Inspection on 29/05/06 for 42 Twyford Gardens

This inspection was carried out on 29th May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 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 15/02/07

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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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 A Taggart Unannounced Inspection 29th May 2007 09:00 42 Twyford Gardens DS0000066941.V336131.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.V336131.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.V336131.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 Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate on service user in the LD(E) category. Date of last inspection 15th February 2007 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. Current fees are £1,400 to £1,800 per week. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the visit, the inspector read the last report and any other relevant correspondence or documentation regarding the service and a planning document was completed. An Annual Quality Assurance Assessment was sent to the manager for completion and surveys were sent to be distributed to service users and families. The Quality Assurance document was completed but no surveys were returned. The unannounced visit was carried out at 2.30pm and lasted for 3 hours. During this time we spent time talking to the three people living in the home, the staff supporting them and observed staff practice. Three care plans with supporting evidence were tracked and the inspector made a tour of the home and also tracked the medication system. We also saw food records and observed the main meal of the day being prepared and cooked. Records for the running of the business were seen including staff training file, the fire book and a Requirement was made regarding regular checks being made and staff receiving regular training. The manager of the home was not present during the visit so staff recruitment records and the complaints book were not seen but evidence was used from the Assessment document and these Standards found to be met at the last visit. Following the visit the manager, Mr. Sandikov telephoned the service and was given verbal feedback by the inspector. What the service does well: What has improved since the last inspection? Some improvements have been made to the environment. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 6 All of the people living in the home now have a comprehensive assessment of need in place. 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. The summary of this inspection report can be made available in other formats on request. 42 Twyford Gardens DS0000066941.V336131.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.V336131.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): 1 2 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In order that the people living in the home and their families are aware of the terms and conditions of residency contracts should be in place and should be signed by the service user or their representative. EVIDENCE: There is a Statement of Purpose and Service user Guide in place and these documents have also been printed in an accessible format using symbols and pictures. Each person living in the home now has an assessment of needs in place but there is no evidence of involvement from service users, their families or advocates in the process, or of people having visited the home prior to moving in. The home uses a standard form to detail the induction to the home for new service users, but for two people these were blank and had not been completed. One person had a written agreement of terms and conditions of residency in place, which had been signed but for the other two people, these were not on file. 42 Twyford Gardens DS0000066941.V336131.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 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In order that the staff team have the information they need to support people, care plans should be fully completed and should be regularly reviewed and updated. EVIDENCE: For one person living in the home a comprehensive plan of care was in place, which included risk assessments, guidelines on personal care preferences, cultural identity issues and emotional support needs. For the other two people, care plans had not been fully completed and documents used by the home such as an induction to the service, personal profiles, risk assessments and personal goal setting for the future had not been fully completed. When the staff on duty were asked why the care plans were not fully in place, especially as the people had been living in the home for some time, they said that they were on the computer being worked on by key workers and therefore not available. There was no evidence that service users, their families or advocates had been 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 10 involved in drawing up the care plans and the documents had not been recently reviewed and updated. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although social activities in the community are accessed, activity plans should be implemented that identify agreed areas for personal development for users of the service and suitable transport provided to aid independence. EVIDENCE: From talking to service users and reading activity plans and records, it was clear that people have opportunities to involve themselves in the local community and have contact with family and friends. People use the local shops and bowling alley and enjoy going to pubs and for meals out. One person said, “I like it here they are very kind to me and I mostly like it because I can go out a lot, bowling, to the shops and to the pub, I like to have some wine”. Another person said, “I go out to buy my paper every day and I am going out to dinner tonight. Everything is o.k. and I like my room”. During the visit one person was looking forward to going out for a meal with friends and another was having a make up session with a staff member and 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 12 said they were planning to go on holiday. People were also