Inspection on 21/03/06 for 24a Lower Hanham Road

This inspection was carried out on 21st March 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

24a Lower Hanham Road 22/04/08

24a Lower Hanham Road 15/04/08

24a Lower Hanham Road 23/08/04

24a Lower Hanham Road 11/05/04

24a Lower Hanham Road 19/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 24a Lower Hanham Road Hanham South Glos BS15 8HH Lead Inspector Andrew Pollard Unannounced Inspection 21st March 2006 09:45 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 24a Lower Hanham Road Address Hanham South Glos BS15 8HH 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) 0117 960 5928 0117 9709301 Aspects and Milestones Trust Mrs Jennifer Elizabeth Waring Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager to complete NVQ training at Level 4 in Care & Managerment by December 2005. 25th May 2005 Date of last inspection Brief Description of the Service: 24a Lower Hanham Road is an Aspects & Milestones Home. The home is registered to accommodate five residents with learning difficulties. Male and female residents are cared for aged 19 to 64 years and 65 years and over. The home is approximately half a mile away from the main Hanham shopping area. This is well served with the full range of community facilities.The building is a detached, extended dormer bungalow in an established residential area and is on a bus route to Bristol. The home comprises a large lounge/dining room, a kitchen/dining room where almost all meals are taken, a laundry area off the kitchen and four residents bedrooms. One bedroom is en-suite. A bathroom and a toilet on the ground floor serve the remainder. The hallway is wide and spacious. On the first floor there is one resident’s bedroom, a bathroom and a staff sleep-in room /office. The front of the house has a hard standing for cars. The remaining area is a garden. A rear garden is mainly paved but has borders of shrubs and flowers. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over one day with the registered manager and senior support worker. The focus of the inspection was on quality of life for residents, policies, organisational and general management staffing, and services. Assessments, person centred planning and day-to-day needs were discussed with the staff and manager. A tour of the premises and facilities was carried out. Requirements and recommendations from the last inspection were also reviewed. One resident was present and spoken with and three members of staff. Staff interaction with the resident was observed. Regulation 26 and 37 reports identified issues since the last inspection were addressed where appropriate and incorporated in this report. What the service does well: What has improved since the last inspection? A quality assurance survey has taken place with positive outcomes. Appropriate staffing documentation is held in the home in accordance with the regulations. Loft cavities have been cleared of rubbish and generally tidied up. A metal drug cabinet has been installed in a hallway cupboard. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 6 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. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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): 1,2,3,4,5 Prospective residents and their families are given relevant information in written about the home. Admission and assessment procedures are in place and have worked well in the past. Contracts and terms and conditions of services are provided to all residents. EVIDENCE: The Statement of Purpose and Residents Guide were available for inspection. These documents are regularly updated and provide all the required information. The manager has updated all of the homes information including assessment, contract and general policies. The home admitted two new residents in 2005.At the previous inspection it was stated that the home had taken great care in ensuring that it only offered a place after a thorough assessment and evaluation of what it could offer to prospective residents. All residents have signed terms and conditions/contracts. One resident has recently left the home due to their physical health care needs Two prospective residents have visited the home with a view to one of them moving in the near future. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 9 The views of existing residents are taken into account and where possible several introductory visits are arranged. Consideration is being given to some residents moving on in future to supported living placements. As part of this aim it is hoped that two bed-sit units could be created in the home if funding is forthcoming. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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 The staff embraces the person centred planning approach, which gives positive outcomes for the residents. There was evidence of needs and risk assessments and life plans being written Evaluation and reviews of resident’s files take place. Residents are involved with decision-making and consulted about the running of the home. Records are stored and handled in a confidential manner. EVIDENCE: The home operates a key worker approach, which is rotated every six months. Three residents files were seen and were evidential of person centred and lifestyle planning. Assessments and plans are prepared with the full participation of the residents and other key people. Person centred planning review meeting take place regularly. All staff had undergone training in person centred care. The Trust offers support through training and additional specialist advice. Specific risk assessments have been completed and are kept updated. Staff and residents complete a daily diary, which is separate from the file. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 11 The manager is starting the process of creating “Health Action plans” and we discussed the material included and it was suggested that there was no need to duplicate information already in lifestyle plans or other documents. It was suggested that the case file be slimmed down as they contain lots of documents with little day to day relevance, the manager said this will be done in April. Staff are encouraged to ‘empower’ residents and include everyone in decisionmaking on everyday matters and other important issues. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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): 11,12,14,15,17 Residents make use of community services. Residents are seen as and respected as individuals. The recreational and occupational arrangements in the home are well organised individualised and varied. The menus are varied, offer balanced diet and are based on individual choice. EVIDENCE: Two residents attend Resource and Activity Centres at Blackhorse and Kingswood during some part of the week. One person works at Elmtree farm four days per week. A resident with staff support has just been successful in accessing direct payments and will be employing a day care worker for six hours per week. Each person has an activity schedules detailing their involvement in occupational, social and educational activities. Links with the local community are maintained through attendance at Resource and Activity Centres and through a variety of leisure activities organised by the home, such as bowling, swimming, trips out and visits to the theatre and cinema. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 13 Some residents are involved with clubs such as lunch and ladies clubs. Two people are involved with a dog-walking scheme. The staff devotes considerable time and resources in creating opportunities for residents for personal development and independent living. Integration into community life and leisure activities are a high priority. All of the residents have a holiday planned during the year generally in caravans or chalets on the coast either individually or with a fellow resident. Families were able to visit whenever they wish. Families and friends are welcomed and their involvement in resident’s lives and activities is encouraged. A video of “A week in the life of” was made recently and given to a resident’s family to illustrate the full life they led and this has improved the relationships within the family. A balanced and varied diet was offered. Residents have individual choice for their meals and there are no set menus. A record is kept of all food served. Some residents are able or wish to assist in shopping and preparation of meals. All can make beverages and simple snacks. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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): 18,19,20 The staff support residents with personal care to maintain health and wellbeing. Appropriate arrangements are in place for residents to access primary and secondary healthcare services if need be. There have been failings to properly manage and administer medication. EVIDENCE: Each individual had a key worker, who offers support in maintaining as much independence as possible. Individual working records set out preferred routines and likes and dislikes of residents. The home works closely with family, friends and relevant professionals in the best interest of individual residents and with their consent. All residents are registered with the GP practice. Community dentistry, chiropody and optical services are accessed where appropriate. Some residents also use domiciliary chiropody services. The consultant Psychiatrist or Registrar supports two of the residents. One person has a continuing health care need, which is well managed. Three people have started a programme to become self-medicating which is progressing well. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 15 However there have been recent irregularities with staff administration and recording of medication and the staff interactions following on, which has resulted in an ongoing investigation by the Trust. Regulation 37 notices have been submitted and a CSCI inspector will monitor the investigation and outcomes. Staff training in administration and recording of medication has been arranged facilitated by an external trainer. At present drugs returned to the Pharmacy are not recorded in a disposal record, detailing the date, drug and number and reason for disposal. The Pharmacist should then endorse this record. A new metal drug cabinet has been installed in a cupboard in the hallway, which is suitable for the private administration of medicine. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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): 22,23, There are satisfactory arrangements in place to manage complaints or allegations of abuse. There are arrangements in place for staff training and awareness of POVA matters. The “No Secrets” documents were not available. . EVIDENCE: A complaints procedure, which includes contact details for the Commission and is in a user-friendly format, is available to Residents and their representatives. The complaints procedure is included in the Service users Guide. The home has protection of vulnerable adults and whistle blowing policies. The Local Authority “No Secrets” documents could not be located. The manager made arrangements to get a copy the same day. The Trust carries out staff training in the protection of vulnerable adults procedures. There have been no complaints or allegations of abuse. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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): Lower Hanham Road is a homely and comfortable environment. The home is suitable for the current resident group The home is generally well maintained clean, safe and comfortable. Bedrooms and communal areas suit the needs and tastes of the residents. It is well decorated and maintained and is suitable for its intended purpose. The kitchen needs urgent attention and the bathrooms look dated. EVIDENCE: Several inspection reports have pointed to the shabby state of the kitchen. Kitchen units well below the standards expected of such an environment. A recommendation has previously been made to install a new kitchen, which has not been met. The manager is of the opinion that funding may be made available in the new financial year. If this is not forthcoming the commission will request an Environmental Health inspection to determine weather or not this matter will be made a requirement. Overall, premises are suitable for the number of residents, safe, comfortable, bright, airy and clean. It is fully wheelchair accessible. The décor in the kitchen hallways and bathrooms in general is tired and appear dated. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 18 All of the individual resident’s rooms well decorated, furnished and had been personalised containing photographs, possessions and individual artwork. All doors are lockable and some residents choose to keep their rooms locked. Staff are fully aware of privacy protocols. The manager hopes to develop two rooms into bed-sitting rooms to enhance people’s protection of vulnerable adults life skills and independence. The home has Infection control guidelines. Laundry facilities are appropriate. The loft space, including spaces have been in part cleared and properly tidied up. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 The home is adequately staffed with appropriately experienced and skilled staff. The recruitment procedures and records are in good order. The training arrangements and staff updating is well organised. Staff appraisal takes place. EVIDENCE: In general two staff are on duty during the day and one person on sleep-in duty at night. There are no staff vacancies at present and there has been no recent agency staffing. Where staff are recruited the residents are encouraged to take part in the process. Interactions between staff and the resident were, warm and friendly. The manager considered that staff morale has taken a knock with particular reference to the situation detailed above concerning medication. Staff have worked hard to instigate Person Centred Planning and have received training in support of it. All staff are on NVQ (National Vocational Qualification) Level 3 courses. All mandatory training has been completed, the Trust provides a print out to identify due dates. Supplementary training on OCD and Cerebral Palsy are being arranged by the manager 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 20 Training needs are assed as part of supervision and appraisal. The home holds copies of all appropriate staffing documentation in accordance with the regulations. All staff have CRB disclosures. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42, The management arrangements are simple and there are clear lines of accountability. There are appropriate arrangements in place to service and repair plant and equipment. The home has good Health and Safety arrangements. The registered manager demonstrates very good leadership and management skills. EVIDENCE: The Manager has completed completing the NVQ Level 4 Registered Managers Award and is an NVQ assessor and load handling trainer. The manager is supported by a senior care worker. Mr sayers is the Trust manager and provides supervision and completes Regulation 26 reports each month. Staff have previously stated they felt well supported and received a clear sense of direction and leadership from the manager. The manager and deputy 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 22 share the staff supervision process and all have annual personal development plans. The home has developed survey documents for relatives and residents as part of the quality assurance systems, the results have been positive. The Trust is about to roll out a formal quality system based on the NMS. Good feedback is gained in other ways including regular reviews of individual life plans with residents, staff meetings, staff personal development planning and review of the home’s standards by an appointed visitor. The manager develops an annual business plan incorporating some of this information. The home has Health and Safety policies and regular safety audits take place. The fire log book was up to date and in order. The hoists had up to date test certificates. The gas safety certificate was no available but it is thought due for renewal in the coming weks. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 X x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 24a Lower Hanham Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 x DS0000003378.V261938.R01.S.doc Version 5.0 Page 24 N/A 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 YA20 Regulation 13.2 Requirement Ensure that all staff adheres to the medication policy of the home. Create a disposal record for all drugs returned to the Pharmacist. Ensure that a copy of the relevant LA “No Secrets” procedures are available. Submit a copy of the gas safety certificate. Timescale for action 21/03/06 2 3 YA23 YA42 13.6 13.4 01/04/06 21/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations Install a new kitchen and redecorate the kitchen based on the recommendations of an Environmental Health Officer. 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 24a Lower Hanham Road DS0000003378.V261938.R01.S.doc Version 5.0 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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