Inspection on 26/07/06 for 4 Romulus Close

This inspection was carried out on 26th July 2006.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Romulus Close 09/12/05

4 Romulus Close 19/05/05

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 Romulus Close (4) Dorchester Dorset DT1 2TH Lead Inspector Marion Hurley Key Announced Inspection 26th July 2006 09:30 Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 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 Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 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. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Romulus Close (4) Address Dorchester Dorset DT1 2TH 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) 01305 263479 www.leonard-cheshire.org.uk Leonard Cheshire Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th December 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 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 residents who have significant physical disabilities but has retained a domestic and homely appearance. Both the property and gardens are totally accessible for all the residents. Staff on a 24-hour basis supports residents living at Romulus Close. Each person has an individual service plan 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. Residents are expected to pay for personal items such as clothing and toiletries, and to make contributions to certain activities that are provided outside of the day service programme. Fees are individually negotiated according to the residents needs. Copies of inspection reports are available upon request from the Leonard Cheshire Home administration Office in Dorchester Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over a period of three hours and was completed as an announced inspection. The team leader was present and there was also the opportunity to meet with three members of the support team. Two residents were met whilst the third person was attending Day Services provided by Dorset County Council. One resident’s records were examined in detail as part of the case tracking method. Records and documentation, which related to the specific standards assessed. were read and a tour of the premises undertaken? The home is currently “managed” by the recently appointed Team Leader who at the time of this inspection is in the process of applying to become the Registered Manager. The team leader is being advised and supported in this new role by the Leonard Cheshire Home’s Regional Service Manager. No additional visits have been undertaken since the last inspection in December 2005. There have been no reported accidents or incidents and no complaints or concerns have been raised internally or to the CSCI. Five comment cards were returned with no identified concerns. A pre inspection questionnaire was sent on May 23rd but not completed or returned prior to the inspection. What the service does well: The home provides residents with a pleasant well-maintained environment that meets their individual needs. Staff support residents in their decision-making and ensure residents are able to access local facilities and maintain contact with their family. Residents choose how they spend their time and enjoy positive professional relationships with staff Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 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. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 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 Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 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&5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been no admissions to the home for many years. The Team leader said that admissions would not be made to the home until a full needs assessment had been undertaken. All the residents must have a written and signed contract and or terms and conditions that reflect where they live and the services they receive. EVIDENCE: The present group of residents have lived at Romulus for many years. They are a well-established and settled group. There is no anticipated change for this group of residents. The team leader confirmed their knowledge and understanding of the principles and good practice for admission procedures. However, they were not aware of the Leonard Cheshire Homes’ policies and formal procedures for admissions. The team leader explained that previously the Leonard Cheshire Home’s Service Manager has dealt with all enquiries, referrals and admissions. It is important if the team leader is going to succeed in their application to become Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 9 the registered manager that they familiarise themselves with the Homes’ policies and procedures and are aware of the National Minimum Standards required to ensure this standard is met at future inspections. Not all the residents have completed contracts and or terms and conditions and this is in part due to the fact that this group have lived and been supported though the Leonard Cheshire Services for over 20 years. However, each resident must have an individual written contract or statement of terms and conditions. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their care assessed and planned satisfactorily and in a way that reflects their individual preferences and abilities. However, the monitoring and reviewing of care is neither consistent nor explicit and the care plans do not illustrate how staff have established and worked to understand the resident’s preferences. On a day-to-day basis staff focus on understanding the needs and wishes of the residents and this positive practical work needs to be reflected in the care plans. EVIDENCE: Care /support plans and risk assessments were in each resident’s file that was seen but several sections had not reviewed. There was little evidence to indicate that they had been drawn up with the involvement of the resident. However, one family had clearly provided a considerable amount of valuable information which staff appreciated. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 11 There was some evidence that residents right to make decisions about their lives were respected. This included choice at mealtimes, decisions about what to wear and how much time to spend alone or with others. There were a considerable number of risk assessments but these did not correspond with the care/support plans and where these had been reviewed staff were not able to recall or describe how the assessor had reached the recoded conclusion of “no change”. However, discussions with staff indicated their understanding and knowledge of each resident and they provided clear descriptions of the different methods each resident had adopted for indicating their likes and dislikes and needs. This information needs to be added to the care plans to ensure they truly reflect a current profile of the resident’s abilities and needs. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for leisure activities are varied and appropriate and are linked to residents’ individual interests and competencies. Residents are offered a healthy diet based on choice. EVIDENCE: One care/support plan viewed for the purpose of this inspection provided information regarding the residents’ activities and how they were encouraged to pursue their choice of activity and where possible develop their independent living skills. One resident continues to attend a day centre, others undertake various activities from physiotherapy to boat trips, shopping, walking, swimming and cooking. Another enjoys participating in various activities organised from Weymouth Outdoor Education Centre. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 13 Documentation confirmed that residents are supported to go on holiday and staff spoken with said that this is discussed with residents during their one to one days. An activity chart is maintained which provides a “timetable” for the week. However, staff and the team leader emphasized that it is only used as a guide and if opportunities arose these would be flexible to take advantage appropriate opportunities. A meal was seen in preparation and one resident had been encouraged to be involved in the different aspects from looking at the cookery book to observing staff in the kitchen. Evidence was seen that balanced healthy meals were provided and the fridge and freezer were well stocked. Fresh fruit and vegetables were available for residents. Staff were able to say how residents made meal choices and records were seen where residents had chosen an alternative. Staff support residents to maintain links with their families and friends. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health care needs are well understood and met by staff in a sensitive and appropriate way. Residents are safeguarded by the medication procedures within the home. EVIDENCE: Residents personal support needs were individually assessed but again, as previously identified, not regularly reviewed. (NMS 6) Staff were clear how much support each resident required. There are both male and female support workers working with this all male household. However, staff felt confident this did not infringe any residents privacy or preferred choice of male or female worker. Records showed that residents were supported to access health care facilities including dentist, opticians and community nurses. GP and other health records showed that individuals had attended appointments and the outcome of the visit. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 15 No residents have the capacity to retain or administer their own medication. Medication procedures were inspected and these were satisfactory. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by policies and procedures and staff understanding. EVIDENCE: Staff spoken with were able to discuss with understanding what constituted adult abuse and confirmed that they had received relevant training. Staff spoken with said that they felt confident to both challenge poor practice amongst colleagues and raise it with management. Leonard Cheshire Homes Administrative Office, Dorchester has a copy of the Dorset Protection of Adult Protection Procedures. The protection of vulnerable adults is covered as part of all staffs’ induction No complaints have been received about this service either to the home or the CSCI. All residents have their own bank accounts. However, no residents have a real understanding of the value of money. Money and records kept were satisfactory. The residents have limited verbal skills to communicate any concerns and staff described how they observe any changes in the residents’ behaviour both for positive reinforcement and/or negative reactions to situations or people. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A homely environment is provided which is mostly safe and comfortable. The internal environment meets the needs of the residents and sufficient toilet and washing facilities are provided. The kitchen is in need of refurbishment; the quality of this specific area is poor. Residents appeared relaxed and at ease in the home environment EVIDENCE: A tour of the home was undertaken and all the communal areas were considered to be comfortable. However, an immediate hazard was identified in the kitchen. The wall mounted central heating boiler situated just above a counter/work surface, was very hot to the touch and within easy reach of both staff and residents to touch or potentially strike their heads on. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 18 The bedrooms are personalised and reflected the individual interests of the residents though one room appeared short of storage and a chest of drawers would benefit from being replaced. Staff reported that the bathroom continues to have on going damp problems despite efforts to improve this and there were no tops on the taps identifying which was the hot or cold taps. New taps are required. The home has a separate utility /laundry room. The home is equipped to meet the physical needs of residents and one bedroom is fully equipped including overhead tracking to support manual handling from the bedroom to the ensuite bathroom. It is recommended the kitchen is fitted with an adjustable height work surface to enable any resident who is a wheel chair user to be able to participate in food preparation. One section of the garden fencing needs to be replaced. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are offered regular training and supervision and all mandatory training is provided for staff in order to ensure that they have the knowledge and skills to undertake their work. However, at the time of this inspection not all the staff had received fire training in the last six months. Staff are employed in sufficient numbers, which enabled them to meet the needs of the residents. Residents are safeguarded by the homes’ recruitment procedures. EVIDENCE: Staff training files were viewed and showed that staff attended a variety of training that supported them in their role. Staff spoken with confirmed that they were encouraged to attend training courses. All staff that work for Leonard Cheshire Homes attend induction training that takes them through their competencies and skills needed to work with people with learning disabilities. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 20 All staff receive a job description and a copy of the General Social Care Council Code of conduct ensuring they are aware of the standard they are expected to work to. Staff spoken with said that they worked well as a team and felt supported by their team leader. Staff receive regular supervision that looks at their personal development needs and monitors their work with residents. The rotas showed that staff worked flexibly and are prepared to cover for colleagues when necessary to ensure the lives of the residents are not affected by any staff changes. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a general relaxed atmosphere with the interests of the residents kept to the fore; however, these could be further enhanced through a more structured approach to monitoring the quality of services. Residents health, safety and welfare were generally being protected however, a percentage of staff have not received fire training for over six months. EVIDENCE: The team leader has commenced studying for the National Vocational Qualification level 4. Staff spoken with said the team leader gave clear guidance as to the standard of care expected and was supportive and open. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 22 At this stage the team leader has not been given the opportunity and time to familiarise themselves with all the roles and responsibilities of becoming a registered manager for this service and it is important that senior managers within the Leonard Cheshire Homes address this. The team leader explained that monitoring the quality of services at the home remains on an informal basis mainly through direct work with staff and contact with the residents. The Leonard Cheshire Foundation must develop a formal Quality assurance system for monitoring the quality of car and services provided to this group of residents. The responsible person representing Leonard Cheshire Homes undertakes monthly monitoring visits “Regulation 26” and these comprehensive reports are sent regularly to the CSCI offices. There were no obvious hazards noted within the home. Residents’ records were safely and securely stored. The Leonard Cheshire has a number of policies and procedures. However, it is important these are regularly reviewed and updated. Information on the running of the home is well maintained i.e. servicing contracts. From observations of the residents, it would seem that they felt comfortable in the home and were looked after by staff that genuinely cared and understood their needs and responded to them. Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 2 X Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 24 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 YA5 Regulation 5(1)(b)(c) Requirement The registered provider/manager must ensure that all residents have a written and costed contract/statement of terms and conditions. The registered provider/ manager must develop and agree with each resident an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The plan must be reviewed at least every six months and updated to reflect changing needs. The registered provider/manager must ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. The home’s premises must be accessible, safe and well maintained. Timescale for action 30/11/06 2. YA6 15 (1) (2) (a) (b) (c) (d) 31/10/06 3. YA24 13(4)(a) 31/10/06 Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 25 4. YA39 8(1) 9(1)(2) 5. YA39 24(1)(2) (3) 6. YA42 23 The registered provider must 30/11/06 appoint a manager who is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Effective quality assurance and 30/11/06 quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. The registered / provider 31/08/06 manager must ensure all staff receive fire training within the required timescales. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole 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. Extracts may not be used or reproduced without the express permission of CSCI Romulus Close (4) DS0000026749.V296604.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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