Inspection on 16/05/05 for 123 Calmore Road

This inspection was carried out on 16th May 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

123 Calmore Road 03/07/08

123 Calmore Road 03/07/06

123 Calmore Road 10/01/06

123 Calmore Road 08/12/04

123 Calmore Road 13/07/04

123 Calmore Road 09/03/04

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

CARE HOME ADULTS 18-65 123 Calmore Road Totton Southampton Hampshire SO40 2RA Lead Inspector Craig Willis Unannounced 16/05/05 9.30am 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 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 Stationary 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. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 123 Calmore Road Address Totton, Southampton, Hampshire, SO40 2RA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02380 668139 New Support Options Limited Joyce Mary Hopgood CRH 6 Category(ies) of LD registration, with number of places 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 08/12/05 Brief Description of the Service: 123 Calmolre Road is registered to provide care and accommodation for six adults with learning disabilities. The home is arranged in two bungalows, with access between them via an office. Staff work in both bungalows, but service users are encouraged to live seperately. The service is provided by New Support Options and the building is owned and maintained by Swaythling Housing Association . The home has a minibus and there is a local bus stop directly outside the home. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first of two inspections of the home in the year April 2005 to March 2006 and took place over three and a half hours. During the visit the inspector met with two members of staff and met three of the service users, observing their interaction with staff. Due to the communication needs of service users the inspector did not have direct conversations with them. What the service does well: What has improved since the last inspection? An assessment has been completed of the dangers one service user faces when they are supported to go swimming and plans implemented to minimise the dangers. Staff have developed the communication tools used with service users. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 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. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The systems for assessing the needs and aspirations of service users are good. EVIDENCE: No new service users have been admitted to the home since the last inspection All service users had an assessment of their individual needs and aspirations through a “vital information profile” and an “essential lifestyle plan”. One service user had a “circle of support”, which brought together important people in their life to help decide what support was required. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 There are clear care planning and risk assessment systems in place, which provide staff with the information required to meet the needs of service users and enable service users to make decisions about their lives. EVIDENCE: The files of three service users were viewed during the inspection. Each service user had an individual plan, which set out how their assessed needs should be met. All of the plans seen had been reviewed within the last month and changes made during the reviews had been added to the documents. The plans included details of how service users should be supported to make decisions, for example through the use of picture cards or objects of reference. Each service user had a set of personal goals in place, which were reviewed quarterly. Risk assessments had been completed for all service users and included action that should be taken to minimise the risks identified. All of the risk assessments seen had also been reviewed within the last month, with changes recorded. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17 The home offers service users a good range of educational and community activities and encourages service users to maintain family relationships. The home provides good meals to meet the dietary needs of service users, although records were not kept of when service users have an alternative. EVIDENCE: Progress has been made to increase the support provided to service users to participate in activities around the home, such as cooking and cleaning. Large instruction sheets, which included pictures to aid understanding, were used in the kitchen to support service users to bake cakes. This was seen as an area of good practice. One service user was being supported to create a sensory garden outside their bedroom window. Service users are supported to maintain regular contact with their family and family and friends are able to visit at any time. Service users attended a local day service, took part in individually organised day activities such as music and movement, swimming and trampolining. Two of the service users attended local college classes in arts, crafts and cooking. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 11 Staff were observed interacting with service users in a respectful manner and maintaining their dignity by knocking on doors before entering and ensuring personal care support was provided in a private place. The home had a planned menu that provided a varied and balanced diet. The menu did not contain alternatives where the menu did not meet the specific dietary needs of service users and this should be amended. Staff spoken with reported that service users were supported to have alternatives to meet their dietary needs. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The personal and health needs of service users are met with evidence of access to a range of NHS services. The medication system at the home is well managed, which protects service users. EVIDENCE: Service users had an “essential lifestyle plan”, which detailed how they prefer to receive personal support. Service users were supported to attend a wide range of NHS services, including GP, dentist, optician, psychiatrist and neurologist. One service user had a communication plan in place, which had been developed in consultation with a speech and language therapist. Medication was stored in metal cabinets in the kitchens in both bungalows and was received from the pharmacist in a monitored dosage system. Records were kept of medication administered, received and disposed of. Staff had received training in the administration of medication, which included an assessment of their knowledge and practice. This assessment was repeated every six months. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home has suitable procedures in place to protect service users from abuse. EVIDENCE: The home had copies of New Support Options’ adult protection procedures and the staff member spoken with demonstrated a clear understanding of types of abuse and adult protection issues. The home looked after the money of five service users. The money was checked for two service users and money held was found to balance with records. Receipts were available for expenditure made on behalf of service users. The manager was the appointee for five service users and keeps the records of bank accounts. These were not checked, as the manager was not available to provide access. These records will be checked at the next inspection. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The fixtures and fittings in the home’s kitchen are poor, resulting in areas of the home that pose a risk to service users. EVIDENCE: The fixtures and fittings in the kitchen of bungalow A had not been replaced or repaired since it was made a requirement by an environmental health officer. The units in the kitchen have chipped doors, some of the drawers have come off their runners and there are chips in the work surface. Staff had cleaned the kitchen as well as they could, but the damage meant that it could not be hygienically cleaned. Staff reported that this work had been requested from the housing association, although no information was available about when the work will be completed. The rest of the home was clean and hygienic and had been well maintained. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 36 The systems for training and supporting staff were good, enabling staff to meet the needs of service users. EVIDENCE: Staff meetings are held every two weeks and records are kept of discussions. The last meeting discussed the support needs of service users, fire safety and feedback from a recent training session. Two members of staff spoken with reported that they met with the manager for formal supervision meetings every month, and found these sessions supportive. All staff have recently completed training in physical interventions and changes had been made to guidelines as a result of this training. One staff member who had been working at the home for a month confirmed that they had received an induction, had completed shadow shifts and had received one to one support from the manager. The training records of three staff members were seen and indicated that they had all received training in first aid, fire instruction, moving and handling, food hygiene, medication administration and autism. It was not possible to check whether recruitment records now contained all of the information they should, as the manager was not available to provide access to the confidential records. This will be followed up at the next inspection. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 16 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home has good systems to ensure the safety and welfare of service users. EVIDENCE: The home had records of the fire alarm system being serviced within the last month and that staff were conducting weekly checks of the alarm. Staff had undertaken fire training twice in the last year and had completed an assessed fire safety questionnaire. The home had a current gas safety certificate. The fridge and freezer temperatures were taken and recorded and food was suitably stored. The home’s water system had been checked for legionella. 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 2 Standard No 31 32 33 34 35 36 Score x x x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 123 Calmore Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 19 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 24 Regulation 16 (2) (g) Requirement The registered person must ensure that the cupboards, drawers and worksurface of the kitchen in bungalow A are replaced. This requirement has also been made by the Environmental Health Officer. This requirement is repeated as the previous time-scale of 28/2/05 was not met. Timescale for action 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 20 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton, Hampshire SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 123 Calmore Road H54 s12374 123 Calmore Road v224971 030505.doc Version 1.30 Page 21 - 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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