Inspection on 23/03/07 for 120 High Street North

This inspection was carried out on 23rd March 2007.

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

120 High Street North 26/03/09

120 High Street North 16/02/06

120 High Street North 14/03/05

120 High Street North 02/08/04

120 High Street North 18/11/03

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

CARE HOME ADULTS 18-65 120 High Street North Dunstable Bedfordshire LU6 1LN Lead Inspector Mr Paul Worthy Unannounced Inspection 23rd March 2007 1.00 120 High Street North DS0000014913.V331136.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 120 High Street North DS0000014913.V331136.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. 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 120 High Street North Address Dunstable Bedfordshire LU6 1LN 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) 01582 750940 www.mencap.org.uk Royal Mencap Society Vacancy Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2006 Brief Description of the Service: The home is a 6-bed service run by Mencap. The home is a semi-detached house to the north of Dunstable town centre. It has four floors. There is a spacious garden to the rear that can be accessed via the kitchen or utility room. The home is situated opposite a convenience store and is within walking distance of Dunstable town centre and public transport links. 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 1.00 p.m. It took place over 8 hours. The inspector met most of the people living at the home and talked to three of them, two of whom showed him their rooms. He talked to two staff and the manager, saw some of the public parts of the building, and saw some records and the evening meal. He also saw the staff and those living at the home interacting throughout the visit, where this included accompanying a staff member and a service user to a local shop. Account was taken of the pre-inspection information that the manager had returned prior to the inspection. The inspector is very grateful to everyone at the home for their help during this inspection. What the service does well: What has improved since the last inspection? The previous requirements related to: involving service users and all stakeholders in the quality assurance process; having specified checks done by external companies; a reviewing of the fire risk assessment; and keeping substances hazardous to health in a locked area. These had all been acted on or were in the process of being acted on. Since that inspection Mencap had introduced a new robust approach to quality assurance that focuses on continuous improvement. The involvement of all stakeholders including service users and staff is seen as an important part of that process. There had been a difficult period due the loss of all the permanent and experienced staff early last year and a new acting manger started in September 2006. Staff confirmed that the new team was now working well together. 120 High Street North DS0000014913.V331136.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. 120 High Street North DS0000014913.V331136.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 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good arrangements for assessing the needs of service users to ensure that they could be met. EVIDENCE: There had been no recent moves to the home. Mencap had, however, good policies and procedures relating to the process of helping someone select and move to the home. The assessment information seen on the personal files and talking to staff showed, however, that it was being kept up to date. The service users plans covered all the required areas in identifying the needs that had to be met. Staff were very aware of the current needs of the service users, where this included the needs identified by assessments carried out by other professionals. These assessments were seen to reflect the range of needs that the service users had and to ensure that appropriate changes were brought to the required services, such as increased staffing and changes to the accommodation. 120 High Street North DS0000014913.V331136.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 good. This judgement has been made using available evidence including a visit to this service. There were good service user plans which ensured that the needs of those living at the home would be met in ways that took account of their wishes and encouraged as much independence as possible. EVIDENCE: The new manager was in the process of changing the format of the service users plans, and reviewing and updating them at the same time. The personal files seen reflected this ongoing change so that the old and new formats were seen; both had, corresponding to the assessments of need, appropriate planning information. The manager intended to ensure that the new plans cross- referenced to other relevant documents that needed to be taken into account at the time of reviewing the plans. This was already being done in 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 10 part. She also intended to ensure that there were clear monitorable goals for those living at the home. No member of staff took particular responsibility as a key worker for supporting a particular person living at the home. This was because of the low number of staff, which was thought to make this impracticable. A named member of staff was, however, responsible for administrative and reviewing tasks relating to a specific service user. There were to be reviews every six months with the person. The intention was that in future the new structure of the plans would encourage the review to cover the plan in a systematic way and determine if goals were being met. Person Centred Planning (PCP) was being revitalised as the basis for involving those living at the home in drawing up their plans and as far as possible understanding its contents, where this could include having their own copy in an appropriate format. There were risk assessments in place and some cross referencing to them in the plans. The manager planned to ensure that these included the arrangements for leaving four of the service users for periods on their own without staff support. There were meetings for those living at the home. These had not, however, been happening on a regular basis. This had been noted on one of the recent monthly inspection visits on behalf of the provider (regulation 26 visits) and the manager was planning on ensuring they happened as part of her own programme empowering those living at the home to feel more in control. 120 High Street North DS0000014913.V331136.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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at the home were provided with the support that they needed to be able to lead fulfilling and enjoyable lives in and outside the home. EVIDENCE: The service users all were seen to be benefiting from living at this home with the stimulation and support that they gave to each other. The home functions well as a group living situation where those living at the home take a degree of responsibility for household tasks. The high level of independence of some is reflected in their ability to access the community without support from staff and to remain at the home without support. The home was seen to provide an ideal context for providing the opportunity of personal development. 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 12 Talking to staff showed that there was a full range of activities, including employment for some, day centres and leisure-activities both at home and in the community, and holidays. Some of those living at the home had a lot of contact with their families including regular stays and holidaying with them. The service users are involved in planning the meals and in purchasing food and the preparation. The plans that were seen commented on likes and dislikes. Talking to staff showed that they were aware of dietary considerations in the case of some of those living at the home. 120 High Street North DS0000014913.V331136.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. There were good arrangements for ensuring that those living at the home received the personal and medical care that they needed to remain in good health. EVIDENCE: There was only a very limited need for personal care. For all those living at the home good arrangements were seen to be in place to ensure that emergency, ongoing and routine medical needs were addressed. Staff spoken to were very aware of the medical needs of the service users. Appropriate arrangements for managing medication were seen to be in place. A recent monthly visit on behalf of the provider had noted errors and a weekly stock check had been set up. Staff confirmed that, as a multiple dosage system is being used, it was expected that there would be a check at the end of shifts to check that there was a correspondence between the contents of the blister pack and what had been signed for. 