Inspection on 26/01/06 for 26, Egerton 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 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

26, Egerton Road 08/02/07

26, Egerton Road 20/09/05

26, Egerton Road 02/02/05

26, Egerton Road 19/07/04

26, Egerton Road 18/02/04

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 Egerton Road 26 Egerton Road Twickenham Middlesex TW2 7SP Lead Inspector Sandy Patrick Unannounced Inspection 26 January 2006 10:30 th Egerton Road DS0000030462.V261223.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 Egerton Road DS0000030462.V261223.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. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Egerton Road Address 26 Egerton Road Twickenham Middlesex TW2 7SP 020 8891 6308 02087449478 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) London Borough Of Richmond Upon Thames Kimberley Jane Poulter-Dell Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: 26 Egerton Road is a residential care home providing short term accommodation for up to six adults with a learning disability. The service is managed by the London Borough of Richmond. Staffing levels reflect the needs of the service users who are accessing the service at any given time. Staffing is provided over twenty-four hours. Over forty service users access the service throughout the year. The average stay at the home is for up to three weeks at a time. Some service users remain at the home for longer if there is a specific need, for example they are waiting for another longer term placement. The home is situated in a quiet residential road and is in keeping with the neighbouring houses. Whitton and Twickenham town centres are a short distance away. The area is well service by transport links and local amenities. The Registered Persons have produced a Statement of Purpose, which includes information on the aims and objectives of the service. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 26th January 2006, and was unannounced. The Inspection Team included a Pharmacy Inspector. The report of his findings are detailed within Section 4 (Standard 20) of this report. The Manager was present throughout the inspection. The Inspection Team met with other staff on duty and was made welcome by all. Four service users were staying at the home, but none of them were at home at the time of the inspection. What the service does well: What has improved since the last inspection? Many more young people in the borough have started to use the service and are helping to develop the service to meet their needs. The staff have worked closely with other professionals to promote the service and to inform people of the opportunities available to them. New decking has been laid in the garden and the area looks really nice. The team have trained together to look at how they can improve and develop the service. There has been further improvements to the way in which staff consult with service users and gain their views on the service. The office has been reorganised, making records and paperwork more accessible and better presented. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 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. Egerton Road DS0000030462.V261223.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 Egerton Road DS0000030462.V261223.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 & 4 There is a range of information for service users and this is being developed in different formats to become easier to understand and access. There is an appropriate procedure for assessment and admission, which includes consultation with service users and opportunities for them to visit the home. The service meets the needs of over forty service users in the borough with diverse needs. EVIDENCE: The home offers a service for approximately forty service users throughout the London Borough of Richmond, and on occasions neighbouring boroughs. There is a very wide range of needs amongst the service users, from those who have recently moved from children’s service to older people who have a learning disability. Service users have differing personal, health, social, emotional, intellectual and educational needs and the service needs to accommodate these. The staff team have consistently demonstrated an in depth knowledge of the needs of various service users, including health care, social and dietary needs. The staff on duty told the Inspector that they enjoyed the challenges of working with such a diverse group. Two bedrooms at the home are designed to meet the needs of service users who are more physically dependent. There Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 9 is evidence that staff at the home have a range of information and training to support them in their roles. The staff work closely with the Community Team for Learning Disabilities Service users and staff have developed a leaflet promoting the service. This was being approved by members of the service user group and finalised. The group are working together to provide more accessible information. The service is working to set up its own website linked to the main borough site. This will be user friendly and will provide a range of information on the respite services. Over the past year a lot of young people have started to become interested in and use the service. The Manager said that these young people have led changes and have helped develop the service. Staff at the home have worked closely with schools, colleges and young people social work teams to help inform more people about the service. There is an appropriate procedure for assessment, which includes consultation with the service user, their representatives, other service providers and health care professionals. Service users are invited to join social groups and to visit the home before they stay there. Egerton Road DS0000030462.V261223.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 & 9 Individual needs are recorded in care plans and risk assessments. Service users are able to make choices about their participation in the service and are consulted about changes and developments. Service users are supported to take risks and these have been appropriately assessed. EVIDENCE: Individual care plans are in place for all service users. These give staff a basic overview of their needs whilst they are staying at the home. There are assessments of risk covering a range of risks for all service users. Both care plans and risk assessments are regularly updated and reviewed. Service users have been involved in the development of these and they reflect individual choices and wishes. The staff are working with staff from day centres and other services to develop person centred plans which cover the different aspects of service users’ lives. The Manager reported that the staff are keen to develop links and networks of support to help make sure that there is a holistic approach to care from all service providers. