Care Home: Woodbury

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What the care home does well Woodbury accommodates people who have both physical and learning disabilities, some of whom have highly dependent needs and limited communication abilities. The home has an established manager and skilled staff team who know and understand each person`s specific needs and individuality. Many of the staff team have worked in the home for many years meaning that people benefit from consistent delivery of care. Plans of care are person centred, well created and closely reflect each person`s unique needs and lifestyle choices. The staff group are skilled in communicating with people, and for those individuals with limited speech, great efforts have been made to document and to interpret their moods, gestures and expressions. Many records are presented in ways that help people understand their plan of care. One care manager wrote "provide support plans for service users which are accessible and comprehensive." People living in the home are provided with a range of stimulating and varied life styles and have regular opportunities to comment and influence how the care home is run. The expert by experience reported: "There are plenty of activities available both in the home and community and I saw these in people`s person centred plans." The manager and staff work well together to raise standards for the people who live in the home and to make sure that they are at the centre of its services. Positive arrangements are in place to protect people, respond to any concerns and to help represent their views where necessary. Relatives, friends and external support organisations such as the `Service User Parliament` group are very involved with the home. Although one of the larger services for people with learning disabilities, the environment is homely, welcoming and well maintained. People`s bedrooms are highly personalised to reflect individual personalities, lifestyles and specific needs. The home keeps good links with a range of health care professionals to ensure that each person`s care needs are met. The expert by experience reported: "This is a pleasant, well-run home. The staff were friendly and professional and the residents were happy there and said they liked the staff and that they were helpful. When I pointed out an improvement [the front doorbell was too high for me] they were keen to put it right." For what the home does well, comments from staff included, "gives our service users a comfortable, supportive and close unit to live in and feel at home." Another staff wrote, "ensures service users inclusion on all aspects of care/ daily living." Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next 12 months. What has improved since the last inspection? There have been ongoing home improvements within the premises. The ground floor bathroom has been refurbished and flooring replaced in the toilets, dining room and three bedrooms. The respite room and dining room has also been redecorated. A juke box has been purchased for people to use in the main lounge and the home has begun to review preferred leisure activities with each person. The expert by experience said, "It was good to see the Wurlitzer juke box in the living room; some residents could put on their choice of music easily." A second vehicle has been added so that people have increased opportunities to go on activities within the local community and beyond. Ongoing staff training has continued. This means that the staff team continue to develop and refresh their skills and knowledge to meet people`s individual needs and keep up to date with current practice and legislation. The home has made further progress in using a more person centred approach to care and continues to look at ways to make records more accessible to people using the service. What the care home could do better: Each person must have an up to date and relevant contract so that they have accurate information about how much they will pay and what the home provides for the money. It will also help each individual and/ or their representative have a better understanding of the care that is promised to them. Some people choose to prop their bedroom door open with a wedge and this practice could compromise people`s safety in the event of a fire. Appropriate door closure devices that link to the fire alarm system are therefore needed. Until the work is completed a risk assessment must be put in place. So that the rights and best interests of people living in the home are better safeguarded, we need to be kept informed of any events that affect the well being of people living in the home. This is so we can track incidents and monitor whether the home has made the correct choices when dealing with events that could have put people at risk from harm. Management must therefore ensure that both they and all staff are familiar with the required guidance under regulation 37. The duty rotas need to be written more clearly so that they provide an accurate and true record of all staff working in the home. Finally, the lock on the downstairs toilet door needs repair to ensure people`s privacy. Based upon our findings, we have made some good practice recommendations for the registered provider to consider. That refresher training on meeting the needs of people who have epilepsy is arranged for both regular and agency staff. This will ensure that staff are up to date with current developments and ways of working with people who have such specific needs. The front doorbell could be more accessible for people who use wheelchairs. In the ground floor bathroom, the lighting could be adjusted and a storage facility provided for the hoist slings. This would create a more homely feel for the people who use it. At the last two inspections, we have put forward suggestions concerning the issue of space on the ground floor and the installation of a lift. We again think that the provider should seriously consider improving the communal space by completion of an extension to the dining room. This would create additional space in the lounge for people with physical disabilities to spend time out of their wheelchairs and relax. A larger dining area would also give people an option to eat together as a group if they wanted. It is acknowledged that the home has requested funding from the local authority to complete an extension and install a lift. CARE HOME ADULTS 18-65 Woodbury Royal Borough of Kingston Community Care Services 8 Kingsdowne Road Surbiton Surrey KT6 6JZ Lead Inspector Claire Taylor Unannounced Inspection 17th February 2009 10:00 Woodbury DS0000034367.V374256.