Care Home: Wylye House

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What the care home does well The relative who responded to the postal survey wrote, "We are informed about all decisions and more than pleased with information given to us. Wylye House staff are well trained and experienced. They give us as a family confidence in all the care they give". People living at the home told us staff were always available and communication was open. They could come and go as they chose whilst being able to rely on every day routines of the home. In addition to informal communication that was fostered within the home, especially at the meal table, there were resident meetings at roughly quarterly intervals. Minutes showed these were used to gain ideas and feedback about things like menus, holidays and Christmas arrangements. People demonstrated during the inspection visit that they readily chose how they used their time. They made choices about getting up, going to bed, going out, and using private or communal rooms. One person described choosing to Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 6be accompanied to doctor`s appointments on some occasions, and other times choosing to go alone. People went into town for shopping, with such support as they needed. The home had a car that was used for trips to various places in the locality, both planned and spontaneously. One person confirmed they went for football training one evening per week. Another person enjoyed a weekly snooker game. People were encouraged to maintain regular contact with families and friends. People attended a variety of external activity resources during the week, including some paid work in one instance. The main meal of the day was at teatime, when everyone was in, but as a result of a residents` meeting decision, the main meal on Sundays was now served at lunchtime, to allow for a more relaxed afternoon and evening. Daily records showed that when people expressed dislikes they chose alternative meals. They also showed that people were supported to get their own breakfasts, when they wanted them. On Saturday evenings people chose takeaway meals. A positive aspect of care planning was that key workers wrote a monthly report on significant events and developments for each person. These drew on daily records kept by support workers, and they enabled good quality six-monthly reviews. One of the people supported by the home was signing their monthly reports to show they had been shared. Staff kept up to date with people`s needs by reading monthly reports and by comprehensive handovers between shifts. Daily records kept by staff showed they were alert to indicators of possible ill health, and took appropriate actions in response. In answering our survey, a GP confirmed that the home communicated clearly and worked in partnership with them, demonstrating "a clear understanding of the care needs of service users." The GP added, "I have always had excellent interaction with the staff." The home benefited from ongoing redecoration. For example, the sitting room looked worn in places, but arrangements had been made for imminent repainting. Communal rooms had a homely feel, with good quality furniture. The people who showed us their bedrooms confirmed they had chosen colour schemes and layouts. They regarded their rooms very much as private space over which they had complete control. This was reflected in the different ways in which they used their rooms. We found good standards of cleaning, including in the kitchen, bathrooms and toilet. The home has had very little turnover of staff, and so there were strong relationships between those who live there and the staff. There were both male and female staff. All staff were in the process of applying for new Criminal Records Bureau disclosures. It was company policy that this must be done every three years, which is good practice. What has improved since the last inspection? One member of staff had the lead responsibility for medicines practice. She displayed professionalism in the task. She could demonstrate compliance with a recommendation the pharmacist inspector made about homely medicines. Following a requirement at the previous key inspection, there were protocols in place for the use and recording of medicines prescribed for use "as needed". At the previous key inspection it was recommended that the home introduce a system for formally seeking supporters` views on the quality of service provision. This had led to a well-designed form that the home used to obtain feedback on quality of service, and ideas for improvement, from people living in the home, and their relatives. CARE HOME ADULTS 18-65 Wylye House 27 Wyndham Road Salisbury Wiltshire SP1 3AB Lead Inspector Roy Gregory Key Unannounced Inspection 23rd June 2008 12:30 Wylye House DS0000069916.V367971.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 Wylye House DS0000069916.V367971.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. Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wylye House Address 27 Wyndham Road Salisbury Wiltshire SP1 3AB 01722 338987 01722 338987 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) Fiver Rivers Child Care Ltd Mrs Lucy Gallagher Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: Wylye House is a terraced house in a residential area within walking distance of the centre of Salisbury, where there are all urban facilities, including good public transport connections. Single room accommodation, complemented by shared living space and bathrooms, is available for four adults with learning difficulties. Individual bedrooms are of generous proportions and include wash hand basins. All are situated on the first and second floors and would not therefore be accessible to service users with significant mobility impairment. The ground floor has an attractive sitting room, kitchen and conservatory dining area, as well as the office, to which service users have extensive access. To the rear is an enclosed garden with seating and a table. Street-side parking is available. All current service users are placed by Hampshire County Council, at a weekly fee of £1084 each. Wylye House DS0000069916.V367971.