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 14 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were effective arrangements for identifying and addressing the concerns of those living at the home so that they would feel in control and for ensuring they were protected so that they would feel safe. EVIDENCE: Mencap had good complaints procedures. The feedback from the CSCI questionnaires to service users showed that all those service users would speak to staff if they had concerns and that they felt they would be listened to. Staff had had training relating to the protection of vulnerable adults and the local procedures were available in the office. There had been no recent complaints. 120 High Street North DS0000014913.V331136.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, 25, 26, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation was well maintained and furnished so that it provided those living there with a homely and comfortable environment. EVIDENCE: The public areas of the accommodation were seen to have a homely and comfortable feel and to be well maintained. The bedroom seen was individualised and reflected the interests of the owner, who clearly liked the room. A wheelchair access ramp had been added to the front of the building by the Housing Association, who owned the property, following new assessments of need. They had also agreed to install a walk-in shower downstairs. The home was observed to be being kept clean and fresh. 120 High Street North DS0000014913.V331136.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, 33,34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff were appropriately trained and organised to ensure that all the needs of those living at the home would be met. EVIDENCE: The staffing seen to be on duty the day of the inspection showed that staffing levels were being maintained to reflect the number of service users at the home at any given time and their particular needs for support. The manager was going to ensure that there were appropriate risk assessments for each service user, indicating if they must always have staff support in the house or if they could be left for periods on their own. The latter risk assessments would make clear the emergency arrangements in place while no staff are in the house to support one or more service users. Account of such arrangements would be taken in the new fire safety plans that the manager was drawing up, and which were to be agreed with the Bedfordshire and Luton Fire and Rescue Service Fire Safety Officer. 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 18 There had been a substantial change of staff over the last year. Staff confirmed that the staff team was now working well together. The LDAF induction and foundation training was in place, although there were plans by Mencap to upgrade this in conformity to new guidance. The staff turn over had left the team with only one member of staff with an NVQ. There were plans for starting the new staff on NVQ training as they finished their induction and foundation training. Staff confirmed that there was a training programme and ongoing updating. The manager noted that the company that provided training to Mencap also provided alerts when mandatory training was required. She intended to set up a training matrix for keeping track of the training needs of the staff. Speaking to staff and observing them interacting with those living at the home showed that they had a good knowledge of the service users and their need for support and encouragement if they were to live as independently and fully as possible. The staff confirmed that there were regular supervision sessions and team meetings. Staff files were looked at and showed the correct procedures were being followed when recruiting staff to ensure that those living at the home were protected from inappropriate selection. 120 High Street North DS0000014913.V331136.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, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at the home benefited from it being well managed so that they could live as independently and fully as possible. EVIDENCE: The acting manager had been in post since 1st October 2006. Prior to that she had an introductory week with the manager who was going on maternity leave. She had come from another Mencap home, where she had been a deputy manager. At the time of the inspection it was disclosed that since then the prior manger had decided not to return. The post had not been advertised at the time of the inspection. Staff felt the manager was taking steps to take the home forward. Talking to the manager indicated that she had clear plans for 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 20 developing the service, in particular relating to ensuring the involvement of service users in planning for their own lives and in the running of their home. The ethos of the home was friendly and relaxed. Observing the running of the home provided evidence of good systems, including administrative ones, being in place to ensure that the needs of the service users were met. Good quality assurance arrangements were seen to be in place for monitoring and reviewing the services provided. These included the required monthly visits on behalf of the provider (regulation 26 visits), when very detailed forms were completed, and the managers monthly compliance check. The manager would also be producing a quarterly report for stakeholders meetings. The latter meetings provided an opportunity for service users and their representatives to have an input. There was also a Continuous Improvement Plan that identified all the areas where improvement to the services could be made. The manger was introducing a questionnaire to obtain feedback from all those who had contact with a service user, including relatives if the service user agrees. She was planning to produce an annual development plan for the home for 2007/2008 based on the findings of the survey and the continuous improvement plan. The fire log did not show that checks were being done as they should and the checks carried out in respect of water temperatures to ensure that they will not cause scalding and of water ranges associated with Legionnaires disease. The forms in place were excellent as prompts for monitoring. A recent regulation 26 visit had noted the need to ensure that all health and safety checks were being done. The manager confirmed that this was something that she was working to ensure happened by allocating appropriately trained staff to take responsibility for specific tasks and routine tasks were incorporated into the daily tasks for staff. A list of tasks for each shift over the week was seen on the office wall. A recent regulation 26 visit had highlighted the need to ensure that risk assessments show the risk ratings and risk reduction methods and identified the need to set up risk assessment training for the staff. The manager confirmed that the risk assessments were under review and being updated. The COSHH documents were also being reviewed and updated. A recent regulation 26 visit had noted that some of the checks that need an outside company to carry them out were due to be done. The manager confirmed that the testing of electrical appliances had been carried out and that a date was fixed for the hardwiring testing to be carried out. There were no risk assessments relating to the possibility of dangerous objects such as protective gloves being ingested by a service user. The manager stated that this had not been considered as none of the service users had shown any tendency to put inappropriate objects in their mouths. 120 High Street North DS0000014913.V331136.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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 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 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA42 YA42 Good Practice Recommendations A risk assessment that takes account of each service user should be carried out in respect of objects, in particular protective gloves, which pose a risk if ingested. Any arrangements, backed up by a risk assessment, for a service user to remain at home without staff support should be noted in the staff rota file so that there can be no confusion when and for how long service users can be left on their own. 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 120 High Street North DS0000014913.V331136.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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