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 Woodbury DS0000034367.V374256.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. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodbury Address 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) Royal Borough of Kingston Community Care Services 8 Kingsdowne Road Surbiton Surrey KT6 6JZ 020 8547 5770 020 8399 7653 jane.wells@rbk.kingston.co.uk Royal Borough Of Kingston Upon Thames Jane Elizabeth Wells Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. A minimum of four staff must be on duty at any one time. A minimum of two members of staff, one waking and one sleeping, must be on duty at night times. At least two senior staff should be employed at Woodbury in addition to the designated senior responsible for managing Chamberlain Way. The Registered Manager is also registered to manage Chamberlain Way, a care home for 2 adults with learning disability. The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. 20th February 2007 Date of last inspection Brief Description of the Service: Woodbury is a service for adults who have a learning disability. The home is owned by the local authority of the Royal Borough of Kingston and is managed by Jane Wells. The service offers both long and short stay residential care with one bedroom on the ground floor that is used for respite stays. The home is a large detached property in a residential area in Surbiton. Accommodation is provided over three floors. There is no lift although the ground floor is equipped for people who use wheelchairs. There is a large rear garden that is well maintained and parts of the building benefit from views of the local area. Fees were £1100.00 per week at the time of this inspection. There been no changes in the ownership, management or the service’s registration details in the last 12 months. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that the service must complete every year. It is used to tell the Commission about the services provided, how the home makes sure of good outcomes for the people using it and any planned developments. The completed AQAA provided us with useful information about what the service does well and where it needs to improve. Some details from the AQAA are included in this report. We spent a full day in the home and the manager was available throughout our visit. An expert by experience was invited to take part in the inspection process and together with their personal assistant, accompanied us for part of the site visit. An expert by experience is a person who has a shared experience of using services and can help us get a better picture of what it is like to live in a care home. Key parts of the report compiled by the expert by experience have been used as evidence to support our judgements. Time was spent meeting with people to discuss what it is like to live at Woodbury. We spoke with some of the staff on duty, the manager and we also met with three visiting relatives. We looked at various records in relation to people’s care, staffing and the way the home was being run. Some people living in the home do not have the capacity to share their views regarding their care. In order to make judgements about the care that individuals receive, we observed care practices; interactions with staff and tracked records of care. Three people living in the home completed ‘have your say’ comment cards with support. We also received surveys from seven staff and three care managers. All those who took part are thanked for their time and contribution to this inspection. What the service does well: Woodbury accommodates people who have both physical and learning disabilities, some of whom have highly dependent needs and limited communication abilities. The home has an established manager and skilled staff team who know and understand each person’s specific needs and individuality. Many of the staff team have worked in the home for many years meaning that people benefit from consistent delivery of care. Plans of care are person centred, well created and closely reflect each person’s unique needs and lifestyle choices. The staff group are skilled in communicating with people, and for those individuals with limited speech, great efforts have been made to document and to interpret their moods, gestures and expressions. Many records are presented in ways that help people understand their plan of care. