Inspection on 13/03/06 for 46 London Road

This inspection was carried out on 13th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

46 London Road 18/12/06

46 London Road 27/09/05

46 London Road 01/10/04

46 London Road 07/05/04

Similar services:

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

The Vicarage

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

CARE HOME ADULTS 18-65 46 London Road 46 London Road Gloucester Glos GL1 3NZ Lead Inspector Mrs Barbara Davies Unannounced Inspection 13th March 2006 09:30 46 London Road DS0000016343.V296058.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 46 London Road DS0000016343.V296058.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. 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 46 London Road Address 46 London Road Gloucester Glos GL1 3NZ 01452 380835 01452 380835 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of acting manager Type of registration No. of places registered (if applicable) londonroad@tiscali.co.uk Milbury Care Services Limited Care Home 10 Category(ies) of Physical disability (10) registration, with number of places 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: 46 London Road is a purpose-built care home run by Milbury Care Services. The building is leased from The Bromford Housing Association who own it. It provides care and accommodation for people with acquired brain injuries. The home is located close to Gloucester city centre. 10 residents are accommodated in single rooms on the ground and first floor. All of the bedrooms have en-suite facilities and a kitchenette. Stairs or lift can access the first floor. The home is designed to be fully accessible to wheelchair users. The home provides a large lounge and dining area and an adjacent communal kitchen. On the first floor there is a large craft and activities room. Outside there is a patio and lawns with extensive usable space. 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the home was unannounced. Most of the core standards had been inspected during a previous inspection of the home on 27th September 2005. The remaining nine core standards were inspected during this visit in addition to the statutory requirements and recommendations imposed following the last inspection. For a more complete picture of the home, the report of this unannounced inspection should be read in conjunction with the report compiled following the inspection of the home that took place in September 2005. This inspection of the home was unannounced and commenced at09.30 on a Friday afternoon and lasted for two and a half hours. The inspection involved discussions with the unit manager and a tour of the premises. One service user was spoken to whilst showing the inspector his bedroom. Some service users were observed to be participating in activities in the home during the inspection and others were at college. Records for staff and service users were examined as were the records kept in relation to fire and risk assessments. What the service does well: What has improved since the last inspection? The standard of practice in this home in previous inspections has, in most areas been assessed as either meeting standards or exceeding standards. Few requirements and good practice recommendations were imposed in the last inspection and it is therefore difficult to identify any significant improvements made in the interim period since the last inspection. The acting manager has now been in post for a longer period of time and is more established in her role. She has submitted an application to the Commission for Social Care 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 6 Inspection to become registered manager. The programme of refurbishment and improvement in communal areas of the home has commenced. 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. 46 London Road DS0000016343.V296058.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 46 London Road DS0000016343.V296058.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): 1 Existing and potential service users will be better informed about the services being provided at the home when the new service user guide is published. EVIDENCE: Following the previous inspection in September 2005, the CSCI reported that ‘a service user guide is provided, but the acting manager is not content with the content and is currently re writing it; the current guide needs to be individualized to 46 London Road’. During this inspection the acting manager reported that the service user guide has been reviewed and amended to include all the details required. It has received formal approval from the service manager and is currently at the printers. 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 The rights of service users to be involved in making decisions are actively promoted. EVIDENCE: The acting manager said that discussion with service users is a fundamental part in determining how their care is provided. Each file examined during the inspection contained a Personal Care Plan for each service user concerned that stated the daily routines to be followed. The plans contained information stating how the service user wished to be cared for and how staff could best deal with particular aspects of their care- ‘how I want staff to assist me’ and ‘how I don’t want to be treated’. Plans do not currently state whether or not individual service users have a stated preference as to whether it is a male or female member of staff that attends to their personal care needs. The acting manager said that only female staff would attend to the personal care needs of female service users. The acting manager described the arrangements for service users receiving their benefits. She said that in most instances social services takes the lead in assisting service users and their families to obtain the benefits to which they are entitled. These are then either paid directly to the service user or their 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 10 family. Where appropriate service users are supported to manage their own money and this may include use of a cash-point card. A financial expenditure sheet is kept of any finances held for safekeeping by the home and of any withdrawals made. The manager gave an example of one service user who has been unable to open a bank account and where the home has arranged for an advocate to work on their behalf. An independent financial appointee monitors the financial arrangements for this person. 