Care Home: Wrekin Villa

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What the care home does well What has improved since the last inspection? This is the first inspection for Wrekin Villa; the success of the service provision will be determined over a period of time. What the care home could do better: To ensure that the home is accountable for the declared services a written contract between the care home and service users should be developed and sets out the terms and conditions of residency, service provision and the rights and responsibilities of both parties. An initial plan of care should be developed at the point of admission (or shortly afterwards) to ensure that staff have sufficient details to ensure that all care needs are adequately met. The registered manager should complete the Registered Managers Award within an agreed timescale to ensure the skills and competencies for managing the home are maintained. To ensure that the home is meeting its stated aims and objectives a formal and effective quality and monitoring system should be introduced. CARE HOME ADULTS 18-65 Wrekin Villa 116 Wrekin Road Wellington Telford Shropshire TF1 1RJ Lead Inspector Joy Hoelzel Key Unannounced Inspection 8th January 2008 10:00 Wrekin Villa DS0000070100.V353609.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 Wrekin Villa DS0000070100.V353609.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. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wrekin Villa Address 116 Wrekin Road Wellington Telford Shropshire TF1 1RJ 01952 248 286 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) Vicky Jane Tellam-Clark Vicky Jane Tellam-Clark Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following category: - Mental Disorder (MD 3) The maximum number of service users who can be accommodated is: 3. New service 2. Date of last inspection Brief Description of the Service: Wrekin Villa is a care home providing accommodation and personal care to three people with mental disorder. The home is privately owned and was registered as a care home in June 2007. The accommodation is provided over three floors; there is no passenger lift to access the floors above ground floor level. All bedrooms are single occupancy with full ensuite facilities and are well furnished. The communal areas consist of a lounge, dining area, conservatory and kitchen all of which are homely and domestic in character. To the rear is a small enclosed garden with parking space at the front of the property. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents are readily available. Information on the current level of weekly fees is available in the documents or can be obtained directly from the home. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours on Tuesday 8thJanuary 2008 and is the first for this service. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty five of the forty three standards of the National Minimum Standards for Care Homes for Adults (18-65) were inspected on this occasion as they are viewed as key standards for services. Two people are currently living at the home and during the inspection were engaged in various activities. A senior support worker was in charge of the premises supported by a care worker. A look around the home took place, which included two of the bedrooms as well as communal areas. The care documents of two people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living and working at the home. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and comments from the AQAA are included within this inspection report. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: Information on the service is provided in a statement of purpose and service user guide, both documents have been recently reviewed and are readily available. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 6 A robust admission procedure is operational ensuring the home is suitable for the individual and that the assessed needs of the person can be fully met. The home is comfortable, warm, and homely. The staff demonstrated a good in depth knowledge of the client group and the dilemmas associated with mental ill health. People living at the home stated – ‘I like it here in the home’ ‘ Staff are all very good, they help me a lot. They take me shopping and help with cooking my meals’. What has improved since the last inspection? 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. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 7 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 Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 8 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): YA 1, 2,5 Quality in this outcome area is good. The home understands the importance of having sufficient information when choosing a care home and provides a statement of purpose that is specific to the individual home and the resident group they care for. Admissions are not made to the home until a full needs assessment has been undertaken and prospective residents are given the opportunity to spend time in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide for the service have been developed and are available upon request form the home. Full details of the weekly fees are included with a full breakdown of what is and is not included. Currently the complaints procedure is not included in either document but is available in a separate document. It is recommended that this be included, the senior staff offered an assurance that the documents will be reviewed to include this information. The home has adopted a robust admission procedure for all prospective clients with many multi agency meetings and discussions arranged to ensure that the Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 9 home is able to fully meet a persons needs and to ensure the suitability of the placement for the person. Two care plans inspected included an assessment of a persons needs by the home, other authorities and agencies. The Annual Quality Assurance Assessment (AQAA) completed by the manager offers an overview of the admission procedures and states – ‘Prospective service users are given the opportunity to have an overnight stay/spend time at Wrekin Villa prior to admission’. Contracts are on file with the home and the funding authority. The home has not yet developed a contract/terms and conditions of the home with the individual person. This was discussed with the person in charge who offered an assurance that contracts/ terms and conditions will be developed and available for all service users. To ensure that the home is accountable for the declared services a written contract between the care home and service users should be developed and sets out the terms and conditions of residency, service provision and the rights and responsibilities of both parties. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. The care plan is a working document reviewed regularly involving the person and their representatives, as appropriate. Reviews focus on asking what has worked for the individual, where there are progress, achievements, concerns and identifies action points. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of the people living at the home were looked at. One of the files was very comprehensive, detailed and well organised. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 11 The care plan is developed and agreed with the person with many reviews and assessments being carried out to obtain a full person centred approach of the individual care needs. This includes the Care Programme Approach, occupational therapy assessment together with an assessment of mental, psychological and physical health, dietary needs, personal care, budgeting, communication, community skills, domestic and self care skills, occupation and leisure, housing and family and personal relationships and quality of life. Where a risk has been identified a care plan has been developed to give staff the details of how the risk can be reduced. The daily events are recorded by the staff and are very comprehensive, giving a full account of the happenings of the day. The case file of another person contained pre admission assessments and information but very little detail of how staff were to deliver the care needed. This was discussed with the staff, who explained the short length of time at the home and the person’s reluctance to contribute. The difficulties were acknowledged; nevertheless an initial plan of the care needed should be recorded (from the information gained from the pre admission assessments) and then reviewed at the appropriate time and with the inclusion of the person and other parties as appropriate. The person in charge gave an assurance that external agencies will be contacted to assist with review of the persons care needs. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 12 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): YA 12,13,15,16,17. Quality in this outcome area is good. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person is currently attending the local college and is on an independent living skills course, staff are additionally assisting with budgeting weekly money and supporting with grocery shopping. This person commented that they go regularly to the local shops and the cinema and discussed the possible membership at the local fitness centre. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 13 One person is a volunteer worker and stated that they enjoyed this and looked forward to returning after the Christmas break, working in the open air and meeting up with other volunteers. Contact with family and friends is encouraged with one person re establishing contact with a parent. People are fully supported and encouraged to make decisions about daily activity. Staff were observed to be assisting, supporting and encouraging with household chores. Staff confirmed that service users have a key to their own room and to the front door and are able to come and go as they wish. Staff were observed to knock on bedroom doors and wait for permission from the resident to enter the room. As part of developing independent living skills people are assisited with planning their weekly menu and are supported with the shopping, preparation and preparing of meals. A kitchen skills assessment is completed with the individual to ascertain their particular needs and capabilities. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 14 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): YA 18,19,20. Quality in this outcome area is good. People receive personal and healthcare support using a person centred approach and is responsive to the varied and individual needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal support is provided following an assessment when needed and as part of the rehabilitation programme. Staff were endeavouring to offer support and guidance to one person during the day and were being proactive with the difficulties they were encountering. Advice from other health professionals was being sought to try to overcome the difficulties and obstacles. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 15 The home operates a designated key worker system to ensure the consistency of care provided. Staff were observed to be working closely with people with apparent good relationships developed and maintained. One person stated that the staff were very good and helpful. The care plans indicated that healthcare professionals (Gp’s, dentists, social workers, psychiatrists, etc) are contacted when necessary to ensure that assessed needs are met. Inspection of medicine storage and administration records, demonstrated the home’s practices meet the guidelines of the Royal Pharmaceutical Society. The procedures for recording the safe receipt of medications into the home were discussed with staff to ensure a robust approach is maintained. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 16 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): YA 22,23 Quality in this outcome area is good. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure; a copy is given to each person at the point of admission to the home. A bound book is available for recording and monitoring any complaints/concerns that are made. One person stated if they had any concerns they would speak with their key worker or relative. The AQAA completed by the manager indicates that – ‘ If a service user wishes to make a complaint, support is given to access independent advocacy service or to talk to a member of staff of their choice’. The person in charge of the home confirms no complaints or safe guarding adults referrals have been made. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 17 The training planner indicates that some staff have received recent training in protection of vulnerable adults. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. The case file of one person clearly documents the agreement with dealing personal finances. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 18 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): YA 24,30 Quality in this outcome area is good. The home provides a physical environment that is appropriate to the specific needs of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wrekin Villa is situated in a residential area of Wellington and is an end of terrace property that is well furnished, homely and domestic in character. Accommodation consists of three bedrooms all with en suite facilities, a communal lounge and dining area, kitchen and conservatory. There is a small garden at the rear of the property staff explained that one person is interested in gardening and is planning and preparing the flowerbeds for the spring. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 19 The premises appear to be satisfactory for the current client group. The local fire officer and environmental health officer visited the home in preparation for the registration in June 2007. The home was clean; staff and one of the service users were busy attending to household jobs during the morning. Staff explained there were some difficulties with the hygiene and cleanliness of one of the bedrooms but this was being sorted by negotiation and discussion with the occupant. Laundry facilities are sited in the conservatory this has been discussed and agreed with the environmental health officer. One person explained that they had requested a change of bedroom, this had been provided and went on to say how pleased they were with the change and that it was – ‘ A lot better and bigger, very happy now’. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 20 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): YA 32,33,34,35. Quality in this outcome area is good. There is enough staff available to meet the needs of the people using the service, with more staff being available when needed. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The two staff at the home demonstrated a good knowledge of the individual care needs of the clients and the difficulties associated with specific conditions. One person living at the home stated – ‘Staff are all very good help me a lot’. A training programme has been developed to ensure that all staff receive the training required in the core and specialist topic areas. The documents records recent training in first aid, National Vocational Qualification level 2, medication, Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 21 moving and handling, food hygiene, adult protection and managing challenging behaviour. The AQAA completed by the manager indicates that of the five permanent staff, four have been accredited with National Vocational Qualification level 2 or above with one person working towards it. The person in charge stated that the staffing levels are determined by the requirements of the people living at the home with additional staff on duty if required. Rotas are maintained to indicate the staff on duty at any given time with generally mainly two workers during the day and one at night. On call staff are available should the need arise. Three staff personnel files were looked at; the records examined showed they contained all the necessary information, which demonstrates potential staff are well screened before they are deemed suitable to start work at the home. Certificates and accreditations of training are included in the files. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 22 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): YA 37,39,42. Quality in this outcome area is good. The manager has the required qualifications and experience and is competent to run the home. Senior staff indicated and demonstrated that the service promotes equal opportunities, understands the importance of person centred care and effective outcomes for people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Vicky Tellam- Clarke is the registered manager of the home and generally works three days a week in a supernumery capacity. Mrs Tellam- Clarke was not at the home during this inspection. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 23 Mrs Tellam- Clarke is an occupational therapist and during the process for registration of manager of the home was deemed to ‘Have sufficient knowledge and understanding to manage a small care home for younger adults with mental health problems’. At the time of the registered manager application Mrs Tellam- Clarke was in the process of enrolling for the Registered Managers Award to commence in autumn (2007). It was not possible to determine if this award had been achieved. Mrs Vicky Holbrook, senior support worker, was in charge of the premises at the time of the inspection and demonstrated a good knowledge of the two clients and the care and support needed and provided. The office and documents relating to the service users and the management of the home were well organised, up to date and kept secure. The person in charge stated that currently there is no formal quality assurance system as home has only been operable for six months; in house audits are carried out at regular intervals for medication, personal finances and routine maintenance. The AQAA completed by the manager states that – ‘Records are routinely completed meeting all health and safety requirements, law and legislation, safe working practices are promoted, risk assessments are completed and feedback on work practices is given to staff’. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept and readily available for inspection. Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Wrekin Villa DS0000070100.V353609.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5(1)(b) Requirement To ensure that the home is accountable for the declared services a written contract between the care home and service users must be developed, and sets out the terms and conditions of residency, service provision and the rights and responsibilities of both parties. Timescale for action 28/02/08 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 YA6 Good Practice Recommendations It is recommended that an initial plan of care be developed at the point of admission (or shortly afterwards) to ensure that staff have sufficient details to ensure that all care needs are adequately met. The registered manager should complete the Registered Managers Award within an agreed timescale to ensure that the skills and knowledge for managing the home are maintained. A formal and effective quality assurance and monitoring DS0000070100.V353609.R01.S.doc Version 5.2 Page 26 2 YA37 3 YA39 Wrekin Villa system should be implemented to ensure the home is meeting its stated aims and objectives and statement of purpose. 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