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. We visited Wylye House on Monday 23rd June 2008 between 12:30 p.m. and 7:30 p.m. During this time we met with all four people whose home it is, and with staff who were on duty. Lucy Gallagher, the registered manager, was available for part of this time. All the communal parts of the home were visited, and two bedrooms were seen with the agreement of their occupants, which also allowed for more in-depth discussions in private. The inspector shared a meal with residents and staff. Prior to the inspection visit, Lucy Gallagher had returned the home’s Annual Quality Assurance Assessment, which gave some descriptive and numerical information. We also sent out a number of survey questionnaires. These were returned to us by one of the people living at the home; from a person’s relative; and from six members of staff. There was also a response from a GP who has worked with the home. Also available at the inspection visit were the returns from the home’s own annual survey of people living there and their supporters, carried out between November 2007 and January 2008. Records examined during the inspection included care plans and records of care, medication records and staff training information. It was necessary to return to the home on Tuesday 1st July to review staff supervision records and to give the manager feedback on the inspection. This inspection took account of a random inspection undertaken by our pharmacist inspector in October 2007. What the service does well: The relative who responded to the postal survey wrote, “We are informed about all decisions and more than pleased with information given to us. Wylye House staff are well trained and experienced. They give us as a family confidence in all the care they give”. People living at the home told us staff were always available and communication was open. They could come and go as they chose whilst being able to rely on every day routines of the home. In addition to informal communication that was fostered within the home, especially at the meal table, there were resident meetings at roughly quarterly intervals. Minutes showed these were used to gain ideas and feedback about things like menus, holidays and Christmas arrangements. People demonstrated during the inspection visit that they readily chose how they used their time. They made choices about getting up, going to bed, going out, and using private or communal rooms. One person described choosing to Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 6 be accompanied to doctor’s appointments on some occasions, and other times choosing to go alone. People went into town for shopping, with such support as they needed. The home had a car that was used for trips to various places in the locality, both planned and spontaneously. One person confirmed they went for football training one evening per week. Another person enjoyed a weekly snooker game. People were encouraged to maintain regular contact with families and friends. People attended a variety of external activity resources during the week, including some paid work in one instance. The main meal of the day was at teatime, when everyone was in, but as a result of a residents’ meeting decision, the main meal on Sundays was now served at lunchtime, to allow for a more relaxed afternoon and evening. Daily records showed that when people expressed dislikes they chose alternative meals. They also showed that people were supported to get their own breakfasts, when they wanted them. On Saturday evenings people chose takeaway meals. A positive aspect of care planning was that key workers wrote a monthly report on significant events and developments for each person. These drew on daily records kept by support workers, and they enabled good quality six-monthly reviews. One of the people supported by the home was signing their monthly reports to show they had been shared. Staff kept up to date with people’s needs by reading monthly reports and by comprehensive handovers between shifts. Daily records kept by staff showed they were alert to indicators of possible ill health, and took appropriate actions in response. In answering our survey, a GP confirmed that the home communicated clearly and worked in partnership with them, demonstrating “a clear understanding of the care needs of service users.” The GP added, “I have always had excellent interaction with the staff.” The home benefited from ongoing redecoration. For example, the sitting room looked worn in places, but arrangements had been made for imminent repainting. Communal rooms had a homely feel, with good quality furniture. The people who showed us their bedrooms confirmed they had chosen colour schemes and layouts. They regarded their rooms very much as private space over which they had complete control. This was reflected in the different ways in which they used their rooms. We found good standards of cleaning, including in the kitchen, bathrooms and toilet. The home has had very little turnover of staff, and so there were strong relationships between those who live there and the staff. There were both male and female staff. All staff were in the process of applying for new Criminal Records Bureau disclosures. It was company policy that this must be done every three years, which is good practice. Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 7 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. Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedures ensure that assessed needs will be met and that the needs of people already living at the home will be taken into account. Information provided to enquirers gives an accurate reflection of service provision. EVIDENCE: There had been no new admissions since May 2005 and at this inspection visit none were in prospect. This group of standards have previously been assessed as met to a good standard. For each person, there was a copy in individual records of terms and conditions relating to their placement, which had been signed by them or a relative. There was a reader-friendly service user guide and photographs were to be added to this. People living in the home had been asked about what pictures would be appropriate to use for this purpose. Wylye House DS0000069916.V367971.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): 6 – 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s assessed needs are reflected in care and support plans, which are reviewed and changed as necessary. People are supported in making decisions about their everyday lives. Risks are identified, and assessed in such a way as to encourage safe participation in a range of lifestyle choices. EVIDENCE: There were care plans for each person, including guidance on preferred daily routines and how specific care and support needs were to be addressed. However, the ordering of folders made it difficult to find information, and there was some mixing of historical and current information and guidance. The provider’s internal monitoring visit in May 2008 had noted a need to update and amend care-planning documentation. Lucy Gallagher said she had arranged to have some administrative assistance from the regional office for this task. It was recommended that care plans commence with clear current guidance on the meeting of essential needs, and that they cross-reference to relevant risk assessments. There is an opportunity to make the care plans Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 11 more “person-centred”, with greater evidence of people’s own contributions to them. Plans that concentrated more on current priorities and goals, clearly agreed by the people they related to (or advocates), would lend themselves better to annual evaluation of how well aims were being met. A positive aspect of care planning was that key workers wrote a monthly report on significant events and developments for each person. These drew on daily records kept by support workers, and in turn enabled good quality six-monthly reviews. One of the people supported by the home was signing their monthly reports to show they had been shared. Staff kept up to date with people’s needs by reading monthly reports and by comprehensive handovers between shifts. Minutes of staff meetings showed they also included a résumé of current issues for people in the home. People demonstrated during the inspection visit that they readily chose how they used their time. They made choices about getting up, going to bed, going out, and using private or communal rooms. One person described choosing to be accompanied to doctor’s appointments on some occasions, and other times choosing to go alone. Another person said they came and went as they chose, which was enabled by the home providing basic routines and necessities. They saw communication as open. In addition to informal communication that was fostered within the home, especially at the meal table, there were resident meetings at roughly quarterly intervals. Minutes showed these were used to gain ideas and feedback about things like menus, holidays and Christmas arrangements. One person chose sometimes not to attend meetings because the timing did not always suit them. It seemed alternative arrangements were made to gather opinions individually, but these were not recorded; this left some evident risk of differences of opinion over what had been agreed. Risk assessments showed there was a good balance between encouraging independence and maintaining safety. The guidance of external professionals was sought in some instances. Where a person had needed guidance and boundaries in respect of risks that had arisen in an area of their life, they had signed agreement to the content of new risk assessments. They had subsequently been supported to pursue an easing of the restrictions they had initially accepted. Wylye House DS0000069916.V367971.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): 11 – 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Varied activities give people opportunities to maintain leisure interests, to develop skills and to access the community. Relationships with families and friends are encouraged. People participate in everyday tasks and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people wish. EVIDENCE: One person was attending a variety of external day activities every weekday, including some paid work, travelling by bicycle. The other people attended a variety of regular external resources for one or more sessions per week, one person travelling a significant distance by public transport. With this level of external activity engagement, plus support to people to be involved in domestic tasks such as cleaning and laundry, there was recognition within the home that people could be tired. There was therefore an emphasis on maintaining an “ordinary” home life. There were games and puzzles in the Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 13 sitting room, and a television and hi-fi. People also made a lot of use of their own rooms for watching television, DVDs and listening to music, or following other interests such as making models. One person liked to have frequent walks with members of staff and another person would indicate if they