Care Home: Windsor House

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What the care home does well Steps are in place to make sure only staff that are suitable to work with vulnerable adults are employed. This helps to protect people who use the service. People living at the home are supported to have their rooms how they want for example they choose the colour paint, their preferred furniture, pictures and things like televisions, stereos that they enjoy watching or listening to. They also have lots of photos displayed of people they are close to. People who use the service for short term breaks can take things into the home with them to help make their visit enjoyable. The health needs of people who use the service are monitored with good liaison with health care professionals ensuring their well being. People are well supported to keep in touch with people important to them such as friends and family. A relative told us that they are always made welcome and the Expert told us that he was offered a drink when he arrived at the home to support our inspection. People told us the service does the following well: "Windsor House has been a wonderful home for our relative and they continue to consider it just that, their home" "It provides a real home and `family` for residents somewhere they each can have their own space but also have companionship of communal living. The care and support provided reaches the right balance of encouragement to help themselves while ensuring they are well cared for" "Residents seem happy and are well supported to be as independent as possible" "Staff give support towards clients and attend to their personal care which I think is very good" "Permanent staff care for the emotional and physical needs of residents. They persist and encourage life skills training and independence. They ensure plenty of trips out and residents can attend their chosen activities and they co-host residents parties" "The staff here are brilliant...I`m happy with the care provided" "There is a very caring atmosphere within the residence – excellent staff who are very competent...I have complete confidence in the care given at Windsor House"Windsor HouseDS0000020686.V377940.R01.S.docVersion 5.3The Expert by Experience said: "I thought the home was in a nice spot, and looked well maintained. The gardens were well kept, and it did not look too much like a care home, which I thought was nice... The staff have positive relationships with all the residents, and the atmosphere was welcoming and relaxed". What has improved since the last inspection? Two people have been supported to move bedrooms to better suit their needs and ensure their safety. They have been helped to make their new rooms individual to them for example been supported to choose the new colour schemes and furniture. One person has been given extra staff support throughout the day. This has helped provide a more structured lifestyle for the person concerned and there have been fewer incidents although there continues to be a risk to others whilst the person remains living at the home. One person indicated that he feels `scared` and said that one person is noisy and shouts a lot and that he does not like this. Another person also said she sometimes feels frightened by the shouting. The Expert by Experience said "People should not live in an environment that is causing them upset, and I feel that it is essential that staff listen and act on these concerns and should do more... I would question whether the placement is suitable for the resident who is persistently very noisy, as it is clearly causing upset to the some of the residents". Care plans and risk assessments seen have been reviewed to ensure that they are still relevant and reflect people`s individual needs. Although they have yet to be developed in a format appropriate to individuals using the service for example pictorial plans may help people understand their plan of care. What the care home could do better: People are provided with a comfortable and homely place to live or stay, but not everyone using the service feels they are safe there. This is because the behaviours of one person put other residents at risk and causes them anxiety. Managers are working with lots of other people such as health and social care professionals and an advocate to make sure the individual is supported to find the right home for them so they are better supported. Priority needs to be given to training so that staff are fully equipped with the skills and knowledge to meet the individual needs of the people they support for example it would be beneficial for all staff to receive training in dementia care, visual impairment and the management of actual and potential aggression (MAPA) as staff are not trained to meet the needs of one individual during times when their behaviour may cause harm to others. We found that guidelines are in place but staff have not yet accessed the recommended training. This is fully acknowledged in the AQAA which states the plans for improvement over the next twelve months are `For all staff to be fully updatedWindsor HouseDS0000020686.V377940.R01.S.doc Version 5.3 with all mandatory training and to be provided with training which is specifically related to the customers who reside at Windsor House`. After a period of some stability people using the service and working at the home are now experiencing further changes with the management arrangements of the service. The registered manager left the home in July and a new manager is due to start in November. The Expert by Experience said "One resident I spoke with was very upset that he had not been involved in the recruitment of the new home manager or had met him. I thought that all residents should have been included in the decision making as it was their home". Another comment we received was "I`m concerned about further changes in the management of the home and the impact it has on the people living here...again there is lots of uncertainty". Concerns were also expressed about the location of the managers office, which is based on the first floor and is not accessible to everyone if they wished to speak with the manager. Important information could be made available in a number of formats to make it easier for people to understand such as pictorial, audio and DVD. We were advised this is being achieved with the support of the organisations media team. People told us the service could do the following things better: "Demand more and better communication between other care departments e.g. college and workplace" "TRIDENT NEED to make more effort to listen to staff concerns – understaffing leads to agency workers who don`t know the residents, their needs, likes, dislikes and routines such as regular club meetings. They need to keep staff, residents and families up to date with future plans for Windsor House and the residents" "Top managers don`t seem to be `in-touch` with the home" "No comment to make – happy with the service my family member gets" "The training staff receive is not consistent with the needs of the people here" "It may help to know more about the management structure, as we live at some distance and don`t always know who we are talking to. I should emphasize this is a very minor issue" "Families need to be informed more when clients have a doctor or hospital appointment" The Expert by Experience said "I was not happy to hear that the home has a short break service, as it does not seem fair, as it is people`s home. You can`t mix a living environment with a holiday environment... I would not like to liveWindsor HouseDS0000020686.V377940.R01.S.docVersion 5.3Page 9like that with people coming and going. It`s far from the worst home I`ve visited but it`s not the best" Key inspection report CARE HOME ADULTS 18-65 Windsor House 47 Windsor Road Oswestry Shropshire SY11 2UB Lead Inspector Rebecca Harrison Key Unannounced Inspection 13th October 2009 09:45 Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 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. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 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 Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Windsor House Address 47 Windsor Road Oswestry Shropshire SY11 2UB 01691 671353 01691 671322 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) joannesp@trident-ha.org.uk Trident Housing Association Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 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: 2. Learning disability (10) The maximum number of service users who can be accommodated is: 10 29th September 2008 Date of last inspection Brief Description of the Service: Windsor House is owned by Trident Housing Association and is registered to provide a service for ten people with learning disabilities to include three placements for people who require a short stay (respite) service. Windsor House is a building that was built to be a care home. Up to 10 people can live there. The home is in Oswestry within easy reach of the town centre. The home has a ten single bedrooms, two shared lounge/dining rooms, two kitchens and a range of bathrooms to include one with an overhead tracking hoist for people who are more physically dependent. The home does not provide a lift for people to use to get upstairs but does provide six bedrooms on the ground floor for people who have difficulty managing stairs. The home has a garden to the rear of the home and ample parking is provided to the front of the home. People are able to gain information about the service from the Statement of Purpose and Service User Guide. Fees charged are included in the Service User Guide and range from £867.98 to £881.07 per person per week. Inspection reports produced by CQC are available in the reception area of the home or on our website at www.cqc.org.uk Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit to the service was undertaken over a period of 7.5 hours by one inspector. The people who live and work at the home did not know that we were coming. A range of evidence was used to make judgements about this service. A number of the residents were involved in the inspection process; we met and spoke with some of the staff on duty and members of Tridents management team. We looked at some parts of the home and sampled a number of records to include staff training, recruitment, quality assurance and health and safety records. We received three surveys from people who use the service who received the help of someone close to them to complete the form, five surveys from people who have an interest in Windsor House and two surveys from staff informing us of their views of the service. Some of the feedback gained has been included in our report. The care received by two people was looked at in detail. This included looking at personal records such as care plans, health and medical records, daily records and how they are supported with their medication. We also discussed their care with them, where possible, and the staff who support them. Some people who live at the home were not able to tell us about the service they receive so we spoke spent time watching how staff support people to live their lives. This helps us gain information and understand the experiences of people who use the service and the quality of care they receive. An Expert by Experience helped us with our inspection. This was someone with personal experience of using learning disability services who had been trained to accompany inspectors during a visit to a service. Experts by Experience observe what happens in the home and talk to people who use the service to get their view of the home. This Expert talked with a number of people living at Windsor House and provided a report of his findings, parts of which have been included in this report. A senior manager completed an Annual Quality Assurance Assessment (AQAA) document for us. This is a form that tells us how Trident thinks the service is meeting the needs of the people they support and also tells us other information relating to how the home is run and the areas that they believe they are doing well. We looked at the outcomes for people living at the home and information to produce this report was gathered from the findings on the day of our visit and also the information that we have received, or asked for, since our last inspection. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 6 What the service does well: Steps are in place to make sure only staff that are suitable to work with vulnerable adults are employed. This helps to protect people who use the service. People living at the home are supported to have their rooms how they want for example they choose the colour paint, their preferred furniture, pictures and things like televisions, stereos that they enjoy watching or listening to. They also have lots of photos displayed of people they are close to. People who use the service for short term breaks can take things into the home with them to help make their visit enjoyable. The health needs of people who use the service are monitored with good liaison with health care professionals ensuring their well being. People are well supported to keep in touch with people important to them such as friends and family. A relative told us that they are always made welcome and the Expert told us that he was offered a drink when he arrived at the home to support our inspection. People told us the service does the following well: Windsor House has been a wonderful home for our relative and they continue to consider it just that, their home It provides a real home and family for residents somewhere they each can have their own space but also have companionship of communal living. The care and support provided reaches the right balance of encouragement to help themselves while ensuring they are well cared for Residents seem happy and are well supported to be as independent as possible Staff give support towards clients and attend to their personal care which I think is very good Permanent staff care for the emotional and physical needs of residents. They persist and encourage life skills training and independence. They ensure plenty of trips out and residents can attend their chosen activities and they co-host residents parties The staff here are brilliant...Im happy with the care provided There is a very caring atmosphere within the residence – excellent staff who are very competent...I have complete confidence in the care given at Windsor House Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 7 The Expert by Experience said: I thought the home was in a nice spot, and looked well maintained. The gardens were well kept, and it did not look too much like a