Care Home: Wychbury Care Services

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What the care home does well The home continues to be managed by an experienced and qualified manager and supported by a stable senior staff team. All members of the care staff team have the National Vocational Qualification (NVQ) Level 2 (or above), or currently undertaking training. The needs of people who wish to come to live at the home continue to be fully assessed to ensure these can be met by the service. People are supported to maintain contact with family and friends through the home`s `open` visiting policy. Systems are in place for regularly monitoring the home`s performance against its Statement of Purpose. It continues to seek the views of people who live at the home, their relatives and other visitors. What has improved since the last inspection? Systems have been put in place to ensure individual staff members receive more frequent supervision sessions. The training programme includes more client-centred courses. This ensures the needs of people living at the home are met appropriately. The home has reviewed its procedures and practice to ensure medication they look after on people`s behalf is safely managed. However, staff would benefit from clearer instructions for when to administer medication prescribed, "as required" to ensure a consistent approach is followed and enable this to be monitored more effectively. Procedures for safeguarding adults from abuse have been reviewed. Staff are aware of the multi-agency procedures for reporting any concerns. The home has reviewed its health and safety procedures and practice, reinstated its system for monitoring and analysing accidents/incidents and staff are receiving regularly fire safety training to ensure the health, safety and well being of people living at the home is fully protected. What the care home could do better: Individual risk assessments should be carried out on tasks that people wish to undertake for themselves, such as making hot drinks in their own room, and appropriate safeguards put in place. Risk assessments also need to be carried out for people who are wheelchair users to ensure their safety and the safety of staff assisting them is fully protected. The home must ensure robust recruitment procedures are followed at all times to ensure best interests of people who live at the home are fully safeguarded. A programme for the upkeep of the premises continues to be implemented. However, attention needs to be given to how people living in the Coach House are supported to maintain their independence by ensuring the facilities in thispart of the home are fully accessible to them. The courtyard should be included in the home`s risk assessment of the environment to ensure it is kept free of any trip hazards. CARE HOMES FOR OLDER PEOPLE Wychbury Care Services 350-352 Hagley Road Pedmore Stourbridge West Midlands DY9 0QY Lead Inspector Linda Elsaleh Unannounced Inspection 11:00 5 7 & 13 August 2008 th th th X10015.doc Version 1.40 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 Wychbury Care Services DS0000063444.V371310.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 Older People. 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. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wychbury Care Services Address 350-352 Hagley Road Pedmore Stourbridge West Midlands DY9 0QY 01562 885106 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) Daniel Timothy Johnson Sara Naomi Bate, Adam David Johnson Ms Rachel Davenport Care Home 42 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (42), of places Physical disability over 65 years of age (12) Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: Wychbury is registered to provide care to a maximum of 42 service users. It is a large detached traditional building that has been extended and adapted to its present form. The home is situated in a beautiful location, with countryside views of fields, hills and livestock. The gardens surrounding the home are very attractive. The home has a large rear garden with patio areas, a good sized fish pond, a summerhouse and lawned areas. At the bottom of the garden there are fields where a number of horses graze. The home is separated into two units, the main house and the Coach House. These two buildings both have bedrooms, lounge areas, dining rooms, toilets, bathrooms and a kitchen. The main house contains the ‘home’ kitchen, laundry and offices. There are two lifts in the main home and a stair lift in the Coach House allowing residents’ to access all parts of the home. The home should be contacted directly for information about the fees. Wychbury Care Services DS0000063444.V371310.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 star. This means the people who use this service experience good quality outcomes. This unannounced inspection was carried out in August 2008. The inspection included three visits to the home during different times of the day. The purpose was to assess the home’s performance against the key standards in the National Minimum Standards for Care Homes for Older People. The home has addressed the all the requirements and recommendations identified in the last key and random inspection reports. Our findings are based on the information received by us, the Commission for Social Care Inspection (CSCI), examination of relevant records and documents kept at the home, discussions with people who live at the home, members of the management team and staff. The views of relatives and professionals who visit the home were also sought. The comments received were complimentary about the service being provided. Here is a sample of those comments: “I have no problems at all I like it here, they like me as well and that’s all that matters.” – a person who lives at the home. “Wychbury is a care home for the elderly that genuinely does offer a caring service.” – relative of a person living in the home. “Rachel and the staff at Wychbury are a fantastic team and are a credit to the care industry.” – visiting professional What the service does well: The home continues to be managed by an experienced and qualified manager and supported by a stable senior staff team. All members of the care staff team have the National Vocational Qualification (NVQ) Level 2 (or above), or currently undertaking training. The needs of people who wish to come to live at the home continue to be fully assessed to ensure these can be met by the service. People are supported to maintain contact with family and friends through the home’s ‘open’ visiting policy. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 6 Systems are in place for regularly monitoring the home’s performance against its Statement of Purpose. It continues to seek the views of people who live at the home, their relatives and other visitors. What has improved since the last inspection? What they could do better: Individual risk assessments should be carried out on tasks that people wish to undertake for themselves, such as making hot drinks in their own room, and appropriate safeguards put in place. Risk assessments also need to be carried out for people who are wheelchair users to ensure their safety and the safety of staff assisting them is fully protected. The home must ensure robust recruitment procedures are followed at all times to ensure best interests of people who live at the home are fully safeguarded. A programme for the upkeep of the premises continues to be implemented. However, attention needs to be given to how people living in the Coach House are supported to maintain their independence by ensuring the facilities in this Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 7 part of the home are fully accessible to them. The courtyard should be included in the home’s risk assessment of the environment to ensure it is kept free of any trip hazards. 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. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is good. People are provided with good information about the home’s facilities and services and opportunities for them to visit to enable them to make an informed choice about where to live. The home’s process for assessing the needs of people to ensure no person moves into the home without being assured that these needs will be met. A written contract/statement of terms and conditions is provided to each person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and other documentation about the home’s facilities and services are on display in the reception area of the home and was last Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 10 reviewed in February 2008 by the home to ensure the information it contained was up to date. People who use the service told us the home had provided them with good information that enabled them to make an informed choice about where to live. We looked at the file for the most recent person to come to live at the home. This showed us the person’s needs had been fully assessed before they moved in. The assessment carried out by the home also includes details of people’s personal preferences and how they will be helped to ‘settle in’. A written acknowledgement from the home confirming it is able to meet her needs was also available. The person living at the home told us they could have visited the home before making a decision about whether they wanted to live here. However, s/he asked relatives to visit on her/his behalf. The person’s relative told us staff made them very welcome, gave them a tour of the building and introduced them to staff and some of the people who were living at the home. People who responded to our survey told us they always receive the care and support they need. Relatives also commented on how they felt the staff meet the needs of people who live at home. One relative told us “I feel my mom’s needs are very well met by Wychbury and its staff.” Information provided by the home tells us it is continuing to provide staff with opportunities to develop their skills in person-centred care. The records we looked at show training in caring for people with dementia had been provided during the last twelve months. Four files we looked at all contained a copy of the contract/statement of terms and conditions with the home. The contracts contain information such as the room the person will occupy, the fee payable and period of notice for leaving the home is to be given by either party. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. People’s needs are set out in their individual care plans and arrangements made to ensure their health care needs are met. More detailed information on people’s plans will ensure a higher level of consistency from staff when delivering care. The home has suitable systems in place to ensure medication is managed safely. People are treated with respect and their right for privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care plans for four people who live at the home and found these are produced based on their assessed needs and personal preferences. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 12 There was evidence that health care needs are regularly monitored and details are kept of appointments and visits from health care professionals such as the dentist, optician and chiropodist. One person’s file identified the need for pressure relieving care to be provided. Records kept by the home show how this care is being provided, details of the visits made by the district nurse and evidence that the plan is regularly reviewed. Another person’s plan shows their have recently become less mobility and her/his bed has been fitted with bedrails to protect them from falling. A risk assessment for this had been carried out but the plan was not signed or dated. The manager told us she would address this. The care plan and risk assessment for another person who has bedrails fitted was signed and dated. The files for two people show they are wheelchair users. Information