Inspection on 19/11/05 for 1 & 1a Christchurch Gardens

This inspection was carried out on 19th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 & 1a Christchurch Gardens 25/07/06

1 & 1a Christchurch Gardens 06/03/06

1 & 1a Christchurch Gardens 08/03/05

1 & 1a Christchurch Gardens 21/04/04

Similar services:

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

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

CARE HOME ADULTS 18-65 1 & 1a Christchurch Gardens Reading Berkshire RG2 7AH Lead Inspector Julie Willis Unannounced Inspection 19th November 2005 09:50 DS0000011049.V263848.R01.S.doc Version 5.0 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 DS0000011049.V263848.R01.S.doc Version 5.0 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. DS0000011049.V263848.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 1 & 1a Christchurch Gardens Address Reading Berkshire RG2 7AH 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) 0118 931 2032/31 Milbury Care Services Limited ***Post Vacant*** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000011049.V263848.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th March 2005 Brief Description of the Service: 1 and 1a Christchurch Gardens are 2 adjacent detached properties situated close to Reading town centre. Each home provides care for up to four adults with learning disabilities. The current service users are all males aged between 18 and 65. Each Service User has a single bedroom. 2 bedrooms have en – suite facilities. There are 2 bathrooms in each property. Each Service User has his own bedroom and there is a kitchen/ diner, lounge and office in each house. There is large garden to the rear. Service Users have a variety of needs and the service provides an individual approach to meet and review needs. DS0000011049.V263848.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of approximately four hours on a Saturday morning and early afternoon. The inspector toured the premises, examined records, spoke to staff on duty and met all of the service users. The senior staff on duty assisted the inspector throughout the inspection period and the newly appointed Manager arrived in the afternoon for general feedback. There was one outstanding requirement from the last inspection and one outstanding recommendation. Both had not been met, but the inspector was told that they would be addressed as part of forthcoming building works therefore the time scale for completion has been extended. What the service does well: The homes are both clean and comfortable with pleasant furnishings and decoration Residents are provided with a range of activities that meet their needs and are encouraged to try new things. All residents go away on holiday each year and take regular trips out to the country and seaside. The home makes sure that residents keep in touch with their families and friends and can visit them regularly. Staff appear kind, caring and respectful of the residents. DS0000011049.V263848.R01.S.doc Version 5.0 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. DS0000011049.V263848.R01.S.doc Version 5.0 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 DS0000011049.V263848.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 All service users are fully assessed prior to admission to ensure the home can effectively meet their need. EVIDENCE: All service users were fully assessed prior to their placement in the home. The tools used for the purpose of assessment were comprehensive and holistic in content and involved the service user, their families and a multi-disciplinary team of professionals. The service user most recently admitted to the home has a diagnosis of ‘Fragile X’ syndrome and staff will be undertaking specific training in this condition in order to meet the needs of the service user more effectively. The service user has settled into the home very well and was cheerful and smiling at the time of inspection. Service users are in the main non-verbal and it was clear that they were relaxed and happy in the staffs care. Staff appeared highly knowledgeable about the needs of individual residents and interaction between staff and service users was age appropriate and appeared caring. DS0000011049.V263848.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 The care plans had not been reviewed for several months and so it was not clear if they were a true refection of the current needs of users or if staff had sufficient current information to provide the right care. Activities that could be hazardous to users were underpinned by risk assessment and risk management strategies that had not been reviewed for several months and were clearly out-of-date which could pose a risk to users. EVIDENCE: Examination of five service user care plans evidenced that the records were holistic in their approach and in the main well documented. It was evident that the staff have tried to involve users in the care plan process and their input was documented. There is a need however, to ensure that care plans are reviewed as a matter of urgency, as it was evident that care plans were significantly out-of-date and had not been reviewed since January or August 2005. There were several incidents of inappropriate recording in daily records and it would be helpful for staff to receive further training in record keeping in order to avoid any recurrence. A photograph of each user should be held on DS0000011049.V263848.R01.S.doc Version 5.0 Page 10 file in case the service user absconds to assist with identification and to assisat new staff to identify individual users. The inspector was told by the manager that new ‘person centred plans’ will be introduced to the home in the next few weeks, which will be written in userfriendly format and focus on the needs of the individual user. It is anticipated that all staff will receive training in person centred planning within the next few weeks and that key-workers will then be responsible for formulating the plans and keeping them up-to-date. Service users are encouraged to try new activities and are provided with opportunity for personal development and growth. All activities that could be hazardous to users were underpinned by risk assessment and risk management strategies. On examination it was clear that all risk assessments required review and updating. One service user indicated to the inspector that he was looking forward to going out. The user put on his coat and was waiting at the door. Staff had planned a drive into town for the afternoon. DS0000011049.V263848.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 17 Service users participate in activities that provide opportunity for personal, practical and emotional development Service users are provided with a menu that is nourishing, varied and meets their individual need EVIDENCE: From examination of documentation and discussion with staff it was clear that service users are provided with a range of stimulating activities, which encourage independence and the acquisition of life skills. Service users are involved with the shopping, cooking, cleaning and laundry activities in the home and this is a well-documented part of their care plan. All of the users attend day services where they are supported to engage in activities that are stimulating and worthwhile and which provide them with the opportunity to make new friends. There was evidence in the daily records that users make good use of communal facilities including local restaurants, cinemas, sports facilities and public houses. A number of the users go to a DS0000011049.V263848.R01.S.doc Version 5.0 Page 12 monthly disco held at Maple Durham Hall and are regular attendees at ‘Thursday Club’. All users have the opportunity to take an annual holiday. This year a number of users went to Scotland whilst others went to Dorset. Users are encouraged to maintain contact with family and friends. Visitors to the home are encouraged and are provided with appropriate hospitality when visiting. The home provides a nourishing menu, which meets the needs of users. Service users are provided with choice and variety and are regularly consulted about the menus. Coloured photographs of different foods are used to aid the users understanding and to assist them in making a choice. Each user is provided with the opportunity to have their own individual choice of menu, one day, each week. Records of food consumed by each user are recorded in the daily records. DS0000011049.V263848.