Care Home: Wycar Leys The Terrace Care Home

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What the care home does well The service has commenced the development of person-centred care planning and this provides a more individualised focus on the needs of each service user. Records are generally well-detailed and reflect the needs and wishes of the service users. The documents inform staff about the level of support that is required to assist each service user. Service users are supported to make decisions about their lifestyle as far as possible, including participation in activities and personal development. There is consultation with each service user living at the home through a process of individual communication on a daily basis, and meetings with service users as a group. The environment is suitably maintained and the health, safety and welfare of service users is promoted through the systems and processes in place at the home. What has improved since the last inspection? There were no requirements or recommendations made at the previous inspection of this service. The service has told us that they have changed the activity programmes to reflect the needs and wishes of the service users. The service also told us about environmental improvements, including the provision of an additional bathroom. They also told us about the development of the person-centred planning concept with regard to the written records held about each service user. What the care home could do better: It has not been necessary to make any requirements at this inspection. We have made recommendations to improve the written documentation about the assessment and support that services users receive at the home. The recommendations relate to documenting the capacity of service users to make decisions, ensuring that all documentation records are identified with the name of the service user to whom they relate, and ensuring that care records are consistently signed and dated. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wycar Leys The Terrace Care Home Kirklington Road Bilsthorpe Newark Nottinghamshire NG22 8TT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Bailey     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Wycar Leys The Terrace Care Home Kirklington Road Bilsthorpe Newark Nottinghamshire NG22 8TT 08703307522X312 01623871753 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wycar Leys Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users who can be accommodated is 10. The registered persons 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 are within the following category: Learning Disability - Code LD. Date of last inspection Brief description of the care home Wycar Leys, The Terrace is a privately-owned care home for adults who have a learning disability. It is situated on raised ground about half a mile from the local amenities in the village of Bilsthorpe. The Terrace, one of the four homes on the site, is a two-storey building providing facilities for ten service users between the ages of 18 and 65 years. It is run independently from the other units and has its own staff team, but shares some facilities with the other three homes: a central kitchen, laundry, transport and extensive grounds. The people who live there prefer to be referred to as service users. The fees charged are based on individual needs. At the time of this inspection they ranged between £1713 and £2875 per week. Care Homes for Adults (18-65 years) Page 4 of 28 Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on 2 February 2007. The service has told us that the people living at the home prefer to be referred to as service users. This terminology is used within the inspection report. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service. The process considers the homes capacity to meet regulatory requirements and minimum standards of practice. The inspection visit was unannounced and took place over a 4 hour period. Care Homes for Adults (18-65 years) Page 6 of 28 There were ten service users living at the home on the day of the inspection, although several were out on activities at the time of the inspection visit. One service user, staff, and the acting manager were spoken with during the visit. We looked at information that we have received since the last inspection. The information included the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The service has also told us about things that have happened at the home and these are called Notifications. We have considered the eight Have your say about... surveys that gave us the views of the service users living at the home, and their opinions have been included in this report. Records were examined during the inspection, including the care records of three of the service users who live at the home. This was part of the process called casetracking that we use to follow the experiences of individual service users. We were able to speak with one of the service users that we case-tracked during the inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessments are undertaken to ensure that needs can be met, and service users can visit the home before choosing to live there. Evidence: In the Annual Quality Assurance Assessment (AQAA) that we received before this visit the service told us that pre-admission stays and visits are available to prospective service users. They told us that they obtain external pre-admission assessments and also undertake their own assessments. Following the assessment process a letter is compiled, which lays down the aims and objectives of the potential placement and includes costings and staffing arrangements. They told us that they were planning to produce an audio version of the Service User Guide. We looked at the surveys that we received recently. One of the respondents could not remember about the admission process, but seven confirmed that they had been asked if they wanted to move in. One respondent indicated that they had not received enough information before deciding to live at The Terrace, but six said that they had Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: received enough information (one did not respond to this question). We spoke with one of the service users that we were case tracking during the inspection. This person felt that they were satisfied with the admission process and had received all the information that they had needed. We case tracked three of the service users, which included examination of the written records held about these people. Case-tracked service users files had evidence of external professional assessments, although the homes assessments had been archived and could not be retrieved at the time of the visit. Another service users file (not case-tracked) did have evidence of a pre-admission assessment that had been completed by the homes staff. The acting manager confirmed that staff do undertake their own written pre-admission assessments. This is part of the process when visiting the prospective service user in their current setting, before trial visits are offered. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support needs of service users are recorded in their written plans, and there is guidance for staff to follow to help them to support the people living at the home. Evidence: The service told us in their Annual Quality Assurance Assessment (AQAA) that they were introducing person-centred plans and that they maintain comprehensive support plans for each service user. They told us service users make their own choices as far as possible and that these choices are risk-assessed where necessary. We followed the care and support processes for three of the service users living at the home. This included examining the written records for these people. The service users had person-centred plans and these provided detailed information about the support needs of the service users. The plans consisted of strengths, support needs and actions to support the service users. In some instances the individual sheets in the person-centred plans did not include the name of the service user. They were held Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: within named ring binders, but if sheets had become separated there could have been difficulty in identifying the person to whom they referred. Staff had not signed all of the individual person-centred plans and some plans did not indicate the date of commencement. Evaluations of the person-centred support plans had been signed and dated by the staff involved in the reviews. We spoke with a service user who was able to confirm that they were able to make many decisions about their life, for example, their participation in activities. The person was aware that written support plans were held about them and stated that staff discuss support issues with them. Five of the eight survey responses that we received told us that service users feel that they can always make decisions about how they spend their time (two said they can usually make decisions and one survey contained no information for this section). There was some evidence within the case-tracked care plans of acknowledgement of where people had decreased ability to make decisions for themselves, for example in respect of the management of finances. The acting manager has identified that more extensive recording of competency will be required in line with the principles of the Mental Capacity Act 2005. The acting manager has attended training on the Mental Capacity Act and Deprivation of Liberty Safeguards. This is an area that the service has recognised will require development to ensure that staff consistently record the capacity of each individual to make their own decisions for themselves. There was evidence of risk assessment within the care files of those service users that we case-tracked and many of these were individualised. There are also activity risk assessments, but these are generic and based on specific activities, rather than focussing on the service user. The service is currently introducing person-centred records and the acting manager stated that activity risk assessments will become person-centred as part of this development. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their 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. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users participate in a range of activities and are supported to lead a lifestyle of their choosing. Evidence: In the AQAA self-assessment that we received before this visit the service told us that the range of activities had been increased, with more physical activities and community access. Activities include bowling, cinema, horse riding and rambling. In the last twelve months the sensory garden has been developed and horticultural activities form part of the activities on offer. They told us that college tutors provide a range of tuition on a group and individual basis. They stated that family and friends are encouraged to maintain contact with service users. Service users are offered two choices for each meal with alternatives available in addition. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: One of the survey responses that we received last year included comment that the service user enjoyed horse riding and card making. One of the service users told us during the visit that they enjoyed going to the cinema, the pub and bowling. The acting manager told us that many of the service users attend courses. The service users that we case-tracked participated in activities such as numeracy and literacy, healthy eating, drama and ground works. The support plans for the service users detailed the social activities that each service user engaged in. Some of the service users visit family members, for example at weekends and the acting manager told us that families and friends are welcome to visit the home. Two of the service users that we case-tracked visit family members in the community. The central kitchens cater for the separate units on the site. The menus offer a choice for each meal and alternatives are available. One of the service users that we spoke with said: The food is good here. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users living at the home receive suitable personal and healthcare support. Medication systems promote the welfare of the service users. Evidence: The service told us in their Annual Quality Assurance Assessment (AQAA) about the health support available to service users. A General Practitioner (GP) visits regularly to see any service users that are unable to attend the surgery. A Consultant Psychiatrist holds a clinic on-site to offer psychiatric support for the service users. The service told us that staff who administer medications receive medication training. Survey responses indicated that service users consider that they receive the support that they need and a service user that we spoke with felt that staff offer good support. The person said: All the staff help me. The service user stated that they can decide their daily routines, for example when they go to bed. The written records that we looked at as part of case-tracking detailed the abilities of service users to meet their own needs and any support needed from staff to assist Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: them to meet their needs, for example, hygiene needs. We examined the medication storage and recording system in so far as it related to the three service users that we case-tracked. The Medication Administration Records (MAR sheets) were suitably recorded and the medication storage was appropriate. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service responds appropriately to any concerns and complaints and aims to protect service users from harm. Evidence: The AQAA self-assessment that we received prior to the inspection told us that the home has a complaints system. The complaints procedure is included in the Service User Guide and this is available to all of the service users. The service told us that all staff are trained to recognise abuse and receive safeguarding training. Staff also receive training about to deal with challenging behaviour. The Commission for Social Care Inspection have not received any complaints about the service in the period since the last inspection. We case-tracked three of the service users and there had not been any complaints recorded in respect of these service users. The survey responses that we received from the Have your say questionnaires indicate that service users know who to speak to if they are not happy and how to make a complaint. We spoke with a service user who was able to confirm that they knew who to approach if they had any concerns. The manager informed us that all staff receive training in safeguarding adults and a Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: staff member that we spoke with confirmed that this training had taken place. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, comfortable and homely environment for the service users. Evidence: In the self-assessment that we received from the service before the inspection they told us that there is now a larger dining room and an extra lounge, and an extra bathroom and two more bedrooms. They stated that service users choose the decor for their bedrooms. When we toured the building we found that it was clean and tidy. The surveys that we received told us that all the respondents felt that the home is kept fresh and clean. We also spoke with a service user that we case-tracked and the person was pleased to show us their bedroom, which they had personalised to their choosing. The service user said: I like my room. Another service user showed us their bedroom and they had also personalised their room. There is a central laundry, which serves all the homes on this site. The service user that we spoke with was satisfied with the laundry arrangements at the home. The acting manager informed us that all staff receive training in infection control and Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: that there are infection control policies and procedures for staff to follow. A member of staff that we spoke with was able to confirm that infection control training takes place at the home. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and recruitment practices promote the safety of service users. Evidence: In the AQAA self-assessment that we received the service told us that staff are trained in equality and diversity. They told us that staff undertake a supernumerary induction period and that there is a programme of annual updates for staff on mandatory training subjects. They told us that staff receive monthly supervision and annual appraisals. They told us that eighty percent of staff have either obtained National Vocational Qualification (NVQ) Level 2 or above, or are working towards this qualification. We spoke to a service user during the inspection and they told us staff treat them well and that they listen to them and act on what they say. The service user said: I love them all. The survey responses that we received also indicated that staff listen to the service users and act on what they say. We examined a sample of the staff recruitment files and we found that satisfactory checks had been included before staff had commenced employment at the home. This included Criminal Records Bureau clearance checks and two written references. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: When we spoke with a staff member they told us that they have good training opportunities including training on safeguarding adults, fire safety, first-aid, manual handling, and health and safety. The acting manager confirmed that the induction training meets Skills for Care standards. Annual update training is forward planned and steps taken to ensure that each member of staff receives all mandatory updates. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of service users are protected by the management systems in operation at the home. Evidence: In the AQAA self-assessment the service told us about the monthly meetings that are held with service users, in addition to the day-to-day communication that takes place with each service user. They told us that the required Regulation 26 provider visits are undertaken and that there is a weekly management report and monthly quality assurance report produced by the unit manager. The information provided in the AQAA dataset indicated that there is appropriate maintenance and checking of equipment and services in the home. The Terrace is currently managed by an acting manager. This person is a 1st Level Registered Nurse and commenced as acting manager a few months ago. She intends to apply to the Commission for the position of registered manager. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: We had feedback from a member of staff to confirm that staff are receiving the necessary range of health and safety related training to enable them to support and protect the service users living at the home. The acting manager confirmed to us that she completes a weekly management report and a monthly quality assurance report. We looked at a recent quality assurance report and this covered areas such as health and safety and records management. We were able to confirm at inspection that the mandatory monthly visits and reports by the registered provider are taking place. These regulatory visits (Regulation 26) are part of the quality monitoring processes, which act in the interests of people who use the service. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 6 Staff should sign each individual person-centred plan and enter the date of commencement. Individual sheets within the person-centred records should include the name of the service user so that they can be suitably identified if they become separated. Documentation processes should be developed to consistently demonstrate that each service users capacity to take decisions has been fully considered, in accordance with the Mental Capacity Act 2005. 3 7 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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