Inspection on 06/07/06 for 16, Curtis Road

This inspection was carried out on 6th July 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

16, Curtis Road 22/11/05

16, Curtis Road 14/06/05

16, Curtis Road 23/11/04

16, Curtis Road 06/07/04

16, Curtis Road 03/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 16, Curtis Road Whitton Middlesex TW4 5PT Lead Inspector Louise Phillips Unannounced Inspection 6th July 2006 9:10am 16, Curtis Road DS0000017361.V305298.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 16, Curtis Road DS0000017361.V305298.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. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 16, Curtis Road Address Whitton Middlesex TW4 5PT 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) 020 8898 6026 020 8898 6026 None United Response Miss Louise Anne Gallagher Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one named service user over the age of 65 years. 22nd November 2005 Date of last inspection Brief Description of the Service: 16 Curtis Road is a care home providing personal care and support to four adults with a learning disability. The service is managed by United Response and the building owned by Thames Valley Housing Association. The home is purpose-built and wheelchair accessible throughout with a large well-maintained garden to the rear of the property. It is situated in a quiet residential area close to public transport, shops and other local amenities. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day with time spent talking to two staff and the manager. A tour of the premises was carried out and care records were inspected along with other relevant paperwork. Information has also been gained from the inspection record for the home. Questionnaires were sent to 9 health and social care professionals and 5 relatives. They were received back from 5 health and social care professionals and 2 relatives. 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. 16, Curtis Road DS0000017361.V305298.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 16, Curtis Road DS0000017361.V305298.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): 1 and 2 Quality in this outcome area is good. This judgement has been made as the resident’s needs are constantly assessed and there is current information available about the service. EVIDENCE: Since the last inspection no new residents have moved into the home and the standard has been met previously. The home has demonstrated that it constantly assesses the changing needs of each resident, seeking and utilising support as necessary. Examples of this are referred to later in the report. The home has recently updated the Statement of Purpose, providing up-todate information about the service and registered persons. 16, Curtis Road DS0000017361.V305298.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, 9 and 10 Quality in this outcome area is good. This judgement has been made as the residents needs are met by the service, although the care plans are not updated to reflect changing needs. EVIDENCE: Health and social care professionals involved with 16 Curtis Road are positive about the service meeting the needs of the residents, with one comment being: “…the home is good at person centred working and looking at the individual needs of the client. The home is able to recognise its limitations and utilise support…”. The professionals also felt that staff follow their advice and guidance. The needs of some of the residents at the home have changed significantly and up-to-date information and guidance was seen in their files to help staff manage this. This included guidance on continence management, moving and handling and medication administration guidance. For one resident there was information regarding their difficulty with eating and drinking, with guidelines from the dietician on how best to manage this. This was seen being put into practice when the resident was assisted with their 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 9 lunch. This is also included an up-to-date risk assessment for supporting the resident with eating and drinking. Individual files contain a lot of current information for staff on how to support residents. However this is not used to update the care plans, as for one resident who is not currently able to eat meals, the care plan discusses their being involved in meal preparation and their going to the hydrotherapy pool, despite their no longer being able to do this. The care plans must be updated to reflect the actual current needs of each resident. For one resident who suffers from a degenerative mental illness, the service has been working with the practice development team on how they can support them with this, where they are currently working on looking at the previous occupation and preferences of the resident to develop activities around this and increase their quality of life. Similarly, the manager discussed how the needs of one resident have changed significantly, particularly around their eating and drinking, where the planning of how to manage this appropriately involves all relevant health and social care professionals, relatives of the resident and also an advocate to speak on behalf of the resident. The record keeping in the daily records have improved slightly, with a line being put after each entry. However, there still remain areas where additional entries could be made and the recommendation for staff to be trained in safe record-keeping techniques is restated. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made as the residents have the opportunity to be involved in activities that are planned around their needs, interests and community living. EVIDENCE: Since the last inspection the home has adapted part of the lounge into a sensory area with a relaxation chair, light tube and projector for the use of residents. During the inspection a resident was seen spending time relaxing in the chair and staff said that the other residents enjoy making use of these facilities. Some residents at the home have very high needs and have needed to refrain from some of their weekly activities in the interests of their health. The manager spoke about how the home works to accommodate this, by ensuring that staff spend time with each resident, taking them out in the car for drives and to places of interest. She also said that staff try and involve residents in domestic chores around the home, such as making their bed and keeping their bedroom tidy. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 11 Professionals involved with the service say they feel the home works in the best interest of the resident, though one comment being: “…the residents should be given more opportunities to be involved in day activities in the home…”. Feedback from relatives indicates that they feel the home understands their relatives individual needs regarding culture/ ethnicity. Relatives also feel the home helps their relative keep in contact through phone calls and post cards. In the file for one resident there was a copy of a letter sent to a relative that had been drafted by the new keyworker. This included an update on what is happening with their relative, such as the holiday they had booked, day trips planned to Brighton, and how their clothing allowance is being spent, as well as the inclusion of photos of the resident. Meals at the home are prepared by the staff and individualised dependent on the likes of each resident and their eating and drinking needs. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 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): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made as the feedback received from health and social care professionals and relatives is that the residents physical and personal care needs are well met. Improvements need to be made to the medication system. EVIDENCE: The health and social care professionals associated with the service commented that the home maintains good partnership links with them, with some adding that “…the manager has been good at encouraging staff to follow advice from the team and usually contacts the team if there are difficulties…”. Records indicate that there are regular reviews of each residents care, with their involvement, and that healthcare issues are dealt with promptly. The professionals surveyed felt that the home generally communicates well, with one comment being that “…not always –although this is getting better with more frequent use of e-mail…”. The professionals surveyed were also asked how they felt the home could improve and in response to this stated: “… the home would benefit from improving its communication and attendance at appointments...Documentation could be improved, particularly when agency staff are working…”. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 13 Relatives of people living at the home said that they are kept well informed about important issues affecting their relative and are “…very satisfied…” with the support the home provides. Where asked where they feel the home provides an excellent service one stated: “ …constant, effective care and understanding…”. Medication at the home is monitored through a weekly check of the stock to ensure that sufficient supplies are in place and the actions taken to address any shortfalls, such as medication running low and needing to contact the chemist. A check of the medication cupboard indicates that medicines are administered via a blister pack system. For one resident there was seen to be a bottle of Tegretol 200mg medication additional to that dispensed in the blister pack, which was not included on the medication record. This is not prescribed in addition to the regular medication and should be disposed of. There was also seen to be a bottle of Clonazepam tablets for a resident who is now given this in a liquid form. When asked, the staff member said that this is “…in case the liquid runs out…”. The tablet form of medication is not prescribed on the medication record and should also be disposed of. The lunchtime medication for one resident was seen been prepared. The two staff on duty were observed to have signed the chart prior to the medication being given to the resident which is bad practice. These findings indicate that a more robust system of monitoring the medication stock needs to be implemented, along with staff training in the administering of medicines and signing of the medication chart. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 14 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 as relatives feel confident to raise areas of concern they have and systems are in place to reduce the risk to residents. EVIDENCE: The home has the United Response comments, concerns, complaints procedure that provides guidance on how to deal with complaints and the different stages of investigating a complaint. All the relatives said that they knew who to speak to if there was something they were not happy about regarding their relatives care and that they know how to make a complaint. Staff records indicate that they have received recent training in adult protection, so to minimise the risk to residents. There are also policies and procedures in place regarding abuse awareness and what to do in the event of this. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made as the staff and residents make the environment welcoming and the home is spacious and homely. EVIDENCE: 16 Curtis Road has a warm, comfortable atmosphere that is enhanced by the homely décor and spacious communal areas. Professionals who visit the service also comment that: “…the staff are always welcoming and friendly…”. Since the last inspection one bedroom that required re-painting in areas has been decorated for the comfort of the resident. Part of the lounge has also been converted into a sensory area for the use of the residents. It was observed that the doors to some of the cupboards in the laundry area were loose and hanging off the hinges, and it is required that these are repaired. One relative commented that:“…the house is clean/ light…”. And on the day os inspection it was observed that the home is cleaned to a good standard throughout. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 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): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made as staff receive relevant training for their role and appropriate recruitment checks are carried out to minimise the risks to residents. EVIDENCE: The previous inspection required that the home maintain a record of the Criminal Records Bureau (CRB) checks carried out on staff who work at the home. The home does not have a record of these, but holds a ‘new appointment form’ that is a record of the recruitment checks carried out on new staff. This includes a record of the CRB check, medical clearance and two references. This form is signed by the area to demonstrate that they have seen the relevant documentation and are satisfied enough to commence the employment of the individual. United Response provide a rolling programme of mandatory training for the staff and additional courses are sought where required. Courses recently undertaken by staff include manual handling, ‘prevention from harm’ and eating and drinking. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 17 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 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): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made as the manager is competent and understands the responsibilities if their role. However, the organisation does not demonstrate that the health and safety of residents is promoted. EVIDENCE: Health and social care professionals raised the issue that: “…there has been a recent change of manager and it is not clear what impact that will have on the service…”. Since the last inspection a new manager has been appointed at the service and they are being supported by a mentor/ manager who is working alongside them in the capacity of manager whilst the new manager deputises whilst getting used to working with the client group and their higher level of needs. Both managers were met with on the day of inspection. The findings in this report demonstrate that a consistent level of service is provided to the residents throughout the change of manager. The mentor/ 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 19 manager has also previously worked at the service for a period of time and she demonstrated a good knowledge of individual residents and their needs. In May 2006 the home sent surveys to the relatives, doctors and other health professionals, seeking their views on a number of areas about the service. This included seeking feedback the support offered by the home, communication and accommodation. The manager stated that the information gained from this is discussed with the staff team and used to make changes and develop the service. The home carries out a health and safety hazard inspection once a month to check such things as power points and furniture coverings, addressing any areas of concern. There is a weekly fire alarm and call point test carried out. The fire alarm system is also checked monthly, along with the emergency lighting. All the staff have delegated responsibilities regarding checking the first aid box, monthly vehicle check, water temperature and fridge/ freezer temperatures. Records for the water temperature checks indicate that the water being dispensed is far too hot. Examples of this are that on two occasions, one in June and the other July 2006 a sink in the kitchen was dispersing water at a temperature of 61C. In the same months the water in one residents bedroom was being dispersed at 47C and 45C respectively. The records indicate that such temperatures are not exclusive to these areas and that water is regularly being dispersed at temperatures well above the required temperature of 43C. The requirement to address this has been required on the previous two inspections of the service and is restated on this occasion. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 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 Standard No Score 1 3 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 2 3 3 2 X LIFESTYLES Standard No Score 11 3 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 2 X 3 X 3 X X 2 X 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 15(2) Requirement The Registered Persons must ensure that the care plans in use at the home are updated to reflect the current needs of each resident. The Registered Persons must ensure that a robust system of auditing the medication is implemented and that staff are trained in correct medication procedures. The Registered Persons must ensure that the cupboard doors in the laundry area are repaired. The Registered Persons must ensure that hot water delivery temperatures are set to disperse hot water from taps at 43C (Previous timescale not met) Timescale for action 30/09/06 2. YA20 13(2) 31/10/06 3. YA24 23(2) 31/10/06 4. YA42 23(2)(j) 31/08/06 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 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. 1. 2. Refer to Standard YA10 YA20 Good Practice Recommendations The Registered Persons should ensure that staff are trained in safe record-keeping techniques. The Registered Persons should ensure that medications no longer prescribed for residents are disposed of. 16, Curtis Road DS0000017361.V305298.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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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