wished to join these. People went into town for shopping, with such support as they needed. The home had a car that was used for trips to various places in the locality, both planned and spontaneously. One person chose to be involved in the routine checks of the car, and in keeping it clean. The same person confirmed they went for football training one evening per week. Another person enjoyed a weekly snooker game. People were encouraged to maintain regular contact with families and friends. A person had received support and guidance, based on input from an external specialist, in relationship issues. Another person had experienced difficulties in visits to their family. Care records showed staff had identified what the person found difficult and had devised ways to facilitate the visits, bringing about improvements. As well as the option to have mobile phones, people had access to the home’s telephone and broadband. People had decided through the residents’ meetings what kind of holiday they would like to have. Arrangements had been made for a holiday centre holiday later in the year, by the sea, to fit with expressed wishes. Individuals could opt out later if they wished. Menus for the most recent five weeks showed a variety of meals had been served. The main meal of the day was at teatime, when everyone was in, but as a result of a residents’ meeting decision, the main meal on Sundays was now served at lunchtime, to allow for a more relaxed afternoon and evening. A fixture at weekends was use of take-away meals on Saturday evenings. Some people had particular dietary requirements, which were recorded in care plans and were well known to staff, as were personal likes and dislikes. People said or indicated that they enjoyed their meals, and that they could always have an alternative to the meal on the menu. Daily records showed examples of people expressing dislikes and choosing alternative meals. They also showed that people were supported to get their own breakfasts, when they wanted them. Staff undertook most cooking, with some involvement of people who lived in the home. This appeared to be by choice. All people were involved often in tasks such as laying and clearing the table. Staff and residents usually ate together and there was plentiful conversation. Where people needed some assistance with eating, this was given discretely and at their pace. People were involved in choosing meals and in shopping. At lunchtime, a person was able to say what the evening meal was to be. Another person asked later what was to be the accompanying vegetable, and was invited to express a preference. Wylye House DS0000069916.V367971.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): 18 – 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides personal support in line with people’s preferences and needs. There are good links and systems to ensure physical and emotional health needs are met. People are protected by the home’s medication procedures. EVIDENCE: Daily records kept by staff demonstrated alertness to indicators of possible ill health, with appropriate actions taken in response. In answering our survey, a GP confirmed that the home communicated clearly and worked in partnership with them, demonstrating “a clear understanding of the care needs of service users.” The GP added, “I have always had excellent interaction with the staff.” People were supported to maintain regular dental, optician and other appointments. It was common practice for professionals seen, to be asked to write up outcomes or guidance in the person’s records. A psychologist had given guidance on working with a person’s behaviours. Records were being kept to enable ongoing monitoring of the person’s needs and of successful approaches. Records and observations showed there was a Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 15 clear emphasis on recognising and valuing acceptable behaviours, confirming staff descriptions of the work they were doing with the person. People required varying degrees of support or prompting to personal care. The staff group was small and stable, and thus had knowledge and the confidence of people to provide personal support. However, care plans could have given more detailed guidance to this aspect of care, in case different staff should have to work with people at short notice. Our pharmacist inspector carried out an inspection of practice in relation to use of medicines in the home, in October 2007. All systems were found to be working in a satisfactory way at that time. A requirement was made in relation to record–keeping for controlled drugs, but at this inspection no such drugs were in use, and it was not anticipated that there would be a return to usage. One member of staff had the lead responsibility for medicines practice. She displayed professionalism in the task. She could demonstrate compliance with a recommendation made by the pharmacist inspector about homely medicines. She had a good working relationship with the supplying pharmacist. From them she had obtained a training pack, which she intended using with each member of staff. Storage of medicines and recording of administration were both good. Following requirement at the previous key inspection, there were protocols in place for the use and recording of medicines prescribed for use “as needed”. Staff members had a good understanding of current medicines used in the home and there was evidence of communication about any changes. People’s care records contained details of any medicines currently prescribed for them. For one person the details were well set out, together with information about the purpose of each medicine. It was suggested this quality of information be replicated in other people’s records. There was evidence of liaison with health professionals over arrangements made for one person to receive medicines, such that they experienced a measure of control without risk to safety. It was recommended that the medications policy and procedure be checked and updated as necessary, to ensure it fully reflected current practice. Wylye House DS0000069916.V367971.