Inspection on 10/10/05 for 29 West Ashton Road

This inspection was carried out on 10th October 2005.

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 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

29 West Ashton Road 26/06/07

29 West Ashton Road 17/05/05

29 West Ashton Road 06/10/04

29 West Ashton Road 28/04/04

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 09/07/2008.

CARE HOME ADULTS 18-65 West Ashton Road (29) West Ashton Road Trowbridge Wiltshire BA14 7BJ Lead Inspector Malcolm Kippax Unannounced Inspection 10th October 2005 09:35 West Ashton Road (29) DS0000028350.V257113.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 West Ashton Road (29) DS0000028350.V257113.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. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service West Ashton Road (29) Address West Ashton Road Trowbridge Wiltshire BA14 7BJ 01225 766654 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) H5M001cobern@mencap.org.uk Royal Mencap (Housing & Support Services) Susan Grace Carwithen Care Home 6 Category(ies) of Learning disability (6) registration, with number of places West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 6 service users with a learning disability which includes the 1 named male service user with both a learning disability and physical disablement currently being accommodated 17th May 2005 Date of last inspection Brief Description of the Service: 29 West Ashton Road is in a well established residential area of Trowbridge and provides accommodation for up to six service users. The home is a Victorian, semi-detached property on two floors. Mencap is registered as the care provider and the property is owned by the New Era housing association. Each service user has their own room. Two bedrooms are on the ground floor and four rooms are on the first floor. There is a lounge, a dining room, a domestic type kitchen and a separate utility room with laundry facilities. At the rear of the home there is a large lawned garden. Mrs S. Carwithen manages a permanent staff team. Staff members provide support for service users in all aspects of their lives. Service users attend a range of college courses and day activities in the community. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two visits and lasted for five hours. The first visit (unannounced), started at 9.35 am on 10 October 2005. The manager reported on some recent developments and a staff member was met with. Records were examined, including medication, fire log book, health & safety and staffing. A second visit was arranged for 12 October 2005 in order to meet with the service users after they returned from their day activities. What the service does well: What has improved since the last inspection? What they could do better: Service users receive support from staff with medication and the records were up to date. However, there were inconsistencies between how certain medication was being given and what was recorded on the containers’ labels. This needs to be corrected, in conjunction with the dispensing pharmacist and the G.P., as necessary. It is also recommended that, in addition to ‘in-house’ training, staff members receive training in medication and related matters from an outside source. This will help to develop knowledge about the medication that service users receive and the conditions for which they are prescribed. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 6 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. West Ashton Road (29) DS0000028350.V257113.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 West Ashton Road (29) DS0000028350.V257113.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): 2 and 4 Prospective service users benefit from the home’s admission arrangements. EVIDENCE: The home had one vacancy at the time of this inspection. The manager said that a prospective service user had previously visited the home and met with the current service users and staff members. The house meeting minutes showed that service users had been asked for their views about this person moving in. The manager said that the admission arrangements were quite advanced before the placing authority decided, for reasons of funding, that the move could not go ahead. One service user met with was disappointed that this move had not gone ahead. A copy of the Mencap admissions policy was available in the home. This states that a ‘Needs Assessment’ form is to be completed, in addition to the home receiving a copy of the prospective service user’s community care assessment. The ‘Operational Procedures’ manual contains other information for the manager and staff about the admission arrangements that should be followed. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 9 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): These standards were not looked at on this occasion (standards 6, 7 and 9 were inspected and met at the last inspection.) EVIDENCE: West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 10 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): 15 and 17 (Standards 12, 13, 14 and 16 were inspected and met at the last inspection.) Service users are involved in activities and relationships that are important to them. Service users are able to choose the meals and help to prepare them. There is encouragement to have a healthy diet. EVIDENCE: Each of the service users met with had contact with a family member. This ranged from occasional contact with a brother, to weekly visits to a parent, for which a staff member provides support with the transport. One service user had recently been on holiday with a sister, who also attended review meetings. Relationships within the home appeared to be friendly and informal. The manager spoke about one service user who has developed relationships with people in the community and is consequently spending less of their time in the home. A review meeting has been held to consider the implications of this. Other service users have some well established activities outside the home, which brings them into contact with friends and acquaintances. This included West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 