Inspection on 14/06/07 for 225, London Road

This inspection was carried out on 14th June 2007.

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

Other inspections for this house

225, London Road 16/11/06

225, London Road 29/06/06

225, London Road 26/01/06

225, London Road 20/05/05

225, London Road 02/12/04

225, London Road 30/07/04

225, London Road 16/01/04

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 18-65 225, London Road Twickenham Middlesex TW1 1ES Lead Inspector Simon Smith Unannounced Inspection 14th June 2007 3:00 225, London Road DS0000017380.V343787.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 225, London Road DS0000017380.V343787.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. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 225, London Road Address Twickenham Middlesex TW1 1ES 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 8892 6406 020 8892 6406 The Regard Partnership Limited Mr John Webster Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16 November 2006 Brief Description of the Service: 225 London Road is registered for six adults with learning disability. The home is owned and managed by the Regard Partnership, an established provider of residential care and specialist support to people with learning disabilities. The Statement of Purpose describes the home as a specialist service for young adults with learning disabilities, some complex needs and challenging behaviours. The home’s fees currently range from £1649.25 to £1975.43 per week. The home is situated within walking distance of Twickenham town centre, which provides a wide range of community facilities and good access to public transport networks. 225, London Road DS0000017380.V343787.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 range of sources when making judgements about the home. These included visiting the home and talking to all residents and three staff on duty. Some written information was examined, including health and safety checks and staff training records. Two residents returned surveys to the CSCI. They said they liked living at the home and feel well cared for. They also said that they can make decisions in the home and that there are good activities they can take part in. One resident said that they like the food at the home all the time, one resident said that they like the food sometimes. One resident said, “I like my room. I choose red colour. I am going to have my door painted”. Some professionals involved in residents’ care also made comments about the home. One professional said, “I think things have improved greatly at London Road… I get the impression that there have been far fewer staff changes and the promised renovations in the physical environment of the home have taken place”. The home met 28 of 30 National Minimum Standards assessed at this visit. One Standard was exceeded and one Standard was almost met. What the service does well: What has improved since the last inspection? There is now a stable staff team that knows residents’ needs well. There have been no changes to the staff team in the last year. The home no longer uses agency staff and has regular bank staff to cover any vacant shifts. Staff work more consistently with residents and work well with other professionals involved in residents’ care. The manager provides good leadership and support to the staff team. There are regular team meetings and all staff get individual supervision. Residents’ support plans are now reviewed more regularly. Care plans contain more 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 6 individualised information for staff delivering care. Systems of recording and administration are more organised and up to date. The appearance of the home has improved a lot in the last year. Most rooms have been redecorated and many have had new carpets or new furniture. The communal areas of the home are more welcoming and standards of hygiene are much better. Residents’ bedrooms have also been redecorated and sensory equipment has been installed for one resident. The garden looks much better and is being used more by residents. 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. 225, London Road DS0000017380.V343787.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 225, London Road DS0000017380.V343787.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): Standards 1, 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home is available to residents. Residents’ needs and strengths are effectively identified. Residents’ rights and responsibilities are set out in a written contract. EVIDENCE: Residents’ needs have been assessed within the last year. The assessment format addresses physical and mental health, communication, diet, medication and religious/cultural needs. The assessment also identifies any professionals who need to have input into the resident’s care plan. There is a Statement of Purpose, which gives details of the service provided and the aims and objectives of the service. A Service User Guide is available to all residents. Residents have a contract with the Regard Partnership, which sets out the rights and responsibilities of both parties. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 9 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 10 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. Care plans contain good, individualised information about residents, identifying strengths, needs and support networks. Residents receive good support to make choices about their lives. Risk assessments are in place where necessary but these should be regularly reviewed. EVIDENCE: Each resident has an individual care plan. These contained ‘support plans’, which identify residents’ strengths and the support they need in areas including health, personal care, daily living skills, communication, social and leisure needs. There was evidence that support plans had been regularly reviewed. Residents’ plans also contained ‘guidelines’, which give staff clear 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 11 information about their work with residents. Most guidelines, but not all, were dated. Staff should ensure that guidelines are dated at the time of writing in order that an appropriate review date can be identified. Discussion with staff demonstrated that the home has a commitment to promoting residents’ rights to make choices about their lives. Conversation with residents’ confirmed that they are able to choose the way in which they spend their time at the home and that their individual programmes reflect their interests. Residents who returned surveys to the CSCI said that they can make decisions in their home. Risk assessments were in place for activities undertaken by residents, such as cooking and travelling in the local community. Some risk assessments on file needed review as they had been first drawn up some time ago (for example June 2006). See Requirement 1. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents take part in activities according to their needs and preferences. Residents are involved in their local community. Residents have good leisure opportunities. Residents are supported to maintain relationships with their families. Residents are involved in planning the home’s menu. EVIDENCE: 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 13 Residents are involved in their community and make use of local shops, pubs and restaurants. Residents also take part in a variety of activities including cycling, horse-riding, trampolining, music therapy and aromatherapy. Most residents attend college or resource centres for some part of their week. Residents also have regular access to a sensory room and a hydropool. A tutor comes into the home twice a week to work with two residents. The home has recently explored employment opportunities for two residents who have expressed an interest in this. Residents have regular contact with friends and relatives and some take holidays with their families. Residents are also encouraged to celebrate birthdays and other events at the home. Interaction between staff on duty and residents was positive during the inspection. Residents have unrestricted access to all communal areas of the home. Residents’ wishes and needs are clearly identified in their individual plans. Staff used appropriate forms of address when speaking to residents. Food served on the day of inspection was home made and of good quality. The home’s menu is planned at residents’ meetings. Staff do the cooking, which is appropriate given the size of the home, and residents are encouraged to participate. One resident is supported to follow her own diet and to buy food separately for this. