CARE HOME ADULTS 18-65
Guildford Road (2a) 2a Guildford Road Chertsey Surrey KT16 0QA Lead Inspector
Marianne Barham Unannounced Inspection 15th November 2005 11:15 Guildford Road (2a) DS0000013481.V252963.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 Guildford Road (2a) DS0000013481.V252963.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. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Guildford Road (2a) Address 2a Guildford Road Chertsey Surrey KT16 0QA 01932 568553 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) Welmede Housing Association Ltd Mr Atmaran Beedasee Care Home 12 Category(ies) of Learning disability (12), Physical disability (4) registration, with number of places Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. It is a condition of Registration that of the twelve people accommodated in the home, up to four may be PD 17th May 2005 Date of last inspection Brief Description of the Service: 2a Guildford Road is a detached property situated off of the main road and within walking distance of Chertsey town centre. The home is owned and managed by Welmede Housing Association, with the staff team employed by North East Surrey Primary Care Trust. The home provides accommodation and care for up to twelve people who have a learning disability, four of whom may also have a physical disability. The accommodation is has communal facilities on each floor so that service users are able to live in smaller groups. There are currently six service users living on the first floor and four on the ground floor. The ground floor is wheelchair accessible throughout and has an assisted bath. Each floor has its own lounge, dining room, kitchen, laundry and toilet and bathing facilities. All bedrooms are single occupancy and none are en-suite. The first floor can be reached by by two sets of stairs, there is no passenger lift or stair lift. There is a well equipped sensory room on the first floor. The home has the use of two vehicles to access activities and local amenities and has limited parking to the side of the building. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 11.15am by Marianne Barham, lead inspector for the service. The inspection took place over a period of three hours and forty-five minutes and was the second inspection in the Commission for Social Care Inspection year April 2005 to March 2006. There was a calm atmosphere at the home and the service users appeared relaxed and well cared for. A total of four staff members and two service users were spoken with during this inspection. The registered manager for the home is currently suspended from duty. There are two acting managers overseeing the home, Cressida Rappella, who is the named responsible manager and Alistair Oglivy. Neither manager was present during this inspection. The deputy manager, Mr Lee Chick was on duty and was able to facilitate this inspection and the inspector would like to thank him and the staff team for making time to give their views despite being very busy on the day. What the service does well: What has improved since the last inspection?
Welmede Housing Association has recently introduced a customer satisfaction survey that is sent out to service users, their families and other involved people. The survey asks for feedback on the care and services provided by the home. Service users now have meetings in the home to discuss any concerns or ideas they have and are involved as fully as possible in the daily running of the
Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 6 home, with records being kept of the activities they take part in. This meets a requirement made at the last inspection on 17th May 2005. The broken work surface in the downstairs kitchen has been repaired, meeting a requirement made at the last inspection. 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.
Guildford Road (2a) DS0000013481.V252963.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 Guildford Road (2a) DS0000013481.V252963.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): N/A These standards were not assessed at this inspection. Please see report dated 17th May 2005 for detail on these standards. EVIDENCE: Guildford Road (2a) DS0000013481.V252963.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): 6, 7, 8 and 9 Service users’ changing needs and personal goals are reflected in an individual care plan, they are supported to make decisions about their lives, to take risks in everyday life and are consulted on and take part in the daily running of the home. EVIDENCE: All service users have an individual care plan generated from their assessed needs. The home has a key-worker system in place, and service users and their families are invited to attend reviews and encouraged to participate in the planning process. Service users are encouraged to take part in the daily routines of running the home such as preparing meals and domestic chores as far as they are able and a record is kept of this. Risk assessments are carried out as necessary in order to maintain and promote independence safely. It was pleasing to see that service users meetings are now held and their views are listened to and acted upon this meets a requirement made at the last inspection on 17th May 2005.
Guildford Road (2a) DS0000013481.V252963.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): 16 and 17 Service users’ rights and responsibilities are recognised in their daily lives and they are offered a healthy diet that takes into account their individual needs and preferences. EVIDENCE: The home involves service users as fully as possible in the daily running of the home, they are encouraged to make choices about how they spend their time, who they spend it with, when to get up and go to bed and what to wear. All service users have free access to all communal areas of the home including the gardens. The home has a policy in place regarding the protecting of service users’ dignity and respecting their privacy, of which there is a copy in the service users guide. The home’s kitchens are of a good size and are well equipped and were seen to be clean and in a good state of repair. It was pleasing to see that the broken area on the worktop in the downstairs kitchen has been repaired, meeting a requirement made at the last inspection on 17th May 2005.
Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 11 Four weekly menus are in place, that have been put together in consultation with the service users and these are available in pictorial format so that the service users are able to make informed choices about their meals. Appropriate food hygiene and health and safety measures were seen to be in place, however it was disappointing to see that though a hand towel dispenser had been fitted in the kitchen as required at the last inspection, no paper towels were actually in the dispenser. A requirement has been made to address this. Members of staff were seen to support service users to have their meals in a caring and dignified manner offering different choices of food and drink to each person and service users spoken with said they liked the food and could choose what they had to eat. Guildford Road (2a) DS0000013481.V252963.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 Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The home has a comprehensive policy and procedure in place for dealing with medicines that all members of staff sign to show they have read. The medicines are stored appropriately and securely and there was no surplus stock. Medication administration records were examined these had been completed accurately, with no gaps or errors evident. The medication is supplied in individually named boxes or bottles, with the supplying pharmacist carrying out medication audits three times per year. The manager also carries out audits monthly. All staff members responsible for administering medication receive training from the pharmacy, with practical assessments carried out by the manager. The training is updated every six months. No service users self medicate. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 13 The home has British National Formulary (BNF) books in place that detail medications, their indications and side effects, however the most recent was from 1998 and a recommendation has been made that the home acquires an up to date version of the BNF or an equivalent in order to have the correct information to hand. Guildford Road (2a) DS0000013481.V252963.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): N/A These standards were not assessed at this inspection. Please see report dated 17th May 2005 for detail on these standards. EVIDENCE: Guildford Road (2a) DS0000013481.V252963.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): 27 Toilets and bathrooms in the home provide sufficient privacy however, adequate facilities for the prevention of cross infection is not provided. EVIDENCE: There are sufficient bathing and toilet facilities in the home and adaptations have been fitted as necessary. It was pleasing to see that paper towel dispensers have been fitted in all the bath and toilet areas, but disappointing to note that only one toilet on the ground floor actually had paper towels in the dispenser. A requirement has been made to address this. At the last inspection it was noted that the floor fixing for the handrail by the toilet in the downstairs disabled bathroom was rusty and unhygienic and a requirement was made to rectify this. Unfortunately the fixing was just painted over without treating the cause of the rust and rust is already coming through again. A further requirement has been made to treat the cause of the rust. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 16 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): 35 The staff team is appropriately trained to meet the needs of the service users. EVIDENCE: The home has a training programme in place for staff and individual training records are maintained. Staff members have received training in mandatory areas such as health and safety, moving and handling, food hygiene and fire safety as well as specialised training such as dementia care. Training needs are identified initially at induction and then through the homes supervision and appraisal process. There is a wide range of mandatory and developmental training courses available through the North Surrey Primary Care Trust and Welmede Housing Association, and members of staff spoken with said that they felt they have enough training, supervision and support to carry out their duties well. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Service users views are listened to and acted upon by the home. The health welfare and safety of service users is generally protected by the home, however risk assessments need to be reviewed regularly to ensure appropriate safeguards are in place. EVIDENCE: The home has house meetings that are attended by the care staff and the service users, with any issues raised by, or relating to service users recorded. Welmede Housing Association has recently introduced a service user customer satisfaction questionnaire that has been circulated to service users, their families and involved professionals. Monthly quality assurance audits are carried out by, senior managers and copies of these are sent to the Commission. Welmede also hold residents and advocates meetings for all service users to air their views, these are recorded and actions identified followed up at subsequent meetings. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 18 The home has policies and procedures in place for health and safety that all members of staff sign as read. Health and safety audits are carried out quarterly and there is a programme of routine maintenance and repairs in place. Fire equipment, alarms etc are checked quarterly with alarm tests weekly and evacuations monthly. All members of staff have received training on health and safety issues at induction and are updated annually. The home has undertaken general workplace risk assessments, however these have not been reviewed in over two years. A requirement has been made to address this. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 19 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 X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X 2 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Guildford Road (2a) Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000013481.V252963.R01.S.doc Version 5.0 Page 20 NO 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 27 Regulation 13 (3) Requirement The registered person must ensure that paper hand towels are supplied in all bathrooms, toilets and kitchens in the home in order to minimise the risk of cross infection. The registered person must ensure that the cause of the rust on the floor fixing for the handrail by the toilet in the downstairs disabled bathroom must be treated. If this is not possible the fixing must be replaced. The registered person must ensure that all risk assessments carried out by the home are reviewed regularly as necessary (at least annually) in order to be sure that appropriate preventative measures remain in place. Timescale for action 18/11/05 2 27 13 (3) 23 (2) (b) 15/12/05 3 42 13 (4) (a) (b) (c) 15/12/05 Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 21 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 20 Good Practice Recommendations It is recommended that the home acquires an up to date version of the British National formulary (BNF) on medications or an equivalent publication in order to have current information on medications available to the staff team. Guildford Road (2a) DS0000013481.V252963.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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