Inspection on 25/08/05 for 26, Cross Street

This inspection was carried out on 25th August 2005.

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

Other inspections for this house

26, Cross Street 09/11/06

26, Cross Street 19/01/06

26, Cross Street 18/11/04

26, Cross Street 25/05/04

26, Cross Street 13/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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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 Cross Street, 26 26 Cross Street Hampton Hill Middlesex TW12 1RT Lead Inspector Sandy Patrick Unannounced 25 August 2005 at 10:00am 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 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 Stationary 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. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cross Street, 26 Address 26 Cross Street Hampton Hill Middlesex TW12 1RT 020 8783 0973 020 8783 0973 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) London Borough of Richmond Upon Thames Mr James E King CRH 4 Category(ies) of Learning Disability (4) registration, with number of places Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18th November 2005 Brief Description of the Service: 26 Cross Street is a care home providing personal care and accommodation for up to four service users who have a learning disability and sensory impairments. The building is owned by London Quadrant Housing Association. The service is run and managed by the London Borough of Richmond. The home is a bungalow situated in Hampton Hill. It is close to local shops, pubs, community facilities and public transport links. Bushey Park is within walking distance. All bedrooms are for single occupancy. The internal layout of the building and the service provision are designed to meet the needs of people who have a sensory disability. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 25th August 2005, and was unannounced. The Manager was not on duty, but the Inspector met with the Deputy Manager and other staff and with three of the four service users. During the course of the inspection, the Manager telephoned to speak with staff at the home, and the Inspector had the opportunity to speak with him also. The Inspector was made welcome by all, and was invited to join the service users and staff for their lunch. This was a pleasant social occasion as well as an enjoyable meal. The atmosphere at the home was calm, relaxing and positive. Throughout the day the Inspector saw examples of interactions which demonstrated deep routed affection and friendship between service users and also with the staff team. Service users presented as happy and comfortable. The staff team were knowledgeable about individual needs and demonstrated that they could effectively anticipate and meet these. The staff on duty spoke in a manner which showed their genuine respect, affection and empathy for service users. The service users at the home have a complex range of needs. Systems and procedures which are in place ensure that these needs are met in an organised but also homely environment. What the service does well: What has improved since the last inspection? Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 6 A new service user has successfully moved to the home and has settled in. They told the Inspector that they were happy at the home. The staff team have worked closely with other professionals to offer support to meet changing needs. Service users and staff have worked together to develop and review individual plans. The service users have enjoyed a number of day trips and social events. The staff team have consistently shown a strong dedication to caring for each individual and providing the service that each person wants and needs. 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. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3 & 4 Service users have contributed to and have access to information about the services and facilities offered them. There is an appropriate procedure for assessing individual needs. Service users are able to visit the home and make choices about how their needs should be met as part of the admission procedure. EVIDENCE: The service users and staff at the home have produced an attractive and comprehensive Service User Guide. This has been designed and created by representatives of the service user group, supported by staff. Information within the document covers the required areas in a range of accessible formats, including pictures, symbols, photographs and text. The Service User Guide includes information on making complaints. All service users have a copy of this document. Copies are available for potential service users. The Registered Person has developed a Statement of Purpose and Aims and Objectives of the service. The staff plan to involve service users in the review and further development of these. One service user has moved to the home since the last inspection. There was evidence of thorough assessment, included detailed information and assessments from a range of health care professionals. The service user told Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 9 the Inspector that they had visited the home and met with staff and other service users prior to moving to the home. There was evidence of liaison with the service users previous carers and family prior to the move. The needs of the service users are complex and varied. The staff have been appropriately trained and have a range of information and expert advice and support to meet this wide range of needs. The layout and design of the home are appropriate. Staff are trained in communication techniques. The Inspector saw examples of original care needs assessments within service users records. These had been appropriately transferred to service user plans, which are reviewed on a monthly basis. The Inspector saw examples of staff supporting service users to meet specific needs and to communicate their needs effectively. Records relating to service users were seen to be clear and accurate and give detailed information to ensure consistency of approach from staff. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 standard(s) 6, 7 & 9 Individual needs are appropriately recorded within service user plans and a range of guidelines and risk assessments. Service users are consulted about their care and are able to make decisions about this and the running of the home. EVIDENCE: Service users contribute to the development of their plans of care. These are reviewed on a monthly basis and up to date information is available for the service user and staff. Each service user and their keyworker set objectives to meet individual needs. These are regularly reviewed. Guidelines from health care professionals and detailed risk assessments are incorporated in service user plans. Plans consistently focused on promoting choice and independence wherever possible. Service user plans included information on individual skills and competencies as well as areas of need. Daily care notes are made and indicate that service user plans are followed appropriately. Staff are trained to use a variety of communication techniques in their work with service users. Staff have developed close relationships with service users and are skilled in interpreting needs. Service users have different sensory Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 11 needs and some of these needs are changing. Staff at the home have supported service users to develop communication techniques, so that they can continue to converse with each other as their needs change. Service user meetings are held monthly and are minuted. Minutes from these indicate that service users are consulted about the running of the home, daily routines, activities, menus and their rights and responsibilities. Minutes are written in words and symbols and are signed by service users. Service users have produced a monthly newsletter, which features photographs, pictures and articles about general activities and special events from the month. All service users are given a copy of their newsletter, which is not only an attractively designed memento of their achievements, but is also used to aid communication and discussion with visitors and relatives. Throughout the inspection, the Inspector saw examples of staff sharing information with service users, consulting them and offering choices. There are a comprehensive range of risk assessments in place. There is evidence of consultation with other professionals in the development of these. The staff on duty spoke to the Inspector about specific work they had taken with individuals to promote self awareness and develop skills in communication, assertiveness and budgeting. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 standard(s) 11, 12, 13, 14, 15, 16 & 17 Service users develop and maintain interpersonal skills in a relaxed and comfortable environment. Individual needs and aspirations are met. Service users participate in a range of leisure and educational activities designed to meet their needs and help them pursue interests. Service users are offered a choice of healthy and nutritious food. EVIDENCE: Service users are supported to develop and maintain a range of skills. Service users respect one another and live in harmony offering each other support and friendship. The service users are well informed and make decisions as a group. Service users participate in house hold tasks according to abilities and wishes. These include recycling, participating in cooking, cleaning, shopping and preparing for meal times. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 13 Service users attend local resource centres, colleges and community based activities. Service user plans included information on individual interests and how these were met through college courses and other activities. Service users recently participated in a local event designed to celebrate achievements. One service user spoke about this and was proud of the art work and other achievements on display at the event. Service users participate in group and individual activities. Leisure needs are recorded in service user plans. Minutes of service user meetings demonstrated that group activities are parties were discussed. Service users access local parks, restaurant, pubs, shops and leisure facilities. The service users produce a monthly newsletter, which includes pictures and writing about some of the activities that take place each month. One service user had recently enjoyed a birthday party. Two service users were due to go on holiday shortly after the inspection. One service user told the Inspector that they were looking forward to this. Staff on duty spoke about their work with the families of service users and the close relationship they had with key people in the service users’ lives. Service users maintain friendships and regularly host parties and attend social events outside of the home. Interactions between service users and staff were positive and indicated mutual trust and respect. Staff are trained in a variety of communication techniques and have supported service users to find ways to communicate with each other. Service users have unrestricted access to all communal areas of the home. Service users’ wishes and needs are clearly identified in service user plans. Staff were observed to use appropriate forms of address for service users. The service users at the home have a range of dietary needs. There was evidence that individual needs and how to mange these had been discussed with appropriate health care professionals and the service user themselves. Service users participate in choosing and preparing food. The menu is flexible and designed to enhance choices. Records of menu choices showed a healthy and varied diet. The kitchen was well stocked with fresh food. The Inspector was invited to join service users and staff for their midday meal. This was well prepared and a relaxed and pleasant occasion. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 standard(s) 18, 19 & 20 Personal and health care needs are appropriately recorded and monitored. Staff work closely with other health care professionals to offer support to meet a range of complex needs. Medication is appropriately administered and recorded. Not all medication was stored securely on the day of the inspection and this presents a risk. EVIDENCE: Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 15 Personal care needs are clearly detailed in service user plans. Service users are supported to maintain as much independence as possible. The service users have a range of complex health needs. There is evidence that they have been supported to meet these by staff and input from appropriate health care professionals. There was a range of written information for staff on individual needs and health care conditions. The staff work closely with other health care professionals. The Inspector saw examples of this when staff liaised with other professionals about the health of one service user on the day of the inspection. The service user was consulted about their needs and well informed by staff of what action was being taken to meet these. A number of different health care professionals had complimented the staff about their work with individual service users and this information had been recorded for all staff to see. There was evidence that staff closely monitor health needs and are perceptive of changes in need. There is an appropriate medication procedure and all staff are trained in the administration of medication. Medication records were accurate. The staff work closely to support health care professionals with monitoring medication needs. The majority of medication was stored appropriately. The Deputy Manager and Inspector discussed a review of the storage arrangements for some drugs. The proposal for new locked cabinets was suitable, however until this can be arranged all medication must be stored within locked facilities. A considerable amount of medication found at the home on the day of the inspection was stored in an unlocked drawer. There was a good clear record of consultations with medical professionals. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 standard(s) 22 & 23 There are appropriate procedures regarding vulnerable adults and whistle blowing. EVIDENCE: There is an appropriate complaints procedure, detailing timescales and information about the Commission for Social Care Inspection. The complaints procedure is appropriately translated into the Service User Guide. There have been no complaints at the home in the past year. There is a record of compliments made about the work of the staff team from other professionals who work with service users. The London Borough of Richmond has produced procedures for the Protection of Vulnerable Adults, Recognising Abuse and Whistle Blowing. All staff receive training in recognising and reporting abuse. complaints, protection of Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29 & 30 Service users live in a comfortable, well maintained and suitable environment. Adaptations have been made to ensure that service users’ needs can be met. EVIDENCE: Accommodation is provided on one level and is designed to ensure accessibility for service users. The building is well maintained and is attractively decorated throughout. Bedrooms and communal areas have been personalised by service users. Bright contrasting colours support orientation. The home has a very attractive and well maintained garden, which has been landscaped by staff. Staff have build a covered area and barbeque and a number of original features. Flowers, photographs, pictures and personal ornaments add to the general ambience. Bedrooms are for single occupancy and are appropriately furnished and equipped. Service users have personalised their rooms and communal areas. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 18 The home has been designed to meet the needs of people with sensory disabilities. The layout of the home allows freedom of access. To support orientation furniture is never moved or rearranged. Staff make regular checks to ensure that all corridors and floors are free from potential hazards. Corridors are equipped with handrails. The bathroom has been equipped with a walk in shower and specialist bath. The home was clean and tidy throughout on the day of the inspection. There are appropriate procedures for infection control, Control of Substances Hazardous to Health and laundering of clothes. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 & 36 Staff are employed in sufficient number and are appropriately trained and supported. EVIDENCE: There has been relatively few staff changes at the home and many of the staff have worked with the service users since the home was registered, in some cases prior to this. The staff have consistently demonstrated an excellent knowledge of individual needs and aspirations. Written information, support and expertise are available to staff and there is a detailed file of information which new staff can refer to. There are good systems of communication, both written and verbal and staff participate in handovers of information between shifts. There is a planned programme of training offered to staff and all staff have been trained in food hygiene, basic first aid, manual handling, fire safety and abuse. Health care professionals have offered additional training relating to specific needs. Staff have undertaken a range of training in other areas relevant to their roles. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 20 Staff are supported to undertake NVQs. The Manager and Deputy Manager are taking NVQ Level 4 and two staff have almost completed NVQ Level 3. Other staff will undertake this training the following year. Staff are offered regular supervision with their line manager. This is recorded. Team meetings are held monthly. Minutes of these indicate that staff actively participate in open discussions about the service, including an input into service development. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 38, 39, 40, 41 & 42 The Manager is appropriately experienced and qualified and the management approach is open, positive and inclusive. There are appropriate procedures for monitoring quality and record keeping. Appropriate checks on health and safety are made and recorded. EVIDENCE: The Manager is appropriately qualified and experienced. He has managed the home since it opened. Since this time he has developed the service and participated in relevant training. Staff on duty have consistently praised the approach of the Manager and Deputy Manager. The Deputy Manager gave examples of how the Manager had effectively advocated on behalf of service users over recent months. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 22 The management style is open, positive and inclusive and service users and staff are able to contribute and make choices. This was witnessed by the Inspector and evidenced in a variety of documents at the home. There is an appropriate system for quality monitoring, including in house checks by staff, consultation with service users and staff and monthly visits from the organisation’s Quality Assurance Manager. There is a wide range of policies and procedures covering the required areas. Records required by Regulation were seen to be in place and were neatly organised, accurate and accessible. Appropriate checks are made on health and safety and are recorded. There are records of checks on fire safety including fire drills. The Registered Person must develop individual risk assessments relating to fire drill evacuations for service users, these must be reflected in the procedure. Cross Street, 26 G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 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 4 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cross Street, 26 Score 3 4 2 x Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 3 2 x G54-G04 S17360 Cross St V227902 250805 Stage 4.doc Version 1.30 Page 24 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. YA20 13(2) The Registered Person must ensure all medication is stored in a locked facility. The Registered Person must ensure that individual fire risk assessments are developed and fire drill evacuation procedures reflect the findings of these assessments. 30/09/05 Standard Regulation Requirement Timescale for action 2. YA42 13(4) & (6) 23(4)(c) (iii) & (e) 30/09/05 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. 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