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Inspection on 16/08/05 for 145-147 Masons Road

Also see our care home review for 145-147 Masons Road for more information

This inspection was carried out on 16th August 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

!45-7 Mason`s Road provides a flexible, small-scale service for three service users who all appear, at heart, to value this service. All three service users expressed general satisfaction with the current service, whilst also, in two cases, being quite able to point out what they saw as shortcomings.

What has improved since the last inspection?

Some environmental and improvements in practice have been made in response to previous requirements and recommendations. It was pleasing to note that one service user, who was previously showing dissatisfaction because of uncertainties and unfulfilled expectations regarding his future, was now more settled since his key worker took on the role of fully keeping him informed and updated on future plans, and unfortunate delays.

What the care home could do better:

Work is required to improve the environment. Whilst much of this requires the home to get action by the organisation, there is much that the home itself should be taking direct responsibility for. In particular, more satisfactory sleeping-in arrangements need to be sorted out, and the hot water and heating systems must be made satisfactory. The service needs to ensure the management of the home is effective and properly supported through this period of change, as it seeks to improve the ways in which service users receive their service.

CARE HOME ADULTS 18-65 145-147 Masons Road 145-147 Masons Road Stratford On Avon Warwickshire CV37 9NX Lead Inspector Martin Brown Unannounced 16 August 2005 12:30 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. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 145-147 Masons Road Address 145-147 Masons Road Stratford On Avon Warwickshire CV37 9NX 01789 414551 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) Turning Point Acting team leader currently Terminate Charumbira Care Home 4 Category(ies) of Learning Disability (4) registration, with number of places 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: That no new service users are to be admitted until there is sufficient staff sleeping-in accommodation. This is so that staff are not required to use service users communal space for sleeping-in. Date of last inspection 7 March 2005 Brief Description of the Service: 145-147 Masons Road is a care home for four adults with learning disabilities. The Primary Care Trust owns the home and the service providers are Turning Point. The home comprises two maisonettes one ground floor and one first floor. There is a small office and laundry on the ground floor separate to the maisonettes. The home was opened in 1994. Up to two service users are accommodated in each of the maisonettes.The home is a domestic property close to a supermarket and is close to the town of Stratford on Avon. All of the bedrooms are singles without en-suite. Each maisonette has two bedrooms, a lounge, kitchen and bathroom. There is a shared laundry, garages and gardens. The home is only suitable for service users who are independently mobile. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection on Tuesday, August 16th, 2005, between 12.30 and 3.45pm. Staff and service users were welcoming and helpful. All three service users were seen and spoken with, as were four staff, including the acting team leader. 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. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 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 standard(s) The vacant upstairs room is now used as a staff sleep-in room. If there was to be a vacancy in the downstairs flat, it is required that this would be used similarly. EVIDENCE: These standards were not looked at on this occasion. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 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 standard(s) 6,7,9 Service users’ care is supported by clearly documented behavioural guidelines, which were observed being followed by staff. The user-friendly format seen in the Home Skills section could usefully form the framework for Life Story books. In view of predicted changes to at least one service user’s living arrangements, the clear setting down and availability of wishes, preferences, life skills and needs, is particularly urgent. EVIDENCE: Two care plans were looked at; they had both been reviewed within the last six months. Both had detailed sets of behavioural guidelines, which detailed how specific behaviours, and the risks entailed within those behaviours, were managed. Other than that, risk assessments seen were generic, rather than individual. A section ‘Home Skills’ within individual files was largely photographic, and showed positive images of service users abilities and skills. The acting team leader advised that person centred plans were being undertaken, but could not locate the details of these plans for one specified service user. The acting team leader advised that one service user was now being kept informed and advised regularly about his intended move to more independent living, and that this had reduced his anxieties and lessened disruptive behaviour. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 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 standard(s) 12,13,16,17 Service users are supported to take part in a variety of activities, in keeping with their wishes, and appropriate to developing life skills and independence. Meals are flexible, and balance healthy eating with expressed wishes. EVIDENCE: Service users expressed satisfaction with their lifestyle and activities. One service user was looking forward to an accompanied shopping trip later in the day. Activity sheets showed the variety of planned activities, subject to change according to individual wishes, for the week. Menus, and discussions with service users and staff, indicated that a variety of nutritious food, taking into account service users’ preferences, was provided. There was some confusion in the home regarding the current menu, but this was resolved during the inspection. Meals are cooked separately by staff for, or with, the service users in each flat, except for ‘big’ meals, such as Sunday roasts. Service users all expressed satisfaction with meals. Towards the end of the inspection, an agency member of staff was preparing to make cakes with the help of one service user, who was looking forward to this. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 10 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 Service users’ identified personal and health needs are supported by guidelines and information that is followed by staff. Completion of individual Health Action Plans would further ensure this. EVIDENCE: Care plans and individual files showed that personal support, and health care needs were being met. ‘Seizure’ guidelines were seen for one service user, discussion with staff, and observation, showed how behavioural issues were resolved according to guidelines. Health Action Plans were available, but these have not yet been completed. Medication was assessed as being satisfactory on the previous inspection, and was not fully inspected on this occasion, other than to note that recording and administration on the sample looked at was accurate and appropriate, and done by staff who had received training. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 11 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) EVIDENCE: These standards were assessed as met on the previous inspection, and were not looked at on this occasion. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 12 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) 24,25,26,27,28,30 The home requires a number of improvements to ensure that it is fully homely, comfortable and safe. The nature of service users’ needs give extra impetus for the need for robust furnishings and regular maintenance. Whilst some of the concerns are around longer-term maintenance, others reflect a lack of day-today observation and maintenance. EVIDENCE: The downstairs carpet throughout 147 is marked and worn, particularly in the hallway, where it is frayed, and is a potential tripping hazard. The upstairs bathroom requires renovation; the neon light has no cover, and the overpainting of tiles is flaking. The downstairs bathroom has no shower curtain; the manager advised that one is to be installed. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 13 The staff downstairs currently sleep-in in the lounge, using a ‘zed-bed’; the upstairs staff now use the vacant service user bedroom. Staff freely acknowledged that the use of the downstairs lounge as a sleep-in room impinged on service users’ freedom there. There is no lock on this door; staff said they pushed a table against the door at night if they wished for security. There was a notice on the laundry door warning of a hazard from a blocked outside drain. Staff said that this had been fixed, and consequently took down the notice. Service users were happy to show me round their bedrooms, which were personalised, and reflected their personalities and interests. All said that they were happy with their rooms. The upstairs bedroom has the boiler for that flat within it. Not withstanding that someone’s bedroom is not the best access for a boiler/emersion heater, this was behind an untreated plywood door that was not secure. The acting team leader advised that this about to be made good by the maintenance team. Lounge lights had twin bulbs; in all of these there were only one bulb. Wallpaper was torn in places, sofas were worn, one in the lounge of 145 was ripped. The fireplace in the upstairs lounge has been boarded over. This now needs to be properly decorated as part of the refurbishment of that lounge. The day of the inspection was a hot one. The upstairs was made hotter by the bathroom radiator being on. Staff could not account for this being on. The service user’s bedroom that is now a sleeping-in room had surplus furniture that was broken and awaiting removal. The ventilation device in the laundry was not working very effectively. Outside, the rear garden is reasonably maintained, and staff informed me that it is used by service users. There are two ash tree saplings, now several feet high, growing right next to the house. A service user drew my attention to the large crack in the tarmac on the front drive, which requires attention. The freezer for the home is in the garage. The garage had no lock on it; the acting manager advised me that this was in hand and about to be repaired. The freezer, whilst within required temperatures, had a build-up of ice on it. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 14 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) 33,35 Greater consistency in meeting service users’ needs would be helped by the recruitment of more permanent staff. EVIDENCE: There are two staff on duty at all times, with the addition of a manager in the day. On the day of the inspection, half the staff were agency staff, who were familiar with the service users. One staff had come on shift prepared for a cooking activity with one service user. One permanent staff highlighted the need for all staff to be familiar with the behavioural guidelines for a consistent approach to service users, and was concerned that this may not happen if agency were used who were unfamiliar with the service users. Supervision records showed regular up-to-date supervision of staff. Training records and certificates were seen for individual staff. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 15 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) 37,39,42 The service must swiftly demonstrate it can run effectively under its current structure if that is to continue. The service must demonstrate that the acting team leader is supported in a manner that enables to run the home effectively. The safety of all those in the home is compromised by doors being wedged open, rather than having alarm activated closures. EVIDENCE: Following the departure of the manager to run another home, an acting team leader is currently in place for a short period, overseen by the service manager. I am advised that this will be until the imminent change of registration of the home. Water temperatures are recorded, and were within acceptable limits on all taps. The one exception to this was the shower, which was extremely hot at its highest setting. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 16 A clear fire procedure was prominently displayed. A number of doors were wedged open. There are no alarm activated door closers. The acting manager advised that gas and electric certificates are up-to-date, but could not locate them. Service user forums take place weekly; records of these were seen. The acting team leader advised that meetings with parents were shortly to take place, but he was uncertain of the dates. 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 17 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 x x x x x Standard No 22 23 ENVIRONMENT Score x x 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 1 2 2 2 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 145-147 Masons Road Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 1 x E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 18 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 24,37 Regulation 23(3) Requirement When a vacancy arises in the downstairs flat, this must be used as a sleeping -in room, to end the practice of staff having to sleep-in in the service users lounge.In the short-term, this practice must be risk-assessed for safety, and audited for its impact on the service users quality of life. Carpeting in 145 must be replaced.(This is an outstanding requirement from previous inspections). The upstairs bathroom requires renovation and a light cover. The downstairs bathroom requires a shower curtain The boiler in the upstairs bedroom is to be securely housed. Lounge light sockets must have working bulbs in them. The upstairs lounge requires redecoration Broken furniture must be removed from the sleep-in room. The heating upstairs must be fixed to ensure that radiators work appropriately. The cracked/lifted tarmac in the Timescale for action 22/9/05 2. 24,28 23(2) 22/9/05 3. 4. 5. 6. 7. 8. 9. 10. 27 27 24,26 28 28 24 24 24 23(2) 23(2) 23(2) 23(2) 23(2) 23(3) 23(2) 23(2) 22/9/05 22/9/05 22/9/05 22/9/05 22/11/05 22/10/05 22/9/05 22/11/05 Page 19 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 front drive requires attention. 11. 12. 13. 14. 24 42 42 33 23(2) 23(2) 23(2) 18 The lock on the garage door must be fixed/replaced. The freezer requires defrosting. The downstairs shower temperatures must be within safe limits. The service must recruit more permanent staff, in order to reduce its reliance on agency staff. The home must consult with the fire officer regarding the installing appropriate alarm activated door closures, and end the practice of having doors wedged open. The service must ensure that the acting team leader is adequately supported to ensure that the home is run effectively. Evidence is required of gas and electricity safety checks. The service must provide the Commission for Social Care Inspection with written confirmation of the arrangements and timescale for managing Masons Road until its proposed deregistration. 22/9/05 22/9/05 22/9/05 22/10/05 15. 42 23(4) 22/9/05 16. 37 8,9, 22/9/05 17. 18. 42 37 23 38,39 22/9/05 22/9/05 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. 2. 3. Refer to Standard 6 19 24 Good Practice Recommendations Life story books, ensuing that service users needs, wishes, and aspirations are clearly documented in a service-user friendly way, are recommended. Health Action Plans should be completed It is recommended that the ash tree saplings next to the building be removed, in case of potential structural damage. E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 20 145-147 Masons Road 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB 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 145-147 Masons Road E53 S57999 145-147 Masons Road V244614 160805 Stage 4.doc Version 1.40 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!