medication is delivered to the home and returned to the pharmacy so a clear audit trail is available. The records show that when medication is administered this is signed for by the staff member. None of the residents self-administers their medication. None of the residents has been prescribed a controlled drug. Each resident also has a list of homely remedies they can take and this has been approved with the GP. There are no medications given “as required”. The training records were inspected and two members of staff who had administered medication in the previous three days had no record to show they had received medication training. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure and feel able to raise any concerns. Procedures on safeguarding vulnerable adults are in place but some staff have not received training. Systems have been implemented to ensure residents personal monies are being managed appropriately. EVIDENCE: “Any complaints from clients, neighbours and outside agencies are taken seriously. We ensure that clients have a clear understanding of what to do in the instance that they would like to make a complaint. All complaints and their outcomes are well documented. We constantly monitor for any signs of abuse, neglect and self harm with our clients and have the appropriate policies, care plans and risk assessments in place to ensure that staff have the knowledge of how to monitor/manage and deal with these situations. We generally find that residents will make any issues known to staff before they escalate and an answer/solution is usually found before it becomes necessary to make a formal complaint”. (Extract from AQAA prepared by the home) Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 19 We looked at the complaints procedure and this was clearly displayed. The complaints procedure is also available in the information pack given to each of the residents. The record of complaints was inspected. There had been one complaint and this had been appropriately addressed. The surveys completed by the residents said they would know how to make a complaint. There had been one safeguarding vulnerable adult issue since the last inspection. The home had appropriately referred this issue to social services and had participated fully in the strategy meetings. Copies of the organisations procedures and social service procedures are available in the home. We looked at the staff training records and these show that for the three staff who work the most hours in the home only one had a record of receiving safeguarding vulnerable adult training and no future training date was arranged. We also looked at the training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours. These show that most of the staff have received this training and from discussions with staff and reading the risk assessments they feel prepared to cope appropriately with challenging situations as they arise. We saw the records for two of the people living in the home relating to their personal finances. The third resident manages his finances totally independently. The two residents have agreed with the staff that they will place their personal monies in the office and will request cash each day to help them budget their finances. When they deposit or withdraw their monies they sign to confirm this has taken place. The money held by the staff is stored in the locked medication cupboard. One resident has his money in a petty cash tin and the other has his money in a plastic cup. It was suggested that it would be more appropriate to put the money in a wallet. The individual arrangements for managing personal monies, is recorded in the care plans. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,28 and 30 were inspected. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a comfortable and homely environment, which is maintained on an ongoing basis. EVIDENCE: “Residents live in a homely, comfortable and safe environment that they can call their home”. (Extract from AQAA prepared by the home) The service consists of a modernized terraced house. The home is clean, safe and comfortable. There are local shops available very close to the home and access to public transport. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 21 The home has four single bedrooms one with en-suite facilities. We looked at two bedrooms and they were adequately furnished. Bathrooms and shower rooms are easily accessible from all the bedrooms. The home has adequate communal space consisting of a kitchen, dining area and a small lounge on the first floor. New sofas have been provided in the lounge. The home also has an enclosed garden. A designated smoking area is provided. One bedroom that was inspected smelt strongly of cigarettes but staff explained they constantly request residents to only smoke in the smoking area. The house was clean and tidy. Since the last inspection a washing machine has been provided that is designed to clean soiled laundry. The home was also well maintained and we saw a record of items for repair and that these were addressed in a timely manner. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are supported by a small team of staff who have all the appropriate recruitment checks in place. The staff are receiving a range of training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: “Residents are supported by competent and experienced staff. We have permanent staff and do not use agencies, which is in the best interests of the clients as they are continuously faced with a familiar person that knows them well”. (Extract from the AQAA prepared by the home) “We have regular meetings and will discuss any changes that take place regarding the clients” (Extract from a staff survey) Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 23 We checked the rota for the home and this showed that there is a team of four regular staff working at the home including the manager. The organisation also operates an internal bank system and staff from other homes come and work shifts where necessary. The staffing structure consists of the manager, one assistant and a team of carers. During the day there are one or two staff on duty and at night there is one waking member of staff. There is also a cleaner who works four days a week. The assistant manager has joined the team in the last year. One member of staff did express concerns about working on his own with the residents as they could potentially have challenging