Inspection on 29/01/07 for 1 Lawrence Road

This inspection was carried out on 29th January 2007.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Lawrence Road 01/04/08

1 Lawrence Road 07/11/07

1 Lawrence Road 15/05/07

1 Lawrence Road 11/01/06

1 Lawrence Road 29/03/05

1 Lawrence Road 28/09/04

1 Lawrence Road 09/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Lawrence Road (1) 1 Lawrence Road Basildon Essex SS13 2NB Lead Inspector Nicola Dowling Unannounced Inspection 29th January 2007 10:00 Lawrence Road (1) DS0000018055.V329065.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 Lawrence Road (1) DS0000018055.V329065.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. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lawrence Road (1) Address 1 Lawrence Road Basildon Essex SS13 2NB 01268 590678 01268 590678 linda.bayley@estuary.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider Name of registered manager Type of registration No. of places registered (if applicable) Estuary Housing Association Limited Manager post vacant Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: Lawrence Road provides twenty-four hour care for two adults with a learning disability. The cost of care at this home is £2774.01 a week The home is a purpose built bungalow situated in a semi-rural area between Southend and Pitsea. Transport links to the area are not very good. The home consists of a large lounge, small dining room, two bedrooms, and one toilet/bathroom for residents, staff and visitors and a kitchen and office. The home has a large garden/patio area to the rear of the property. There is limited parking to the front of the property. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection site visit took place over a six hour period on one day. The site visit consisted of a tour of the home, talking with staff, observing the residents and reading of documents. All the residents were seen. A member of staff on duty assisted with the inspection as the acting manager was not on duty. In addition three survey forms were received back from professionals and contributed to this report. The residents at this home have challenging behaviour and communication difficulties. It is difficult to know how much they understood about the visit to their home. However a thank you is extended to the residents and staff for their help and hospitality during the visit. A random inspection was undertaken to this home on 16th May 2006. This inspection focussed on staffing and management. Requirements were made to ensure that suitable numbers and skilled staff worked at the home to care for the residents needs. Also that a manager is recruited. At this inspection it was found that there has not been any development for the post of manager or an increase in the staff team. Leaving the home team heavily supported by agency workers and without leadership. What the service does well: What has improved since the last inspection? What they could do better: Most information in the home is available in words and there are not many pictures to help identify and explain the words to those that cannot read. There is a very small Estuary staff team. To support them in the delivery of care the home use a high number of agency workers. There has also been no registered manager for over one year to take the leadership of the home. Slow reaction to maintaining the back garden fence leaves the home insecure. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 6 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. Lawrence Road (1) DS0000018055.V329065.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 Lawrence Road (1) DS0000018055.V329065.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): 1, 2, 4, and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information in the home is generally up to date but not in a format that the residents can understand. EVIDENCE: The residents have lived at this home together for some years. Currently there is no plan to change their living arrangements. Therefore the home is full and there have not been any new or planned admissions. From the documentation available the home has a statement of Purpose and a Service User Guide. Both were in text format with few pictures to illustrate the words. These documents are not yet available in any other format. The residents do not have an allocated advocate however there is a leaflet with information about an advocacy service should they need one. There is a detailed admissions policy and information about being introduced to the home. The residents each have a contract, however these were not signed or dated by the acting manager. There was no evidence to suggest that the residents or a representative had seen the contract. . Lawrence Road (1) DS0000018055.V329065.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents changing needs are reflected in their care plan. EVIDENCE: Two care plans were inspected. Both were up to date and had been reviewed and contained risk assessments. The home operates a key worker system and plans focus on all aspects of daily life and well-being. Currently the care plans are in text format. The daily care notes were detailed and described the resident’s day and mood. The last annual review for one resident was October 2005 and there was evidence that the resident had been invited and attended with an advocate present. Annual reviews are now due again. In the past advocates have been involved along with other professionals to help determine how much residents can understand. One resident has very limited understanding and needs staff support with most decisions. Staff do keep records of how decisions are made, for example behaviour associated with an activity. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 10 Residents were unable to comment on their care however from observation they appeared happy. They were dressed in their own clean clothing and were comfortable with the staff around them. Lawrence Road (1) DS0000018055.V329065.