Inspection on 20/07/06 for 198, Powder Mill Lane

This inspection was carried out on 20th 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

198, Powder Mill Lane 21/02/06

198, Powder Mill Lane 17/08/05

198, Powder Mill Lane 31/03/05

198, Powder Mill Lane 20/07/04

198, Powder Mill Lane 22/01/04

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Edenvale

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Chatsworth Care - Dawson House

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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 18-65 198, Powder Mill Lane Whitton Middlesex TW2 6EJ Lead Inspector Simon Smith Unannounced Inspection 20th July 2006 13:15 198, Powder Mill Lane DS0000017386.V308447.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 198, Powder Mill Lane DS0000017386.V308447.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. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 198, Powder Mill Lane Address Whitton Middlesex TW2 6EJ 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 7445 020 8898 7445 www.unitedresponse.org.uk United Response Ms Janice O’Brien Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one named service user over 65 years of age. 21st February 2006 Date of last inspection Brief Description of the Service: 198 Powder Mill Lane is home to five adults with learning disabilities. The property is owned and maintained by the London & Quadrant Housing Association. The service is managed by United Response, a not-for-profit provider of community services for people with learning disabilities. The home’s fees are currently £1197.40 per week. The home is situated in a pleasant residential area and benefits from proximity to community resources as well as parks and open spaces. A good standard of decoration has been achieved throughout the home and the property has a well maintained garden. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a wide range of sources when making judgements about the home. These included a visit to the home and discussion with residents, staff and the manager. Surveys were given to residents, relatives, staff and a number of professionals who are involved with the home. A sample of records was examined at the home, including staff and residents’ files. The inspector was made welcome during the visit and wishes to thank all those who gave their views about the home. The home met 27 of 30 National Minimum Standards assessed at this visit. One Standard was exceeded and two Standards were almost met. The home had taken action to ensure that all Requirements made at the last inspection were met. Relatives said that staff understood residents’ needs well and that residents receive excellent care. One relative said, “Since moving to Powder Mill Lane my brother has never appeared happier”. Relatives also made positive comments about staff. One relative said that staff are “always kind and helpful”, whilst another said, “I cannot speak highly enough of their dedication and commitment”. Two relatives said that the home had provided particularly good care when residents had needed to stay in hospital. One relative said, “During his time in hospital, the staff organised a rota to ensure he always had someone he knew with him during waking hours. This is typical of the extraordinary level of care provided by the staff at Powder Mill Lane”. There is a stable management team who work well together and with the staff group. Staff feel well supported in their work and that their opinions are encouraged and valued. One member of staff said, “The management are very keen to try new ideas and improve the home in any way they can”. Staff also said that the home “gives service users independence to choose the way they want to live their lives” and provides good support to enable residents to be active in their local community. What the service does well: Provides a stable staff and management team that provides good quality care to residents. Promotes residents’ participation in their community. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 6 Provides opportunities for residents to access a range of social and leisure activities. Supports residents to develop and maintain positive relationships with their friends and families. Keeps relatives well informed of events affecting residents. Identifies any changes in residents’ needs and ensures access to appropriate care and support. Works well with other appropriate professionals and agencies where necessary. 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. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 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 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 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): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There is clear information about the home and the service it provides. Residents’ individual needs are appropriately assessed. EVIDENCE: The home has produced a Statement of Purpose, which gives details of the services and facilities provided and the aims and objectives of the service. A Service User Guide is issued to all residents. Care plans indicated that residents’ needs are effectively identified through the assessment process and that this information forms the basis of care and support delivered. The home is committed to ensuring that individual plans are person-centred and reflect the needs and aspirations of residents. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 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): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home records residents’ needs and strengths and works with residents to identify goals that are important to them. Residents receive good support to make informed choices about their lives. Residents are consulted about issues that affect them in the home. EVIDENCE: Three residents’ files were examined. Care plans reflected the individual skills, strengths, needs and goals of residents and recorded preferences in terms of daily routines and leisure activities. The inspection provided evidence that any changes in residents’ needs are effectively identified and addressed. Two of the care plans examined had been reviewed in June 2006 whilst the third had been reviewed in May 2006. All relevant parties had been invited to contribute to residents’ reviews. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 10 Staff demonstrated a good knowledge of residents’ individual needs and a commitment to supporting residents in making informed decisions about their lives. Observation confirmed that residents are able to choose the way in which they spend their time at the home. The service consults significant others, such as family members and care managers, where appropriate regarding the care of residents. United Response provides appropriate guidance for staff in the identification and management of risk. Risk assessments are in place addressing specific activities undertaken by residents. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 11 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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents participate in a range of activities appropriate to their needs and preferences. Residents are involved in their local community. Residents are supported to maintain relationships with their families and friends. Residents’ rights and responsibilities are promoted. The home’s menu is varied and well balanced. EVIDENCE: Residents have settled programmes of day opportunities. All residents attend Whitton Community Resource Centre, which provides a range of in house 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 12 activities and outings. Staff advised that the resource centre has allocated a linkworker to the home, who visits weekly to work with residents. Several residents went out with staff during the inspection. Those residents that were at home were clearly able to choose how they spent their time. When asked what the home does well, staff said that the home “gives service users independence to choose the way they want to live their lives” and provides good support to enable residents to be active in their local community. Interaction between staff and residents was positive during the inspection. Residents’ wishes and needs are clearly identified in their individual plans. United Response has produced a range of information for residents about direct payments. Residents are registered to vote. Most residents have regular visits from or contact with family members and receive support from staff to sustain these relationships where necessary. Relatives returning questionnaires confirmed that staff keep them informed of important events affecting their family members and provide good support for residents to maintain contact with them. The advertised menu indicated that the home provides a varied and wellbalanced diet. Responsibility for cooking and preparing food is shared amongst the staff team. Standards of food hygiene and storage at the time of inspection were good. Fridge and freezer temperatures are recorded daily. The meal served during the inspection was well received by residents. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 13 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, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the home. Residents receive excellent care. Residents receive good support to access community and specialist healthcare resources where necessary. The home works co-operatively with other professionals in delivering care. Changes in need are effectively identified and receive an appropriate response. Guidance for staff is reviewed and updated when necessary. The home had accumulated too much of some medication. EVIDENCE: As highlighted in the Summary of this report, relatives feel that the home delivers excellent care to residents. Two relatives commended the particularly good care provided when residents had needed to stay in hospital. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 14 Healthcare professionals reported that staff work well with them and that the home effectively implements guidelines regarding the delivery of care to residents. Staff on duty demonstrated a good awareness of residents’ needs and care plans contained good, individualised information. Any changes in residents’ needs are addressed at weekly team meetings. Notes of the most recent meeting demonstrated that the team discussed one resident’s reduction in mobility. Notes also confirmed that the home sought appropriate professional advice on this issue when necessary, including the community nurse and physiotherapist. As a result, guidelines for supporting this resident in maintaining his mobility had been updated and communicated to staff. The home is required to manage some challenging behaviour. The manager reported that incidents of challenging behaviour are now less frequent than in the past and usually less intense. The manager advised that, in her opinion, this is due to the consistency of approach maintained by staff and good communication of any changes in need. The home had taken appropriate measures to protect residents in the extremely hot weather. Residents were dressed in suitable clothing and were frequently encouraged by staff to have cool drinks. Fans had been installed and residents’ attendance of day services was reviewed on an individual basis. Individual medication records include residents’ photographs. Inspection of medication records for three residents revealed no omissions or errors. No residents self-medicate. In house medication procedures were reviewed in March 2006. Guidance for staff regarding residents’ preferences about how they take their medication was also updated at this time. The home had accumulated too much of some medication and should avoid this in the future. For example approximately 450 paracetamol were in stock for one resident whilst approximately 300 were in stock for another. See Requirement 1. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 15 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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Appropriate procedures are in place for the management of complaints. Training must be provided for all staff in the recognition, prevention and reporting of abuse. EVIDENCE: United Response has an appropriate Complaints procedure, a copy of which is on file at the home. United Response also has a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. A record of complaints is maintained. There have been no complaints about the home since June 2004. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’. The policy offers definitions of abuse and provides guidance for staff in the recognition and reporting of abuse. Inspection of records and discussion during the visit indicated that training is needed for some staff in the Protection of Vulnerable Adults. See Requirement 2. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 16 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, 25, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home is comfortable, safe and well maintained. The communal rooms of the home are welcoming and homely. Residents’ bedrooms reflect individual preferences. The home is clean and hygienic. EVIDENCE: The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport networks. A good standard of decoration has been achieved throughout the home and the property has a large, well-maintained garden. Toilet and bathroom facilities are accessible and are available in sufficient numbers. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 17 Communal rooms were welcoming and homely and private accommodation indicated individual tastes and preferences. All areas of the home were clean and hygienic. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 18 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): 31, 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Job roles within the service are clear and defined. Systems of communication within the home are clear and effective. Staff receive effective induction, supervision and support. Staff are appointed following an appropriate recruitment and selection procedure. Staff are encouraged to attend training relevant to their roles, although some staff need to attend Protection of Vulnerable Adults training. EVIDENCE: The management team and the core of the staff team have worked at the home for some tome. As a result residents are cared for by staff who know them well. Relatives said that staff understood residents’ needs and spoke highly of the care they provide. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 19 There was a clear shift plan in place and staff had a good awareness of their roles and responsibilities. Job descriptions and contracts of employment are in place for all posts within the staff team. There is a Designated Responsible Person for each shift. Records demonstrated that staff meetings take place regularly and are used effectively to address important issues within the service. Records for two members of staff were examined. Both provided evidence of a robust recruitment procedure and confirmed that the home carries out appropriate pre-employment checks on staff, including Criminal Records Bureau disclosures. Staff files also provided evidence of induction, supervision and appraisal. Staff confirmed that they are encouraged to attend training and to achieve qualifications relevant to their roles. As highlighted in Standard 23, some staff need to attend Protection of Vulnerable Adults training. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 20 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, 38, 39, 42, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home has a skilled and experienced manager. The manager provides good leadership and guidance. There is a commitment to effective quality monitoring and to running the home in residents’ best interests. The health and safety of residents and staff is maintained. EVIDENCE: The manager has much experience in her role and has achieved qualifications relevant to the post. The manager provides effective leadership to the home and good support to staff. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 21 Staff surveys confirmed that they feel supported in their roles and that their ideas and contributions are valued. One member of staff said of the management team, “they encourage you”. Another member of staff described the management team as “excellent” and identified “good teamwork” as one of the strengths of the service. Discussion with the manager and staff, and the comments of other stakeholders, confirmed that there is commitments to running the home in the best interests of residents and to ensuring residents’ wishes are met wherever possible. United Response is committed to effective quality monitoring. The manager advised that the ‘Way We Work’ team visited the home in March 2006 to assess how well service meets needs of residents and to identify potential areas for improvement. The home was clean, hygienic and free of obvious health and safety hazards on the day of inspection. All substances potentially harmful to health (COSHH products) were stored appropriately. Staff conduct a monthly health and safety check. Accident/incident records were accurate and up-to-date. There is a clear procedure to be followed should a resident go missing. The home has valid Employers Liability Insurance. The home has an appropriate fire detection system. Health and safety records provided evidence of regular fire point and emergency lighting tests. The last fire drill took place on 19 June 2006. The fire alarm and the emergency lighting systems were serviced in June 2006. 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 22 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 3 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 4 3 2 X 3 3 3 X X 3 3 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Timescale for action The Registered Person must 30/08/06 ensure that the home does not accumulate excessive amounts of any medication. The Registered Person must 30/10/06 ensure that all staff receive training in the Protection of Vulnerable Adults. Requirement 2 YA23 13(6) 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 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI 198, Powder Mill Lane DS0000017386.V308447.R01.S.doc Version 5.2 Page 25 - 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. 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