Inspection on 19/06/08 for 119 Victoria Street

This inspection was carried out on 19th June 2008.

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

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

119 Victoria Street 17/06/09

119 Victoria Street 22/06/07

119 Victoria Street 13/06/06

119 Victoria Street 25/02/06

119 Victoria Street 20/09/05

119 Victoria Street 23/03/05

119 Victoria Street 23/03/05

119 Victoria Street 23/03/05

119 Victoria Street 23/03/05

119 Victoria Street 13/04/04

119 Victoria Street 13/04/04

119 Victoria Street 13/04/04

119 Victoria Street 13/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 119 Victoria Street 119 Victoria Street Cinderford Gloucestershire GL14 2HU Lead Inspector Mr Simon Massey Key Unannounced Inspection 19th& 24th June 2008 09:30 119 Victoria Street DS0000016319.V362223.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 119 Victoria Street DS0000016319.V362223.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. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 119 Victoria Street Address 119 Victoria Street Cinderford Gloucestershire GL14 2HU 01594 516582 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) Mr Thomas Alfred Mills Mrs Beverley Mills Mrs Elaine Elizabeth Watkins Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2007 Brief Description of the Service: 119 Victoria Street is a terraced house on the outskirts of Cinderford. Care and accommodation are provided for three people with learning disabilities. Support and staffing levels are minimal and the home aims to help service users to develop their independent living skills. Service Users each have their own room. In addition there is a lounge, bathroom and kitchen. A smaller room upstairs is used as an office. There is a garden with a patio at the back of the house and a small front garden. The home has close links with another nearby home, which is operated by the same providers and run by the same manager. Service users move on from there to 119 Victoria Street when they are assessed as able to manage more independently, rather than being directly referred to the home. The home’s Statement of Purpose and Service User Guide provide information as to the services that the home provides. The current fee range for the home is between £307.50 and £859.34 per week. 119 Victoria Street DS0000016319.V362223.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection consisted of two visits to the home over two days. The Inspector met with all the service users, members of the care staff, the deputy manager and the Registered Provider. The registered manager was on leave at the time of the inspection. Records relating to care planning, health and safety, staff recruitment and training were examined and an inspection of the environment was also completed. The inspector would like to thank the service users for their friendly welcome and positive approach in helping complete this inspection. What the service does well: What has improved since the last inspection? What they could do better: The home needs to review and update its Statement of Purpose and Service User Guide and also consider producing them in different formats. The home needs to improve its system of person centred planning to more fully involve the service users in planning their future. The home needs to provide more structured plans to develop independence skills such as food preparation, menu and budget planning, managing of personal monies. The home could provide more guidance, education and support in the area of personal relationships. The home needs to ensure that agreed staffing levels are maintained in order to support the service users to continue develop their independent lifestyle. 119 Victoria Street DS0000016319.V362223.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. 119 Victoria Street DS0000016319.V362223.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 119 Victoria Street DS0000016319.V362223.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users would benefit from the information in the Statement of Purpose and Service User Guide being regularly reviewed and updated and presented in formats that were easier to understand. EVIDENCE: There have been no admissions to the home since the previous inspection and the home is currently fully occupied. The home has an admissions policy that complies with the regulations. The home has a Statement of Purpose and Service User Guide in place but these documents have not been reviewed since 2006 and this needs to be done. Improvements could also be made to how the information is presented and structured, with the production of the documents in formats that would make the information more accessible to the service users, and also any future admissions. These could also provide more of a flavour of what life was like in the home. 119 Victoria Street DS0000016319.V362223.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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved use of person centred planning would support service users to develop and progress their independence skills and confidence in a more planned, structured and personalised way. EVIDENCE: All service users have care plans in place and these reflect to some extent the needs of the service users. There is scope for people to have more ownership of these plans and for them to better reflect people’s aspirations and identified needs. There is scope to improve the identifying of short and medium terms goals, particularly in relation to the development of independent living skills. Whilst service users demonstrated some understanding of the content and purpose of their plans they could be supported to use them better to plan their futures and identify the support they require. People explained how they are supported to make decisions about their daily and weekly routines and how they exercise choice over their activities and 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 10 interests. However the reduction in staffing hours, which has occurred over the previous months, has contributed to some issues being unresolved and people being a little uncertain about some aspects of the immediate future in terms of work activities and personal issues. The home is partially staffed with various periods being left for service users to live independently and mange the house themselves. People have been risk assessed to establish their abilities and confidence in relation to this. Service users were very positive about this aspect of their care and they have been well supported to develop their responsibilities in relation to living without constant supervision. On arrival the home was unstaffed and the service users required the inspector to produce their I.D. and sign the visitors book. The service users contacted the other home to inform the staff that the service was being inspected. People were also able to explain how they would respond if an emergency occurred and how they maintained the security of the building. 