about the use of the wheelchair was not included in their care plan. A full risk assessment also needs to be carried out to ensure the safety of the person and staff assisting them is fully protected. There are some detailed recordings of how care has been provided by individual staff. This shows the staff team are aware of how care needs are to be met and have knowledge of the person’s preferences of how care is to be delivered. Staff we spoke to told us they feel they are provided with good information about people’s care needs. One member of staff said “All clients have their individual care plans and all information is updated when needed.” However, the care plans do not always provide sufficient details for new or less experienced staff. For example, words such as “support” “encourage” “take action” is not defined/explained. We discussed with the manager the need for clearer information to be provided on how care is to be given to ensure a consistent approach is taken by all staff. There is a system for regularly reviewing care plans to ensure these continue to meet the needs of the individuals living at the home. This involves monthly monitoring of plans and, wherever possible, discussions with the individual. People who choose to participate in discussions about their care are encouraged to make any comments they have and sign their records. Relatives and/or representatives, where applicable, are also encouraged to participate in the review process. The home has informed us, that following consultation with the pharmacist, it has changed some of its medication arrangements. It has also reviewed its procedures for the safe handling and administration of medication. We looked at how medication is managed by the home on people’s behalf. There are suitable arrangements for ensuring medication are safely and securely stored. Medication is administered by staff that have been trained to do so. Regular audits take place to ensure procedures are being followed appropriately. The member of staff we spoke to told us the pharmacist is requested to completed the allergy section on the medication administration Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 13 record (MAR) sheets. At present not the people currently living at the home have any known allergies. She was clear about recording processes and the procedures to be followed in the event of an error or a person refusing to take prescribed medication to ensure their health and well being is appropriately managed. We looked at the medication administration records (MAR) sheets completed for four people whose medication is managed by the home on their behalf. These were fully completed according to the home’s procedures and, where applicable, the relevant codes where being used. Where medication is prescribed outside the normal cycle of delivery and a printed MAR sheet has not been provided, a second signature is obtained to confirm the handwritten entry is correct. This is done to reduce the risk of errors occurring through inaccurate recording. A senior member of staff told us one person is prescribed “as required” medication for when s/he becomes agitated. A plan has been produced for staff to follow when assessing whether medication should be administered. However, this needs to be more detailed to ensure a consistent approach is taken. This was discussed with the senior member of staff and the manager. Care plans include how a person’s privacy and dignity is to be respected by staff. For example, meeting with health care professionals in private and receiving their mail unopened. However, staff are available to help people when requested and written agreements are obtained if individuals request or require assistance in such areas. Three people we spoke to said staff always knock the door before coming into their bedroom and they can have keys to their door and cupboard if they wish. Visiting health care professionals told us staff are “..always courteous and very good at caring for the service users needs”, “Wychbury allows us to have one to one with the service users” and “…service users get their own choice”. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. People who live at the home are able to follow their preferred lifestyles. They are supported to maintain contact with family and friends and participate in a range of activities. Meals are served in pleasant surroundings and the choice of menu meets their individual dietary needs and individual preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided to us by the home tells us it has reviewed the activities they provide for people who live at the home. This is based on the comments they have received during residents’ meetings and responses to surveys completed by the people who live at the home and their relatives. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 15 The activities programme is provided in pictorial form and displayed in the hallway. People we spoke to told us they are consulted by their key worker and during residents’ meetings about what activities they would like to do. Throughout this visit we observed people participating activities such as movement to music sessions, some chose to watch while others chose to spend their time in one of the quiet lounges. The home has also arranged boat trips this summer. Photographs of the various activities people have enjoyed are displayed on the notice board. Some people told us the home had arranged a summer fete to celebrate its 25th anniversary. The deputy told us people had been involved in the preparations by making different items and potting plants for the stalls. The event was well attended by relatives and other interested parties. One person told us how staff supported her/him to attend a family celebration. The key worker helped them to get ready and accompanied them so they could return when they wanted to. Another person has tea/coffee making facilities in her/his bedroom. A risk assessment for this activity