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 6 One care manager wrote “provide support plans for service users which are accessible and comprehensive.” People living in the home are provided with a range of stimulating and varied life styles and have regular opportunities to comment and influence how the care home is run. The expert by experience reported: “There are plenty of activities available both in the home and community and I saw these in people’s person centred plans.” The manager and staff work well together to raise standards for the people who live in the home and to make sure that they are at the centre of its services. Positive arrangements are in place to protect people, respond to any concerns and to help represent their views where necessary. Relatives, friends and external support organisations such as the ‘Service User Parliament’ group are very involved with the home. Although one of the larger services for people with learning disabilities, the environment is homely, welcoming and well maintained. People’s bedrooms are highly personalised to reflect individual personalities, lifestyles and specific needs. The home keeps good links with a range of health care professionals to ensure that each person’s care needs are met. The expert by experience reported: “This is a pleasant, well-run home. The staff were friendly and professional and the residents were happy there and said they liked the staff and that they were helpful. When I pointed out an improvement [the front doorbell was too high for me] they were keen to put it right.” For what the home does well, comments from staff included, “gives our service users a comfortable, supportive and close unit to live in and feel at home.” Another staff wrote, “ensures service users inclusion on all aspects of care/ daily living.” Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next 12 months. What has improved since the last inspection? There have been ongoing home improvements within the premises. The ground floor bathroom has been refurbished and flooring replaced in the toilets, dining room and three bedrooms. The respite room and dining room has also been redecorated. A juke box has been purchased for people to use in the main lounge and the home has begun to review preferred leisure activities with each person. The expert by experience said, “It was good to see the Wurlitzer juke box in the living room; some residents could put on their choice of music easily.” A second vehicle has been added so that people have increased opportunities to go on activities within the local community and beyond. Ongoing staff training has continued. This means that the staff team continue to develop and refresh their skills and knowledge to meet people’s individual needs and keep up to date with current practice and legislation. The home has made further progress in using a more person centred approach to care and continues to look at ways to make records more accessible to people using the service. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 8 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 Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 9 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): 2 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are arranged in a planned way and the needs of people who use the service are fully assessed prior to moving in. This ensures that the needs of the person are understood and can be met. Up to date contracts are needed so that people have accurate information about the facilities and services they can expect to receive. EVIDENCE: The same group of people have lived in the home for a number of years and there have been no new admissions. Suitable policies are in place however to ensure that the home would only admit people whose needs can be met. We looked at the care records for three people and each file contained a needs assessment that was undertaken through care management arrangements in the local authority of the Royal Borough of Kingston. The assessment gave a good overview of the person’s life, including individual strengths, hobbies, social/ cultural needs, dietary preferences, medical history and personal care needs. Records showed that the home considers the ethnic and diversity needs of each person such as their age, race and chosen religion. The home has one respite facility that is used by regular people who come to stay for short term care. People who use this service all live within the Royal Borough of Kingston. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 10 Records showed that the home makes sure that people who stay for short breaks are well supported when they are away from their family or carers. We met with one person who was staying short term at the time of our visit. They showed a photo album which had pictures of their family, keyworker staff and other things that were important to them. Staff explained that this helps the person know their routine and provide reassurance while they are away from their family. The individual contracts for each person are now in need of review as some dated back to 2003. All people living in the home must have an up to date and relevant Individual Service Agreement. This will help them and/ or their representatives to have a better understanding of the care that is promised and likewise the home’s duty of care to them. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 11 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): 6, 7 and 9 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are met as the home has a plan of care that the person, or someone close to them, has been involved in making. Individuals are consulted and given good opportunities to influence how the home is run. People are supported to take risks that promote their independence as well as their safety. EVIDENCE: For what the home does well, the AQAA said, “The service is committed to empowering and offering choice and, where service users have severe communication difficulties, in understating their choices, needs and desires. All service users have a Person Centred Plan, a full Needs Assessment and Individual Support Plan. All service users are reviewed by the Care Management Team.” Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 12 We looked at three people’s care records that included assessments of their strengths and needs in a range of areas. Each plan provides staff with clear direction about the most appropriate ways to give the required care and support. Written in a person centred way, there was good information about a person’s likes and dislikes and plans were also supplemented with pictures and photographs to help individuals understand them. The plans also emphasise the individuality of each person and reflect their qualities and personality. Examples said “I like going to the supermarket and parties and discos.” For dislikes one plan said, “other people shouting.” Each person’s preferred communication style was clearly recorded so that staff can recognise and understand their individual means of expression. I.e. through body language, gestures or behaviour patterns. In addition, one person uses particular sign language to communicate and had a photograph booklet of each sign and its associated meaning. This is a useful aid for anyone who may be unfamiliar with the person’s needs and preferences. Discussions with staff and observation confirmed that they knew each person’s specific means of communication. There were also guidelines in respect of individual needs such as mobility, communication and eating. They were clear and straight-forward and enable any new staff to get a clear idea of a person’s most immediate needs and how to meet them. Care records included clear information about any specific preferences in relation to peoples ethnicity and culture. One example being dietary requirements associated with one persons religion. We saw staff encouraging individuals in a variety of activities, allowing them personal space and time when this appeared appropriate, and of people opting to do activities that they enjoy. One person took obvious enjoyment watching a DVD of themselves at their birthday party. The expert by experience reported: “One resident was keen to show me her PCP which was full of pictures and symbols which were nice and bright and clear.” Through regular meetings, relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We sampled some records of meetings. Recent discussions centred on people’s choices for outings, menus and plans for a birthday celebration. Other meetings covered topics such as ‘keeping warm’ and bullying / respecting each other. We saw risk assessments reflecting activities that people take part in so that there are efforts to minimise risk and promote people’s safety. Guidelines for daily routines also show staff how to meet typical daily needs in a safe way. Individual assessments covered the full range of assessed risks and matched the needs of each person. Examples seen included personal hygiene, eating and drinking, mobility, accessing the home / wider community and managing finances. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 13 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): 12- 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead fulfilling lives as they are supported in the lifestyle they choose and have good links with the local community. Relationships with family and friends are well supported and daily routines ensure that people’s dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. EVIDENCE: For how the home has improved over the last 12 months, the AQAA said, “We have doubled our transport capacity and are responsive to individual community needs. We listened to service users who did not want to attend traditional Day Services and changed their programmes.” The manager also explained that the home was due to recruit some additional staff to work as activity coordinators. We looked at three people’s records concerning their Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 14 lifestyle. Care plans and PCPs contained detailed information about people’s activities and their preferred leisure time. At the six monthly review meetings, current activities and opportunities to take up new ones are explored. They were written in a person centred way and included pictures and photographs to make them more meaningful. Daily diaries are completed to show what social and leisure activities people have taken part in. Overall these corresponded with each person’s planned activity timetable although the home was in the process of reviewing each one individually. We spoke to one person who said “I like to walk down the road and buy my paper.” We saw that holidays are planned well and arranged according to each individual’s preference and needs. The majority of costs are funded by the home and people can go away together as a group or individually. Holiday destinations have included Centre Parcs, Butlins, a trip to Scotland and a short break at Alton towers theme park. People also had photos of their holidays in their care plans. The expert by experience reported: “Residents talked with enthusiasm about their music groups both in the home [as well as a drama group] and at a day centre. They also had a regular, themed disco at the home which friends are invited to. These are some people’s favourite activities. One resident talked a lot about going to his day centre; he really likes it. One person showed me the DVD they had made of their work with the goats at a city farm; they said they really liked it there.” The manager advised that the home had purchased a second vehicle so that people have further opportunities to do the things they enjoy in the community. The expert also wrote, “It was good to see that they used the whole range of transport available not just their own vehicles. They make trips into London and Brighton as well as using the train to visit relatives in Scotland and use local buses [including the wheelchair users]; the home is well served with bus routes.” The expert by experience spoke to people about community activities available to them and reported, “they mentioned going to different pubs, shops, supermarkets, swimming pools, football matches, boat trips and one