Inspection on 26/04/05 for 33 Blanford Road

This inspection was carried out on 26th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

33 Blanford Road 04/04/07

33 Blanford Road 23/08/05

33 Blanford Road 23/11/04

33 Blanford Road 26/08/04

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

CARE HOME ADULTS 18-65 Blanford Road 33 Blanford Road Reigate Surrey RH2 7DP Lead Inspector Mrs Sue McBriarty Announced 26 April 2005 th 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. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Blanford Road Address 33 Blanford Road Reigate Surrey RH2 7DP 01737 243818 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) Prospect Housing Association Mr Anthony Berner Care Home 6 Category(ies) of LD - Learning Disability (4) registration, with number of places LD(E) - Learning Disability over 65 (2) PD - Physical Disability (1) PD(E) Physical Disability over 65 (1) Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 8. The age range of service users falling within catergories LD(E) or PD(E) is 65 years and over 2. Of the four residents within category LD, up to 1 may also fall within category PD (physical disability) 7. The age range of service users falling within the categories LD or PD is 40 64 years 6. Of the two residents within the category LD(E), up to one may also fall within category PD(E) Date of last inspection 23rd November 2004 Brief Description of the Service: 33 Blanford Road is a detached bungalow located in the town of Reigate. The home is registered for six adults with both learning and physical disabilities. the home is owned and managed by Prospect Housing Association. Service users have their own individual bedroom and share adequate bathroom, toilet and shower facilities. The combined lounge and dining room are domestic in character with views over a nicely and well-stocked large enclosed garden. Furniture in the lounge is sufficient and can accomodate all the service users including those in wheelchairs. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the first for 2005 – 2006. Previous inspection reports are available from CSCI on request. During the inspection three service users and four staff were seen excluding the manager and head of services. The three service users had complex needs and were not able to offer their views without considerable support. Two staff were spoken to in depth as was the manager and head of services. Documents including care plans, risk assessments, policies and procedures and personnel files were sampled. The manager had completed a pre-inspection report; unfortunately no comment cards had been completed by service users, families or other professionals and sent to CSCI. What the service does well: What has improved since 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. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 6 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 Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 7 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) 2, 3, 4 Information about the home was available for new service users and they would be able to visit the home before making a choice about living there. There was evidence of assessments being undertaken prior to a new service user moving into the home. EVIDENCE: The home was working with a group of professionals to offer care and support to a new service user. Assessments were underway and the person had been able to visit the home to meet the other service users. The manager and head of learning disability services were working together to make sure they could meet this person’s needs. This is the first new person to be admitted for some time. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 8 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, 8, 9, 10 The service users care plans were based on observations by staff and their knowledge of the person. All aspects of daily living and risk assessment formed part of the care plan and confidential information was stored securely. Some work is required with regard to the care plans and risk assessments. EVIDENCE: The current service users have complex needs and had limited verbal skills. The staff at the home know the service users well and are able to understand their various methods of communication. This includes either a change in behaviour or individual style of the use of makaton. Some of the service users had some speech and were make simple needs known. Each of the service users had a detailed care plan that noted their likes, dislikes, support and care needs. Staff had signed the plans, however the service users were unable to sign their own care plans due to their disability. There were no signatures from external representatives. The staff encouraged service users to make their own decisions and during this visit several observations were made of staff reacting to service users. For Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 9 example one person wished to return to their room and the member of staff checked that this was what they wanted and then did as asked. The home provided detailed risk assessments for each service user noting each aspect of their daily life. The risk assessments were reviewed regularly and signed by staff. The service users had not signed the risk assessments. It is required that where service users are not able to sign either their care plans or risk assessments as they either unable to sign their name or may not fully understand the content that this is recorded. The care plans and risk assessments should note the reason why someone else is signing on their behalf. All information regarding service users is held confidentially in a lockable office. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 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 standard(s) 12, 13, 14, 15, 16, 17 The home assists the current service users with their finances and maintains appropriate records. A wide variety of activities are made available both in the home and outside of the home. Where families are involved the staff seek to maintain contact. The menus were seen and a simple lunch sampled, the arrangements for service users meals were good. EVIDENCE: The home was acting as appointee for some service users and was aware of those who had funds held elsewhere. The fact that other funds were held was briefly noted within their care plans. However the details were held separately. It was recommended that the home detail any financial issue within the care plans as they already do with benefit information. The petty cash system was looked at and contained the information needed to assist an audit. Prospect Housing Association’s finance department regularly go to the home to check the petty cash and sign individual service users files. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 11 The service users had access to a wide range of activities including the ‘music man’ who visits the home on a regular basis. An activities co-ordinator also works at the home. Their hours are usually Monday to Friday during the day but they are able to work flexibly and will help out at the weekends if needed. On the day of the visit one service user was out all day, another for part of the day and a third was enjoying their new television. It was not possible to discuss the views of the service users with them without considerable support and planning. Throughout this inspection staff were heard and seen talking to service users with respect and warmth. Those service users seen all required some help with getting about the home and staff were seen to be responding to those needs in a safe and supportive way. The menus for four weeks were seen and were said by the manager to show the service users favourite meals. The staff spoken to during this inspection stated that they meet with the service users each month to discuss menus confirming what the manager had said. Fresh fruit and vegetables were seen. The home is introducing a new way of showing service users what is for breakfast, lunch and dinner. At the time of this visit only breakfast was seen. Photographs had been put by the hatch from the dining room to the kitchen showing the choices available. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 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 standard(s) 18 19 ,21 Personal care needs were being met in the way preferred by service users. Detailed health action plans were in place. Policies and procedures were in place to support those who may be ageing, ill or dying. EVIDENCE: The care plans had recently been updated and showed in detail the needs of each of the service users. Their preferred way of being supported was noted. All the current service users needed help with personal care. Health action plans were in place and recorded what each person needed and how and when their needs were met. The plan included for example; hospital admission dates, chiropodist appointments and doctors appointments. One persons review noted that they needed staff to be able to use makaton; no training has been given as yet. A requirement has been made to provide the training in order to ensure this person’s needs are met. The home has a key worker system and a photograph of a service users key worker is kept in the bedroom of each person. The manager and head of learning disability services were uncertain about consent issues when supporting people with health that needed an operation or similar. It is recommended that the organisation seek advice and training on this subject. This to ensure that staff are not asked to give medical consent on behalf of a service user. Information is also available through the Internet on the Lord Chancellors website for areas of capacity and consent. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 13 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 The home has both a complaints procedure and adult protection procedure in place. The staff team know what action to take if any concerns arise. EVIDENCE: The pre-inspection report noted that no complaints or adult protection concerns had been made in the last twelve months. The home provides adult protection training for staff during their induction and a copy of Surrey County Council’s multi-agency procedure for the protection of vulnerable adults policy was available in the office. The staff spoken to during this visit were clear that they could talk to the manager or deputy manager on any issues and were clear about what to do if they were worried. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 14 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 There are a number of areas in the home, which require attention, and more work could be done to make it safe, homely and well presented for the people living there. EVIDENCE: The home was toured during the inspection and all but one bedroom was seen. One person agreed to show the inspector his room but was not able to talk about his views. The rooms had been personalised and two of the bedrooms seen had small electric sensory lights to aid relaxation in the evenings when getting ready for bed or when in bed. One person had a new television with a flat screen, which he was very pleased with as observed by the inspector. The bathroom had an assisted bath with tracking for a hoist available. There were adequate toilets and baths for the size of the home. Liquid soap was provided in the bathroom but no paper towels. It is required that the bathroom and kitchen are provided with liquid soap and paper towel dispensers. It is strongly recommended that staff members are provided with an alcohol scrub to wash their hands when supporting people in Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 15 their rooms. The staff members were providing personal care on a regular basis and there is a risk of cross infection. The kitchen was clean and tidy and documented evidence was seen of the temperatures of the fridge and freezer being taken. Dates had been put on food being stored in the fridge to reduce the risk of food poisoning. The freezer was locked in the shed and the top and sides were very dirty. It is required that the freezer is cleaned and kept clean. The shared areas were a good size and had enough space for wheelchair users. The room has not been decorated for some time and the furniture is ageing. Some parts of the room show damage where wheelchairs had knocked against the wall. One area had been covered in a clear hard plastic to reduce the amount of damage. The rooms were clean but appeared dark because of the decoration and furniture. A previous requirement to replace the furniture and redecorate has not received action since the last CSCI inspection and has been carried forward to this report. The garden was pleasing to see. The service users had access to the grounds that were kept clear and had a good range of plants to see and take pleasure in. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 The organisation had policies and procedures in place for the recruitment and selection of staff. Full training records were held at the home. However some changes were required in respect of where records were being kept. All staff received appropriate training and supervision taking into account the service users needs. EVIDENCE: The pre-inspection reports and records within the home show a good range of training. The home’s induction training included first aid, food hygiene, adult protection and fire safety. The staff also completed the Learning Disability Award Framework (LDAF) induction and foundation standards. The home had six care staff that had their NVQ Level 2 and a deputy manager who is a qualified nurse. Training in Makaton has already been highlighted in this report so that staff can communicate with one of the service users. The manager had a training plan for all staff members that noted what training was provided to whom and when as well as what training was still needed. Job descriptions were held separately in the office to enable staff to have access to them if they wished. Some of the staff files held the original CRB checks and other photocopies of the original. One reference for a staff member was unsigned. It is required that all the original CRB checks are held at the Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 17 home in order that they may be inspected by CSCI. The home has the copy of the checklist followed by the organisations human resources department that shows all the checks required and on what date the information was received. It has been recommended that references are checked to ensure that these are signed. Staff members were supervised on a regular basis, and ongoing formal supervision sessions had been booked for some while to come. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 18 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) 37, 38, 39 , 40, 41, 42 The home had an open and inclusive approach where staff and service users were listened to. Records, policies and procedures were updated regularly. Staff training was provided and recorded in full. Further progress is required with regard to maintaining cleanliness in some areas and staff records. (see also the sections on Environment and Staffing).` EVIDENCE: The manager had nearly completed the registered managers award and was doing the NVQ Level 4 at the same time. The managers training record was seen and showed that he had regularly received training in food hygiene and manual handling as well as other core training requirements. At the time of this inspection the home had two vacancies and had reduced the staffing levels until the service user vacancies were filled. Two staff not including the manager were on each day shift and two staff on nights, one Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 19 waking and one sleep-in. The head of learning disabilities services stated that the staffing team would increase as soon as new service users enter the home. The staff spoken to during the visit felt that the home had a good staff team that supported each other and the service users. They felt able to talk to the managers and let them know if they had any concerns. Last year (2004) the home took part in a quality assurance check, however they have not received the report as yet. The manager stated that he will forward a copy to CSCI as soon as it arrives. The quality assurance check included services users and took note of their views. The pre-inspection report noted that Prospect Housing Association completed the review of it’s policies and procedures in January 2005. Staff sign that they have read and understood the policies. All staff and service user records were up to date. The pre-inspection report noted that all the health and safety checks required had been completed. In general the home ensures the health, safety and welfare of the service users. Some requirements were made during this visit including keeping the freezer clean externally and providing staff with paper towels to prevent cross infection. Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 20 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 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Blanford Road Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 x H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 21 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 6 Regulation 15(1)(2) ( c) Requirement Timescale for action 31st May 2005 2. 24 3. 4. 30 30 5. 34 6. 35 The registered person must ensure that where possible the care plans and risk assessments of service users who cannot sign are signed by a third party external to the home. 23 The dining and lounge areas require re-decorating and refurbishment. (Timescale of 23rd December 2004 not met) 13(4)( c) The freezer must be cleaned and 23(d) defrosted on a regualr basis. 13(3)(4)( The registered person must c) ensure that liquid soap and disposable paper towels are provided in the bathroom and kitchen to prevent cross infection. 19(1)(a)(c The CRB and identity records are ) to be kept at the home in order Schedule to ensure that they can be 2, inspected by CSCI. Schedule 4 (6)(f) 18 The registered person must (1)(a)(c)(i ensure that staff receive the ) required training in Makaton 29th July 2005 6th May 2005 31ST May 2005 31st May 2005 30th June 2005 Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 22 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 12 19 Good Practice Recommendations It is recommended that the registered manager detail within the care plans the financial standing of particular service users funds in addition to their benefits. It is recommended that the registered manager and staff receive training and or seek good information regarding medical consent and that individual service users needs are noted in their care plans It is strongly recommended that staff are provided with an alcohol scrub to wash their when providing support in service useres rooms. 3. 30 Blanford Road H58_s13487_Blanford Road_v213425_250405_stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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