Inspection on 16/05/07 for 1a Tollgate Road

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

1a Tollgate Road 06/06/06

1a Tollgate Road 12/10/05

1a Tollgate Road 12/04/05

1a Tollgate Road 14/09/04

1a Tollgate Road 20/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 1a Tollgate Road Ludlow Shropshire SY8 1TQ Lead Inspector Sue Woods Key Unannounced Inspection 16th May 2007 10:15 1a Tollgate Road DS0000020673.V336224.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 1a Tollgate Road DS0000020673.V336224.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. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1a Tollgate Road Address Ludlow Shropshire SY8 1TQ 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) 01584 877737 01584 878063 Vision Homes Association vacant post Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: 1A Tollgate Road is one of 3 Bungalows, which were purpose built, on the same site in Ludlow, South Shropshire, and run by Vision Homes Association. The project was set up in 1991 in partnership with Bromford Corinthia Housing who own the properties. The home is registered to provide care and accommodation for 5 service users who are visually impaired and have additional physical and learning disabilities. The Registered Provider is Vision Homes Association, the manager is Caroline Edwards who is in the process of registering with the Commission for Social care Inspection. She is Line Managed by Wendy Morse, Assistant Service Manager. Consultation with service users takes the form of regular observations and detailed care and support plans that identify and review likes and dislikes. Advocacy services are promoted. Current fees for the service range from £60,451 to £78,262 per year. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of 1A Tollgate Road was carried out 16th May 2007 from 10.15 am until 1.30 pm to fit in with the pre planned activities of the day. The inspection reviewed all 22 key standards and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity the inspector met all five service users, spoke with all of the staff on duty, both in private and in general discussions and reviewed care files as well as other documentation referred to within the report. The manager was available throughout. Observations made during the inspection support judgements made and the inspection report also refers to information gathered at the time of the random inspection of the home in January 2007. What the service does well: Service users are supported by a committed and enthusiastic staff team who receive ‘excellent’ training opportunities. Staff have developed skills in order to safely support service users with identified medical and dietary needs and this has impacted positively on the lives of those service users. Joint working arrangements with health care professionals are also to be commended. Person centred plans including the newly implemented health action plans contain detailed information relating to individualised care and support needs. Service users have opportunities to access community resources and maintain family links. Holiday opportunities are varied and cater for the needs and preferences of individuals. The home has enough staff to enable service users to have excellent opportunities for leisure and social activities. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. 1a Tollgate Road DS0000020673.V336224.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 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place that would enable the successful admission of a new service user to the home however no admissions have taken place over the last year. EVIDENCE: There have been no new admissions to the home since the time of the last inspection therefore the judgement made at the time of the last inspection will be carried forward. The Statement of Purpose was reviewed at the time of the inspection in January as a new manager had been appointed for the service. The document was seen to contain all essential information and was readily available. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Person centred care and support plans enable staff to offer service users choice and assist with decision making as well as delivering care in a way that people prefer. People using the service are not yet fully protected by the risk assessments potentially placing them at risk. EVIDENCE: The care file belonging to one service user was reviewed in detail at the time of the inspection. Previous inspections have found that the plans contain detailed information that needs to be reviewed and updated. The manager was able to demonstrate that she has started this process. For example Communication needs were reviewed in January 2007. Monthly reviews also take place and the information contained in these reviews reflected staff comments that service users are supported to participate in all aspects of their lives. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 10 At the time of the unannounced inspection in January 2007 it was identified that the manager had ‘prioritised the review and update of all risk assessments’ and in particular the assessments for activities and care and support procedures. However at the time of this inspection risk assessments were seen to be in need of further review and update. The manager was aware of this requirement and demonstrated that she has started the process. Staff told the inspector how they use their knowledge of service users to assist with decision making processes. For example one service user enjoys being pampered and her activities centre around this. The manager reported that she has referred one service user for assessment with health and social care professionals in response to his changing support needs. She is currently awaiting the outcome. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users lead full and active lives with opportunities to participate in new and exciting activities of their choice. Service users benefit from a balanced and varied diet. EVIDENCE: At the time of the inspection service users were all at home and having individual massages. In the afternoon one service user was going shopping in preparation for her forthcoming holiday. Activity sheets seen identify numerous activities on offer both at the home and within the community. The manager encourages family contact and service users retain friendships. The manager has recently changed staff working patterns to ensure a gender and skills mix on each shift. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 12 Records of foods eaten were seen by the inspector and reflected that service users enjoy a varied and balanced diet. One service user told the inspector that breakfast was ‘nice’. Other service users were visibly enjoying their mealtime. The inspector was able to sit and observe the lunchtime meal. Service users were having individualised meals to reflect their particular likes. For example one person who likes fish was having a salmon salad. The atmosphere over the meal time was relaxed and staff were seen to be sensitive to individual needs and offered support discreetly and professionally. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is good overall with aspects of personal care and support being excellent This judgement has been made using available evidence including a visit to this service. Service users benefit from a knowledgeable and responsive staff team who support them in ways that they prefer. Service users are protected by effective systems for the storage, recording and monitoring of medication and the monitoring of processes ensures that any errors in recording are promptly investigated. EVIDENCE: Personal care and support needs are detailed in individual care plans. Individual likes and dislikes were recorded and preferred routines identified. A health action plan was seen for one service user case tracked by the inspector dated January 2007. It was a very detailed document and is supported by monthly review sheets and records of observations including activities, sleep patterns, appetite and seizures. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 14 The arrangements for storing and recording the administration of medication were seen by the inspector. Gaps seen in MAR sheets had been previously identified by the manager who was in the process of taking appropriate remedial action. The manager is also going to review the detail recorded on MAR sheets to ensure it is more specific. The medication cupboard was seen to be well organised with a variety of dispensing methods used. The manager detailed how staff carefully monitor mood and behaviour to monitor health needs. Appropriate action had been taken following a change in one service users mobility. The home is supported by the local team of community nurses to support one service user with managing a medical condition and also offer support and training for the staff team. Staff commented on how well this service user is currently looking. The staff team effectively supported two service users earlier this year when they both needed hospital admission. The staff team supported both service users while maintaining appropriate staffing levels at the home. Advice given to the team following recent ill health for one service user is well documented in the care plan seen. Guidelines to support the moving and handling of service users were available and had been reviewed in January and March 2007. The manager is in the process of writing manual handling risk assessments for all service users. Doctor’s visits are well documented. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by staff being aware of procedures for managing concerns and complaints and by operating an open and accountable system of supporting service users to manage their money. EVIDENCE: The home has received no complaints in relation to the service within the last twelve months. A book is now available should a complaint be raised to record basic information and outcomes. Staff who spoke with the inspector were aware of the complaints and whistle blowing procedures. The personal accounts book for one service user, chosen at random, was seen by the inspector. Records detailed that regular personal allowance payments are received by the service user. Transactions were well recorded. Staff felt that the recording process was straightforward. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24 an 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is generally satisfactory, providing service users with a safe and stimulating place to live. Interim measures ensure that service users and staff are safeguarded while adaptations are made in line with professional guidelines and health and safety risk assessments. EVIDENCE: As part of the inspection the inspector was shown around the home by the manager visiting all communal areas and two bedrooms. Since the time of the last inspection one service users bedroom has been re decorated following the repair of a leak and the bathroom has been ‘tidied up’ while awaiting a new bath and flooring. Although no date has been agreed for this the manager confirmed that the funding is now in place. A risk assessment supports the current use of the bath. All bedrooms seen were very personalised and all areas of the home were clean and tidy. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 17 The manager outlined plans to improve the garden by replacing a fountain and making other changes to make the garden more accessible. A recent fire officer’s visit identified alterations required to ensure the safety of the home. While waiting for alterations to be made the manager has implemented an interim risk assessment and sought further guidance from the fire service. Water temperatures were tested in the bathroom and found to exceed the safe limit. Tests carried out on the morning of the inspection recorded the temperature at that time was within the safe limits and therefore the manager will further investigate and take any action required. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by well-trained and competent staff in sufficient numbers to deliver a user led service. EVIDENCE: Since the time of the last inspection the manager and staff in individual discussions felt that staffing ratios have improved and there are now extra hours available for service users to access community resources. Staff on duty at the time of the inspection were professional and knowledgeable about the needs of service users. Staff continue to believe that training opportunities are a strength of the organisation and all receive regular supervision. The inspector spoke in private with two of the three staff on duty and as part of the inspection visit on 16/01/07 the inspector spoke with three staff. All spoke positively about the new manager and improvements that she has made to what they already believed to be a good service. All spoke of excellent training opportunities within the organisation both for mandatory training and ‘specialist’ training. On 16/01/07 one staff member described her ongoing induction training and support. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 19 All felt that staffing levels were currently ‘good’ and this has impacted positively on opportunities for service users. The management stated that there have been no new staff recruited since the time of the last key inspection of the home and at that times staff files were found to contain all required information. This arrangement is also reflected in the other homes run by Vision Homes Association. 1a Tollgate Road DS0000020673.V336224.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from the home being supported and monitored by a competent and knowledgeable manager. The health, safety and welfare of service users and support staff is promoted and protected. EVIDENCE: The manager stated that she is currently applying for registration as manager at 1A Tollgate Road. She is currently working towards the NVQ Level 4 in Care and is also attending management training in addition to the completed Registered Managers Award. The manager has also identified additional training in Supervision and Appraisals and a more complex training course in relation to Risk Assessment. 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 21 Over recent months the manager has reviewed staffing arrangements and is looking at reviewing care files and risk assessments. Visits from senior managers in line with Regulation 26 are happening although not currently monthly as required. It is acknowledged that changes have taken place within the senior management team and the manager was able to speak with the managers line manager at the time of the inspection to confirm that appropriate support and monitoring will be in place to support all managers and carry out monthly visits. Only minimal records in relation to the monitoring of health and safety in the home were reviewed at the time of this inspection although previous visits have reflected that records are well kept and appropriate checks are carried out. Those reviewed were in place and up to date. The fire officer has recently undertaken an in depth review of fire safety arrangements within the home and action is being taken to address issues raised. Accident reports are now being stored securely. There has been only one accident recorded since the time of the last inspection of the home. 1a Tollgate Road DS0000020673.V336224.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 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 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 23 No 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 YA9 Regulation 13 (4) (c) Requirement Risk assessments must be developed and implemented to support service users to ensure identified risks are acknowledged and reduced wherever possible. Timescale for action 26/07/07 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 1a Tollgate Road DS0000020673.V336224.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 1a Tollgate Road DS0000020673.V336224.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. 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