resident goes to church.” Records showed that the activities reflect people’s interests and ambitions and help provide a varied and stimulating experience. Care records include details about each person’s social needs and who is important in their lives. Families are involved and the staff support people to visit and to keep contact with those that are close to them. One relative confirmed that the home always keeps them up to date with important issues. The expert by experience reported, “People have regular contact and time with their relatives if they wish and are enabled to phone them as well.” The AQAA said, “Many of our service users have severe communication problems, so choice is assisted with accessible formats, pictures and ongoing staff observation. Preferences are recorded e.g. likes and dislikes of food preferences.” Records confirmed this and staff had useful ‘on hand’ information about each person’s favourite foods, chosen cultural dishes and any dietary needs such as soft food preparation. “They also made use of speech and language services for eating and drinking advice” said the expert by experience. A part time cook works evenings at the home and staff prepare Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 15 meals at other times. During both lunch and the evening meal, we observed that individuals were supported sensitively; receiving the help they need, whilst encouraging independence and dignity. Adapted cutlery, cups and plates were available to help people maintain their independence. The expert by experience reported, “Residents mentioned cooking favourite meals and said they were happy with the choice available. The meal I shared was pleasant and there was good use of the rooms; there is a choice of where to eat as the kitchen diner can get noisy. The people who need a lot of staff help are enabled to stay as part of the group.” We saw people join in tasks to do with the evening meal, like setting the table and washing up. Woodbury DS0000034367.V374256.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): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. The home’s medication practices are well managed. If people cannot manage their medicine, the care home supports them with it in a safe way. EVIDENCE: Some people who live in the home depend on staff to fully support them with their personal care needs. Where support is required with personal physical care, this is identified and guidance is available on how specific tasks should be undertaken whilst also maintaining privacy and dignity. Staff were observed to manage a variety of tasks required to promote people’s well-being and safety, such as manipulation, and correct resting positions for those individuals who use wheelchairs. They were attentive to individuals and were able to identify with the gestures and reactions they gave, what these were likely to indicate and respond appropriately. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 17 We saw that good information about healthcare needs is available in the individual care plans. Some people had their own health action plan that outlines the support they may need for health check-ups and health screening. The manager plans to develop health action plan books for all people living in the home. These will provide a more person centred profile of an individual’s healthcare needs and detail how they will be delivered. People living in the home in have regular contact with General Practitioners, consultants and other health care services as required. E.g.. Physiotherapy, speech therapy, dentist and optician. We saw records for all medical appointments attended, with the outcomes and any follow up action required. Some people living in the home have epilepsy and the staff work in partnership with other healthcare professionals to enable each person to lead an active life as far as possible whilst managing their health condition. Literature about epilepsy was available in the home and individual guidelines for staff to fully support people with such specialist needs. We suggest however that all staff attend training on epilepsy to keep their knowledge and skills up to date and in line with current good practice. Each person had a written profile about their medication and the reasons for its use. Medication is supplied from a ‘Boots’ chemist and records were accurate for the receipt, disposal and return of medication. The administration charts were signed and accounted for and records showed that a suitable number of staff have been trained to administer medication. We spoke with one staff and they showed some good knowledge and understanding of the medicines that people were prescribed. In addition we observed safe practice when medication was administered. Guidelines for the use of ‘as required’ medication were being used to ensure that staff are clear about when and how to administer this type of medication. An appropriate healthcare professional carries out regular reviews to ensure that individuals receive the correct medication regime or treatment where necessary. Woodbury DS0000034367.V374256.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): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or those close to them, know how to complain. Their concern is looked into and action taken to put things right. Arrangements for protection from abuse are well managed and help ensure that people living in the home are safe although any reportable events must be notified to all relevant parties. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. People spoken to knew who to talk to if they were unhappy. Individuals also ticked that they knew who to complain to on the three surveys that we received. People who are able to communicate their opinions are provided with regular opportunities to voice their views or concerns. This is achieved through group meetings every two months and organised contact with their keyworkers. Some individuals living in the home would need total support to make a complaint and would rely on a relative, staff or other people to raise a concern on their behalf. The home helps to ensure that their views are represented through an independent group or ‘Service user parliament’ set up by the local authority. We met three relatives during our visit. Each said they had no complaints, having only praise for the service and the care provided. One relative that she was “very happy with the care” her daughter receives and if she had any concerns she would discuss it with the manager. The expert by experience reported, “It was good to hear a resident say that Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 19 the staff had helped him cope with an upsetting experience [as well as dealing with the problem].” Since the home’s last inspection in February 2007, no complaints or safeguarding concerns about the service have been raised with us. We looked at incident records and saw that two events were correctly reported to the local authority under the remit of safeguarding. We were not notified however and the manager must therefore ensure that all staff are aware of the relevant guidance and tell us about any reportable events. This has been discussed further under ‘Management & Administration’. Records showed that all staff at the home have undertaken recent training in safeguarding vulnerable adults through the owning local authority. An updated policy on safeguarding was also issued in November 2008. One care manager wrote, “safeguarding alerts are acted upon swiftly by the manager.” Staff surveys confirmed that Criminal Record Bureau checks had been carried out before starting work and that staff understood what to do if a concern was raised. For how the home has improved over the last 12 months the AQAA stated, “We have supported service users to meet with Parliament to encourage more debate and critical analysis of the service. Revised Complaints Procedure. Completed questionnaires.” Woodbury DS0000034367.V374256.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): 24, 26, 27, 28 , 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. The home makes sure they have the right specialist equipment that encourages and promotes each person’s independence. EVIDENCE: The home is well placed to access local transport links, community facilities and shops. Since our last inspection, there have been some home improvements within the premises. The ground floor bathroom had been refurbished and flooring replaced in the toilets, dining room and three bedrooms. The respite room and dining room had also been redecorated. We viewed several bedrooms with people’s permission. Each person is supported to make the room their own with possessions and furnishings that are meaningful to them. Individuals have their own TV, music systems and chosen items such as art creations, soft toys and personal photographs. One person Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 21 we met in their room showed a picture they had bought on a recent holiday. We saw that individuals have the equipment and aids required for staff to meet their current needs e.g. wheelchairs, lift, hoist, rails and adapted beds for those who have physical disabilities. The expert by experience reported, “The equipment in the home was really good for helping people with a high level of physical need. It was good to see overhead hoists in all the downstairs bedrooms and the bathroom. There were good, profiling beds and adjustable chairs as well as the small scale things needed like individually suitable cups and plates. I saw one resident using her walker very confidently and independently; this was helped by the way the furniture had been arranged so as to be uncluttered; which also aided the resident with visual impairment.” We have made good practice recommendations at the last two inspections concerning the issue of space on the ground floor. We again suggest that the provider seriously considers improving the communal space so that people using the service have a further living area that meets their physical needs. The second dining area is part of the main lounge and there is limited space for people with physical disabilities to spend time out of their wheelchairs and relax. An extension to the main dining room would create additional space in the lounge and an area for staff to support people’s sensory and physical needs. The expert by experience reported, “There were no mats to help folk get comfortable on the floors or beanbags, but the staff said that if people needed or wanted them then they would be provided and there was a good physio available.” The manager had also highlighted on the AQAA, “Seek funding from the Capital Expenditure Programme to secure additional space on the ground floor and to install a lift to all floors of the building.” We also recommended that a lift be installed at the last two inspections so that there is unrestricted access in the home for people who have physical disabilities. There are adequate toilets and bathrooms situated throughout the building, with an adapted bath to meet the needs of people with physical disabilities. On the ground floor, we found that one of the bathroom door locks needs repair to ensure people’s privacy. We think that the refurbished downstairs bathroom could be made to look more homely. The expert by experience reported, “ The bathroom could be made even more pleasant by having lighting that could be adjusted so that someone could relax in a gentle light. All the slings hanging up made it look a bit like a big cupboard and a few more homely touches would make a lot of difference; making it a more friendly room.” The laundry facilities provided are appropriate for the needs of the people who use the service. Protective clothing is available to staff and appropriate arrangements were in place for the safe storage and regular disposal of clinical waste. People responded on their comment cards that the home was “always” fresh and clean. Following a Food Hygiene Inspection by the Environmental Health Department the home was awarded a four star rating (out of a possible 5 stars), which is commendable. The expert by experience reported “There was a pleasant, accessible garden [by wheelchair] that people enjoyed in the better weather, as well as a smoking area; though this did not have a shelter or heater for when residents are out there [at least one resident does smoke]. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 22 There were plenty of chairs and tables outside and one resident mentioned playing football in the garden.” Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a competent and knowledgeable staff team, who are provided with the necessary training and guidance to support their needs. Good recruitment practices ensure that staff are vetted correctly so that people are protected from unsuitable workers. EVIDENCE: The staff team remain largely unchanged with low turnover. This enables consistency and familiarity for the people who live there. Staff allocation is adjusted where necessary to meet individual needs i.e. extra staff support for one person who was staying in hospital and for planned outings or trips. The manager advised that there were five staff vacancies to be filled and the home was looking to employ an activities coordinator. Regular bank staff from other homes and some agency staff are used to cover vacancies. The expert by experience reported: “I saw plenty of staff available to support people to do the things they wanted and needed to do and it was good that they are employing extra activities workers as this should improve the choice available.” Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 24 We saw that staffing levels were good and corresponded with the duty rota. Some improvements are needed with the rotas however as they did not provide an accurate record of who worked. Rotas did not include the manager, the full names of the staff or who was in charge. This must be addressed for better clarity and legal purposes. Interactions we saw showed that people living at the home were comfortable and relaxed around the staff on duty. Regular staff team meetings are held; minutes were clear and focused on people’s needs as well as the day-to-day running of the home. Records showed us that staff receive a thorough induction to the post and are supported in their jobs through regular supervision and an annual appraisal of their work. We received seven staff comment cards and all ticked that their induction covered everything ‘very well’. Staff spoken with confirmed having appropriate training and regular management support. When surveyed five staff responded that they ‘regularly’ meet with their manager for support and to discuss how they were working and two said ‘often.’ These systems therefore support staff to do their jobs well and reflect upon their performance and practice. People living at the home responded positively that staff ‘always’ treat them well. One person said that they ‘like the staff’ at the home. The expert by experience reported: “I saw a group going to the pub for someone’s birthday and a staff member made sure that they took the camera with them. One resident was keen to tell us about having her nails done by staff [and show us her nails].” A care manager wrote on their survey, “staff have always appeared respectful and professional.” The home’s recruitment procedures are thorough to ensure that staff are vetted correctly and people are safeguarded. The main staff records are held centrally at a head office in line with an agreement made with the Commission. In the home, a record is kept to evidence that appropriate recruitment checks have been carried out by the Royal borough of Kingston. We looked at four staff files which each contained all the correct records. The local authority have a planned programme of training which means that staff refresh their knowledge and skills regularly as well as develop their expertise and learn new skills. The manager provided us with a detailed copy of staff training which identified any completed courses and planned ones. Records also showed that the staff team have a wide range of experience to meet the specific needs of people using the service. Two senior staff have also attended a course which allows them to deliver training to other staff on moving and handling. For how the home has improved over the last 12 months the AQAA stated, “All staff have received training on Mental Capacity Act and senior staff on Deprivation of Liberty, to ensure compliance with new legislation (April 2009) More care bank staff have been recruited. More candidates enrolled for rolling N.V.Q programme.” Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 25 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): 37, 39, 40, 41 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run by a competent and established manager. Peoples opinions are central to how the home develops and reviews its practice and there and good arrangements in place for monitoring the quality of care provided. Record keeping is generally well managed to ensure that people’s rights and best interests are safeguarded although reportable events must be notified to the Commission more promptly. The overall health and safety arrangements protect people living and working in the home from avoidable harm. Appropriate fire door closures need fitting to bedroom doors where necessary however. EVIDENCE: Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 26 The registered manager Jane Wells has worked in the home for many years and continues to demonstrate good management practice. She has achieved the required qualifications and continues to update any training as necessary. Discussions and observation confirmed that she is knowledgeable about each person’s specific needs and understands the importance of person centred care and effective outcomes for people who use the service. Staff feedback was positive about the manager’s leadership and staff felt well supported. A range of quality assurance systems are used to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include care plan reviews, best interest meetings and various in house audit checks. A responsible individual from the local authority visits the home each month to check how well the home is running. Reports were detailed and showed that senior management make sure the conduct of the home is closely monitored. People using the service and their families or carers are offered a questionnaire once a year and there is a forum group known as service user parliament This is an elected group of people who have a learning disability and represent those individuals who do not have the capacity to share views about their care. Set up by the Royal Borough of Kingston, members of the Parliament report directly to the Joint Partnership Board in the local authority to give feedback about the services provided. Appropriate records are kept for accident and incident reporting although we must be kept informed of all significant events that affect a person’s well being. This is so we can track incidents and monitor whether the home has made the correct choices when dealing with events that could have put people at risk from harm. The completed AQAA stated that all relevant safety checks were up-to-date. We sampled the servicing and maintenance records for the home. We examined the fire log, which shows that tests on the alarm system are carried out each week and each person who lives in the home, and staff members, take part in regular fire drills. Some fire precautions need improving however. We saw that two bedroom fire doors were propped open; one with a rubber wedge and one with a CD rack. Staff explained that some individuals choose to keep their door open during the day. As this practice could compromise people’s safety in the event of a fire, an appropriate door closure device that connects directly to the fire alarm system is needed. Until the work is completed a risk assessment must be put in place. There were appropriate maintenance contracts for the home concerning gas and electrical safety and for servicing equipment such as the assisted baths, hoists and wheelchairs. These had all been checked regularly to ensure safe operation. The local authority has a rolling programme of mandatory training to ensure that staff update their skills and knowledge in key health and safety topics. Most staff had completed training on fire safety, moving and handling, infection control, food hygiene and first aid. There were arrangements for remaining staff to update such training. Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 27 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 X 2 3 3 X 4 X 5 2 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 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 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 3 X 3 X 3 2 X Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 5 (1)(c) (3) Requirement Timescale for action 31/05/09 2. YA23 37 3. YA42 23(4)(a) Each person needs an up to date and completed contract so that they or their representative are given full information about the services that are being arranged and what the home provides for the money. The Commission must be notified 31/05/09 of all significant events that are reportable under the remit of safeguarding vulnerable adults. This is so we can track that appropriate action has been taken and people are safe. The manager must ensure that all staff are familiar with the reporting of incidents and accidents under Regulation 37 of the Care Standards Act. Fire doors must not be propped 30/04/09 open unless they are secured by a suitable device that activates on the fire alarm sounding. An appropriate door closure is needed to ensure that people’s safety is not compromised in the event of a fire. Until the work is completed a risk assessment must be put in Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 29 place. 4. 5. YA27 YA33 12(4)(a) 17(2) shc.4(7) The lock on the downstairs toilet door needs repair to ensure people’s privacy. Staffing rotas must be recorded in more detail so that they provide an accurate and true record of staff working in the home. 30/06/09 31/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA24 YA27 YA28 Good Practice Recommendations That the front doorbell is moved to an accessible position for people who use wheelchairs. To create a more homely feel in the downstairs bathroom, the owners might consider adjusting the lighting and provide a facility to store the hoist slings. That the extension to the dining room is completed so that people have an option to dine together as a group and have more space to relax in the lounge. Repeated from last two inspections The registered provider should consider installing a lift in the home to allow those service users in wheelchairs unrestricted access to the home. Repeated from last two inspections All staff attend training on epilepsy to keep their knowledge and skills up to date and in line with current good practice. 4. YA29 5. YA35 Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 30 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 Woodbury DS0000034367.V374256.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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