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 adequate. This judgement has been made using available evidence including a visit to this service. Staff provide good food for the residents, however activities both structured and unstructured are restricted by the skills of the staff on duty. EVIDENCE: Staff eat meals with residents to promote normal living. The meals are home cooked and menus are bases on resident’s choice. A process of elimination has established this choice. Staff have observed the residents preferences and made a record of the food they do and do not like. Menus have been made from this record. Following a meal residents clothing is changed is food is spilt to keep them comfortable and maintain dignity. Residents can choose to spend time on their own in their room or in the sitting room. There are some restrictions in place, for example access to the kitchen and the back garden. This has been risk assessed for the safety of the resident and the reasons documented in their care file. Staff were observed to talk to residents with respect and called them by their preferred names. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 12 Currently there are limited structured activities for the residents. For example one resident goes out to a centre for two hours for ball games and has a travelling sensory unit visit at the home for an hour. Otherwise all activities are unstructured and include going out for drives or for walks. One resident needs two staff to accompany them when going out of the home. Therefore when this resident goes out the other resident has to go as well, because there are only two staff per shift. One resident also has difficulty in walking long distances, whereas the other resident enjoys walking. To overcome this the home has had one resident assessed for a wheelchair. This will mean that walking over a distance will be managed better. However at the moment the unstructured activities suit one resident better than the other. The staff plan to put a picture board together to display trips out and holidays. There was evidence that equipment had been purchased for this purpose. Some activities are available in the home such as playing musical instruments. However due to a small staff team and the level of support residents need in the community, spontaneous activities are difficult to arrange. For example a shift staffed just by agency staff would not be able to use the home’s car to take residents out for a drive. Lawrence Road (1) DS0000018055.V329065.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. Residents receive good support with their health and personal care. The home’s medication practices protect the residents. EVIDENCE: Health care is well documented. Personal care and how to deliver personal care is written into the care plan. There are various charts recording and monitoring behaviour and medical conditions, for example epilepsy charts. These are filled in and up to date. There is evidence of psychiatrist appointments and behaviour therpy input to help manage challenging behaviour. There was a positive response about the care of the residents from the general practioners questionnaires. A recent hospital addmission was managed well with a good outcome for the resident. From the daily care notes, residents take themselves to bed when they want to go and get up when they want to for example one resident was up at 7am getting up. Whilst another went to bed at 10pm. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 14 Medication is administered safely and is stored in a secure place. There were no gaps found on the medication administration record sheets (MARS). Signatures of staff including agency staff are recorded. There was evidence that staff had received training in administering medication and this extends to agency workers. Documentation was also available confirming that residents have regular medication reviews with their doctor. Lawrence Road (1) DS0000018055.V329065.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 adequate. This judgement has been made using available evidence including a visit to this service. The complaints policy and adult protection policy are satisfactory EVIDENCE: There have not been any adult protection incidents at the home. The policy contains a clear procedure about what to do if abuse is suspected and there is evidence that staff including agency staff have had training on this topic. There have been no recorded complaints since the last inspection. Information on how to complain is displayed on the office wall and is in picture format. This information could be in a more accessible place for residents and other professionals that visit the home. Complaint information is also contained in the service user guide. Residents at this home are vulnerable and responsibility is placed on the staff to contact advocates should the need arise. Currently due to changes in the advocacy services there are no allocated advocates for the residents unless staff ring up to arrange an appointment. The regular Estuary staff work with the residents to establish their views, likes and dislikes. As residents do not communicate well this is done by a process of elimination. Staff record for example, food that is pushed away and food that is eaten well to establish what the residents like. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents home remains a comfortable and clean area for them to enjoy. It is well kept and homely. However slow maintenance leaves residents and staff at risk. EVIDENCE: A fence panel has been blown down in the recent strong. This has been reported to the Estuary maintenance team however, twelve days later it has still not been replaced. This has left the back garden insecure. Staff have reported that large dogs from neighbours property have wandered through into the back garden. Staff have felt unsafe because of this and have restricted residents movement outside because of ths potential risk. Estuary Housing Association had plans to extend the back of the property for a staff toilet and laundry area. Planning permission for this has recently been refused. This has inturn set back improvements for the back garden. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 17 The home intend to review the internal lay out of the home. This is because the washing machine that is domestic in type is housed in the kitchen. Soiled laundry has to pass through the dinning area and into the kitchen to be washed. Staff spoken to do ensure that foul laundry is not washed at the same time as food preparation, however there are not protocols in place to ensure that all staff follow this procedure. The residents do not require the use of any specialist moving and handling equipment. However there are confusion locks on some doors for health and safety purposes. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Estuary Housing Association has not developed the staff team and relies heavily on the use of agency workers. EVIDENCE: There are training plans for staff. Mandatory courses such as medication, health and safety and fire training have been undertaken. There are five members of the Estuary team, all other staff are from the Essex Nursing Agency (ENS). Of the five Estuary staff one has obtained the National Vocational Qualification (NVQ) to level 3 in care and three are undertaking the NVQ level 3. As there is such a small team of staff, agency workers cover whole shifts. Most agency workers used are regular and familiar to the residents. However at the random inspection undertaken on the 16th May, the high use of agency workers was raised as an issue. From the pre- inspection questionnaire over the last eight weeks all individual shifts have included an agency worker. As yet there has been no improvement in this area. The outcome for the residents is that there activity schedules are limited and sometimes Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 19 interrupted. For example, staff rotas take into consideration when a driver is needed for transporting residents to their activities, however this is sometimes difficult to maintain. Staff reported that supervision takes place on a peer group basis and covers day-to-day practice in the home. However there is no formal supervision recorded for Estuary staff or the regular agency staff at the home. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Estuary Housing lack drive to recruit a manager. The home is drifting with little improvement to develop the home. EVIDENCE: There is no registered manager at this home. The previous manager left in December 2005. Since that time a senior member of staff has been acting in the role of manager. Staff report that the mangers position was advertised on one occasion however, since then there have been no further active attempts at recruiting a new manager for the home. The last regulation 26 visit occurred on the 27/06/06, leaving the home lacking in senior management support. This lack of commitment to seek a manager for Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 21 the home is also reflected in the staff team numbers, and the lack of supervision and support for staff. The residents at the home take part in the Estuary quality review. The staff at the home are also focussing on how their residents will gain from this review. Last year both residents were left out from the preferred trip. There was evidence that one staff member commenced work on this project on 20.01.07. A random selection of safety certificates were inspected and these were all up to date. For example the portable appliance testing was dated 04/06 and the gas certificate dated 15/11/06. A random selection of policies was inspected. As soiled linen is laundered in the kitchen the infection control policy was requested. This was unable to be found. There were also no risk assessments relating to this activity. There were environmental risk assessments in the home and these were dated for October 2005 with no evidence of review. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 22 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 2 2 3 3 x 4 3 5 2 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 x 28 x 29 3 30 2 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 3 36 2 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 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 x 3 x x 2 x Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 23 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. YA12 YA13 YA32 Standard Regulation 18(1)(b) Requirement The Registered Person must ensure that agency staff in the home have the skills to meet the residents needs regarding, Activities and accessing the community Timescale of 20/03/06, 06/07/06 not met The Registered Person must ensure that the garden is safe and secure for the residents. The Registered Person must ensure that risk assessments are in place for the laundering of soiled linen. The Registered Person must ensure that there are sufficient numbers of skilled regular staff to meet the residents’ needs. Timescale for action 31/03/07 2 3 YA24 YA30 23(2)(o) 13(4)(c) 31/03/07 31/03/07 4 YA33 18(1)(a) 31/03/07 5 6 YA36 YA37 18(2)(a) 9 Timescale of 06/07/06 not met. The Registered Person must 31/03/07 ensure that all staff received formal supervision. The Registered Person must 31/03/07 recruit a manager for the home. Timescale of 20/03/06, 06/07/06 not met Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 24 7 YA42 26 Visits under regulation 26 must be made monthly with a prepared report available at the care home. 31/03/07 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 3 Refer to Standard YA1 YA5 YA36 Good Practice Recommendations The home should use formats other than text to communicate information to the residents. It is good practice for contracts to be read and signed in the presence of an advocate. Staff should receive supervision at least six times a year. Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Lawrence Road (1) DS0000018055.V329065.R01.S.doc Version 5.2 Page 26 - 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. 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