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 14 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, 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer. Residents’ healthcare needs are met. Residents are supported to access community and specialist healthcare resources where necessary. Residents’ medication is appropriately stored and accurately recorded. Staff provided excellent support to residents following the death of a fellow resident. EVIDENCE: Staff on duty demonstrated a good knowledge of residents’ healthcare needs and care plans contained guidance for staff delivering care. Care plans also provided evidence that specific healthcare conditions are managed well and 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 15 that the home seeks specialist advice where necessary. All accidents/incidents and healthcare appointments are recorded. The home has introduced Health Action Plans for residents, although some of the plans examined needed further work to complete them. There is an appropriate system for the storage of medication and clear administration procedures. Sample staff signatures are held on file. Each medication record contains a photograph of the appropriate resident. Homely remedies are authorised for each resident by their general practitioner. Inspection of medication records for three residents revealed no omissions or errors. The home has an agreement with the community pharmacist, which includes advice and two medication checks each year. However the agreement expired at the end of March 2007. It is recommended that this agreement be renewed. The manager is working with one resident’s family to develop a satisfactory system for administering and recording medication during the resident’s visits to her family. One resident had sadly passed away since the last inspection. This had clearly affected both the residents and staff of the home. There was evidence that staff had provided valuable support to residents at this time. A book of condolence was opened and a remembrance ceremony was held at the home. Residents were supported to attend the funeral and bereavement counselling has been made available to residents and staff. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 16 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. There are appropriate procedures for the management of complaints. Training is provided for staff in the recognition, prevention and reporting of abuse. EVIDENCE: The home has an appropriate Complaints procedure and keeps a Complaints book. There have been no complaints since the last inspection. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’. There is also a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. Training records indicated that all permanent staff have attended training in the Protection of Vulnerable Adults. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 17 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): Standards 24, 25, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The appearance of the home continues to improve. The communal rooms of the home are welcoming. Residents’ bedrooms reflect their needs and preferences. The home is clean and hygienic. EVIDENCE: The appearance of the home has improved greatly in the last year. Most rooms have been redecorated and many have had new carpets or new furniture. The communal areas of the home are welcoming and standards of hygiene are much better. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 18 Residents’ bedrooms have also been redecorated and sensory equipment has been installed for one resident who particularly benefits from this. The garden looks much better and is being used more by residents. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 19 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): Standards 31, 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Establishing a stable staff team has had benefits for residents. Staff work consistently with residents and implement guidelines drawn up by healthcare professionals. Staff receive relevant training and good support to do their jobs. The Regard Partnership carries out all necessary pre-employment checks on new staff. EVIDENCE: There have been no changes to the staff team in the last year. The home no longer uses agency staff and has regular bank staff to cover any vacant shifts. The establishment of a stable staff team has been one of the most important factors in the improvements achieved by the home. Staff know residents’ 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 20 needs well and work more consistently with them. Staff also follow guidelines drawn up by other healthcare professionals involved in residents’ care. Staff are clear about their roles and responsibilities. There are three teams within the staff group, each led by a senior support worker. Each shift has a shift plan and a designated responsible person. Staff said that they have team meetings every month and that all staff have individual supervision. Staff spoken to during the inspection said they had a thorough induction when they started work and good support from the home manager. Training records demonstrated that staff attend all areas of core training. Staff records are not available in the home but are held centrally by the Regard Partnership. The Regard Partnership has an agreement with the CSCI that the organisation will carry out all pre-employment checks, including Criminal Records Bureau disclosure, required by the Care Homes Regulations (2001). The agreement also entails an annual audit of staff recruitment records by the CSCI. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 21 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. The home has a skilled and experienced manager. The manager provides good leadership and support to the staff team. There is a commitment to running the home in residents’ best interests. The health and safety of residents and staff is maintained. EVIDENCE: The manager has contributed much to the improvements at the home since her arrival in post. Staff feel well supported and the care provided to residents 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 22 has improved. The home itself is cleaner and more homely and paperwork systems have improved greatly. Staff on duty said that the manager is always available to staff and that she provides good support to the team. Staff also said that the manager and the deputy manager “make a good team” and that they “get things done”. Residents have opportunities to contribute their views about the service they receive at regular residents’ meetings. Discussion with staff confirmed that there is a commitment to running the home in residents’ best interests and to ensuring that residents have opportunities to make decisions about their lives. Systems of recording and administration are more organised and up to date. There was evidence that health and safety checks are carried out weekly. The home had valid Employers Liability Insurance at the time of inspection. There are clear fire procedures in place and staff attend fire training. The fire alarm system and emergency lighting were checked in February 2007. The last fire drill took place in April 2007. The manager reviewed the home’s fire risk assessment in May 2007. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 23 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 3 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 3 26 X 27 X 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 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 3 X 3 X X 3 X 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 24 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 YA9 Regulation 12(1), 17 Timescale for action The Registered Person must 30/08/07 ensure that risk assessments are regularly reviewed. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA19 YA20 Good Practice Recommendations Date guidelines at the time of writing so that an appropriate review date can be identified. Ensure that residents’ Health Action Plans are complete and recorded using an accessible format. Renew the agreement with the community pharmacist. 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 225, London Road DS0000017380.V343787.R01.S.doc Version 5.2 Page 26 - 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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