care home, which I thought was nice... The staff have positive relationships with all the residents, and the atmosphere was welcoming and relaxed. What has improved since the last inspection? What they could do better: People are provided with a comfortable and homely place to live or stay, but not everyone using the service feels they are safe there. This is because the behaviours of one person put other residents at risk and causes them anxiety. Managers are working with lots of other people such as health and social care professionals and an advocate to make sure the individual is supported to find the right home for them so they are better supported. Priority needs to be given to training so that staff are fully equipped with the skills and knowledge to meet the individual needs of the people they support for example it would be beneficial for all staff to receive training in dementia care, visual impairment and the management of actual and potential aggression (MAPA) as staff are not trained to meet the needs of one individual during times when their behaviour may cause harm to others. We found that guidelines are in place but staff have not yet accessed the recommended training. This is fully acknowledged in the AQAA which states the plans for improvement over the next twelve months are For all staff to be fully updated Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 8 with all mandatory training and to be provided with training which is specifically related to the customers who reside at Windsor House. After a period of some stability people using the service and working at the home are now experiencing further changes with the management arrangements of the service. The registered manager left the home in July and a new manager is due to start in November. The Expert by Experience said One resident I spoke with was very upset that he had not been involved in the recruitment of the new home manager or had met him. I thought that all residents should have been included in the decision making as it was their home. Another comment we received was Im concerned about further changes in the management of the home and the impact it has on the people living here...again there is lots of uncertainty. Concerns were also expressed about the location of the managers office, which is based on the first floor and is not accessible to everyone if they wished to speak with the manager. Important information could be made available in a number of formats to make it easier for people to understand such as pictorial, audio and DVD. We were advised this is being achieved with the support of the organisations media team. People told us the service could do the following things better: Demand more and better communication between other care departments e.g. college and workplace TRIDENT NEED to make more effort to listen to staff concerns – understaffing leads to agency workers who dont know the residents, their needs, likes, dislikes and routines such as regular club meetings. They need to keep staff, residents and families up to date with future plans for Windsor House and the residents Top managers dont seem to be in-touch with the home No comment to make – happy with the service my family member gets The training staff receive is not consistent with the needs of the people here It may help to know more about the management structure, as we live at some distance and dont always know who we are talking to. I should emphasize this is a very minor issue Families need to be informed more when clients have a doctor or hospital appointment The Expert by Experience said I was not happy to hear that the home has a short break service, as it does not seem fair, as it is peoples home. You cant mix a living environment with a holiday environment... I would not like to live Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 9 like that with people coming and going. Its far from the worst home Ive visited but its not the best 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. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 10 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 Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 11 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): Standards 1 and 2 People using the service experience adequate quality outcomes in this area. Information is available to help prospective residents decide if Windsor House is the right place to live or stay. An assessment of their needs is undertaken with people close to them to make sure the staff have enough information and are confident that the service is able to meet their individual needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People looking for a care service are provided with information about what Windsor House has to offer in the Statement of Purpose and Service User Guide, which were last updated in May 2009. The guide includes some pictures but could be further developed and provided in different formats so that people have an alternative way of finding out about the services the home provides such as a DVD or developed using audio for people with a visual impairment. This is acknowledged in the AQAA as an area for further development. Fee information is now included in the guide, as required by the previous inspection so people are informed about the fees charged and who is responsible for paying these. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 12 There have been no new permanent admissions to the home and only the people who live at Windsor House all of the time were there at the time of our visit. We recently received a concern relating to an individual who used the service on a short term basis. Although we were advised that the home had undertaken their own assessment and also obtained an assessment carried out by the funding authority, there were problems with the provision of equipment and staffing implications being made available to fully meet the individual needs of the person concerned. This was fully acknowledged at the time of our inspection and has since been resolved however assessment procedures need to be robust, given previous concerns raised that led to the temporary suspension of short-term placements last year which were reinstated before our last inspection. The Expert by Experience told us that he was not happy that residents are made to share their home with people who visit on a short break basis. He stated I asked whether people who lived permanently at the home had been asked their opinions when the home decided to start using short break services again. The answer was no. If I was living there I would have liked to have been asked and listened to. I would not like to live like that with people coming and going. These are similar views expressed by another Expert by Experience when he visited the service last year and stated I would feel uncomfortable if my home was opened up to other people and I had no control over who stays in my home. I dont think this way of working is very person centred at all. The Statement of Purpose states We offer introductory visits to prospective customers and avoid unplanned admissions. There is little else documented to inform people that that it is the expectation that the home is shared with individuals receiving a short term service. The service user guide clearly states The home does not consider itself suitable for people with complex and challenging needs. At our previous inspection we expressed concerns about the impact that the behaviours one person was having on other people placing them at risk of harm. The person has since been reassessed and funding for additional staffing throughout the day has since been agreed by the placing authority. We have been advised that an appropriate placement has recently been identified and a number of people are working to support the person concerned to ensure a smooth transition. Contract of terms and conditions of residency were available on the records of the people whose care we looked at in detail, as recommended at the last inspection. This informs people of their rights and responsibilities and is going to be produced in an easy read format to make it easier for people to understand. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 13 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): Standards 6,7 and 9 People using the service experience good quality outcomes in this area. Detailed support plans ensure individuals receive personalised care and support in a way that they prefer. Staff have a good understanding of individuals preferred methods of communication and provide some opportunities to enable people to make choices and take risks to lead the lives they wish and maintain their independence. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the records held on behalf of two people who use the service. These were written using a person centred approach and were detailed covering the health and personal care needs of both individuals. There was evidence that both people had been reassessed with people close to them and new care plans developed and reviewed by designated key workers on a monthly basis. However these have yet to be developed in an accessible format and signed by the individual/their representative. The Expert by Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 14 Experience spoke with one person who said she had never seen her care plan and did not know where it was kept. The Expert said This worried me, as people should know about their care plans and who their key worker is. But more importantly it is best practice for people to be involved in writing their care plan, and I think this should be implemented, as this promotes peoples choices and their independence. Records seen and discussions held clearly evidence that the unpredictable behaviours of one individual continues to cause anxiety to other residents on a daily basis and places them at risk of harm. The team have worked closely with professionals and guidelines have been developed for staff to support the individual concerned but staff are unable to fully adopt these as they have yet to receive the recommended training. Some individuals are unable to communicate their needs verbally; therefore they are reliant on people who know them well to represent them such as designated staff, known as key workers, relatives or advocates. We spoke with the key workers and some of the staff on duty about the individuals whose care we looked at in detail. Staff demonstrated a sound knowledge of the individual needs of the people they support, which was an accurate reflection of the information held on their care files. We spoke with staff and observed them supporting individuals and it was clear that they know peoples communication preferences. The Expert felt more could be done in this area for example by making menus more easily accessible to people to understand by using pictures, symbols and photographs to help people decide what they would like to eat. The AQAA states The organisation has invested in a computer pictorial programme to assist staff to translate the written word into meaningful pictorial communication and this will be introduced to all care homes in the coming months. Care records for the individuals whose care we looked at in detail told us that both people are unable to make complex choices but should be offered opportunity to make simple choices to include choosing the clothes they wish to wear, activities they wish to partake in and holiday destinations etc. An advocate is currently working with one of the people whose care we looked in detail in finding an appropriate placement as this service is unable to meet the persons needs. Two other people have also had advocacy involvement and residents meetings are also held which provide people with the opportunity to raise ideas or concerns. The statement of purpose states We recognise that risk taking is vital and often enjoyable part of life and of social activities... A member of staff said Anything identified as a risk is assessed and written up. This was evident on the files of the people whose care we looked at in detail and covered areas such as personal care, self help, medication, leisure activities, use of transport and finances. These show that people are not stopped from taking risks as part of everyday living but that the necessary Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 15 systems are in place to minimise risk and live as independent as possible with the necessary level of support. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 16 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: Standards 12,13,15,16 and 17 People using the service experience good quality outcomes in this area. People are provided with opportunities to lead the lifestyle they choose and maintain and develop relationships that are important to them. Dietary needs and preferences are catered for and arrangements are being made to promote a healthier lifestyle and provide a wider choice of menu. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When we arrived at the home there was only one person being supported at the home, everybody else was out attending day services. We were told that people can decline going to day services if they are unwell or do not want to go. The person who remained at the home does not attend day services at all and is supported to do her chosen activity such as listening to music, going to the library, spending time with family and friends, basic food preparation and tidying their room. The person told us that they had been on holiday to London Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 17 with another person who lives at the home and two members of staff. She said London was lovely, I saw Big Ben and we also visited a museum. She also told us that she sees her family and a friend also visits. During our visit she had two visitors and went out for lunch with them. When people arrived back from day services they told us about the holidays that they had enjoyed throughout the year and some holiday photographs were seen displayed in the dining area. Records seen for the other person indicate the person is provided with a variety of activities to include college, bike rides, cooking, nail care, trips to local areas of interest and assistance with household tasks. It was reported that more opportunities for more activities are now available for this individual following the agreement to fund 1:1 support. This has helped to provide the person with a more structured lifestyle which in turn has improved the amount of incidents and behaviours displayed to others. Another person told us that he really enjoys looking after the garden and observations evidence