Inspection on 06/06/06 for 1a Tollgate Road

This inspection was carried out on 6th June 2006.

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 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1a Tollgate Road 16/05/07

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 6th June 2006 10:00 1a Tollgate Road DS0000020673.V292548.R02.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.V292548.R02.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.V292548.R02.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 Mr Guy Charles Nisbet Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 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 registered manager is Guy Nisbitt and he 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 annum. 1a Tollgate Road DS0000020673.V292548.R02.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 6th June 2006 from 10.00 am until 2.30 pm. 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 service users however due to their complex needs was unable to directly obtain their views in relation to the quality of the service they receive. Interactions were observed and these are reflected within the report. The remainder of evidence was obtained through speaking with staff and management and through review of care records and plans. The inspector received three surveys from staff on duty at the time of the inspection and spoke to one member of staff and the acting manger at length. The assistant service manager was on site at the time of the inspection and supported the process. The registered manger is currently suspended from duty pending an internal investigation. Records reviewed included individual care plans, rotas and health and safety information. 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 and when reviewed and updated will provide the home with a valuable resource. Service users have opportunities to access community resources and maintain family links. 1a Tollgate Road DS0000020673.V292548.R02.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. 1a Tollgate Road DS0000020673.V292548.R02.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.V292548.R02.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including information taken from a previous visit to this service. Appropriate procedures are in place that would enable the successful admission of new service users 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. There are no vacancies therefore the judgement made at the time of the last inspection will be carried forward. 1a Tollgate Road DS0000020673.V292548.R02.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 adequate. 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. This process will only be effective if plans are reviewed and updated. Service users may be at risk if risk assessments are not reviewed or readily available to refer to. EVIDENCE: The inspector case tracked two service users during the fieldwork activity. Care files contained all essential information relating to individual care and support needs. Communication recommendations seen on one file reflected individual likes, dislikes and accumulated information to support offering choice and decision making processes. Support guidelines were seen on both files reviewed 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 10 although they had not been signed and dated to demonstrate that they had been updated. Due to the complex needs of service users living at 1A Tollgate Road these guidelines are essential to enable service users needs and wishes to be considered and promoted. The assistant area manager was aware of this and is in the process of updating all records. Risk assessments are currently stored on a shared file containing general and individual assessments. Again the assistant area manager and the acting home manager are in the process of reviewing them and then filing them appropriately. Records sheets that are required by the organisation to be signed and dated by staff as they read and understand risk assessments have not been completed. The acting manager has identified that some care reviews are overdue and actions plans are in hand to arrange these 1a Tollgate Road DS0000020673.V292548.R02.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 this service. The acquired skills of the staff team mean that service users receive a healthy and nutritious diet. Service users access activities both in house and within the community. Service users benefit from staff supporting them to maintain family contact. EVIDENCE: One service user has quite complex needs in relation to his diet. There is detailed information available to explain his needs to staff and material to assist with making appropriate calculations to ensure an appropriately balanced diet. The acting home manager gave details of how initially the service user had pre prepared meals to ensure this happened but now staff use their knowledge of the service user’s needs to prepare fresh food and offer more variety. 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 12 A four weekly main meal menu was seen on file with recipes and shopping lists to ensure correct ingredients are purchased. Records of foods eaten are maintained. During the inspection staff were seen to offer drinks to service users on a regular basis and prepare healthy snacks. Service users have opportunities to access community activities although staff reported that they would like to see these opportunities increase in the future with a greater variety considered. During discussions with the inspector staff gave details of family involvement and how staff support service users to maintain contact with family. In house activities were numerous and appropriate to the needs and likes of the service users. One service user had his television on a low shelf and another service user had a variety of different lights in his room for his enjoyment. 1a Tollgate Road DS0000020673.V292548.R02.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 this service. Service users benefit from excellent support from various professional health care professionals. Health action plans are a valuable resource to demonstrate that staff are meeting the identified health care needs of service users. Service users are protected by effective systems for the storage and recording of medication EVIDENCE: At the time of the inspection a speech therapist was doing some observations on service users in order to assist staff to develop communication strategies. Staff spoke enthusiastically about this input and the positive effect that they believe it will have on opportunities for service users. Personal care and support needs are detailed in individual care plans. Individual likes and dislikes were recorded and preferred routines identified. 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 14 A health action plan was seen for one service user case tracked by the inspector. It was a very detailed document and is supported by monthly review sheets and records of observations including activities, sleep patterns, appetite and seizures. The assistant service manager stated the team were in the process of completing these plans for all service users. The arrangements for storing and recording the administration of medication were seen by the inspector. There were no gaps in the administration records (although it was acknowledged that it was a relatively new recording sheet. The acting manger stated that he regularly checks these records and there are no gaps in previous documents). The medication cupboard was seen to be well organised with a variety of dispensing methods used. The assistant service manager stated that all staff receive a recognised training package for the administration of medication. Staff were seen to informally introduce themselves when they entered a room. Physiotherapy input had been arranged for one service user although a referral to the community team has also been made and one service user regularly uses the services of a chartered physiotherapist who visits her at home on a regular basis. The home is supported by the local team of community nurses to support one service users with managing a medical condition and also offer support and training for the staff team. 1a Tollgate Road DS0000020673.V292548.R02.