Inspection on 15/02/07 for 42 Twyford Gardens

This inspection was carried out on 15th February 2007.

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

Other inspections for this house

42 Twyford Gardens 01/05/08

42 Twyford Gardens 29/05/06

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 42 Twyford Gardens Worthing West Sussex BN13 2NT Lead Inspector Mrs K Allen Unannounced Inspection 15th February 2007 2:00pm 42 Twyford Gardens DS0000066941.V327352.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 42 Twyford Gardens DS0000066941.V327352.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. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 42 Twyford Gardens Address Worthing West Sussex BN13 2NT 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) 020 8544 8900 www.caremanagementgroup.com Care Management Group Limited Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 To accommodate one service user in the LD(E) category First inspection Date of last inspection Brief Description of the Service: 42, Twyford Gardens is a care home registered to provide care and accommodation for up to 4 people with a learning difficulty. It is a detached bungalow and situated in a residential street on the outskirts of Worthing, West Sussex yet close to shops and other amenities. All of the residents have a single room on the ground floor, three of which are fitted with overhead hoists. Each room has en-suite facilities. Communal space consists of an open plan lounge/dining room and kitchen. There is a rear garden mostly laid to lawn with a ramp for wheelchair access to the patio. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the site visit a review was made of the contact between the home and the Commission for Social Care Inspection (CSCI). This included an analysis of incident reports and those of other statutory bodies such as the fire service as well as any complaints and changes to the registration of the home. The manager completed a pre-inspection questionnaire prior to the site visit, in order to provide up to date information about the home. This visit took place from 2.00pm over three hours. Two people are resident at the home. One was in hospital but the other person was available and spoke to the inspector in the presence of staff. Two staff were interviewed and observed going about their duties. A senior member of staff assisted with the provision of records. Five requirements and four recommendations have been made. They are shown under the heading below - ‘What they could do better’. What the service does well: What has improved since the last inspection? What they could do better: The needs of prospective service users must be assessed so that the home can be sure it can meet their needs. A written record must be available. Residents must be provided with a programme of activities and have access to the local community. This would necessitate wheelchair accessible transport. A manager must be registered for the home. Monthly monitoring visits on the conduct of the home must be carried out. Arrangements must be in place to record all accidents. Please contact the provider for advice of actions taken in response to this 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 42 Twyford Gardens DS0000066941.V327352.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 42 Twyford Gardens DS0000066941.V327352.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate Prospective service users needs are not always fully assessed prior to coming into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current resident had a full written assessment. However there was no written assessment available, for a second person who had been at the home for a few weeks, but was currently in hospital. A third person was being introduced to the home and had had one visit and was due to stay overnight. There was no available written assessment for this person. This matter was discussed with the staff on duty who stated that assessments were carried out but were unable to produce any written documentation. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. Service users needs are reflected in an individual plan of care. They are assisted to make decisions about their lives and are supported to take risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a written care plan for both residents, which give comprehensive details of their needs and how they are to be met. They include social interests and cultural needs. Staff assisted the person living at the home to make choices for example about how she wished to spend her time. They encouraged her to speak for herself and to express her opinion. Limitations are placed on her due to a lack of resources at the home. (see Standard 13) 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. Service users are not always able to take part in age or culturally appropriate activities, or to be part of the community. Service users have appropriate personal relationships. Their rights are respected in their daily lives and they are provided with a good diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no programme of planned activity. Staff endeavour to occupy the current resident within the home and by short trips to the local shops. They have made links with a local college with a view to a part-time programme being set up. The person concerned expressed a wish to go to the cinema but this had not taken place. There is no transport at the home suitable for a wheelchair user and therefore trips other than those within easy walking distance are more difficult. Staff confirmed that a suitable vehicle is due to be delivered in two 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 11 weeks and were discussing the type of activity the resident would enjoy. These included horse riding and swimming. Contact with family is encouraged. Plans were in hand to accompany a resident on a visit to her family. With just one person living at the home it was possible for the routines to be flexible and in line with her wishes. Staff consulted regularly about when and where to do things and were keen to keep the person concerned motivated. They encouraged her independence and ensured her privacy when attending to personal care. They confirmed that she did not like the door to her room locked but were careful to close it when need be. There is unrestricted access to the home and there is a ramp to the garden patio. The garden lacks interest and staff expressed a wish to improve it with planting and more paving. Meals are provided on an individual basis with a personal menu for each resident. This shows that a varied diet is provided. The current resident was happy with her food which reflected her cultural identity. Staff were keen to ensure that sufficient food and fluids were taken. They also enabled the resident to share in the preparation of meals. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. Service users receive personal support in the way they prefer and require. Their health needs are met and they are protected by the homes medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Good support is given so that the person is able to keep mobile and is moved in the manner in which she prefers. A new wheelchair is being arranged and when transferring staff ensure that they only assist to the extent that is necessary thereby preserving any self help and independence skills. Personal care is provided by people of both genders and this was said to be acceptable by the person receiving the care. Service users choose their own clothes and hairstyle although access to the hairdresser is limited, again due to the lack of suitable transport. Service users are registered with a local doctor. The surgery is within walking distance and staff accompany residents as necessary. There is an overhead hoist in three bedrooms and a mobile hoist for use throughout the home. Links have been made with the local physiotherapist service. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 13 Medication is managed on behalf of the resident. It is stored and administered safely. Staff receive training in its administration and good records are kept. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. Service users views are listened to and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a written complaints procedure which is made available to residents. There have been no complaints received however policies and procedures are in place to ensure that should any be made they are recorded and acted upon in a timely manner. The home has a comprehensive written policy and procedure regarding adult protection. Staff were able to describe the action they would take should they be concerned about how a resident was being treated. They knew the hierarchy of the organisation and therefore, who to report any concerns to should someone at the home be implicated. Guidance is available to staff in managing challenging behaviour as well as caring for anybody who is particularly at risk of abuse or allegations of abuse. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. Service users live in a comfortable and safe environment which is clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users have their own room with en-suite facilities. Three rooms have track hoists and they are all very well decorated. Communal space consists of an open plan lounge, dining room and kitchen all of which are well furnished, decorated and equipped. The home is situated in a residential area and is in keeping with its surroundings. There are local shops and other amenities nearby. The premises meet the requirements of the local fire and environmental health services. The premises were clean throughout and free from offensive odours. There is a laundry situated away from food preparation areas. It is equipped with a tumble dryer and washing machine, however, the washing machine did not have a suitable hot wash for the control of infection. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. Service users are supported by staff some of whom are trained. There is not always an effective staff team. Service users are protected by the homes recruitment procedures. Their needs are not always met by appropriately trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were respectful to service users who in turn were comfortable in their presence. Staff showed interest in residents wellbeing and were motivated. They had a good knowledge of the needs of the person currently living at the home and had received some training. This included areas such as health and safety, infection control, first aid and adult protection. There is a training programme and dedicated budget which is accessible to all staff, however apart from the person acting as manager, only one member of staff had a National Vocational Training Qualification (NVQ). Staff reported that they generally work alongside agency staff and that they regularly did more than their contracted hours to cover shifts. Two new staff were due to start at the home and it was anticipated that the use of temporary staff would be reduced. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 17 Staff work at the home only after they have undertaken a Criminal Records Bureau (CRB) check and two references have been taken up. They are issued with a contract of employment. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. Service users benefit from a well run home although the manager is not yet registered. It is run in their interests. Their health and safety is generally protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a nominated manager who has almost completed an NVQ level 3. He intends to apply to the Commission for Social Care Inspection (CSCI) for registration in the near future. Staff understood who was in charge and were clear about the lines of accountability. There is a comprehensive system for quality assurance however, it has not been fully implemented due to the short length of time that the home has been operating. Monthly visits have been made to the home under Regulation 26 of the Care Standard Act however, records show that these lapsed in November 2006. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 19 Staff receive instruction regarding safe working practices during their induction training and this is supported by specific training in areas such as moving and handling, fire safety, first aid, infection control and food hygiene. Hazardous substances are safely stored, water and fridge temperatures are monitored, radiators are covered and some risk assessments are carried out. However, staff were unable to locate a book for recording accidents and risk assessments did not cover all areas. For example, the kitchen is open plan and there was no risk assessment regarding the use of equipment although the knives were kept locked. One person was known to be prone to choking and there was no written risk assessment regarding this or guidance for staff in managing this. 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 2 x 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 21 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 2 Standard YA2 YA13 Regulation 14 16 Requirement The needs of all prospective service users must be assessed and recorded Arrangements must be made for a suitable programme of activities and access to the local community An application must be submitted to CSCI for a registered manager Monthly monitoring visits must be made to the home A record of all accidents must be kept Timescale for action 30/03/07 30/03/07 3 3 4 YA37 8 26 17 30/03/07 30/03/07 30/03/07 YA39 YA42 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 3 Refer to Standard YA30 YA32 YA33 Good Practice Recommendations A washing machine with programming ability to meet disinfection standards should be provided. A more comprehensive NVQ training programme should be established The use of agency staff should be reduced DS0000066941.V327352.R01.S.doc Version 5.2 Page 22 42 Twyford Gardens 4 YA42 Risk assessment should be carried out for all safe working practices 42 Twyford Gardens DS0000066941.V327352.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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