Inspection on 15/01/08 for Cobham Road (60)

This is the latest available inspection report for this service, carried out on 15th January 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cobham Road (60) 07/11/05

Cobham Road (60) 14/07/05

Cobham Road (60) 17/11/04

Cobham Road (60) 06/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cobham Road (60) 60 Cobham Road Fetcham Surrey KT22 9SS Lead Inspector Gary Bartlett Unannounced Inspection 15th January 2008 10:00 Cobham Road (60) DS0000013894.V357285.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 Cobham Road (60) DS0000013894.V357285.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. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cobham Road (60) Address 60 Cobham Road Fetcham Surrey KT22 9SS 01372 379623 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) www.milburycare.com Milbury Care Services Ltd vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2006 Brief Description of the Service: Cobham Road is registered with the CSCI (Commission for Social Care Inspection) to provide accommodation and care for six service users with a learning disability. The property is located in a residential area and in close proximity to Epsom, Guildford and Leatherhead town centres. Accommodation is on two floors accessed by stairs and comprises of an office, lounge, kitchen, dining room, laundry room, bathrooms, toilets and six single bedrooms. The home has a garden to the rear of the property which is secure and private parking is available. The fee charged by the home is £1286.35 per week. The registered provider is Milbury Care Services Limited. There is a new Manager at the home who is in the process of submitting an application for registration. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in 60 Cobham Road from 10:00 a.m. until 1:30 pm. During that time the Inspector spoke with the Manager and briefly met with some staff and the service users who were on their way out to lunch and activities. Parts of the home and some records were inspected. The provider had completed an Annual Quality Assurance Assessment prior to the inspection. This was detailed and very helpful in the inspection process. The service users living at the home have communication difficulties and judgements were made about them based on their mood, behaviour, records and information given by Manager. Prior to the site visit, survey forms were returned to the Commission from service users and staff. The service users’ survey forms had been completed with the assistance of their key-workers. Statements made are quoted in the text of the report. The inspector would like to thank everyone for their contribution to the inspection. What the service does well: 60 Cobham Road provides a comfortable and homely environment for people living there. The home has a new Manager who is very experienced at the home and provides management continuity, stability and direction to the staff team. The home is committed to staff training and development and staff working at the home have LDAF (learning disability award framework) training and NVQ (national vocational qualification) training. It is clear from staff survey forms that they are committed to professional development. Care planning at the home is good and individual care plans are well presented, kept in good order and reflect person centred planning. Staff working at the home have positive relationships with service users and work to improve their quality of life. The home is aware of equality and diversity matters and policies and procedures are in pictorial format to enable service users with a disability to access the information. Records confirm staff have an understanding of the religious needs and cultural heritage and dietary requirements. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 6 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. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users’ aspirations and needs are assessed before admission to the home. EVIDENCE: The Manager described how prospective service users are only admitted to the home after a full assessment of needs. These assessments are recorded and are the starting point for service users’ individual care plans The records sampled included assessments of personal support, health care needs, religious and cultural needs and social activities. The home has an Everyday Living Skills assessment and an Adaptive Behaviour Scale to assess prospective service users’ needs. The Manager confirmed the home offers service users a ‘settling in’ period of three months to ensure the home is the right place for them and they are compatible with service users already living at the home. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems for care planning to identify service users’ needs and how they are to be met. Service users are enabled to make decisions about their lives, as far as is practicable, with assistance as needed. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: Each service user has an individual care plan and the Manager described how he had augmented the system by introducing “My Daily Diary” and “You and Your Health” records. The plans are now more pictorial to make them more readily understandable and written in the first person. Three care plans were examined in detail. They are well presented, comprehensive in content and regularly reviewed. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 10 The home operates a named key worker system to promote consistency of care and support. The Manager is committed to promoting service users’ right to make decisions. To help facilitate this, there are regular service users’ meetings and keyworker meetings. Records of these meetings are kept. Service users survey forms received by the Commission included the comments: • “I do take decisions about what I want every day and they do take my decisions very seriously. I do take part in different home living skills activities to promote my independence”. • “Staff respect my wishes. They help to promote my independence as an individual and I am really enjoying my home at Cobham Road”. • “I am unable to communicate verbally and in writing but there is an advocate who acts on my behalf and supports me”. The Manager stated the home has a policy on risk taking and records indicate staff have training in risk assessment. The risk assessments seen reflect actions to minimise risks and promote the independence of service users. Risks assessments are regularly reviewed, dated and signed by management and key workers to ensure good information on which to base decisions. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are given encouragement and support to make choices about a range of local social and recreational interests as far as is practicable. Service users can maintain good links with family, friends and the community. The daily routine of the home promotes the independence and freedom of movement of service users. A variety and choice of meals is offered. EVIDENCE: The Manager described how the home strives to enable service users to participate in meaningful and fulfilling activities. On the day of inspection, the Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 12 service users were about to set off for lunch at MacDonalds followed by a regular trip to a day centre for structured activities including arts and crafts, drama therapy, aromatherapy and physical exercise to promote health. The demeanour of the service users indicated they were looking forward to this. The activity programme and daily log indicate service users also help with domestic tasks, shopping and participate in the local community making use of the local pubs, cinema and other facilities. Staff are aware of the ethnic and religious needs of all service users living in the home. This includes provision of special dietary needs and support to attend church to mark special religious occasions and events. The Manager said service users are able to maintain family links. This was conformed by records seen. The Manager stated the daily routine of the home promotes independence and observations confirmed service users move freely in the home. Staff address service users by their preferred names and promote their privacy and dignity. Service users survey forms received by the Commission included the comments: • “I visit restaurants, pubs etc. I go for outings to parks, beaches and other places of interest. I usually attend movies and I go to church every Sunday”. • “I go out for a trip to the sea side, cinema, playgrounds, parks and also structured activities for me and my peers”. Service users participate in planning the menu, which is displayed in the dining room. Since the last inspection, the menus, with particular regard to supper, have been improved to show service users enjoy a balanced and nutritious diet. The menus are now more pictorial to make them more readily understandable to service users. Those seen indicate a variety and choice. With support, service users are involved in the preparation and cooking of foods to the best of their ability. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, social and personal care needs of those living here are well supported with regular contact with specialists and external professionals. Residents are protected by staff adhering to good practice guidelines in the administration and storage of medicines. EVIDENCE: Records show that staff are clearly made aware as to the type and nature of the support required for individual’s personal and intimate care needs. Through discussion with the Manager and assessing the three care plans, it is evident that residents have ready access to health and social care professionals. This includes General Practitioners, Dentists, Chiropodists, Opticians and a Psychiatrist. The Manager said staff provide flexible support to service users based on individual choice and personal care is provided in Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 14 private to promote the dignity of service users. Observations confirmed service users had good personal hygiene and were appropriately dressed for their outing. Guidance regarding personal hygiene is recorded in individual care plans. Records show that all staff administering medications have been trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets inspected had been completed appropriately and medicines were seen to be given in accordance with good practice guidelines. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable people living and those visiting the home to raise concerns or complaints. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: The home has a complaints policy and staff have training in handling complaints. The complaints policy is in a pictorial format to reflect the communication needs of service users. The Manager said the home keeps a record of all complaints received by them. The Annual Quality Assurance Assessment received prior to the inspection indicates there have not been any complaints received by the home in the last 12 months. The Commission has not received any complaints about the home in that time. Service users survey forms received by the Commission included the comments: • “I am aware of the service procedure to make a complaint if I am not happy about something”. • “Staff always listen to me and do what I want them to”. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 16 There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager has a sound understanding of safeguarding adults procedures and records indicate staff have training in Adult Protection. During the last year, there have not been any alerts raised. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 17 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, 27 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, comfortable and homely environment. EVIDENCE: On the day of the inspection the home was clean, well presented and free from offensive odours. The home generally has a good standard of décor and is bright and airy. The one notable exception being the ground floor bathroom. Here, parts of the wall covering had become “bubbled” and the paint discoloured. The redecoration of this bathroom would make it a more pleasant area for the service users and staff to use. Furniture and fittings are of good quality. There is an ongoing programme of redecoration and refurbishment. The maintenance of the home is satisfactory; indeed a maintenance man Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 18 arrived during the inspection, to undertake necessary repairs that had been notified to him by the Manager. There is restricted access to the front entrance of the home to promote the safety of service users. There is a policy on control of infection and staff have training in infection control. The home has adequate laundry facilities and hand-washing facilities are prominently sited in the kitchen, toilets and bathrooms. Staff and service users share responsibility for the cleaning. There is a large and well-maintained garden for service users to enjoy in more clement weather. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 19 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff. Recruitment processes are good, ensuring only appropriately vetted people work at the home. EVIDENCE: Service users survey forms received by the Commission included the comments: • “Staff are patient and listen to my wishes and fulfil my changing needs at all times”. • “I am always supported by staff in every aspect of my life”. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 20 Robust recruitment processes are followed to ensure only staff properly vetted work at the home. Applicants are required to complete an application form, provide two references, an employment history, proof of identity and satisfactory POVA (Protection Of Vulnerable Adults) and CRB (Criminal Record Bureau) checks. New staff are required to complete an induction programme that is in line with the Skills for Care Common Induction Standards. The Induction records seen are dated and signed by the employee, supervisor. Since the last inspection, staff have been given copies of the codes of conduct and practice set by the General Social Care Council to further safeguard the welfare of service users. A review of staff training records indicates staff have completed LDAF (Learning Disability Award Framework) training and NVQ (National Vocational Qualification) training to give them the knowledge and skills necessary to work with service users in the home. It is clear from staff survey forms that they are committed to professional development. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 21 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The day-to-day management of the home is good so service users benefit from a well run and safe home. The views of service users and other stakeholders are sought to enable them to participate in the development of the home. EVIDENCE: 60 Cobham Road has a new Manager who is very experienced at the home and provides management continuity, stability and direction to the staff team. He has an NVQ level 3 and is currently undertaking the Registered Managers Award. The Manager is in the process of making an application for registration Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 22 and demonstrates a commendable commitment to delivering a high quality service. The home has a policy on quality assurance and there is an annual service review involving staff, service users and other stakeholders to obtain feedback about the service. The Operations Manager undertakes monthly Regulation 26 monitoring visits to promote quality assurance. Staff training records indicate staff have training in food hygiene, first aid, people handling, fire awareness and other appropriate and relevant training to promote the safety and welfare of service users. The kitchen is clean, food appropriately stored and refrigerator and freezer temperatures are within expected limits. COSHH (Control Of Substances Hazardous to Health) products are stored in a locked cupboard. The Annual Quality Assurance Assessment received prior to the inspection indicates records of maintenance and safety checks are up to date and the organisation regularly reviewes policies and procedures to ensure they comply with current legislation and good practice advice. Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Cobham Road (60) DS0000013894.V357285.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA24 Good Practice Recommendations It is recommended the damaged wall surfaces of the bathroom on the ground floor be repaired and redecorated to make this a more pleasant area to use. 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