reading, watching TV and playing dominoes with staff. Activity plans are in place but these are mostly around social activities and need to be further developed to introduce a more “person centred” approach regarding identified goals for people’s personal development. At the last visit it was confirmed that a vehicle would be provided to the home and was due to be delivered two weeks after the visit. This has still not happened which means that for one person, who is a wheelchair user, access to other than local facilities, is difficult. It was clear from records that although taxis are used for some outings, this person spends a lot of time in the home, becomes frustrated, expressing their feelings in ways that causes stress to themselves and the other people they live with. There was evidence in records and from talking to people, that families are made welcome and people often visit or telephone their parents. Menus show that a variety of fresh, home cooked meals are provided and service users are asked about their preferences and choice. For one person the food provided reflects their cultural identity and people said they were happy with the meals they receive. Records showed that service users are not offered a sweet following their main meal and when asked why this was, a staff member said that ice cream or fresh fruit was always available if requested. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In order that the staff team have the information they need to support people’s healthcare needs, care plans should be updated and further training provided in medication management. EVIDENCE: For one person living in the home there were comprehensive guidelines in place concerning dealing with their healthcare needs. For the other two people records were incomplete and for one person who had recently been discharged from hospital following a lengthy stay, there were no updated guidelines regarding their induction back into the home or changes to the care plan regarding their current needs. Records show that the home works with other healthcare professionals including district nurses, speech therapist, physiotherapist and local doctors but there is no evidence of access to a dentist, chiropodist or the Community Learning Disability Team. Access to specialists in learning disability is of high importance as records show that one person displays difficult behaviours that 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 14 cause distress to themselves and the other people living in the home on an almost daily basis. Medication is stored in a locked cabinet in the home’s office. A monitored dose system, supplied by a local pharmacy is used. Gaps were found in the Medication Recording Sheets for medication and topical creams prescribed by a doctor and the number of tablets in the blister packs did not correspond to records. A Requirement has been made regarding medication management. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure that the people living in the home are protected from risk of all forms of abuse, further staff training should be provided and staff practice monitored. EVIDENCE: The home has a complaints procedure in place, which is also produced in a pictorial form and prominently displayed in the home. As the manager was not at the service, complaints records could not be accessed but in the self-assessment document, the manager stated that complaints are taken seriously, recorded and acted upon. The procedure needs to be updated to reflect the change in address of the Commission. Not all of the staff team have attended training in the protection of vulnerable adults from abuse and in discussion showed that they were not fully aware of their responsibilities. Guidelines are in place for dealing with challenging behaviour for one person but input has not been received from the Community Learning Disability Team or other specialist advisors to ensure that responses from staff are professional and respectful. Records show that unprofessional language such as “kicking off” is used to describe challenging behaviour and one staff member used this phrase when speaking to the inspector. Daily records also contained staff responses to challenging behaviour such as, “sent her to her room”, and “taking her to her room and talking to her in an assertive way, but that didn’t work”. These records indicate that the staff team are not trained in current methods of 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 16 communication and dealing with challenging behaviour. It is a Requirment that all staff members receive further adult protection and management of challenging behaviour training and that individual care practice is monitored formally through supervision. 42 Twyford Gardens DS0000066941.V336131.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 26 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean and comfortable environment and the people have the specialised equipment they need in order to aid independence. EVIDENCE: The home is easily accessible with ramps to the front and rear and consists of an open plan style, situated all on one floor. There is a large lounge/dining room/kitchen area, which is attractively decorated and comfortably furnished with access to a garden area. Service user’s bedrooms are large and comfortable and have been personalised to reflect people’s individual personalities. Further improvements such as a barbeque area in the garden and improvements to the lounge area are planned for the future. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 18 Three bedrooms have track hoists and other specialist equipment that has been installed following an Occupational Therapist assessment and each bedroom has a large ensuite bathroom, which is well equipped. People said they were happy with their private space and were seen to access their rooms and all areas of the home freely. The home was clean and hygienic throughout and protective clothing was available for the use of the staff team. 42 Twyford Gardens DS0000066941.V336131.