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 good. This judgement has been made using available evidence including a visit to this service. Service users are protected by staff having an awareness of complaints and adult protection procedures. EVIDENCE: The home does not have a book to record complaints but stated that they have never received any. The assistant service manager stated that she would introduce such a recording tool and also introduce a section for recording comments and compliments, of which they have received many. The assistant service manager was aware of the complaints procedure and the procedure for referring to the Adult Protection team via the multi agency policy guidelines of which there was a copy of in the office. Service users views are noted through behaviours and responses to situations. These are well documented. Contact details of a local advocacy service were seen on one file reviewed. A group of staff are book on the adult protection training on 7/6/06. 1a Tollgate Road DS0000020673.V292548.R02.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, 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. Refurbishment works are now impacting on the personal space of service users. EVIDENCE: The shower room and bathroom are still awaiting refurbishment and this had been identified at the time of the last inspection of the home. The leak in the shower room is impacting on a service user’s bedroom in that the wall is marked and the paint is peeling. Despite the need for these refurbishments bathrooms and all other areas of the home were found to be clean on the day of the inspection. 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 17 Bedrooms seen had been personalised and reflected individual personalities. The use of lights and scatter cushions reflected that rooms were used and enjoyed by service users. Cleaning products were stored securely in the kitchen and data sheets were available to support their use. A generic risk assessment supported all products used. 1a Tollgate Road DS0000020673.V292548.R02.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): 32, 34, 35, 36 Quality in this outcome area is adequate. 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. Service users are protected by satisfactory recruitment and selection procedures. Service users would benefit from staff receiving formal supervision and appraisal to review their work performance. EVIDENCE: Staff stated that they thought training opportunities were a strength of the organisation and gave details of courses attended or planned in the near future. The inspector spoke with the homes training coordinator who explained his role and detailed how he ensures staff received information about various courses. Staff training records on site were not up to date to reflect recent training however the assistant service manager stated that these records are available upon request at the main office on computer. The arrangement of staff files has improved since a recommendation was made at the time of the last inspection of the home. The two files reviewed 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 19 were chosen at random and contained all essential information. The acting manager is liaising with the office administrator to review all files and ensure they contain all required information. The acting manager detailed recent staff shortages and the impact this has had on activities. It was positive to note that these issues are now being resolved following an effective recruitment campaign. It was noted that a formal appraisal system has yet to be introduced therefore the requirement made at the time of the last inspection will be carried forward. Likewise the assistant service manager stated that staff are not receiving regular formal supervision. 1a Tollgate Road DS0000020673.V292548.R02.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, 39, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users may be at risk if appropriate records are not maintained. Service users are receiving continuity and positive input from interim management arrangements. Generally health and safety is promoted and protected within the home. EVIDENCE: The last regulation 26 visit was carried out on 6th March 2006 by Wendy Mores. Although details were not sent to CSCI a copy of the report was seen at the home. There have been no further visits however the assistant service manager has been spending time at the home as the manager is currently suspended from duty. The report seen identified issues in relation to the home as well as detailing improvements and strengths. 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 21 The acting manager, who was on duty at the time of the inspection, was dynamic and enthusiastic. He stated that he is just starting NVQ level 4 in Care. The current management team have already reviewed processes within the home and initiated plans to resolve issues identified. They were aware of requirements made at the time of the inspection in relation to record keeping. Although some records were being well maintained there were also a significant number of others that were not. The accident book contained details of accidents that have been recorded in the book but had not been removed and filed. Completed accident forms were seen either still in the accident book or within one folder containing details of all accidents. Given that the book in use has been developed to ensure confidentiality of information it should be used appropriately. The assistant area manager reviewed the risk assessment for the use of bed rails and concluded that it was in need of updating as the bed has changed since the last assessment took place. Water temperature and fridge and freezer temperatures were seen to be recorded regularly. Records also demonstrate that vehicles and wheelchairs are also checked regularly. The whirlpool bath is sluiced on a regular basis. The inspector noted that vehicle checks were taking place at the time of the inspection. 1a Tollgate Road DS0000020673.V292548.R02.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 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 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 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 2 3 X 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 23 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 YA27 Regulation 23(2)(j) Requirement The bathroom and shower room must be refurbished and the leak in the shower room repaired. Necessary repairs must then be made to the service user’s bedroom that is affected by the leak. Timescale for action 21/08/06 2. YA36 18(2) All staff must have regular 03/07/06 formal supervision and an annual appraisal to review performance against job description and agree career development plans Care and support plans must be reviewed and updated on a regular basis Risk assessments must be reviewed and updated on a regular basis and as needs change. Records must be maintained appropriately and reviewed and updated as required. 03/07/06 03/07/06 3 4 YA6 YA9 15 (1) (b) 13 (4) 5 YA41 17 (3) (a) 24/07/06 1a Tollgate Road DS0000020673.V292548.R02.S.doc Version 5.2 Page 24 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.V292548.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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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