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): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. EVIDENCE: There had been no complaints from people who live at Wylye House, or from their relatives or advocates. There was a record of how some neighbour issues had been addressed. The prevailing culture of the home is one of constant communication, particularly as people come and go, and at meal times. Those who were able to describe things in detail said staff shared issues with them, both individually and as a group. Therefore, any areas of concern were identified at an early stage, and people were involved in seeking solutions to problems. It was also made clear to people and their relatives how they could make a formal complaint if they wished, and how the company would respond. One use of residents’ meetings was to test people’s satisfaction with how different aspects of the service were provided. One person specifically saw safety as a major benefit of living at the home. There was at least one member of staff available at all times. When people went out alone, they carried identification, and had the means to contact staff at once. Two people had chosen to have money kept safe for them in the office, but they signed monies in and out when they wished and spent it as they chose. The other two people had difficulties understanding money, and were Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 17 supported by a sound system of double-signing and keeping receipts. Their respective families had given written agreement to the systems in place. Sleeping-in staff used monitoring devices for people that presented identified risks at night. Protocols that were in place demonstrated the balance of risks that had been assessed, and showed family members had been consulted and had agreed to the use of the devices. Any marks noticed on people’s bodies were recorded by use of dated body maps. Where people exhibited behaviours that could disturb themselves or others, incident sheets were filled out. These required staff to consider the context of the behaviour and of approaches used to address it. Records showed there was a good level of insight and understanding on the part of staff, with an emphasis on consistency of approach and on de-escalation techniques. People who were able, were sometimes invited to indicate agreement to how they and staff would work together to reduce stress points. External professionals, such as a psychologist, had helped devise individual behaviour strategies. Staff displayed knowledge of local inter-agency safeguarding procedures and details of these were kept to hand. Renewal abuse awareness training was the next priority on the current training programme and there was discussion about resources that could be used. However, safeguarding training was not among the service’s mandatory training courses, which would ensure regular updating for all staff. An issue that had arisen in the service had been referred to the safeguarding procedures and had resulted in a strategy that enabled a person to develop an aspect of their life in a safe way. Wylye House DS0000069916.V367971.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): 24, 26, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a homely environment, maintained and kept clean to a good standard. EVIDENCE: The home benefited from ongoing redecoration. For example, the sitting room looked worn in places, but arrangements had been made for imminent repainting. Good quality furniture was used in the communal rooms, which had a homely feel. There was “tired” paintwork in the shower room and bathroom. The carpet on the stairs had holes on a number of the risers. Whilst these were not presenting a hazard, they were unattractive and contributed to an uncared for look. Two bedrooms were seen, at the invitation of their occupants. Each person confirmed they had chosen colour schemes and layouts, and they regarded their rooms very much as private space over which they had complete control. This was reflected in the different ways in which they used their rooms. Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 19 A daily duties sheet was signed off by staff to show cleaning schedules had been adhered to. Lucy Gallagher said she routinely checked actual standards against these. We found good standards of cleaning, including in the kitchen, bathrooms and toilet. A raised toilet seat had been obtained for one person through the community team, and there was negotiation with the person concerned about how to make best use of it. A maintenance person was employed by the company to work in a number of services. This ensured notified faults received attention quickly. Any more major issues were subjected to risk assessment pending rectification. The garage was temporarily out of use whilst a potential asbestos issue was being investigated. Alternative arrangements had been made for the safe storage of a person’s bicycle. The garden was maintained as an attractive and safe area in which to sit or dine in good weather. Wylye House DS0000069916.V367971.