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 11 The staff team are working closely with service users to produce a range of accessible and useful information. Some well designed leaflets and information is already in place and work to develop more continues. The staff team have received training in Makaton and use this to support communication. Regular service user meetings are held. These are open to all users of the service. Minutes of meetings indicate that there are open discussions and that service users are well informed and appropriately consulted. Egerton Road DS0000030462.V261223.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, 12, 13, 14, 15 & 17 Service users are supported to develop and maintain skills and to have new experiences. Service users are supported to continue and participate with their normal activities, such as attending college and day services and seeing their friends and family. EVIDENCE: Service users are supported to participate in household task, menu planning, shopping and cooking whilst they stay at the home. Individual service user plans record needs and wishes. Staff on duty spoke about the work that they undertook to support service users to learn new skills and to become independent in areas of their lives. Service users are supported to carry on with their normal activities such as attending college or resource centres whilst they stay at the home. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 13 Staff have worked closely with link workers from the local resource centres to make sure that the needs of service users are identified an met. There is a wide range of activities and social opportunities organised for people staying at the home and through the groups who meet on a regular basis. These are arranged according to individual needs. Group activities open to everyone include several parties and day trips. There is a planned short break for some of the older service users in March 2006. A party for all service users was held over the New Year and was enjoyed by everyone. The home is located close to Whitton and Twickenham town centres and is well served by public transport links. Service users are supported to access community facilities and to have a positive presence in the local community. Many of the service users live locally and are able to maintain community links whilst staying at the home All bedrooms are equipped with TVs and videos or DVD players. There is a wide range of music, videos and DVDs available to service users and they are encouraged to bring their own whilst they stay at the home. Staff at the home work closely with families and friends of service users where needed so that everyone can feel valued and listened to. Service users are able to invite friends and family to the home and activities organised by the service. There are regular carers meetings for families. These provide information on the service and other services and also are an opportunity for peer support. Menus are chosen daily by service users. Service users are encouraged to participate in the shopping and preparation of meals. Staff reported that fresh food is brought daily and there is an emphasis on buying quality products. Staff reported that service users were encouraged to help themselves to snacks, as they would in their own home. Staff on duty demonstrated a good understanding of different dietary needs, both for health and cultural reasons. Food allergies are clearly highlighted on staff daily shift plans. Egerton Road DS0000030462.V261223.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 & 20 Personal and health care needs are appropriately recorded, monitored and met. Omissions in recording and inappropriate supplies of medication were found that might have an affect on the health and welfare of residents. These issues were already being addressed at the time of the visit. EVIDENCE: Personal and health care needs are identified and recorded within care plans. The staff work closely with health care professionals to have a good understanding of health needs. The written medication policies and procedures were found to be adequate previously and were not reviewed on this visit. All medications administered by staff along with the records relating to handling and administration of medication were examined and the manager was interviewed. From these discussion and observations the amount of medication coming into the home and leaving the home is not currently recorded. This is mainly due to the current system of supplying medication to the home for the period of Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 15 respite. This is changing in line with the new policy and medication coming into and leaving the home will be recorded. Medication for the respite period is prepared by the main carer in a compliance aid before admission to the home. Staff are not able to identify individual medications and because of this the administration record only states that medication from the compliance aid has been given. The administration record does not detail the name, type or amount of medication given for those items provided in the compliance aid. One resident had three missing entries on the current record detailing administration/non-administration of medication. The manager said that this had been followed up and the medication had been given at those times. No record was made stating this. The administration of medication not in the compliance aid is recorded accurately. The entries on the administration records are written by hand and the dose is written in figures rather than fully in words. Currently these practices in the home do not match the policies. This is being addressed by the home. Medication for residents self-medicating is kept in the office and residents collect their medication when needed. This has been agreed with residents but no mention of medication is made in the risk assessment. On the day of the visit one of the compliance aids had no label indicating the dose of medication. One other item of liquid medication was not labelled. The dose had been checked and confirmed as the same dose on the previous admission. A daily shift plan is kept. This details which residents are in the home and when they require medication along with any specific individual needs relating to medication. Regular meetings are held with residents and carers to discuss issues, which also cover medication. Staff monitor the conditions of residents and any concerns recorded in the daily log and in the shift plan. All medication was stored securely and records indicated that trained staff administer medication. Egerton Road DS0000030462.V261223.