he clearly takes much pride in his work. The Expert by Experience said One of the male residents said he liked having a bet on the horses, and that the male carer takes him into town. This was good to hear, as peoples interests should be supported. I chatted to two people in the lounge that had earlier returned from day services. I asked them about what they like to do in the evening, because for the past hour they were just sitting in the lounge, with no music or TV on and they did not seem to have much to do. There did not seem to be any opportunity for people do any activities, I would like to see people enjoying activities and being supported by staff to do so. One lady said she did not know what she liked to do; maybe some suggestions should have been made to her. I was told that people always need 1:1 support to go out in to the community as they are vulnerable. As there is only 3 staff on shift to support 7 residents, it is difficult to see how this would happen and this would limit peoples choices to pursue their interests. People are encouraged and supported to maintain relationships that are important to them for example through telephone, visits, attendance at reviews and social events held. One person received two visitors during our inspection and they were made welcome and offered refreshments. The AQAA states that plans for improvement over the next twelve months are To promote customers opportunities to develop and grow personal relationships outside of the home and the support network, to encourage new relationships within their local community to broden customers, social network, circle of friends and opportunities, thus enhance customers skills to develop their confidence within the community and broden their social skills. The care plans and daily records viewed indicate routines are flexible and that people are encouraged to help out with household tasks such as laying the dining table, giving out meals, clearing their dishes away, keeping their room tidy and basic food and drink preparation. This helps with developing their skills and independence. The AQAA states Staff respect each individuals Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 18 human rights, promoting fairness, equality, dignity, choices and preferences in the way each individual wants their care provided. Staff spoken with felt people are provided with a healthy diet and can help prepare meals. The AQAA states We plan to fully incorporate the governments drive on Change4Life into the homes menu to promote a healthier lifestyle whilst working with customers to enhance their awareness and knowledge in this area...we plan to have more healthy option sessions where customers can participate in making simple healthy option meals. One of the people whose care we looked at in detail had recently enjoyed making a pizza on their cookery course at college. Staff spoken with demonstrated an understanding of people with specific dietary needs such as gluten free and weight reducing diets and a bowl of fresh fruit was seen readily accessible to people. We were told that people are supported to shop for food on a Monday and are offered a choice of meals. The Expert by Experience said I had a look at the menus; they were hand written on a piece of paper and were planned 4 weeks in advance. I did not like this as menus were not in an accessible format so the residents were unable to understand it. People should not have to think about what they want to eat in 4 weeks time. The member of staff said they were doing a weekly one instead, but this was on a scrap piece of paper and people with a learning disability would not be able to read it. The member of staff said people plan their own menu but did not say how people are invited to choose. I think that it needs to be a picture menu so people can clearly see what’s on offer, and that the menu should also be accessible to those residents with visual impairments. I observed that staff were preparing snacks and drinks in the kitchen and had put out a snack and drink on the table ready for a resident. I think that person should have been supported to make a choice rather been given a snack. I did not think that was right. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 19 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): Standards 18,19 and 20 People using the service experience good quality outcomes in this area. People using the service can be confident that their health needs are now closely monitored with good liaison with health care professionals ensuring their well being. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans sampled were detailed and provide staff with the necessary information for the delivery of care and support. People looked well presented indicating that people receive the support they need ensuring they feel good about themselves. Male and female staff work at the home therefore when possible people can express their preferences when receiving personal care. As previously reported we received a concern about the provision of equipment for one individual receiving a short-term service which meant that he was unable to have a shower as the required equipment was not available. The situation has since been resolved. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 20 The last inspection identified concerns with the management of an individuals complex health needs and that medical advice had not been sought soon enough. The AQAA states Staff members are very alert to changes in moods, behaviour and general wellbeing of each customer and respond in a more skilled way to take the most appropriate action. This was an accurate reflection of the findings on the day of our inspection. We discussed this individual health needs with a member of the management team and a member of staff on duty and both reported an increased monitoring of peoples health needs. One said We have really tightened up and are a lot more vigilant regarding this persons health needs, its much improved. The person went on to tell us the measures now in place to prevent a reoccurrence of the situation we identified last year. We spoke with a member of staff who is the health facilitator for people using the service. She demonstrated a sound knowledge of the health needs of the people at Windsor House and of those we looked at in detail. The two care records that we looked at evidence that people attend regular health care appointments with their key workers and those close to them if desired. Health action plans have been developed for each individual and contain relevant information to ensure good health is maintained. Records seen show the home works closely with health care professionals to include a clinical psychiatrist, psychologist, behavioural care managers and GPs to ensure peoples needs are met. People close to them also accompany individuals on health appointments if desired. We looked at the medication arrangements in place for people who require help with the management of their medication. The service uses the monitored dosage system issued by a well known pharmacy. Medication is only administered by senior shift leaders who have received training in the safe administration of medication and have their ongoing competency is assessed. The home has a medication policy and procedure in place and a member of staff spoken with stated We now have robust procedures here and staff are very familiar with what people are prescribed...I have no concerns at all about the procedures here to include medication for people on respite which we will refuse if medication is not named and boxed. It was confirmed there has been no medication errors since our last visit. Records seen for the people whose care we looked at in detail evidence that medication reviews are regularly held to ensure individuals are on the correct prescribed medication and dosage required to maintain their health. The AQAA states Staff continue to develop their knowledge on medication practices such as the purpose of customers medication and the potential side effects to this medication through the resource library, training and personal awareness and development sessions. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 21 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): Standards 22 and 23 People using the service experience adequate quality outcomes in this area. Staff are alert to signs that people might have concerns about something but current systems do not fully assure that these are actioned. Although much improved some individuals are at risk of harm due to the unpredictable behaviours of one person and the lack of staff training which can make people vulnerable impacting on their quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The surveys completed by three people who use the service indicates that they know how to make a complaint, know who to speak to if they are unhappy, that staff usually or always treat them well and that staff usually or always listen and act on what they say. We were told that a residents meeting was held and the complaints procedure discussed with people, as suggested at the previous inspection. The Expert by Experience said I noticed there was a complaints procedure in the hall on the notice board, but it was very difficult to understand and not in an easy read format and therefore not accessible. I was concerned that people would not know how to complain and think it would be appropriate to address this as a priority. One of the people I spoke with told me that one of the residents shouts a lot and sometimes this frightens her. She did not seem to know how to complain. I feel staff should be responding to the issues she has. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 22 We looked at the record of complaints held at the home and saw that the concern we raised with the home regarding assessment and provision of equipment for an individual who used the service on a short term basis was logged and has since been resolved. We were advised that people had raised concerns regarding noise levels of one individual who lives at the home and that this had been sent to the contracts officer; however this was not logged therefore it was difficult to ascertain the outcome. This does not assure that the views of people who use the service are fully investigated, as recommended at the previous inspection. Proposed plans include implementing a comments and compliments book to seek views and opinions from all visitors to the home on what they think the service does well and ideas on how we can continue to improve the quality of the home and service. Our last inspection identified shortfalls in the reporting of behaviours that impact on others placing them at risk of harm. The action plan we received indicates that advice was sought from the safeguarding team following our inspection, written up and shared with the staff team. Additional staffing has since been secured to support the person whose behaviours place others at risk. We were told that there are now fewer incidents, that the person had been reassessed and had received involvement and support from the relevant professionals as seen on the file belonging to the individual concerned. We were told that guidelines to manage the persons behaviour have been devised and an alternative and more suitable placement has been sought. We looked at the behaviour support plan and spoke with staff on duty. Although behaviours have significantly improved with the additional staffing in place, staff are unable to follow the suggested guidelines as they have not received the recommended training. We were told that staff are therefore reliant on the use of distraction techniques and segregation, which is not good for the persons wellbeing. Daily records show the person continues to pose a risk to one individual in particular who has been subject to local vulnerable adult procedures following an incident at day services. This person told us he feels scared. Recommendations made by one professional in a report over a month ago have yet to be acted on. The home has a copy of local safeguarding adult procedures and staff spoken with confirmed financial procedures are robust following improved measures taken by the provider last year. The Expert spoke to one individual about the support they receive with managing their money. He said I asked her about where she keeps her money, she told me that it was kept upstairs in the office, but she had her own purse which is said was in her bag. I was unsure why she could not have her own money in her room, and maybe she could have been supported to manage her own money. It was not possible to ascertain exactly how many staff have received training in adult protection because the staff training matrix could not be located and evidence of such training was not available on the three staff files sampled. We spoke with a new member of staff who confirmed that she has yet to Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 23 receive training in adult protection but had read the local policy and procedure and was confident that any concerns would be reported. Information about safeguarding adults was seen displayed on the homes notice board. The AQAA states The organistion holds a induction programme which consists of one day around safeguarding vulnerable adults, identfying and recognising signs of abuse, procedures to follow in reporting adult protection concerns. We have also indentified a training provider who will deliver taining on the protection of vulnerable adults (PoVA). Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 24 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): Standards 24 and 30 People using the service experience good quality outcomes in this area. People using the service are provided with a clean, safe and homely environment which they are able to personalise. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Windsor House is situated in Oswestry within easy reach of the town centre. Accommodation is provided over two floors providing four bedrooms on the first floor and six on the ground floor suitable for people with a physical disability and providing access to bathroom with an overhead tracking hoist for individuals unable to weight bear so they can move safely. People living at the home on permanent or a short term basis share the same living accommodation. The AQAA reports We continue to maintain a noninstitutional environment which constantly involves customers in decision making on all areas of their home and service delivery. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 25 We looked at the shared areas of the home, the bedrooms of the people whose care we looked at in detail, a vacant room used for people on shortterm care and the bedroom of two other people who wanted to show us their room. With the help of a member of staff one person told us that he had moved to a ground floor bedroom as it was unsafe for him to continue living upstairs due to his visual impairment. He told us that he very much likes his new room and had chosen some new furniture that he had paid for himself but also wanted a new carpet due to an underlying odour left from the previous occupant. A senior manager advised us that this is to be replaced by Trident. This therefore needs to be actioned at the earliest opportunity given the issues with the odour. The AQAA identified improvements for the next twelve months to include sourcing funding for raised flower beds and a greenhouse to provide opportunity for individuals to grow their own vegetables in addition to creating a sensory garden and the possibility of providing a summer house to provide additional space for people who use the service. The floorcovering in the lounge will also be replaced with peoples involvement. The Expert by Experience said When I arrived I thought the home was in a nice spot, and looked well maintained. The gardens were well kept, and it did not look too much like a care home, which I thought was nice. I spoke to a lady in her bedroom. Her room was really nice, covered from floor to ceilings with her own posters, which she was very proud of. The room was well kept, clean, smelt fresh and was very homely. I asked her if she liked living here she said yes Staff ensure people are provided with a safe environment to live or stay by carrying out the necessary health and safety checks. It was reported there are no outstanding recommendations from the fire officer who last visited in 2007 and that recommendations made by environmental health in December 2008 have been met. The rooms that we viewed were found clean with only a slight odour detected in one room. With the assistance of staff people are encouraged to keep the home clean and tidy. Substances such as cleaning products that could cause harm to people are safely stored and we were advised that some staff have received training in the control of infection and contamination and the necessary equipment such as gloves, soap and aprons readily available. All visitors to the home are requested to use hand gel on entry to help prevention of infection. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 26 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): Standards 32,33,34 and 35 People using the service experience adequate quality outcomes in this area. Staff work positively and are committed to providing quality care. Training is inconsistent and does not fully ensure that staff have up to date knowledge and skills which could impact on their ability to meet the needs of people consistently. People have confidence in the staff at the home because all the relevant checks have been done to make sure that they are suitable to care for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Expert by Experience felt the staff have formed positive relationships with all the residents. During our visit we were advised 6 of the 9 permanent care staff employed hold a care qualification known as NVQ at level 2 or above in care or equivalent and 1 member of staff is currently working towards the award. Discussions held with a number of staff evidence that they are very much committed to their work, that they function well as a team but that staff Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 27 morale is mixed with one person reporting morale as a bit low and another person saying morale is really good Comments received by staff include: Its a lovely place to work, I love my job and we work well as a team People are well cared for The core staff team genuinely care about the residents and show commitment. People are supported in ways they choose and key workers work with residents best interests at heart. The standard of care here is very good and staff are very motivated Staffing levels have increased from 3 to 4 per shift throughout the day after the provider was successful in securing additional funding for one individual whose behaviours were impacting on the lives of others. The AQAA reports Staffing levels and contractual compliance are managed by effective rota management that is flexible to meet the needs of the customers. Staff spoken with considered staffing levels are sufficient to meet the individual needs of the people who use the service. Staff recruitment has improved since we last visited the home. We were advised that four new staff have been appointed, one persons contract was not made permanent after the probationary period and the provider has recently appointed to the full time waking night position subject to pre-employment checks being undertaken. Regular agency staff are being used for the individual currently receiving 1:1 support. We looked at the files of three staff employed since our last visit and with the exception of certificates relating to training and qualifications they contained all the necessary pre-recruitment checks required to ensure people living at the home are safeguarded. We were told that people are involved in the selection process for new staff although the Expert by Experience said One of the people I spoke with was very upset that he had not been involved in the recruitment of the new home manager or had met him. His key worker, whom he had a very close relationship with, had been acting up as the home manager and he wanted her to be the permanent manager. I thought that all residents should have been included in the decision making as it was their home. Other people also shared similar views. We passed this feedback to a senior manager present at the inspection who reported that people are usually involved and that they will be reviewing the management interview process. A completed training matrix was not available to demonstrate the training that have undertaken. The AQAA identifies that this is an area for development to ensure training needs of front line staff are managed effectively to ensure a quality delivery of service. It was reported that the four staff responsible for administering medication have received training to ensure staff have the necessary knowledge in the safe handling of medication. Staff have recently been awarded individual learning accounts to spend on their training needs Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 28 although we were told that staff have not had the opportunity to undertake training opportunities of late due to risks around swine flu. One person told us that they had completed a course on dementia care and found it extremely beneficial in supporting the person that she holds key worker responsibility for. One other person has attended a one day dementia awareness course but feedback we gained indicates every member of staff would benefit attending this course given they support an individual who has the condition. Staff would also benefit from training in visual impairment, hearing aid management, the management of actual and potential aggression (MAPA), catheter training and recent legislation introduced so that they are aware of the processes to follow for people considered to lack mental capacity. This should be undertaken at the earliest opportunity to effectively support individuals using the service. It is of particular concern that a member of staff, with no previous care experience has not received any training to date despite being in post for over three months. A record of in-house induction was available but was incomplete. We did not see any evidence of formal induction although the member of staff told us she was due to commence corporate induction 1 day a week for 6 weeks that week. As previously stated there were no training certificates available on any of the staff files sampled for new staff employed. We were advised that the training for another new member of staff was up to date as she had obtained this through another employer that she works for but no certificates to evidence such was available. Some staff require training/updates in safe working practices to include fire training, manual handling and food hygiene. Given the considerable efforts and improvements made in staff development as reported last year, the findings of this inspection were disappointing. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 29 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): Standards 37,39 and 42 People using the service experience adequate quality outcomes in this area. The recent change in the managerial arrangements has created some instability although the provider is confident that the recent appointment of an experienced manager will enhance peoples lives and further develop the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Following the departure of the registered manager in July people are experiencing further changes with the management arrangements of the service. Interim management arrangements were in place for a short period until a new manager was successfully appointed. These arrangements have since changed with service dependent on some management support from a Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 30 registered manager of a sister home two days per week. We were not informed of such arrangements that may impact on the service provided at the other home. The new manager was due to commence on the 28th September but this has since changed to the beginning of November due to unforeseen circumstances. One person said Ive recently met the new manager and he seems very nice. People expressed concerns about yet another change in manager given the unstable period that people have previously experienced. It was reported that satisfaction surveys to gain the views of people who use the service have recently been given out, completed and returned to the Head office for review. Surveys have yet to be sent to others with an interest in the service to ascertain their views in order to help assess how the service is currently performing and aid future planning. A report should be made available on the information gained. There was evidence that visits to support the performance of the home, as required by Regulation 26, are undertaken but not at the required frequency and not undertaken by the Operational Leader as stated in the improvement plan completed by the provider and sent to us, as required following the last inspection. The shortfall in monthly visits was also found at our previous inspection when we reported If the service is to improve further it is vital that the provider assesses performance monthly and sets clear objectives... The recommendation made previously has therefore not been met. People have access to a copy of the last inspection report which is available in the reception area of the home for people to read. The AQAA reports planned improvements include putting in place A quality assurance system that represents the views of the customers and stakeholders. People told us that overall they are happy with the health and safety arrangements in place to help keep people safe. Records evidence that the required health and safety checks are undertaken at the required frequency to ensure the safety of people using and working at the service. Issues identified at previous inspections relating to acceptable water temperatures has since been resolved and we were advised new water valves have now been fitted to prevent people from being at risk of scalding themselves. Equipment is serviced to include lifting equipment as required to ensure its safety. However a number of staff are in need of training in safe working practices to include fire training. We were advised that there are no outstanding requirements made by the Fire or Environmental Health Departments. It was reported that an independent fire audit has recently been undertaken by a company commissioned by the provider and the home is waiting for a report on the findings with some recommendations made. A fire drill has been undertaken following our last inspection and the fire risk assessment has been updated but we did not see any individual fire evacuation plans on the records sampled. Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 31 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 2 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 3 33 3 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 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 3 x 2 x 1 x x 2 x Version 5.3 Page 32 Windsor House DS0000020686.V377940.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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA22 Good Practice Recommendations Any complaint made under the complaints procedure should be fully investigated. This will assure service users and other parties that their concerns are listened to, valued and acted upon. Recommendation made at previous key inspection undertaken 28/9/08 not fully actioned. Service specific training should be made available at the earliest opportunity to ensure all staff have the skills and knowledge necessary to effectively meet the individual needs of the people using the service. New recommendation made as a result of this inspection. Effective quality assurance and quality monitoring systems based on seeking views of service users should be in place to measure success in achieving the aims and objectives of the home. This should inform an annual development plan for the home. DS0000020686.V377940.R01.S.doc Version 5.3 Page 33 2 YA35 3. YA39 Windsor House 4. YA39 This recommendation was made August 2007 and was not met at the key inspection undertaken 28/9/08 and only partly met at this inspection. Regulation 26 visits should take place at least once a month and should be unannounced to support the performance of the home. This recommendation was made at the key inspection undertaken on 28/9/08 and only partly met at this inspection. Individual Fire Evacuation plans should be in place for people living and staying at Windsor House. Where necessary advice should be sought about these from the Fire Service. This recommendation was made at the key inspection undertaken on 28/9/08 and evidence was not available at this inspection to suggest it had been addressed. Staff should attend training in safe working practices at the earliest opportunity to ensure the health and safety of people using the service and themselves. New recommendation made as a result of this training. 5. YA42 6. YA42 Windsor House DS0000020686.V377940.R01.S.doc Version 5.3 Page 34 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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