Inspection on 30/06/06 for 135 Tennyson Road

This inspection was carried out on 30th June 2006.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

135 Tennyson Road 11/11/08

135 Tennyson Road 25/01/06

135 Tennyson Road 08/09/05

135 Tennyson Road 21/03/05

135 Tennyson Road 16/12/04

135 Tennyson Road 29/03/04

135 Tennyson Road 15/10/02

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

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

CARE HOME ADULTS 18-65 135 Tennyson Road Luton LU1 3RP Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 30th June 2006 17:10 135 Tennyson Road DS0000014978.V297607.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 135 Tennyson Road DS0000014978.V297607.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. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 135 Tennyson Road Address Luton LU1 3RP 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 721257 Advance Support Ltd Mrs Eileen Wright Care Home 4 Category(ies) of Learning disability (4), Old age, not falling registration, with number within any other category (4), Physical disability of places (4) 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: 135 Tennyson Road was a mid-terrace house owned by Advance Housing and Support Limited and situated in Luton. The home provided accommodation for four adults who have learning disabilities. The first floor consisted of three single service users bedrooms, a utility room, a toilet and a bathroom. The ground floor consisted of a lounge, single bedroom, ground floor toilet/shower room, and a kitchen/diner. A pay phone for service users was also available The home offered access to a bus stop at the end of the road and the buses go to Luton, Harpenden, St Albans, Watford and London. The local shops and a memorial park were available nearby. Stock wood Park was also available in ten minutes walking time and there were also churches nearby. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced key inspection carried out on 30/06/06 over 4 hours by pursotamraj hirekar. The method of inspection included review of outstanding requirements and recommendations, study of care plans, risk assessments, discussion with the service users’, staffs on duty, partial tour of the premises and observations. The staffs on duty coordinated the entire inspection. What the service does well: What has improved since the last inspection? 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. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 6 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 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 7 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 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. The statement of purpose and service user guide enabled potential service users to make informed decisions. EVIDENCE: The home did not have any new admissions of service user since the previous inspection. The statement of purpose and the service users’ guide was comprehensive. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 8 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had developed detailed care plans of service users’ and implemented acorrdingly. EVIDENCE: The home had made appropriate arrangements for the needs assessment, risk assessments, care plan preparation and care plan review of service users’. The needs assessment were comprehensive and the care plans have taken into account the changing needs and aspirations of service users’. Service user – 1 risk assessment was reviewed on 15/11/05 and the care plan was revised on 29/06/06. The service user was diagnosed having dementia and needed quite a lot of care. Currently, the home does not have the capacity to meet the growing needs of the service user. Therefore, the home was in the process of making arrangements to shift the service user to an alternate home. At the moment, the service user was having tea visits and had planned for a weekend also at Greenacres at Dunstable. Service user – 2 Care plan was reviewed and revised on 23/05/06 signed by link worker, service user and the manager. Service user – 3 Care plan was reviewed and updated on 27/03/06. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had consultations with all service users’ and developed activites that meet the individual service users’ needs and aspirations to achieve quality of life goals. EVIDENCE: The home had consultations with the service users’ and had prepared individual need specific activity plans. Service user – 1 activity plan include to attend Farley hill club, encouraged to play dominos and drafts, visit church local church in winter, participate in the home garden work, visit to pub, café, and local park, visit garden centre, go to shopping with staff, and would like to go to 21 club and attend monthly buffet. Service user – 2 activity plan included attending down lands day centre 5 days a week, Tuesday 444-club, attend catholic church once a month, Wednesday club-21 in the evening, garden, shopping, and pubs as required. Encouraged to clean his room, sink, participate in household chores, participate in garden work, and help in making cakes and puddings. Service user continues to visit his sister once a fortnight 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 10 and maintains link with the family. Service user – 3 activity plan included to continue to attend Bramingham three days a week, attend farley hill club, continue shopping, visit pubs, cook a simple meal, learn to sort clothes, participate in gardening, budget small money. Service user had relationship with girl friend, and maintains friendship with other male friends. The home had planned to take 2 service users to Blackpool in September for a week’s outing. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 11 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 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. The assessed personal and health care needs of the service users’ were met as per the care plan. EVIDENCE: The home had made comprehensive personal and health care needs assessment s and had appropriately developed the care plan, which was used as a reference document for implementation. Service user – 1 medical report chiropody, GP, daily logs, nurse appointments, chiropody appointments, opticians appointments have been attended and the information was up to date in the records. Personal care was planned systematically which include bath, foot care, shaving and dental care. Medical appointments with GP, chiropody at Liverpool road health centre, dentist, hearing aid, sight, and psychiatrist for depression and dementia were organised. Trained staff administered medication. Adequate diet needs were taken into account and talking the service user for walks encouraged the mobility needs. Service user – 2 appointments with practice nurse and district nurse, optician, dentist, chiropodist, GP, hospital appointments, link worker sessions, leg and feet care routine were regular. Personal care provided by the home included help in washing in the morning, encourage to have a shave in the morning, help in cleaning teeth, help in cleaning and applying cream on his feet and give assistance during bath. Medical care support included medical appointments, 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 12 chiropody, optician, support with surgical support socks, and application of cream on his hands for eczema, support in medication as required. Mobility supports included help him walk as much as possible, maintain his wheel chair in good conditions, and maintain his scooter. Communication: need staff to read and explain written communication. Service user – 3 medical appointments, chiropody, optician, dentist, nurse, daily log, link worker individual sessions report, monthly activity sheet were regular. Medical care support included regular medical appointments, maintain hearing, administration of medication by trained staff as required, support with his arthritis, support to manage anaemia, and support to manage skin problems. Personal support included washing feet and his back when required, support to clean himself well, provide foot care support. For communication needs written communication was explained and was encouraged him to interact with others. Service user was provided help in money management. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 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 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. The home had made appropriate arrangements with regard the complaints policy and procedures. Service users’ views were listened to and acted upon by the home. EVIDENCE: The home had a robust complaint policy and procedures. One service user had problems of disturbing during nights by another service user. This problem was addressed by the home with an appointment of a temporary night staff. The service user spoken to had said that now there was no problem. However, there were two incidents since the previous inspection. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had redecorated and maintained comfortable environment for the service users’. However, However, the pavement outside the kitchen leading to the rear garden needed repair before any accident occur. EVIDENCE: However, the pavement outside the kitchen leading to the rear garden was uneven and slippery especial during winters and with service users who regularly participate in the home garden work and continue to take interest in the garden work. The uneven pavement was unsuitable for a service user with physical disability who uses tripod walker. 2 service users’ have slipped few times, the home must repair the pavement before any accident happens. Service users’ were involved in keeping the home was maintained clean and hygienically. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a good skill mix of staff that complemented with team work. EVIDENCE: The staffs had complementary skills that enable to meet the needs of the service users’. The staffs and the service users’ have had good working relations. Staff – 1 was working as a support staff since 11 years and the responsibilities included regular household chores, check water temperatures, quarterly health and safety audit, monthly room checks, personal care of service users, days out to doctors, garden centres and shopping with service users’. Training received included first aid, food and hygiene, personal safety, manual handling, abuse and neglect, challenging behaviour, dementia, person centred planning, risk assessment course and NVQ2 in care. Supervision was held once a month and the latest was on 08/05/06. Staff – 2 was working since 3 years as support worker, responsibilities included security, well being of service users’, assessments, link work, review care plan, arrange hospital and GP appointments, 1:1 with service user, personal care, gardening, cooking with service user, take them out, paper work. Training received included NVQ3 half way due to finish at the end of the year, attended some 21 courses including mandatory courses. Supervision was held once a month. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 16 Staff suggested to have that the home must have on call system to attend accidents relating fire alarms, service users falls. One service user had a stroke and was taken to hospital and continues to be in hospital. However, there was no on call staff mechanism and in these emergencies there was no backup to attend at the home. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The manager had made several attempts to meet the outstanding requirements and in improving the service delivery. The manager and the staffs work as a team in the interest of service users’. EVIDENCE: The home was managed well by the manager as was evident during this inspection that the staffs and the service users’ have had good working relations, the documentation and care records were in order. The support staffs on duty were well aware of all the service users’ needs and care plans. The staffs had received appropriate training and had regular supervision. The manager and the staffs work as a good team. 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 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 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 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 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 19 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 YA24 Regulation 23 (2) (b) Requirement Timescale for action 31/08/06 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 135 Tennyson Road DS0000014978.V297607.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. 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