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): 22 & 23 There are appropriate procedures regarding complaints, protection of vulnerable adults and whistle blowing. These are designed to protect service users and uphold their rights. EVIDENCE: There is an appropriate complaints procedure. Work to develop this in pictorial and different formats is taking place. There have been no complaints since the last inspection. The London Borough of Richmond have suitable procedures for the protection of vulnerable adults and whistle blowing. Staff have undertaken relevant training. Pre employment checks, including criminal record checks, are made on all staff. Egerton Road DS0000030462.V261223.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, 25, 26, 27, 28, 29 & 30 The environment meets the needs of a wide range of service users and provides a homely and attractive environment for people to stay in. EVIDENCE: Accommodation is provided on two floors in a detached property. The home has two driveways but roadside parking is restricted. There is a small garden to the rear of the home. Over the past two years the majority of the home has been redecorated and new furnishings and fittings have been purchased. The ground floor has been equipped with new flooring and there is new furniture in private and communal rooms. The home is looks attractive and welcoming, with flowers and pictures throughout. The garden has been redeveloped and now has decking throughout creating an attractive and accessible area. Staff and service users plan to plant pots and tubs. Service users and staff have been and continue to shop together to equip all bedrooms with new furnishings, furniture and DVD players. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 18 All bedrooms are for single occupancy. One bedroom is smaller and does not contain a hand washbasin. Service users have appropriate information regarding this room prior to admission. Staff reported that this room meets the individual needs of some of the service users. All bedrooms are appropriately furnished and equipped. Service users are able to bring their own belongings to personalise rooms during their stay. Service users are able to make choices about the bedroom they wish to occupy, and the home try to accommodate this choice, providing their needs can be met in this room. All bedrooms seen by the Inspector were attractively decorated and comfortable. The building is equipped with grab rails throughout. Two bedrooms have been especially adapted to accommodate service users who are physically dependent. Both rooms have ceiling track hoists leading to a bathroom. All bedrooms are equipped with a call bell system. The kitchen is equipped with adjustable surfaces and there are low-level light switches throughout. The home was clean throughout on the day of the inspection. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 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, 35 & 36 Staff are appropriately trained and supported. EVIDENCE: The home was fully staffed at the time of the inspection. Some of the staff team have worked at the home for many years and know the service well. The Manager reported that all the staff have different skills and talents and use these to develop and enhance the service. The staff undertake a range of training. The London Borough of Richmond offers a good selection of training opportunities including support to achieve NVQ qualifications. The staff team have recently undertaken person centred planning training together and are using the principles they have learnt from these in their work. Other group training includes looking at how to make information more accessible to service users. All staff meet with their line manager individually and as a group on a regular basis. The team contribute to the running of the home and are able to take a lead when introducing new systems and procedures. Staff have annual appraisals where they and their managers can look at personal development. Egerton Road DS0000030462.V261223.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): 37, 38, 39, 41 & 42 The service is appropriately managed and the management style is open and inclusive. There are good systems for quality monitoring and these continue to improve. Paperwork systems are well organised and accessible. Appropriate checks are made to maintain good health and safety throughout the home. EVIDENCE: The Manager has worked at the home for several years and is appropriately qualified and experienced. She has an excellent understanding of the needs of the service. The management approach is open and inclusive and service users, their representatives and staff are able to contribute their ideas. Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 21 There are good systems for quality monitoring. These include regular consultation with service users and their representatives. Comment cards about the service have been designed and agreed by the service user group. These will be used to obtain written feedback about food, activities, staff and general comments about people’s stay at Egerton Road. The Manager and staff use clear systems to record how principles of good care practice are met through their work. Staff have worked hard to reorganise the office and various filing and paperwork systems. This has improved efficiency and accessibility of information. There are regular checks on health and safety, fire safety and equipment. These are recorded. Egerton Road DS0000030462.V261223.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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 4 X 3 3 X Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 23 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 YA20 Regulation 13(2) Requirement The Registered Person must: 1. Make sure that the resident’s risk assessment includes a section on March medication. 1st 2006. 2. Make sure that all medication administered by staff is given from the original labelled container unless. 1st March 2006. 3. Make sure that there is a full record of all medication administered. 1st March 2006. 4. Make sure that a record is made of all medication coming into and leaving the home. 1st March 2006. Timescale for action 01/03/06 Egerton Road DS0000030462.V261223.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations 1. It is recommended that the dose of medication on hand-written entries on the administration record be written fully in words. 2. It is recommended that a record be made when missing entries are detected on the administration record. Egerton Road DS0000030462.V261223.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. 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