Inspection on 19/05/05 for 4 Romulus Close

This inspection was carried out on 19th May 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 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

4 Romulus Close 26/07/06

4 Romulus Close 09/12/05

4 Romulus Close 15/02/05

4 Romulus Close 03/08/04

4 Romulus Close 23/12/03

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 4 Romulus Close Dorchester Dorset DT1 2TH Lead Inspector Marion Hurley Unannounced 19 May 2005 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. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 4 Romulus Close Address Dorchester Dorset DT1 2TH 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) 01305 263479 Leonard Cheshire Dorchester Homes Mrs Elaine Bernice Grant CRH PC - Care Home Only 3 Category(ies) of LD - Learning disability (3) registration, with number of places PD - Physical Disability (3) 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 15 February 2005 Brief Description of the Service: Romulus Close is a registered care home accommodating three adults who have a learning disability, and additional physical disabilities. The home is one of seven similar services in Dorchester that are owned by the Leonard Cheshire Foundation, a ‘not for profit’ organisation providing services to people with disabilities. The Registered Manager, Mrs Elaine Grant, is based at the provider’s local office in Alexandra Road, Dorchester. She is also the Manager of three of the other Leonard Cheshire homes in Dorchester. The bungalow is located in a popular residential area of Dorchester, within walking distance of the town centre and local facilities. The physical environment has been adapted and equipped to meet the needs of service users who have significant physical disabilities; however, the house retains a domestic and homely appearance and feel. Both the property and gardens are totally accessible for all the residents. Service users living at Romulus Close are supported by staff on a 24-hour basis. Each person has an individually tailored plan of support to assist them to live as independently as possible, and to take full advantage of social, educational and work opportunities available to them. The service provided includes the provision of accommodation, day services, personal care, meals and laundry services. Service users are expected to pay for personal items such as clothing and toiletries, and also make contributions to certain activities that are provided outside of the day service programme. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act, 2000. Romulus was assessed according to the Care Home for Adults (18-65) National Minimum Standards. The overall time spent to complete the inspection process was a total of five hours, two of which were spent at Romulus. In the course of this inspection both the Registered Manager and Responsible Individual were available and two members of the staff team. Two residents were present and participated and contributed in their own individual non-verbal ways. All records, documents and files were easily accessible on the day. The premises and garden are well maintained and suitable to meet the needs of the three residents. From observations and discussions with staff it is clear there is positive job satisfaction and they genuinely enjoy the company of the residents. The residents are equally “comfortable” in the presence of the staff. This was a positive inspection of a service that continues to develop and aim for high standards of practise working side by side with residents with varying abilities and complex needs. The inspection process was assisted by the openness of the staff and management and the inspector was grateful for their time and commitment to the inspection. What the service does well: Staff work very positively with the three residents supporting and supervising each to lead active lifestyles, participating in a range of leisure and social events both locally and nationally. Staff have established good working relationships with Doctors and Consultants ensuring the health and general well being of each resident is maintained and carefully monitored. The standard of cleanliness and hygiene was good on the day of the inspection. All the residents have their own bedrooms, which have been personalised. The home has a committed staff team who appear well informed about the needs of the residents. Romulus has a homely and busy atmosphere and the staff spoken with on the day of the inspection stated they were always “seeking the best for the residents” 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 6 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. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed at this unannounced inspection. One recommendation from the previous inspection remains within the timescale for completion and will be fully assessed at the next inspection. EVIDENCE: 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 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 standard(s) 6,7,8,9 • • • Care Assessments and Plans are in use for each of the residents. Each plan incorporates risk assessments, which indicate where residents are particularly vulnerable and what action must be taken to safeguard each resident. Residents are encouraged to participate and make decisions in all aspects of their daily lives to enable them to retain as much independence as possible. The level of participation is very personal to each resident’s abilities and interests. EVIDENCE: Two residents were met during the course of assessing the above outcomes, neither were able to formally indicate their understanding of the assessment /care plan process. One person intermittently observed while their care assessment and plans were read and discussed with staff. Each person has a support plan, which is a combination of care assessments, and plan. These documents contain a lot of relevant detail but do not give the reader a feel of the person and this is partly due to some of the terminology used which refers to people as “ clients”. The support plans set out how their 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 10 current needs are met but do not clearly identify short /long term goals for each person. Some documents had been reviewed whilst others had not and this included some risk assessments. The risk assessments were generic and not specific to the individual person (in name only) and because they had not all been reviewed there was no evidence to indicate how that person’s behaviour may have changed and developed since the assessment was originally completed. All assessments/plans should be reviewed every six months to reflect any changing needs/abilities. The Registered Manager and staff need to consider ways to develop and produce a simple plan for each resident which through graphics and symbols may be recognisable to them and reflect their different activities. Observations of the two staff working with the two residents present during the visit very clearly indicated their understanding and excellent communication skills with the residents. They seemed relaxed in each other’s company. Several times a resident would lead one of the staff to what they wanted or needed. Residents participate at varying levels in the running of the household this varies from one person smiling to acknowledge a question while others contribute to domestic chores i.e. vacuuming, washing up. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14, • • Residents are given every opportunity to learn and develop through participating and experiencing a wide range of appropriate leisure and daily living activities. Residents with staff support and supervision use the local community and facilities, which enhance the residents’ local network and understanding of the community in which they live. EVIDENCE: It was evident from reading the individual diary entries and talking with the two staff on duty that residents are given every opportunity to learn and develop. Such are the residents disabilities they would not be able to participate in any activities without intensive staff support and in some cases this will require a ratio of 3:1 to simply but safely go to the local shops. The staff described a recent and very successful holiday for one of the residents who benefited from the individual time with two members of staff. This enabled the person to try new activities they otherwise find more difficult and stressful in a group situation i.e. eating out in restaurants, going on ferry trips, enjoying long walks. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 12 Residents participate in many activities some of which enhance their daily living i.e. hydrotherapy, reflexology massage and others for pure fun e.g. canoeing, and water skiing, cart riding. Residents access all local amenities and go to the local pubs for suppers and use all the local shops. Residents assist according to their abilities and interest in kitchen and household tasks. Some residents attend day services and mix with a wider peer group others enjoy and are more comfortable pursuing activities that are one to one. Trips and entertainment are organised sensitively given the resident’s complex needs and the unnecessary trauma these could cause. One resident enjoys music and television and at the time of the visit was enjoying watching a favourite film. Their body language, laughter and gestures certainly demonstrated their delight at watching this film. Activities at home are generally more limited to relaxing times for recreational music, videos, and birthday celebrations. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 ,19 & 20 • • Staff provide flexible support and personal care for each resident ensuring their health and general well-being is carefully monitored and maintained. Medicines in the custody of the home must be handled according to the requirements of the Medicines Act 1968. EVIDENCE: Residents are not able to take control of their own healthcare needs, however there were clear records which indicated staff ensure residents health and well being is carefully monitored. Records of medication received, administered and leaving the home or disposed of were not found to be in sufficient detail to ensure a thorough a audit could be undertaken at any time. Each resident has a comprehensive support plan which incorporates many aspects relating to their health and general well being. There was not sufficient evidence in the records to indicate that moving and handling assessments are regularly reviewed and adjusted to meet the resident’s changing needs. A record of appointments and outcomes with health and other related professionals were available in the resident’s files. All residents are registered with local GP’s who staff said were extremely helpful and 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 14 understanding in their management of the residents’ sometimes complex health and emotional needs. Aids and adaptations have been discreetly incorporated into this family style home. Behavioural and emotional changes are carefully monitored and staff work closely with specialist nurses and consultants to establish realistic methods of supporting residents to encourage their potential and life experiences. If a resident requires in patient hospital treatment 24-hour support is provided from the home. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 15 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. • The current group of residents would have great difficulty in understanding the concept of a complaint or information on the subject However from observations it was evident staff listen carefully and do act on the residents views and wishes and moods. EVIDENCE: Staff are sensitive and have identified what residents like, dislike or object to and explore avenues to overcome any difficulties. The three residents all have different levels of comprehension and each has developed their own method of indicating their pleasure or apprehension. Staff explained they have learnt to interpret the gestures through a process of elimination and through their own observations of the residents. One person will put his hands up palms facing you if he feels you are crowding his space another makes distinct noises for yes and no. Staff have considerable intuitive knowledge and it would be advantageous for this to be recorded in the residents support plan. The plans contain some information about communication but when talking with the support staff their sensitivity and detail surpassed the written documents. No complaints or concerns have been raised since the last inspection. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 16 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) 24,25,26,28,29,and30 • • • • Romulus provides a homely comfortable and safe environment for the residents. Residents have their own bedrooms. All have been personalised to reflect their interests and provide a safe but stimulating environment. Specialist equipment has been installed as required to maximise individual potential and independence of residents. There is sufficient communal space and on the day of the inspection the premises were clean, creating a safe and comfortable environment for both residents and staff. EVIDENCE: Romulus is a bungalow and totally accessible for the residents. A tour of the premises and garden were completed. Staff work hard to maintain a bright, homely and cheerful environment. Each bedroom has been fitted and furnished according to resident’s interests, and needs. Residents would not be able to use locks on their bedroom doors. The residents have access to the separate dining room, lounge, kitchen, utility/laundry room and a good size garden. There is a staff sleeping in room. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 17 The home has a domestic style washing machine and tumble drier. The washing machine has a cycle, which will wash, to temperatures of 95 degrees centigrade. Any foul laundry is washed in dissolvable sealed “ red bags”. Staff were well briefed on aspects of COSHH and when asked were able to competently explain the Home’s procedures for the control of infection. Chemicals are kept securely in locked cupboards in the utility room. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 18 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) 36 • All staff receive regular supervision and the support they need to carry out their jobs and this helps maintain a quality staff team working for the benefit of all the residents. EVIDENCE: Two staff, both support workers were met at the time of this unannounced inspection visit. Both stated they felt well supported by the management and other members of the staff team. They explained that informal supervision was always available from senior staff whilst formal supervision was regularly conducted with their Manager. Notes of supervision sessions were checked. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 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 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) 37,38,42, • • The Registered Manager is competent and experienced to run the home and is currently studying for NVQ level 4 in both management and care studies. At the time of this unannounced inspection safe-working practices appeared to be satisfactory ensuring a safe environment for both residents and staff. EVIDENCE: The Registered Manager has created an open and inclusive atmosphere within Romulus and on the day of this inspection visit the staff, manager, and residents were confident and happy in each other’s company. Two staff on duty stated they had received manual handling training (April 2005) and fire prevention training. The last “simulated fire evacuation”, which always includes residents was completed in February 2005. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 20 There is a comprehensive training matrix which clearly indicates when staff have received training and when refresher training for mandatory courses is due. This confirmed previous information received. The Training Co-ordinator who is based in the Leonard Cheshire Administrative Office in Dorchester ensures this information is kept up to date and then passed to the Regional Office to be included in the Regional Training Matrix. The house is fitted with smoke and heat detectors in addition to fire extinguishers and blankets. All staff have completed basic first aid training and all members of the management team are Approved First Aiders and available on a 24 hour call out basis. From discussions with the Manager it was evident they are fully aware of their responsibilities for the practical day-to-day health and safety issues for both residents and staff. However overall management responsibility for fire prevention, risk assessments and safe working practises is the responsibility of the designated “Health & Safety” employee who is based at the Dorchester Administrative offices. This person has completed a range of risk assessments. These assessments are generic and do not specifically relate to the individual residents and their different abilities and understanding of risk and personal safety. It is important these risk assessments are completed and regularly reviewed with or by staff that live and work side by side with the residents and who therefore have a good practical understanding of the residents abilities and needs. All electrical testing has been completed. Certificates and records verifying this information were readily available and checked. The designated responsible person, on behalf of Leonard Cheshire Homes, completes monthly visits. The reports are detailed and regularly provided to the CSCI offices. The last report in April 2005 indicated there were no areas of concern. Residents were not able to contribute to discussions concerning health and safety issues but from observations and discussion with staff residents appear to be thoughtfully and safely looked after. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 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 x x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 4 Romulus Close Score 2 3 x x Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 2 x D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 22 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 42 Regulation 23 Requirement All staff must receive three monthly fire training by a competent and qualified person Timescale for action 1st August 2005 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 5 Good Practice Recommendations Each resident should have an individual costed contract/statement of terms and conditions between themselves and the home. This recommendation is carried forward from the inspection in February 2005 as this standard was not fully assessed at this inspection. The individual care/service user plans need to be written based on the principles of Person Centred Planning and should include a record of the residents short and long term goals and acheivements. Risk assessments should be reviewed regularly and provide details of who has been involved /consulted with during the assessment process. Risk assessments must reflect the individual residents abilties/needs and the hazards applicable to them and the plan of actions to minimize the hazards and risks. The medication recording sytem should allow for an audit to be undertaken of the medicines received into the home. This recommendation is carried forward from the previous D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 23 2. 6 3. 9 4. 20 4 Romulus Close 5. 35 6. 42 inspection undertaken in February 2005 as this standard was not fully assessed at this inspection. Each member of staff should have an individual training/devlopment plan. Staff training must be linked to the needs of the residents. This recommendation is carried forward from the previous inspection undertaken in February 2005 as this standard was not fully assessed at this inspection. There should be evidence that the moving and handling assessment/plan for residents have been reviewed and updated regularly. 4 Romulus Close D55 S26749 4 Romulus Close V227807 190505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF 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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