119 Victoria Street DS0000016319.V362223.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 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have the opportunity to develop and live an independent lifestyle but this experience could be enhanced and improved with greater structure, planning and staff support. EVIDENCE: At the time of this visit two of the service users had recently finished their employment at one location and were unsure what would be occupying some parts of their weekly routines in the future. This was obviously a cause of some concern to them and support is clearly required to manage them through this period. This is an example of where the care planning system could be better utilised to establish in partnership with the service users what options are available and what realistic goals and aspirations can be identified. People expressed general satisfaction with social activities and their ability to travel independently greatly helps them to pursue their interests. Examples were given of local visits and trips and activities that are undertaken, some with staff support and some completely independently. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 12 Previous inspections have commented upon the need for service users to have a more structured approach to developing their skills around menu planning, budgeting, cooking and shopping. Some improvements were previously identified in this but at this inspection it appeared that staff again were taking the majority of responsibility for this. This aspect of care and support needs to be reviewed and better and more consistent plans put into place. People should be fully involved in planning their menus and should have responsibility for some aspects of their shopping and budgeting. Service users need to be supported to improve their skills in terms of managing finances, including their personal monies. There is a need to review the risk assessment in relation to one service and their safety in the kitchen. This issue was discussed with the deputy manager. It was evident in discussion with all three service users that various aspects of cooking and menu planning could be the source of some conflict within the group. This issues needs to be addressed by the staff supporting the service users to develop a system that they understand and are happy with. An important aspect of independent living is the ability and confidence to develop personal friendships and relationships. There is a need for the care staff, possibly with the help of outside professionals, to provide clearer and more positive support, guidance and information in this area in order to support the service users to progress this aspect of their lives in a positive manner. These issues were discussed at the time of the inspection with the deputy manager 119 Victoria Street DS0000016319.V362223.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 & 20 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 to access the healthcare professionals they require to ensure that physical and emotional health needs are met. Service users are protected by the homes medication and administration procedures. EVIDENCE: Service users confirmed that they supported to attend health appointments and that they can discuss any issue regarding their health and well being with the care staff. People expressed satisfaction with the help they receive in respect of their personal care needs. Appointments are documented in the personal files. One person is supported to self medicate and all medication was correctly stored and documented. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 14 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. Service users are able to approach care staff and the Providers to raise concerns, and feel confident that they will be listened to. Training undertaken in Adult Protection by the staff team provides further protection for the service users. EVIDENCE: Service users explained how they would make a complaint or raise a concern. People said they felt confident about approaching the staff, the manager or the Provider with issues they were concerned about. All service users were very positive about the staff who worked in the home and felt that they could talk to them. The home has a complaints procedure in place but has had no formal complaints to respond to over the past twelve months. Staff and managers have completed training in Adult Protection. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 15 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have homely and comfortable accommodation which they maintain to a good standard. Improvements could be made to the process for reporting and organising repairs. EVIDENCE: The home is generally well maintained and decorated throughout, with service users completing the majority of the domestic cleaning chores and able to personalise the home to their own taste and preference. The home was very clean and hygienic and it is evident that the service users take pride in their home and have the necessary skills to perform thee tasks well. People expressed satisfaction with their personal space and people commented that the other occupants in the house generally respected their privacy. At the time of the inspection the washing machine was broken, and had been out of action for nearly four months. Also the tumble dryer was now not working either and people were having to send, or take, their washing to the 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 16 other home run by the same Provider. This is unsatisfactory, the washing machine should have been repaired much sooner, regardless of the cause of the breakdown. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users enjoy positive relations with staff but the quality of care has been compromised by the reduction in the staffing hours provided. EVIDENCE: Service users were positive about the staff who worked in the home and they said they all got well. One person said of their regular support worker, “she’s brilliant, we get on really well”. Another said that, “she’s always there when we need her and helps with anything we want”. However service users expressed dissatisfaction with the loss of staffing hours and could not explain why this had happened. They felt they had not been properly consulted over this and were keen to have more support. This was particularly in the area of menu planning and food preparation and shopping. Other areas have been highlighted in the report where the inspector considers that the reduction of staffing hours have impacted upon the home. Following previous inspections more structured and planned staffing was put into place in the home. This provided a defined and regular staffing pattern and also demonstrated the exact amount of staff hours being done on shift in the home on a weekly basis. This practice now seems to have ceased and the 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 18 Inspector was concerned by the relatively low number of hours being provided every week and also the amount of time being spent by the service users at the other home run by the same Provider. Service users expressed their own dissatisfaction with the decreased hours and, as mentioned elsewhere in the report, there was evidence that the situation was impacting upon them. Greater support and input is required in a number of areas, not least in terms of giving some direction and momentum to the care and support being provided. The home has one staff member who comes in most mornings for between ½ an hour to an hour, and then one full shift from another support worker later in the week. The service users were very positive about this input. There was no designated time for the managers to visit, though it was confirmed that they generally visited weekly. People were also able to see the manager when they visited the other home. The home shares the registered manager with another home, a practice that has been in place for a number of years. However, if it is not possible to manage both services effectively with one registered manager the Commission will take steps to review this situation and may require the home to register its own manager. The service users should be provided with a certain number of support hours per week as agreed in their contracts with the placing authorities and any reduction in these hours should be risk assessed. The change should ideally only be implemented in agreement with the placing authorities, the service users and the Commission. The deputy manager stated that they were recruiting another worker for the home but it was not yet definitely decided what hours they would be working. This situation needs to be addressed and the Commission informed of the amount of staff cover being provided on a weekly basis. Staff were up to date with the required statutory training and had had regular supervision meetings. Staff have had annual appraisals completed. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management need to provide leadership and direction to the staff in order to ensure that needs are correctly identified and planned for and the service users receive the support and guidance they need to develop their skills to live independently. EVIDENCE: Service users all spoke positively about the management, saying they were approachable and they got on well. Whilst there are a number of positive aspects about the home it appears to have lost a certain amount of direction and focus, particularly in relation to the developing of independence skills. The Inspector was concerned that it was proving not to be effective having one registered manager between two homes. Though some aspects of the home are run efficiently and there are good relations between staff and service users, the concerns identified in this report need to be addressed. This 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 20 situation will be considered on reflection when the Commission is informed of the details of the proposed staffing changes that the deputy manager outlined during the inspection. There is not formal quality assurance process in place, though surveys have been circulated in the past. A more formal system could help staff and service users to develop plans for future improvements and changes. All routine health and safety checks had been completed and staff were up to date with training in fire safety. A fire risk assessment is in place but this appears not to be a very detailed document. This needs to be reviewed and advice taken as to whether a more comprehensive fire risk assessment is necessary. 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 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 Standard No Score 1 2 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 3 33 2 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 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 3 x 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 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. Standard YA39 Regulation 24 Requirement The home must ensure that there are formal quality assurance systems in place. This requirement is repeated from previous inspection (previous timescale 31/12/06) Timescale for action 30/08/08 2. 3. YA1 6 YA9 4. 5. YA24 YA30 6. YA33 The home must reviewed and update its Statement of Purpose and Service User Guide 13(4)(b) The home must review the risk assessment regarding accessing the kitchen in relation to one service user 16(2)(f) The home must repair the washing machine and tumble dryer. 16(2)(f)(j) The home must ensure that 23(2)(c) service users are aware of how to report mechanical breakdowns and how repairs can be organised. 18(1)(a) The home must provide sufficient staffing to meet the needs of the service users. The home must inform the Commission of the revised staffing arrangements for the home. DS0000016319.V362223.R01.S.doc 30/08/08 30/08/08 30/08/08 30/08/08 30/08/08 119 Victoria Street Version 5.2 Page 23 7. YA42 23(4) The home must ensure that it has a fire risk assessment in place that complies with the regulations. 30/08/08 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 YA6 YA16 YA15 Good Practice Recommendations The home should further develop its person centred planning to more fully involve the service users. The home should provide more structured guidance and planning in relation to developing independence skills. The home should review the support, guidance and education it is providing in relation to the developing of personal relationships 119 Victoria Street DS0000016319.V362223.R01.S.doc Version 5.2 Page 24 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. 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