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): 32, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by competent, trained staff, whose work is regularly supervised. Recruitment practices ensure people are protected from being cared for by unsuitable staff. EVIDENCE: The home has had very little turnover of staff, and so there are strong relationships between those who live there and the staff. There were staff of both genders. One member of staff had left the home in the previous year. A person already employed by the company, who had experience of covering shifts at Wylye House, had replaced them after being interviewed for the post. They underwent an induction, including shadowing existing staff, and the necessary checks on suitability were in place. All staff were in the process of applying for new Criminal Records Bureau disclosures. It was company policy that this must be done every three years, which is good practice. There were nine members of staff, three full-time and six part-time. Five staff had obtained National Vocational Qualification (NVQ) in care to level 3 or higher, with one person working towards it. There was a programme for Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 21 maintenance of annual mandatory training. Staff had been invited to identify other areas in which they would like to receive training, as the provider intended wider training opportunities to be a priority. Some staff suggested, through the staff survey and during inspection, they would like to see the company more pro-active in seeking and providing additional training. We recommend that staff should have opportunities to learn more about “Valuing People” and person-centred planning initiatives. There was a record of one-to-one supervision of staff taking place at suitable intervals. Notes from supervision sessions showed they covered both service user needs and personal development issues. The records reflected the positive views that members of staff expressed about supervision, which was delivered by the manager and deputy manager. Quality monitoring visits by company management had identified a shortfall in achieving annual staff appraisals. Lucy Gallagher said it was a current priority to complete these, and her line manager was to help with this task. Wylye House DS0000069916.V367971.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): 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Home and company management provide leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of people living in the home, and their supporters, to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. EVIDENCE: Lucy Gallagher, the registered manager, holds the Registered Managers Award and NVQ level 4. She was awaiting details of further NVQ units that she can study for. She was feeling very well supported by a new line manager, from whom she received monthly supervision. She was also getting support from the company’s administrative resources to improve the way care planning and staffing records were kept, with noticeable benefits already. Records of company monitoring visits showed that action points were identified, and Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 23 followed up. Annual development planning appeared to be receiving a renewed impetus. Thorough handovers between shifts, and regular minuted staff meetings, kept staff well informed. At the previous key inspection it was recommended that the home introduce a system for formally seeking supporters’ views on the quality of service provision. This had led to a well-designed form that the home used to obtain feedback on quality of service, and ideas for improvement, from people living in the home, and their relatives. The latest survey period was from November 2007 to January 2008. It was suggested that the survey should be extended to a range of external professionals and Lucy Gallagher said this was intended. Risk assessments showed evidence of review and amendment, demonstrating a pro-active approach to health and safety for people living and working in the home. Members of staff were aware of risk assessments, and some people living at the home had an appreciation of health and safety issues because of how they were included in discussions in the home. It was a key worker responsibility to ensure people understood fire procedures and there were records of evacuation practice. Most staff were up to date with safety-related training such as first aid, food hygiene and a certificated health and safety course, but there were a few gaps in the record, which need to be filled. Wylye House DS0000069916.V367971.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 25 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 YA23 Regulation 13 (6) Timescale for action Staff training in abuse awareness 30/09/08 and how to respond to suspected abuse must be made mandatory and be delivered to staff at least every two years. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA7 Good Practice Recommendations Care plans should adopt a person centred approach, and clearly show the current priorities in people’s lives. When people contribute to significant decision-making outside formal processes such as residents’ meetings, their expressed views should be recorded and shared with subsequent meetings. Care plans should clearly indicate individual preferences about receipt of personal care, including bathing arrangements. Aim for consistency in how information about people’s medicines is presented in each person’s care plan. 3. 4. YA18 YA20 Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 26 5. 6. 7. 8. YA20 YA24 YA35 YA42 Check the medication policy, updating as necessary, to ensure it fully reflects and guides current practice in the home. Plans should be made to replace worn stair carpets. Identify and provide training to familiarise staff with person centred approaches and the Valuing People agenda. Ensure all staff are up to date with mandatory training relating to health and safety. Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wylye House DS0000069916.V367971.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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