11 going to Church each week and attending some social events in connection with this. One service user said that he had been on holiday with a friend who lives in another home run by Mencap. Another service user said that she had enjoyed going on holiday to Devon with one of the other service users earlier in the year. On the day of the inspection, two service users were due to meet up with some friends during the evening at a Gateway Club. Information about the service users’ significant contacts and the support that is needed with relationships is included in their personal records. There are no rules on visiting. Service users can see people in their own rooms or in the lounge. One of the service users opened the front door when the inspector arrived and was familiar with the inspector’s role. One of the service users was met in the kitchen, where she was helping a staff member to prepare tea. Service users had decided at a house meeting that they wished to share out some of the domestic tasks and various rotas have been drawn up. Meals are based on a four-week cycle of menus although changes are regularly made. The manager said that that there were no special diets required and everybody was able to eat independently. On the day of the inspection one service user had received advice about diet and healthy eating. As result of this some different, low fat foods had been bought, which the service user was happy to talk about. In discussion about the keyworker role, the staff member said that one service user was at some risk of choking, because of the speed of eating, and that staff members reminded the service user about the need to eat slowly. Care plans were not looked at during this inspection although any risk of choking and guidance for staff will need to be clearly identified within the written records. It would also be useful to check that the first aid instruction given to staff includes dealing with a person choking. A record is kept of the meals prepared although this does not include details of the sweet course. Service users said that they enjoyed helping out in the kitchen and have meals that they like. The evening meal is taken together and service users have their own choice of breakfast. One service user said that she enjoyed having porridge at breakfast. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 12 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): 20 (Standards 18 and 19 were inspected and met at the last inspection.) Service users are well supported with their medication, although a discrepancy in its administration needs to be corrected. EVIDENCE: Service users were receiving support from staff with the management and safekeeping of their medication. When asked, the manager thought that one person might be able to look after some of her own medication. This was raised with the service user concerned, who said that she is happy with the arrangements as they are. Suitable storage facilities were in place. There was a stock record of medication, which, when checked, was consistent with the actual quantities of medication kept in the cabinet. Staff members administer medication each day and these records were up to date. It was noted that one service user’s medication was to be given twice a day, according to the instructions on the pack, although this was recorded as PRN (as required) on the administration of medication forms. There was a similar inconsistency in the administration of a prescribed cream to another service user. This was brought to the manager’s attention, who felt that staff members were administering the medication as the GP intended, although acknowledged that this needed to be followed up to West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 13 ensure that the instructions are consistent, with no uncertainty as to when the medication needs to be given. A staff member confirmed that training in the medication procedures is included in the home’s induction programme. There is a video to watch and a ‘Confirmation of on-going competency’ form is also completed every three months. The manager showed evidence of how this is covered in supervision sessions with staff. Although these in-house activities are very relevant, the involvement of an outside specialist is also recommended. This will help to widen the staff team’s knowledge of medication and drug use. The home’s procedure about what to do in the event of a death did not include an appropriate statement about the need to retain medication. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 14 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): These standards were not looked at on this occasion. (Standards 22 and 23 were assessed and met at the last inspection.) Since the last inspection the manager has notified the Commission of matters that have been followed up under the vulnerable adults procedure. EVIDENCE: West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 15 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 (Standard 30 was assessed and met at the last inspection.) Service users benefit from the home’s location and their proximity to local activities and amenities. Appropriate arrangements are in place for keeping the home well maintained and in good order. EVIDENCE: One service user spoken with said that he liked to walk into Trowbridge town centre and bought a newspaper each day. During the inspection, another service user went out to post a letter at a nearby box. Service users know the local area well and have regular activities that they can either walk to or quickly get to by car. There is also public transport close by. The home is owned by the New Era housing association, which has responsibility for the upkeep and refurbishment of some areas. The manager said that internal and external redecoration was shortly to take place, as part of a five-yearly cycle of works. The work was being planned in conjunction with the service users, who were looking forward to the results. The home’s office was being decorated at the time of the inspection. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 16 The condition of the ground floor bathroom has been commented on at previous inspections and the manager said that this was also due to receive attention. Refurbishment and a new bathroom suite have been arranged, although relocation of the bathroom as previously recommended is not being planned or thought to be a feasible proposition. During the inspection, service users were using their own rooms as well as mixing with others in the lounge. The lounge is comfortably furnished and has a television and video. A separate dining room is available for individual and quieter activities. The garden is large and provides a good space for recreation and entertaining. Safety within the home environment is monitored through a monthly check that includes the grounds, bedrooms and the other part of the accommodation. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 17 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, 34 and 35 Staff appointments during the last year have been successful. There are good opportunities for training, although specialist input in some subjects would be beneficial. Staff meetings and procedures are helping to promote the service users’ welfare and their safety. EVIDENCE: There have been no new staff appointments since the last inspection. There are organisational policies and procedures, which cover the recruitment arrangements. Two staff members appear to be well established in the home after joining the staff team at the beginning of the year. One of these staff members was met with and she spoke about her role as keyworker and her responsibilities as a staff member. Tasks are delegated to staff members as they become more familiar with the service and the running of the home. Comments from service users and the manager indicated that there is now a settled staff team following a period of change. Good relationships were observed during the inspection. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 18 The staff member said that she had attended several training events and courses, some in conjunction with the programme of induction and foundation. NVQ at level 2 had been achieved. Other staff had also completed their NVQ at level 2 and two staff members are now undertaking NVQ at level 3. The manager said that she had control of a budget for NVQ and other training activities. There is a clear record being kept of staff training and of when refresher courses are due. The training programme includes food hygiene, medication, moving and handling, fire, health & safety, first aid and ‘Protect Me’ (abuse awareness). The manager said that she had attended a course on the carrying out of risk assessments. This would be a relevant course for other staff to attend. The manager said that training in epilepsy was available through Mencap, but this had not been taken up. Although this may not be directly relevant with the current service users, such training would widen the staff members’ knowledge of conditions that are often associated with learning disability. The manager also mentioned training relating to one service user’s needs that, in retrospect, would have been useful at the time. The minutes of staff meetings showed that there is regular discussion about the responsibilities of staff members, with an appropriate focus on the service users’ needs. One of the subjects under discussion has been ‘Client Inclusion’ and the staff team have been looking at ways in which service users can be more involved in decision making and in house matters. The manager said that person centred planning was also to be introduced and a suitable format for this was being looked at. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 19 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): 42 (Standards 37 and 39 were inspected and met at the last inspection). The practical arrangements are helping to ensure that service users are safe in the home and that the facilities are well maintained. EVIDENCE: As reported earlier, a health & safety check of the home environment is undertaken and recorded each month. The home’s health & safety file also contained evidence of other checks and the arrangements for servicing. Some of these are carried out by staff, e.g. water temperatures and C.O.S.H.H., while others, such as gas safety and P.A.T. testing are undertaken by outside contractors. The home’s fire log book was up to date, although the actual date (not just the three-monthly period) on which staff members receive instruction needs to be added to the record. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 20 The manager said that a health & safety advisor from Mencap had recently visited and as a result of this some new generic risk assessments were now being undertaken. Some new equipment, e.g. a different type of stepladder, has also been provided. West Ashton Road (29) DS0000028350.V257113.R01.S.doc Version 5.0 Page 21 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 X 3 X 3 X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 West Ashton Road (29) Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000028350.V257113.R01.S.doc Version 5.0 Page 22 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 Timescale for action 11/10/05 2 YA20 13(2) Information about the administration of medication must be accurately maintained in accordance with the GP’s instructions. The procedure about what to do 08/11/05 in the event of the death of a service user must be amended to include a statement about the need to retain medication for a period of seven days. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA35 Good Practice Recommendations That staff members have the opportunity to receive training in medication and drug use from on outside, specialist source. That the programme of staff training is developed to include a wider range of topics relating to learning disability and associated conditions. It may be useful to establish a database of training courses and resources in various subjects that can be utilised in the future. DS0000028350.V257113.R01.S.doc Version 5.0 Page 23 West Ashton Road (29) Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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