Inspection on 26/01/06 for 225, London Road

This inspection was carried out on 26th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

225, London Road 14/06/07

225, London Road 16/11/06

225, London Road 29/06/06

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 London Road, 225 Twickenham Middlesex TW1 1ES Lead Inspector Simon Smith Announced Inspection 26th January 2006 10:45 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service London Road, 225 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 Patricia McKeown Care Home 6 Category(ies) of Learning disability (6) registration, with number of places London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th May 2005 Brief Description of the Service: 225 London Road is home to six young adults with learning disability. The home is owned and managed by the Regard Partnership, an established provider of accommodation and specialist support to people with learning disabilities. The Statement of Purpose describes the service provided as follows: 225 London Road provides a specialist service for young adults with learning disabilities, some complex needs and challenging behaviours. There is an emphasis on independent living and supporting individuals to develop their social and interpersonal skills. 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. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the course of a single visit and involved speaking to residents, the manager and members of staff. A sample of records was examined and a tour of the building made. The inspector was made welcome and wishes to thank residents and staff for their help during the inspection. The home met 15 of 22 National Minimum Standards assessed at this visit. Seven Standards were almost met and six Requirements were made. One Requirement was reinstated from the last inspection. The home has experienced challenges with staff sickness and shortages in recent months and several posts were vacant at the time of inspection. The manager said that the Regard Partnership will supply temporary cover for the vacant deputy manager post and that two new staff had recently been appointed. There were no resident vacancies at the time of inspection. Much of the information on residents’ files was misfiled or out of date. The home needs to improve the written information held about residents to make sure that staff work with accurate, up-to-date information. What the service does well: What has improved since the last inspection? What they could do better: Ensure that all information held about residents is accurate, up-to-date and accessible. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 6 Ensure that risk assessments address all activities undertaken by residents and are regularly reviewed. Ensure that written guidelines for the delivery of individual personal care are clear and up-to-date. Provide training for all staff in the Protection of Vulnerable Adults. Repaint or replace the first floor window frames at the rear of the home. Provide all staff with regular individual supervision. 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. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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, 3 The home makes available clear information about the facilities and services it provides. There are appropriate procedures governing assessment and admission for new residents. The home works co-operatively with other agencies to assess whether the service meets residents’ needs. EVIDENCE: The home has a Statement of Purpose, which gives details of services provided and the philosophy of care. A Service User Guide is available to residents. Each resident has a contract, which sets out the terms and conditions of the placement and the rights and responsibilities of both parties. Prospective residents’ needs are assessed before they move into the home. The home is currently working with one resident’s placing authority, and other relevant agencies, to assess whether the service is effectively meeting the resident’s needs. The manager advised that one assessment already been carried out and that another, residential, assessment is planned for February 2006. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 9 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Care plans and residents’ files need to be updated and reorganised. Residents are supported to make informed choices about their lives. Residents are involved in the running of the home. Risk assessments do not address all activities undertaken by residents and are not reviewed often enough. EVIDENCE: Much of the information held about residents was misfiled or out of date. Residents care plans and files need to be updated and reorganised to ensure that staff work with accurate, up-to-date information. Old material should be archived and formats used for recording should be standardised. See Requirement 1. The manager reported that the London Borough of Richmond person-centred planning co-ordinator worked with the staff team for a day in December 2005 and was to visit the home again the day after inspection. The manager and London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 11 one member of staff have attended a person-centred planning facilitator course. There is little evidence to indicate that the home has effectively adopted the principles of person-centred planning yet, but the manager advised that the home will focus on improving this area now that staff have attended relevant training. Discussion with the manager, staff and residents demonstrated that the home has a commitment to supporting residents to make choices about their lives. Residents are also encouraged to involve themselves in the routines of the home (see Standard 11) and are consulted on decisions in the home that affect them. Information is available to residents about advocacy groups should they need it. The Regard Partnership has developed guidance for staff about the role and value of risk assessments. Whilst some risk assessments were seen to be in place, a number of improvements are needed in this area. Firstly, the risk assessments on file did not address all areas that are relevant to residents and the activities they undertake. Secondly, risk assessments are not reviewed frequently enough. Finally, some risk assessments did not record the date or identify the member of staff completing the assessment. See Requirement 2. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13, 14, 16 Residents are encouraged to involve themselves in the routines of the home and to develop independent living skills. The manager and staff are committed to supporting residents in community participation. Residents are supported to take part in a range of social, educational and leisure activities. EVIDENCE: Residents are encouraged to develop the skills required for independent living through involvement in the routines of the home, such as cooking, cleaning and shopping. Residents are actively involved in their local community, using shops, cafes, pubs and other community resources. Several residents attend college locally. The manager reported that the home is considering using a volunteer tutor to enhance the opportunities available to residents in house. Residents participate in activities including horse-riding, London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 13 companion cycling, swimming, trampolining, aromatherapy and music therapy. The manager said that staff are supporting one resident’s aim of beginning supported employment. Residents have unrestricted access to all communal areas of the home. Residents are able to have privacy when they want it and are given keys to their bedrooms. Where restrictions are in place, such as the security measures at the front door of the home, these are in place to maintain residents’ safety. Staff used appropriate forms of address and spoke to residents with respect. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 Written guidelines for the delivery of individual personal care need to improve. Residents are supported to access community and specialist healthcare resources where necessary. EVIDENCE: Written guidelines for the delivery of individual personal care need to improve. The ‘Guidelines for personal care’ on file were not dated, although appeared to have been developed some time ago, and did not identify the member of staff completing the guidance. As highlighted in Standard 6, it is important that all staff have access to accurate, up-to-date information about residents. See Requirement 3. Residents are registered with local general practitioners and specialist advice is sought from community healthcare professionals to address residents’ needs where necessary. The manager reported that the home has a good relationship with local healthcare services and that community practitioners provide valuable support to the staff team. The home is required to manage some ongoing healthcare conditions experienced by residents, such as epilepsy. Inspection confirmed that these London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 15 conditions are managed well and that the home provides appropriate support to residents and staff. For example an epilepsy specialist visits the home regularly to monitor residents affected by the condition. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Training must be provided for all staff in the Protection of Vulnerable Adults. EVIDENCE: The home works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’. The Regard Partnership has a Whistle-blowing procedure, which enables staff to report any concerns about malpractice they may have. Training records indicated that not all staff have attended training in the Protection of Vulnerable Adults (POVA). See Requirement 4. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 The home is comfortable and safe. The communal rooms of the home are welcoming and homely. Action is required in some areas to maintain the appearance of the home. EVIDENCE: The home is situated in a pleasant residential area and has good access to local community facilities and public transport networks. Some communal areas of the home were being repainted at the time of inspection. Staff reported that residents were involved in choosing the new colour schemes. The appearance of the garden has been improved since the last inspection. The last inspection made a Requirement that the first floor window frames at the rear of the home be repaired or replaced. The Requirement has not been met and is reinstated in this report. See Requirement 5. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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): 33, 34, 36 Recent staff shortages have had an impact on the continuity of care provided to residents. Staff are appointed following an appropriate recruitment and selection procedure. All staff must be provided with regular individual supervision. EVIDENCE: The full staff complement for the service comprises a manager, deputy manager, three senior support workers, five support workers and two night support workers. The home has experienced challenges in recent months due to staff sickness and shortages, which has had some impact on the continuity of care provided to residents. The manager reported that a number of posts remained vacant at the time of inspection. Vacancies included one support worker, one senior support worker and the deputy manager post. The manager said that the Regard Partnership will supply temporary cover for the deputy manager post and that other service managers are to provide management support to her. The manager said that two staff had recently been appointed following a recruitment day and were awaiting preemployment checks. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 19 Two staff files were examined. Both provided evidence of an appropriate recruitment procedure, involving application form and interview, two references, proof of identity and Criminal Records Bureau disclosure. Records indicated that staff have not been receiving individual supervision as often as they should. See Requirement 6. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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): 39, 41, 43 Residents are consulted about decisions taken within the home. Standards of record keeping need to improve. The health and safety of residents and staff is maintained. EVIDENCE: The Regard Partnership has demonstrated a commitment to involving residents, staff and other stakeholders in the Quality Assurance process. For example, a ‘Policy Review Forum’, comprising people from across the organisation, was established to consider and review operational policies and procedures. As indicated in Standards 7 and 8 of this report, Residents are supported to make informed choices about their lives and are consulted about issues that affect them in the home. The standard of record keeping in some areas was poor. As highlighted in Standard 6 of this report, much of the information on residents’ files was London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 21 misfiled or out of date. Information held about residents needs to be updated and reorganised to ensure that staff work with accurate, up-to-date information. See Requirement 1. The home was clean, hygienic and free of obvious health and safety hazards on the day of inspection. All COSHH products were stored appropriately. Standards of food storage were satisfactory. The home maintains an Accident book. The property has an appropriate fire detection system. Staff conduct fire and health and safety tests on a regular basis. Clear instructions for use in the event of a fire were displayed. The home’s fire fighting equipment was tested in July 2005. London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 X X X X 3 X 2 X 3 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6YA41 Regulation 17 Timescale for action The Registered Person must 30/03/06 ensure that all information held about residents is up-to-date, clear and accessible to staff. Old material should be archived and formats used for recording should be standardised. The Registered Person must ensure that: • risk assessments are performed for all areas that are relevant to residents and the activities they undertake risk assessments are reviewed regularly to take account of changes in need Requirement 2 YA9 12(1) 13(4) 30/03/06 • 3 YA18 12 risk assessments record the date and identify the member of staff completing the assessment. The Registered Person must ensure that written guidelines for the delivery of individual personal care are accurate and DS0000017380.V281651.R01.S.doc • 30/03/06 London Road, 225 Version 5.1 Page 24 up-to-date. 4 YA23 13(6) The Registered Person must ensure that all staff have attended training in the Protection of Vulnerable Adults. The Registered Person must arrange for the repainting or replacement of the first floor window frames at the rear of the home. This Requirement is reinstated from the last inspection. The Registered Person must ensure that all staff receive regular individual supervision. 30/05/06 5 YA24 23(2)(b) 30/05/06 6 YA36 18(1)(2) 30/03/06 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 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 Page 25 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 London Road, 225 DS0000017380.V281651.R01.S.doc Version 5.1 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. 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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