Inspection on 04/04/07 for 12 Middle Green Road

This inspection was carried out on 4th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 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

12 Middle Green Road 15/02/06

12 Middle Green Road 20/09/05

12 Middle Green Road 21/12/04

12 Middle Green Road 21/12/04

12 Middle Green Road 21/12/04

12 Middle Green Road 21/12/04

12 Middle Green Road 01/07/04

12 Middle Green Road 01/07/04

12 Middle Green Road 01/07/04

12 Middle Green Road 01/07/04

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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 12 Middle Green Road Langley Slough Berkshire SL3 7BN Lead Inspector Kerry Kingston Unannounced Inspection 4th April 2007 10:00 12 Middle Green Road DS0000011276.V331412.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 12 Middle Green Road DS0000011276.V331412.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. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 12 Middle Green Road Address Langley Slough Berkshire SL3 7BN 01753 532415 F/P 01753 532415 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) londonroad@tiscali.co.uk Milbury Care Services Limited Ms Iona Campbell Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person aged 65 years or over to be admitted to the home. Date of last inspection 15th February 2006 Brief Description of the Service: 12, Middle Green Road provides twenty-four hour care for up to four people with learning disabilities. The home is a detached chalet style bungalow in a residential area of Langley Slough. It is close to local shops and the transport links and facilities in Slough Town Centre. On the ground floor there are four single bedrooms, a lounge/dining room, kitchen, a bathroom and a cloakroom. On the first floor there is a staff office/sleep in room, laundry room and bathroom. The staff team consists of a manager, senior support worker and support workers. The fees are £1085 - £1400 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit, which took place between the hours of 10.00am and 3.00pm on the 4th April 2007, to collect additional information to inform the report for the key inspection. The information was collected from a pre-inspection questionnaire, completed by the manager, surveys completed by three of the four service users (with help from their families), discussions with one staff member, the manager, and a limited communication with and observation of one service user. A tour of the home and reviewing service user and other records were also used to collect information, on the day of the visit. The home has excellent outcomes for service users in several areas. What the service does well: What has improved since the last inspection? There was nothing that could be done better, noted at the last inspection. Staff and the pre-inspection paperwork noted a new bathroom, a new carpet and a new shower to make the house more comfortable for the residents. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 6 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. 12 Middle Green Road DS0000011276.V331412.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 12 Middle Green Road DS0000011276.V331412.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 excellent. The home fully assesses the needs and aspirations of service users who are able to make, (with the help of families if necessary), an informed choice about where they want to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessments and admission programmes for two service users were looked at, one service user has only been resident for a few months. They included asessments by the care management team; the home manager and deputy go to the service users’ homes to do an assessment (using a recognised assessment scoring system). The assessment is then sent to the organisation’s psychologist for his views with regard to the suitability of the service user for the place in the home. The admission programme includes a visit to the home accompamied by a family member and care manager, an unaccompanied visit and two overnight stays. All visits are recorded and service users’ views and behaviours are carefully noted. Service users are spoken to about their feelings or are observed for their reactions. New placements are reviewed after six weeks and service users are involved in making the decision as to whether they will stay in the home. The Statement of Purpose has been adapted for use by individual service users (photographs are used and the individuals diverse methods of communication). The Service User Guide has also been developed into a service user friendly format. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 9 Care plans and risk assessments are presented in as service user friendly a format as possible and developed from the full assessments as quickly as possible. Service user surveys and six week review notes confirm that service users are able to make a choice about whether they want to live in the home. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. Service users are as aware of their current and changing needs as is possible, they are involved in the development of their care plans. Excellent risk assessments and behavioural guidelines ensure that service users are able to develop or maintain their independence, as far as they are able. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for three service users were looked at. They include all aspects of care, presented in as service user friendly a format as possible and reflect the diverse needs of the service users. Behaviour guidelines and risk assessments are signed by individuals, if they are able, or their reactions to the discussions are noted. Personal support guidelines include service user preferences and how they let you know their decisions and feelings. Care managers hold annual Person Centred Planning meetings and the home review the plans once a month, they make any amendments or additions as neccesary, responding quickly to service users’ developing needs. Service users surveys confirmed individuals can do what they want to and were observed making decisions 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 11 about daily activities. Care plans are well presented with pictorial aids, personal and health care guidance is simple and clear. It is absolutely clear how the service users are cared for, what support is necessary and how it is given. Any challenging behaviours are also clear, as is how staff should help service users to deal with it. The Manager and staff member spoken with had detailed knowledge of the needs of service users and any areas that may currently be of concern. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. The home ensures that service users lead as positive and fulfilling a lifestyle as possible. They involve the service users, as far as they are able, in the planning and quality of their lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have a varied day care programme according to their individual needs. One service user attends an extenal day centre five mornings per week, she pays for three mornings per week out of her own finances. This practice was discussed with the manager who advised that it had been identified that she needed and wanted more activities but no official funding was available. The concerns discussed were that this practice would discriminate against a service user without personal funds, and providers are expected to provide suitable activities for service users; it was also not clear the amount of day care paid for by the local authority in the care contract with the provider. The manager agreed to pursue this issue at the service user’s next review. One service user has two and a half days of external day 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 13 activities and one attends a day centre for five days per week. One service user, who is more elderly, receives day care from the home, as she chooses and is able to participate. All service users have day care/activities plan on their walls in pictorial form so that they know what they are doing. On the morning of the visit all the service users were out, pursuing their daytime activities. Daily notes show visits to the community, the manager said there are outings at least once a week in the summer, mainly at weekends. Service users have an annual holiday (contributed to by the provider), go out for meals and visit local leisure facilities. One service user said she had plenty to do and liked living in the home, she was observed choosing what she wanted to do that afternoon. A music lady comes one evening a week, service users attend MENCAP club once a week and an aromatherapist visits once a week. Evenings, especially in the less clement weather, tend to be quieter if service users have had a full day, they may choose to pursue activities in the house, these are noted in their daily notes. All service users have family contact , three of the service users’ families helped them to complete the surveys. One service user regained contact with a family member five years ago and went out for a meal with her for the first time on her birthday this year. The Manager and staff work very hard to keep families involved and work with them to assist service users in their development and improve outcomes for them. The three completed service user surveys noted that staff always listen to what they say and act upon it. Care managers and families are involved in the decision making processes, as is appropriate. The service users recieve good support from the care management team (Slough). The menus seen were varied and nutritious and it was clear that service user choices are respected. Three of the service users have some nutritional issues and appropriate advice is sought. All service users are encouraged to eat a healthy diet. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is excellent. The home offers service users excellent support to ensure they stay well and healthy, so that they are able to maintain their positive lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Excellent comprehensive care plans, give clear guidance with regard to service users’ likes and dislikes and preferred daily routines. They include any necessary guidelines to support individuals with their behaviour or special routines. The documentation is clear, concise and some is presented in service user friendly formats (as appropriate), the home is continuing to improve service user access to information. Care plans are reviewed monthly and any necessary amendments are made quickly. An annual person centred planning meeting is held by the care managers and the home for an overall review of care and progress. Meetings and reviews are held more often if neccesary, such as if any new behaviours emerge or any medical problems arise. Service users are involved in the care plan reviews and person centred planning meetings, they sign the action plan, if they are able, or their reactions are described. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 15 All service users have retained their own GPs and three surgeries are used for four service users. Care plans show referrals are made to psychologists/ psychiatrists and dieticians as is necessary. One service user has lost approximately five stone in weight because staff have encouraged her to eat healthily (advice given by dietician) and increase her exercise. Health care records are well kept, follow up appointments are attended and all annual health checks are noted in annual reviews. A shower has been installed in the downstairs toilet to make personal care easier for the service user who is getting older. Only two service users use medication, this is safely administered by the staff. The home uses the Boots Monitored Dosage System, all records seen were accurate and medication is safely stored. There are photos of service users and a description of how they prefer to take their medication on the medication file. The Manager advised that staff do not administer medication until they are properly trained by Milbury, Boots or Slough training courses (this was confirmed by a staff member). A medication error noted in December 2006 was appropriately dealt with. A letter received by The Commission for Social Care Inspection in January 2007 from a family member expressed that she was very impressed by the care given to her relative. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. The home listens to the views of service users and protects them from all forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recorded no complaints since the last inspection, the manager confirmed that there have not been any. The Commission for Social Care Inspection has recieved no information with regard to complaints or safeguarding adults issues. The service users are able to tell staff, their care manager or families if they have any concerns and the two that cannot communicate clearly verbally, display by their behaviours if they are not happy. All service users have contacts outside the home including good support from their care manager/social worker. The home has safegurding adults policies and procedures and the providers have a robust whistle blowing policy (which has been used in the past). The staff member spoken to had an excellent understanding of how to protect the people in her care and was completely upto-date with the home’s policies and procedures. She was able to talk through the procedure and was in no doubt how she would use it, if necessary. She was very clear about what she would do if she had concerns that were not being dealt with by the organisation. The home does not use physical restraint. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 17 Service users’ financial records were seen to be accurate and well kept but the service users (or the manager) do not know what their income is, as it is dealt with by the organisation’s ‘head office’. The manager agreed to talk to the organisation to make sure that all service users are aware of their income as well as their expenditure so that she is able to help protect them from any financial abuse. 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The house is well maintained, clean and homely. It is suitable to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and fresh and very well kept. It has good quality furniture and equipment and was homely and welcoming. Laundry facilities , sited on the first floor, were tidy and well ordered. A shower has been installed in the downstairs toilet, for an individual service user’s comfort. 12 Middle Green Road DS0000011276.V331412.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): 32,33,34 and 35. Quality in this outcome area is good. The home has a competent, effective and well qualified staff team who offer excellent standards of support to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has nine staff with two vacancies (currently). The manager advised that 50 of the staff team have an N.V.Q. 2 or above qualification. New staff receive a house induction and an organisational induction, which covers all the Health and Safety manadatory training. A staff member confirmed that training is encouraged by the manager and is discussed at regular supervision sessions. She requested autism training as a service user with some autistic behaviours had been admitted, she and other staff completed the training course to ensure the best outcomes for the newly admitted service user. There is a minimum of two staff on duty and there are extra staff available to enable activities and outings. Staff numbers can vary as service users visit their families for weekends and holidays. The home uses robust recruitment processes and all the necessary information is kept on staffing files. Interview notes, supervision contracts and notes and inductions are also kept in the files. A staff member confirmed that supervision was very regular and very useful to her professional development. 12 Middle Green Road DS0000011276.V331412.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 excellent. The home is very well managed and service users’ safety is protected, as far as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has achieved a Registered Managers Award and has been managing the home for several years . Staff said that she was a good manager, she is supportive and makes sure the home is ‘completely service user centred’. Records are well kept, informative and kept securely. The Quality Assurance tool is completed annually and is up-to-date. The home makes sure the service users are as involved as possible in the information collection process. Families help those service users who are unable to clearly express their views and staff ensure they note behaviours and reactions to questions. There are specific questions for service users about what they think 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 21 about their care and these are responded to verbally or with the help of others. The Quality Assurance review includes looking at environment, food, personal care support, your home and management of the service. An annual development plan is produced as a result of the Quality Assurance exercise, which is focussed on service user satisfaction levels. All health and safety maintenance checks are completed, a food hygiene inspection in January 2007 resulted in the home being given two stars, with no requirements or recommendations. There have been no service user accidents or incidents reported since the last inspection. Accidents and incidents that do occur are recorded appropriately. The home has a disaster plan and can access maintenance whenever necessary. Risk assessments are comprehensively completed, as necessary. 12 Middle Green Road DS0000011276.V331412.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 4 2 4 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 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 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 4 X 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 23 NONE 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. Refer to Standard Good Practice Recommendations 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 12 Middle Green Road DS0000011276.V331412.R01.S.doc Version 5.2 Page 25 - 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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