needs to be carried out and was brought to the attention of the manager. People who responded to our survey stated that overall the home arranges activities they can participate in. One person told us “I choose to stay in my room a lot I come down for meals and chat then I also have my hair done but ive always liked my own company my family visits often.” During this visit we saw visitors arriving at different times throughout the day. People were seen receiving visitors in communal areas and in their bedrooms. One visitor told us “Their [people who live at the home] dignity and self reliance is always an important element of their care.” These observations and comments show staff respect people’s right to make their own choices about how they spend their time. The home provides people who live at the home with menus that reflect their needs and preferences. We spoke to the cook on duty she told us senior staff provide them with good information about people’s dietary needs and likes and dislikes. She told us people are consulted daily about their choice of meal and alternatives are provided on request. Information about how individuals like their meals and drinks served are available in the kitchen. For example, if they prefer fruit with their cereals or sugar in tea/coffee. Snacks and drinks are served throughout the day by the kitchen assistant and care staff. Nutritional assessments are available on the files we looked at. Individual records are kept of meals for monitoring purposes. This enables any concerns to be addressed promptly. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 16 People we spoke to told us the meals provided by the home are good. Most people choose to take their meals in the dining room. The tables were laid appropriately for the meals being served. This included condiments and drinks. The records show catering staff are suitably trained and care staff receive training in basic food hygiene. The cook told us equipment is maintained in good working order and no concerns have been raised from the environmental health officer’s last visit. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. People who live at the home and their relatives are confident any concerns they have are listened to and acted upon. The home has procedures and systems in place to protected people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided by the home shows it last reviewed its complaints procedure in March 2008. It also tells us the service has received three complaints during the last twelve months. The records show these have been investigated and the complainant has been informed of the outcomes. We looked at the records kept by the home in respect of managing any concerns about practice and found any issues raised where addressed and monitored by the manager. People we spoke with, and responses received to our survey, tell us people know whom they would speak to if they were unhappy and how to make a Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 18 complaint. Relatives informed us that any concerns they have raised with the home have been dealt with to their satisfaction. Since the last key inspection the home has worked with the other professional agencies to improve its practice in ensuring the well being of the people are fully protected. It has reviewed its procedures for safeguarding adults from abuse and incorporated the local authority’s multi-agency procedures. Training in adult protection is provided to staff. Senior staff told us this training includes reference to the multi-agency procedures. There have been no further safeguarding concerns raised. Staff we spoke with reports a reduction in the number of incidents of behaviour that challenges the service. Senior staff told us training continues to be provided in managing challenging behaviour and these sessions include reference to caring for people with dementia. Staff told us they feel more confident in handling potentially challenging behaviour at an early stage. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. Generally people who live at the home are provided with a safe and wellmaintained environment. However, there are some improvements yet to be made to ensure people are fully supported. The infection control systems and practices within the home provide people with a pleasant and hygienic environment in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our last visit the home has informed us the hall on the ground floor and corridor on the first floor has been re-decorated and better lighting has been Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 20 provided for the hall. Handrails have been fitted in the corridors and the dining room now has double doors to support people with their mobility and provide better access to wheelchair users. A tour of the communal areas was undertaken. We found some areas of the home, such as upstairs corridors and vacant bedrooms, where being redecorated and refurbished. A protective covering has been fitted to the radiator in the large lounge to prevent accidents occurring. Most people living at the home were in the large lounge or one of the smaller lounges. They were watching television, listening to music, reading or socialising with other residents or staff. Toilets are situated close by communal rooms for their convenience. Suitable aids are fitted in the toilets and bathrooms in the main building. Staff are provided with training in moving and handling to ensure people are supported to get in and out of the bath safely. Any concern regarding equipment is dealt with promptly. As identified toiletries are no longer stored in the bathrooms. This reduces the risk of cross infection by people using each other’s toiletries. Staff informed us that people who are accommodated in the Coach House are more independent. We were told some areas in the Coach House are being used. The kitchen is accessible, but not provided with any provisions. The bathroom is domestic in style and not