CARE HOME ADULTS 18-65
135 Tennyson Road Luton LU1 3RP Lead Inspector
Ansuya Chudasama Announced Inspection 8th September 2005 09:30 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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.V251710.R01.S.doc Version 5.0 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.V251710.R01.S.doc Version 5.0 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.V251710.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21.3.05 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. Stockwood Park was also available in ten minutes walking time and there were also churches nearby. The home had a ramped access to the front door intended for wheelchair access and a pleasant garden at the rear of the house for staff and service users to enjoy. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Announced inspection took place over 5 hours. The manager Mrs Eileen Wright was present at the inspection. The inspection comprised of a tour of the bedrooms, bathing facilities and the communal areas of the home, care tracking in relation to two service users and conversations with the service users, staff and the manager. There were two service users in the home two service users were at the day care services. The inspector would like to thank the manager staff and service users for helping with this inspection What the service does well: What has improved since the last inspection?
Most of the requirements were met by the home. The home had been painted and the kitchen had been refurbished completely and looked very pleasant. Two service users bedroom carpets had been replaced. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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 the following standard(s): The homes statement of purpose and service user’ guide provided prospective service users and their families information of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: The home had a statement of purpose, which clearly set out the age group of service users for whom the home was suitable to provide care. The service user guide for the home was comprehensive. A new service user had been admitted to the home. Records showed that the home had carried out an assessment of the service user. The service user had also visited the home on a number of occasions prior to admission. The views of the service users living in the home were also sought by the home. The home did not admit emergency admissions. All service users had contracts with the home. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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 the following standard(s): There was clear and consistent care planning systems in place to provide the staff with the information they needed to meet the needs of the service users to a high standard. EVIDENCE: The care plans for two service users were examined and this was found to be very comprehensive, containing detailed information about what care would be provided and the service user’s preferences for the way in which the care would be given. The plans covered information on personal, social and healthcare needs. The risk assessments undertaken for service users were also detailed and these were explained to them. The care plans were discussed with the service users and signed by them. They were also reviewed on a regular basis. Observation on the day of the inspection showed that the staff empowered service user’s to make choices and they were involvement in the decision making process. The staff on a monthly basis had meetings on an individual basis with the service users to discuss issues about the home and the care plans. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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 the following standard(s): Service users have opportunities for personal development to enrich their social and educational opportunities. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The service users were given opportunities to take part in valued and fulfilling activities and encouraged the development of individual interests. Information about local activities and events was brought into the home by staff and service users when out in the community. The care plans seen had information on service users likes and dislikes for activities, and food. An activity planner for each person on a weekly basis showed the activities undertaken by the service users. Some of the activities included helping with cooking, cleaning, going to day care activities and clubs, walking to the park, shopping, pub, church, and going to the garden centre. Service users were given choices for meals and the staff spoken to were aware of service users likes and dislikes of food. The meals eaten were recorded in the diary. The meals provided were varied and healthy. The service users spoken to stated
135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 11 that they enjoyed their meals. Regular monthly meetings with service users were held and a discussion about what was happening in the home, health and safety issues, activities, outings and holidays were discussed. All service users went on holiday with the home in small groups and the service users chose the holidays. The home encouraged service users to maintain contact with friends and families. The service users were also involved in staff and agency recruitment process. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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 the following standard(s): The knowledge of staff, safe systems for administering medication and detailed care planning meant that the health needs of service users are met. EVIDENCE: The care plans inspected had detailed information on how service users personal care needs were being met by the staff. The service user’s preferred routines were made very clear in the plan. The staff spoken to were aware of the service users needs. The service users bought their own clothes with support from staff and went shopping on most Saturdays. The plans also had detailed information about the service users health care needs and how the home was helping them meet their needs. Information on medical appointments were recorded well. The home had a policy on medication. None of the service users in the home administered their own medication. The staff who gave out medication had received the accredited training. The medication cabinet seen was clearly labelled with service users names and well maintained. The medication file was also very detailed and clearly laid out. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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): The staff have good knowledge and understanding of adult protection issues, which protect service users from abuse EVIDENCE: The home had a complaints procedure, which was explained to the service users. The service users spoken to stated that they would speak to the staff if they were not happy about any thing. This home had a Protection of Vulnerable Adults policy and whistle blowing policy and all staff had been trained in issues relating to potential abuse. The staff spoken to were able to give examples when a service user was unhappy. It was also stated that they would be able to tell if a service user was unhappy by the way they behaved. Risk assessments were also undertaken on what made service users vulnerable in the community and in the home. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 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): The premises were not suited to meet the needs of the service users as to allow all those living at the home to enjoy a comfortable environment that was safe. EVIDENCE: The home was clean, homely, comfortable and free from offensive odours. Redecoration throughout the home was being undertaken at the time of this inspection. The kitchen was totally refurbished and looked very pleasant. As stated at the last inspection, an occupational therapist report had raised a number of issues about the home’s environment. It was stated that the environment was more suited for a fitter group of service users who had no problems climbing the steps. One service user had to leave because the person was unable to manage the steps. The inspector was informed that the home was looking at suitable accommodation to meet the service users needs. The home had recently identified a bungalow and had passed on the relevant information to the organisation. It was stated that some of the problems identified in the report had been met. The uneven paving at the back of the garden had been identified as a risk to service users years ago. However no work had been carried out to repair this. The furniture in the garden needed replacing as it was old and broken and some of it was not safe to use. It was stated by the service users that they would use the garden more often if the
135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 15 furniture was pleasant and safe. The green house needed taken out as it was broken and dangerous. The roof of the summerhouse was leaking and it was not safe to use. One of the trees needed cutting as it was long and did not let the sun through. The house had been painted. Two service users had new carpets, and another service user was having his carpet replaced in the near future. The curtains in the lounge, kitchen, and two service users rooms needed replacing. One service user needed a new bed to meet his needs. The chairs in the lounge needed replacing. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 16 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): The home provided very good training so that the people living at the home had their needs met by competent and suitable staff. The staffing ratio to service user needed reviewing to ensure all service users needs were being met by the home. EVIDENCE: The home had been short staffed since last year. The home had recently appointed a full time and a part time permanent staff. The manager stated that they had been using the same agency staff to provide continuity. The home was waiting for CRB checks and references before the new staff could start. It was stated that the recruitment process took a long time to complete by the HR department and some times the staff took up other employment due to having to wait a long time for their starting date. The staff recruitment files were kept up to date and nicely presented. All the information required in the standard was available. The staff spoken to stated that they had supervision on a monthly basis and appraisals on a yearly basis. Also monthly staff meetings were held. The home had a small core of staff that had been working at the home for a long time and they provided stability to the service users. Evidence showed and staff spoken to had received good training and most were completing their NVQ level 2 or 3 training in care. The home was able to rota two members of staff to be on duty when they needed to take service users to appointments or to assist them to participate in specific activities. Two members of staff were on duty during the evenings and
135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 17 weekends and one at night. The home needs to assess the needs of the new service user and the staffing ratio accordingly. Observations on the day of the inspection showed that a new service user who had recently been admitted to the home required one to one with a member of staff. Discussion with staff and management about meeting the needs of service users showed that the home needed a waking staff as two service users in the home got up in the middle of the night, and the sleeping in person had to get up to assist the service users. The staff on the sleeping in duty had to work the next morning shift and they were finding this difficult, as they had been up in the night helping service users. One service users comments card received stated that the noises at night time and a service user trying to get into his room was keeping him awake in the night. It was stated that the home had at one time high sickness levels due to the above problems and because they were short of staff. It was stated to the inspector that the management from the organisation criticised the home about the sickness levels but the underlying reasons for why this was happening was not looked into. It was also stated that the staff had worked very hard during the difficult times and they had put in extra effort to meet service users needs 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 18 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): The home has an experienced and committed manager who ensures strong leadership, and safe working practices so that service users health, welfare and safety are safeguarded EVIDENCE: The manager was a qualified learning disability nurse and was undertaking NVQ Level 4 in Care and the Registered Managers Award. The manager had substantial experience in working with this service user group and the quality of care planning and care provided demonstrated her competence as a manager. Health and safety, food hygiene, and fire safety was discussed with service users in their monthly meetings and individually. The staff and service users had regular fire drills. It was stated that all the service users knew what to do when the fire alarms were activated. On the day of the inspection, one of the service users accidentally put a tea towel near the cooker whilst the staff member had gone to answer a knock at the front door. The staff followed the fire procedures and set the fire alarm off. The two service users went out side the front door with the support from staff. The staff on duty having analysed the situation, got the fire extinguisher and put the fire out. This was handled
135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 19 well by the staff. The incident and accident logs seen were completed and dealt with in a satisfactory manner. 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 3 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 2 3 x x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
135 Tennyson Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 x DS0000014978.V251710.R01.S.doc Version 5.0 Page 21 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 YA24 Regulation 12 14(2) 23 Requirement The registered person must submit an action plan, which sets out a programme for reviewing the future needs of the existing service users in the context of the suitability of these premises. Original timescale of 31st January 2005, extended to 31st March 2005, was not met 2 YA24 12.23 30/11/05 Timescale for action 30/11/05 The registered person must submit an action plan to state how the concerns raised in standard 24 will be addressed. The registered person must review the staffing ratio to service users and for night staff. The outcome of the review must be implemented immediately to meet the needs of the service users. 3 YA33 18 30/11/05 135 Tennyson Road DS0000014978.V251710.R01.S.doc Version 5.0 Page 22 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.V251710.R01.S.doc Version 5.0 Page 23 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
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