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users physical and personal support needs are well met and medication is dealt with safely and appropriately. EVIDENCE: Throughout the inspection staff demonstrated their awareness of the needs of service users with limited or non-verbal skills. Staff were clearly able to interpret users non-verbal signals and gestures appropriately and were seen to offer appropriate choices in relation to their every day lives. Personal care was offered in a discreet and sensitive manner, which maintained the users right to privacy and dignity. Examination of service user documentation indicated that all service users are registered with a local doctor who offers regular health checks, screening and preventative services. Examination of health records indicated that a number of the users choose not to have chiropody and dental treatments. There is a need to discuss the users decisions fully with their care Manager and any agreements made in respect of these services should be documented in the care plan. DS0000011049.V263848.R01.S.doc Version 5.0 Page 14 The system adopted for the administration of medication is the monitored dosage system. This system reduces the likelihood of medication error and provides an accurate record of administration. All staff are fully trained in medication administration including the administration of rectal diazepam. DS0000011049.V263848.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This standard was not fully inspected on this occasion EVIDENCE: This standard was not fully inspected on this occasion DS0000011049.V263848.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The home was clean, hygienic and free from residual odours. All bedrooms were individually personalised to reflect the interests of the occupant. Communal space was well used by residents but appeared somewhat cramped. EVIDENCE: A tour of both homes evidenced that standards of hygiene and general cleanliness were satisfactory throughout. The homes were pleasantly decorated and comfortably furnished. New decoration had been recently completed in house no.1a that had enhanced the overall appearance of the home and improved the ambience for users. The staff office had been repainted and reorganised since the last inspection, which brightened its overall appearance and helped to make records more accessible to the staff. The inspector was told of plans to extend both homes and provide a conservatory to each home in the new financial year. This will be of benefit to residents since the communal areas were well used by residents and at times appeared rather cramped. The gardens to the rear of the houses and the car parking area at the front of the house will also receive a make over since they DS0000011049.V263848.R01.S.doc Version 5.0 Page 17 are rather bland in design and present little of interest to users of the service. There are plans to enlarge the two small laundry areas, which will make them more spacious, safe and more user friendly. Service users were observed to making good use of the communal facilities. Several residents had taken themselves back to their bedroom after breakfast and were relaxing quietly in their rooms. DS0000011049.V263848.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This standard was not fully inspected on this occasion EVIDENCE: This standard was not fully inspected on this occasion DS0000011049.V263848.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 The home is well run for the benefit of users by a competent and experienced manager. There were a number of shortfalls in relation to health & safety, which could pose a risk to the safety of users. EVIDENCE: The home is well run by a newly appointed Manager who is competent and experienced to run the home and meet its stated aims and objectives. The Manager is nearing completion of an NVQ 4 in care & management and Registered Managers Award to further enhance his knowledge and skills. Although new in post it is clear that the manager has the respect of the staff team and is liked by the residents. The manager leads by example and communicates a clear sense of direction and leadership. DS0000011049.V263848.R01.S.doc Version 5.0 Page 20 There were several significant shortfalls in relation to health & safety observed at the time of inspection which could have compromised both service user and staff safety: • • • • The storage of dishwasher powder and caustic toilet cleaner in an unlocked cupboard at the top of the stairs in house no. 1 could pose a serious risk to the health and safety of users. Confidential paperwork, which gave details of the staff teams home telephone numbers, was found in the car park by the inspector. Staff were observed wearing disposable gloves around the home and between service users which poses a risk of cross contamination. The front door of house no.1 could pose a risk to users and staff in the event of fire, as it does not open easily. The door is currently fitted with 2 locks and a chain at the top of the door. It will be a requirement of this report that in consultation with the Fire Authority the fitting of key coded locks linked to the fire alarm system is considered. One user attempted to abscond during the inspection when the door to house no. 1was left open for a short time. Staff told the inspector that this incident was a frequent occurrence. Recurrence of this incident could be avoided if key coded locks were fitted to the door. • DS0000011049.V263848.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 1 x DS0000011049.V263848.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 Standard YA41 YA9 YA6 YA41 Regulation 18 13 (4) c 15 (2) b 17 (1) b Requirement Ensure that all staff receive refresher training in appropriate recording Ensure that all risk assessments in relation to service users are kept up-to-date Ensure that all care plans are kept up-to-date Ensure that documents containing staffs personal information is stored securely and disposed of safely Ensure that products subject to COSHH requirements are safely locked away Ensure that in consultation with the Fire Authority locks that can be opened easily in the event of a fire be fitted to the front doors of both homes. That the proposed conversion of a bathroom to a shower room is completed. This requirement has been outstanding since 21.4.04 Timescale for action 19/02/06 19/12/05 19/12/05 20/11/05 5 6 YA42 YA42 13 (4) c 23 (4) a 20/11/05 19/12/05 7 YA27 23 20/02/06 DS0000011049.V263848.R01.S.doc Version 5.0 Page 23 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 YA28 Good Practice Recommendations That consideration is given to providing more communal space DS0000011049.V263848.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 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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