fitted with suitable aids. This should be refurbished to enable people to use this facility if they chose. Items that are no longer required are being stored in the laundry room preventing access. The management should give consideration to providing people with more support in maintaining their independence by making these facilities accessible to them. Four people living at the home gave us permission to look at their bedrooms. The bedrooms situated at the rear of the premises have views of the large garden and countryside. All rooms are personalised with ornaments and photographs and some have also been recently re-decorated. The floor covering in one of the rooms has been replaced eradicating the malodour identified in our previous report. Grab rails are in the process of being fitted in another person’s en-suite facility. Items stored in the courtyard, which leads to the laundry facilities, should be re-organised and to ensure it is kept free from any trip hazards. The laundry is appropriately equipped and the person carrying out the laundry tasks told us all equipment is maintained in good working order. We did receive a few comments from people about items of clothing not always being returned to them from the laundry. The minutes of the residents’ meetings show that where such issues have been raised action has been taken to try to resolve this. The floor in the laundry has been re-coated and we were told a double sink was being installed. There are suitable sluice facilities. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 21 Information provided to us states the home has used the Department of Health guidance to assess its current infection control management and training in infection control has been provided to staff. Senior staff carries out observations of staff practice. Staff are periodically requested to complete an infection control questionnaire to demonstrate competency in this area. Two staff we spoke showed they were familiar with the control of substances hazardous to health (COSHH). The cupboard where cleaning materials are stored is kept locked. Mops are coloured coded for use in specific areas to prevent cross infection and a cleaning schedule is in operation. One person commented on how hard she thinks the care and domestic staff work to keep the home looking clean and tidy. All people who responded to our survey told us the home is always fresh and clean. However, a malodour was detected in the inner hall on the ground floor. The manager is advised to look at appropriate ways for controlling this more effectively. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. An experienced staff team with a range of skills are employed to meet the needs of people living at the home. However, robust recruitment procedures must be followed at all times to ensure people’s wellbeing is fully safeguarded. The staff team receive guidance and training to enable them to satisfactorily carry out the duties required of them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota shows care is provided on each shift by a team of staff who have a mix of experience and skills. Senior members of staff are available to provide the team with guidance and support to carry out their duties. Increased staffing levels are provided at ‘peak times’ to ensure people’s needs are met throughout the day. Shift times have recently been altered, for example some shifts now finish at 16:30 instead of 15:30. The manager has yet to amended the template for the rota to reflect these changes. A much-reduced number of staff are on duty during the night-time hours. Waking night staff are supported by local ‘on call’ managers who they can Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 23 contact for advise and support. The manager and staff told us that people’s night-time needs are under constant review and staffing levels are adjusted accordingly. For example, earlier in the year more people required assistance at night and the rota for this period showed staffing levels had been increased. Information provided by the home states 20 of the 29 care staff employed hold the National Vocational Qualification Level 2 or above and seven are working towards a recognised qualification. This well exceeds the 50 minimum stated in the National Minimum Standards for Older People. Photographs of the staff team are on display in reception together with their roles in the home and their qualifications/training. We looked at the recruitment files for two staff. We did this to check the home follows robust procedures to ensure the well-being of people living at the home is fully safeguarded. There were completed application forms and a record showing gaps in the person’s work history had been satisfactorily explored. Written references were available. However, these were character references. The manager needs to ensure references are obtained from the person’s last employer or relevant professional. The home should also record the verification of all references. Both files show the applicants commenced work following receipt by the home of a POVA First Check (Protection of Vulnerable Adults initial check). This was followed by a full report from the Criminal Record Bureau (CRB). The home’s policy states that a CRB check must be obtained before the person commences duty. Hence, the home is not following its own procedures. This has the potential of placing people at risk. A copy of the General Social Care Council (GSCC) Code of Code and the home’s handbook is issued to newly appointed staff. The home provides them with an induction programme and they work under supervision until they are able to demonstrate their competence. They are also required to complete the Common Induction & Foundation workbook. A senior staff member is nominated to support them to complete the booklet and to discuss practice issues with them as part of this process. The booklets we saw were well completed and contained comments from their supervisor to promote good practice. Staff we spoke with told us the induction process for newly appointed staff has continued to improve. One person commented that they feel “fully supported in my job”. The records we looked at show the home has provided a range of training to staff during the last twelve months. This includes client-centred courses for caring for people with dementia, managing challenging behaviour, positive approach to care and equality and diversity. Staff who have attended recent courses told us they found them beneficial. One staff member reported “Training helps me in my role to understand new techniques in mental health for example”. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. People benefit from a home that is well managed and run in their best interests by a suitably qualified and experienced person. The staff team are appropriately supervised to ensure people’s best interests are met. There are systems in place to ensure people’s financial interests are safeguarded. Suitable practices are followed to promote and protect people’s health, safety and welfare. This judgement has been made using available evidence including a visit to this service. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager holds the Registered Manager’s Award (RMA) and the National Vocational Qualification (NVQ) Level 4 in care management. An experienced and suitably qualified deputy and senior staff team support her with the day-to-day running of the home. The home has good systems for monitoring its performance against its Statement of Purpose and aims and objectives. The responsible individual provides the manager with regular reports on his assessment of the home’s performance. This shows plans are in place for a systematic approach to the re-decoration and refurbishment of the home. A variety of systems are used to obtain the views of people who live at the home and other interested parties. These include discussions at residents’ meetings and key worker sessions and issuing of surveys. The comments received and the records kept show people’s views are acted upon by the home. An example of the action taken by the home is changes made to menus, activities and the laundry service. It is recommended that the home implements a system for providing regular feedback of the home’s findings on its performance and make available its plans for the future development of the service to all interested parties. We looked at the records kept by the home of the personal allowance they manage on behalf of two people. Written agreements for the home to manage the personal allowance on the individual’s behalf are available on their files. Receipts are obtained for each transaction. There are two staff signatures for each entry made on the records. The relative/representative of people who are unable to sign on their own behalf are asked to sign for transactions, where applicable. A copy of completed record sheets is provided to the individual and/or their relative/representative. There is a system for regularly auditing these records. We looked at the supervision records for two staff. We did this to see appropriate support is being provided to staff. The records show each member of staff receives a minimum of six sessions per year. These sessions are used to discuss practice issues, any areas of concern and identify how these are to be addressed. These sessions are used to inform the annual appraisal meetings and identify future training and development needs. Staff we spoke to told us they find their supervision sessions “useful”. The home regular reviews its health and safety procedures. There are systems in place for monitoring and analysing accidents to reduce similar accidents occurring, wherever possible. Records are kept to show equipment and appliances used in the home are regularly checked and serviced. We were informed the home has its own trainers who provide in-house training in fire safety and manual handling. Records show fire safety equipment is regularly checked and serviced. Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 4 3 X 3 Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 Requirement Care plans must be produced and risk assessments carried out for people who are wheelchair users to ensure the safety of the person and staff providing assistance is fully protected. A risk assessment must be carried to ensure the person who has tea/coffee making facilities in her/his bedroom is able to safely make their own hot drinks. The home must obtain a reference from a person’s last employer, record this has been verified and ensure a satisfactory Criminal Record Bureau check is received prior to a person commencing work in the home to ensure the well being of people living at the home is fully safeguarded. Timescale for action 07/11/08 2. OP14 12 07/11/08 3. OP29 19 07/11/08 Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should clearly identify how people are to be supported, encourage and what action is to be taken, when necessary, to ensure staff provide a consistent approach to meeting people’s individual care needs. Detailed information should be provided for assessing when “as required” medication should be administered. This is to ensure a consistent approach is taken to enable accurate monitoring to take place how beneficial the medication is. The facilities in the Coach House, such as the kitchen, bathroom and laundry, should be made more accessible to people living here and the home should support them to maintain/maximise their independence. The courtyard should be regular checked to ensure it is kept free of any trip hazards. The home should keep all interested parties informed about the findings on its performance by implementing a system for regularly feeding back and publish it plans for the development of the service. 2. OP9 3. OP26 4. 5. OP26 OP33 Wychbury Care Services DS0000063444.V371310.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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