behaviours. It is recommended that the risk assessments are completed for lone working reflecting the needs of the residents. The manager and care staff explained that staff team meetings take place on a two monthly basis and are for the staff from all the homes. The staff training records were inspected for the manager and the three staff. Two of the staff had completed an NVQ in care level 3. We looked at the recruitment record for staff member who had started working at the home since the previous inspection as well as two other staff. It was found that all the staff had all the necessary recruitment checks including two references and ID, a POVA check and a CRB disclosure. Where needed the staff had evidence of current permission to work in the country. The staff all had completed and signed contracts of employment. We looked at the induction records for all the staff and they all had completed the homes internal induction programme and a record was available. The member of staff who had recently joined the team was interviewed and explained that as part of his induction he had been introduced to the residents and had completed the induction programme. Each member of staff had an individual training record. An ongoing programme of training was available till the end of the year covering a range of training to support staff to work effectively with the residents. This included courses on promoting positive mental health, communication skills, counselling, the mental capacity act and writing care plans. We looked at the supervision records. All the staff had received regular individual supervision. The format used for supervision is appropriate however the record shows that there is very limited discussion. It might help to prepare an agenda of issues to be discussed at all supervisions to help guide the supervision. Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. All residents benefit from a permanent manager who can provide stable leadership in the home. Health and safety measures are in place to safeguard the people living in the home. A system of quality assurance helps to maintain and improve standards in the home. EVIDENCE: “The manager is an experienced mental health nurse and has been running the home for 5 years. The manager is supported by day and night care coordinators all of whom are registered mental health nurses”. (Extract from Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 25 AQAA prepared by the home) The service has a registered manager. The manager is a qualified nurse but has not completed an NVQ level 4 in management and care. The manager provides a calming and experienced presence in the home. He has an excellent understanding of the needs of each of the residents and how to approach them in a non-confrontational manner. The registered provider and the care coordinators assist with many aspects of managing the service and this means that the manager is not undertaking many of the responsibilities you would find are necessary for managers in other services. The care co-ordinator for example had prepared the AQAA for the home and the registered provider takes the lead in assessing new residents and leading staff meetings. It was however observed in the managers training records that he had attended very little training in the last few years and much of his mandatory training was out of date. The company has questionnaires to seek the views of residents, relatives and other care professionals as part of a quality improvement exercise and these have been completed. The feedback from earlier in the year was inspected and was very positive and an action plan implemented to address any issues that had arisen. In terms of fire safety we looked at the fire safety risk assessment and emergency plan and this was complete. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills have been taking place quarterly. The training records show that fire safety training has been completed for the whole staff team. The AQAA showed that all the health and safety maintenance checks had taken place. The staff training records show that most staff have completed health and safety training including food hygiene, first aid and infection control but some need this training refreshed and training dates are not available. The insurance certificate was displayed and confirmed the service was appropriately insured. Wimbourne House DS0000010779.V372195.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 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 2 x Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered person must provide a safe system for administering medication by ensuring all staff who administer medication have received training. The registered person must safeguard the residents by ensuring all the staff have completed training on safeguarding vulnerable adults. The registered person must ensure the manager has updated his skills and knowledge by attending refresher courses for all mandatory training that is outstanding. The registered person must ensure that all the staff have up to date health and safety knowledge by attending refresher training where needed. Timescale for action 30/11/08 2. YA23 13(6) 31/12/08 3. YA37 18(1)(c) 31/01/09 4. YA42 18(1)(c) 31/01/09 Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 28 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. 5. 6. Refer to Standard YA17 YA19 YA23 YA33 Good Practice Recommendations The registered person should keep a record of what food the residents eat so that it is possible to establish if they are having a healthy and nutritious diet. The registered person should maintain the system of supporting residents to check their weight monthly so that can monitor any changes. The registered person should provide an appropriate container for one resident’s monies that are held by staff on his behalf. The registered person should carry out a risk assessment for staff working on their won in the home that reflects the needs of the residents. The registered person should provide a standard agenda for supervision sessions to ensure they are used productively. The registered person should ensure the manager’s knowledge is kept up to date by ensuring he attends all, the mandatory training as needed. YA36 YA37 Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wimbourne House DS0000010779.V372195.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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