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the staff members on duty were kind and caring, the staff team do not have the support, skills and experience to offer a fully effective service to the people living in the home. EVIDENCE: Staffing rotas showed that there are two members of care staff on duty at all times during the day and awake at night. The manager’s hours are in addition to the rota. The home is still experiencing difficulties with recruitment, records show that a high level of agency staff is still being used and staff work long hours in order to cover shifts. The staff on duty were kind and caring in their dealings with the people living in the home but from observation of practice, discussion with the staff on duty and reading service user records, a lack of experience and understanding of the skills needed for working with people with a learning disability, especially those with challenging behaviour was highlighted. There is no evidence that staff members receive a structured induction in line with the Learning Disabilities Award Framework and all staff have not received 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 20 training in understanding learning disability or managing challenging behaviour. Records used terms to describe people’s behaviour, for example, as “very naughty” and other terms demeaning to service users. A Requirement has been made regarding the staff team being trained in the specific needs of the people they are supporting. As the manager of the home was not available during the visit, staff recruitment records were not accessible but were found to be in good order at the last visit. Training files showed that a programme of training including mandatory courses such as fire, health and safety, first aid and epilepsy management is undertaken and one member of staff team currently holds the NVQ Award in Care. One staff member who has been employed at the home for three months said that they had not yet received a formal induction or had yet attended any training and no training records were on file for them. The staff on duty said that they did not receive formal supervision and as the manager was not available records could not be accessed to confirm this. 42 Twyford Gardens DS0000066941.V336131.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In order to ensure that the home is competently and safely managed, there should be a registered manager, who is suitably qualified and have the skills and experience to manage the home. Fire records should be kept updated and risk assessments completed. EVIDENCE: The manager of the home has not yet completed NVQ level 3 in Care, and a Requirment made at the last visit for an application for Registered Manager to be made to the Commission has not been met. The Care Management Group Ltd has a comprehensive quality assurance system in place, which involves users of the service and their families but as yet this has not been fully implemented in the home. During the visit the organisation’s quality assurance assessor was making a three monthly visit to 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 22 carry out an audit and records show that Regulation 26 monthly monitoring visits are also carried out. Where the home holds monies on behalf of users of the service records and receipts are kept and checked each day at staff handover time. The records and money of one person was checked and found to be correct. Records for the running of the business were seen including maintenance books, fire records, fire staff training, monthly health and safety checks and accident reports. Records of accidents and body maps detailing any injuries sustained were seen in users of the service’s personal and daily records but none had been entered in the accident book, which was blank. The weekly fire logs had not been completed since 24/4/07 and the three monthly fire training for staff working night duty was overdue. Risk assessments both environmental and personal to service users were also not fully completed. 42 Twyford Gardens DS0000066941.V336131.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 3 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 x 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 X 3 X 2 2 x 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 24 Yes 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 YA5 Regulation 5. (b) Requirement All of the people living in the home should must have a contract of terms and conditions of residency in place. Timescale for action 30/06/07 2. YA6 15 (1) and 12(1) 3. YA20 13 (2) 4. YA32 18 (1) and (2) To ensure that the staff team 30/06/07 have the information required to ensure all users of the service receive the care they need, care plans must be regularly reviewed and updated to reflect changing personal and healthcare needs. To ensure that safety of the 30/06/07 people living in the home, the medication system must be reviewed and staff training updated. To ensure the protection of the 30/07/07 people living in the home, the staff team must receive induction, training and support in caring for the specific needs of people with a learning and physical disability and also those with challenging behaviour. A record of all accidents must be kept Outstanding from 30/03/07 To ensure the safety of both the DS0000066941.V336131.R01.S.doc 5. 6. YA42 YA42 17 23 (4) 30/06/07 30/06/07 Page 25 42 Twyford Gardens Version 5.2 7. YA37 10 (1) staff team and users of the service, fire checks should be carried out as instructed by the fire service and staff working night duty should receive training every three months. An application must be submitted to CSCI for a registered manager Outstanding from 30/03/07 30/06/07 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 YA12 Good Practice Recommendations As at the last visit, consideration should be given to providing the home with it’s own transport so that people who are wheelchair users can more easily access community and educational facilities. 42 Twyford Gardens DS0000066941.V336131.R01.S.doc Version 5.2 Page 26 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. Extracts may not be used or reproduced without the express permission of CSCI 42 Twyford Gardens DS0000066941.V336131.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. 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