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Service users are supported make decisions and assume responsibility for aspects of their life. EVIDENCE: A copy of the daily routine and personal timetable for each service user is displayed in the room of the service user to whom it relates as well as on the service user file. The daily routines seen during the inspection show how the home is supporting service users to develop to their potential. Some service users attend courses run by Gloscat and the National Star Centre. The manager reported that quite a few of the residents are interested in computers and the inter-net. Computer facilities are not currently provided for service users by the home although the manager said that they able to have access to the office computer to send e-mails. Personal Care Plans and personal timetables show some of the leisure activities in which service users participate. The manager said that trips and holidays have included destinations such as Alton Towers and Devon. It is hoped to arrange a holiday abroad and the acting manager is currently exploring the option of a cruise. Photographs are displayed around the home of some of the outings and activities that have taken place. Personal possessions in some 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 12 bedrooms, such as hi-fis and televisions, provide a further indication of the activities in which individual service users like to participate. The manager said that one service user has his own computer. Examples were given of opportunities that service users are given to access community resources such as the cinema, the pub and being taken to shops to purchase food Service user files contained evidence of the home working closely with the families of service users to plan care to be delivered. Arrangements for contact between service users and their families were detailed in some of the plans seen. The manager said that most service users spend time visiting their families but that families can visit the home if they want to. Service users can entertain either in their own room or in communal areas. Staff said that they aim to respect and maintain the privacy of service users by not entering bedrooms of service users without first knocking on the bedroom door and obtaining verbal permission to enter. The manager described the arrangements for staff to receive their post. Post slots are provided for each resident in the communal sitting room. In circumstances where service users require assistance to open their mail this is given by staff. Although during the inspection, most service users were involved in a programme of daily activity some were observed to move around the home freely and to choose whether they wanted to spend time in their own rooms. Service user plans do not currently contain details of the service user’s preferred form of address. Current practice would be enhanced if plans were amended to include this detail and if staff then referred to service users in this way. The manager said that the staff meet service users every Sunday evening to discuss and agree the menus for the week ahead. Weekly menus are then compiled and displayed in the kitchen for people to read. These indicate the names of the residents that have selected particular meals. The manager said each week, service users have at least one opportunity to prepare, cook and eat a meal in their own room. This will usually be breakfast or lunch with the meal to be cooked being chosen by the service user. Service users have a member of staff identified to help them do this. The report of the previous inspection included reference to the fact that two service users had made a criticism of the food. Whilst it was acknowledged that it would be difficult for the home to fully address this matter a recommendation was made that the home find extra ways to ensure all residents are content with their food and a suggestion made that input from a dietician may help. The acting manager discussions have not yet taken place with a dietician. It was noted that Personal Care Plans do not currently include information about the culinary likes and dislikes of service users and this may also be of benefit. 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Promotion of health is taken seriously. The health of service users is closely monitored and responded to. External services are obtained where necessary. EVIDENCE: The files seen during the inspection contained a health assessment for each of the service users concerned. A document for each service user describing the daily routine provides more information about how the health needs of individuals are attended to by staff. A record is kept of any visits to health professionals. Details of any treatment required and medication administered are also recorded. None of the residents currently administer their own medication. 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards was assessed during this inspection EVIDENCE: None of these standards was assessed during this inspection 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The programme of refurbishment and improvement should be accelerated to create a more pleasant environment for service users and their visitors. EVIDENCE: During the inspection conducted in September 2005 it was reported that new carpets were to be fitted once remedial decoration had been completed during October 2005 and that that new furniture will be provided to the communal area. Communal areas have now been painted and the manager said that there are plans for new carpets, blinds and curtains to be fitted. The home was clean and tidy at the time of the inspection and free from offensive odours. An inspection of the home in October 2004 had assessed that the arrangements for attending to soiled linen and bedpans were inadequate. Following this and subsequent inspections a requirement has been made for an independent sluicing facility to be provided. The manager said that this requirement has not yet been fulfilled. It was described as a lengthy process to obtain permission from the owners of the building to make the alterations necessary to install a sluice. The manager reported that the sluice will probably be installed before the end of March 2006. The Requirement concerning this matter will therefore remain. 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 The home is good at providing training in key aspects of social work practice but the home needs to support more staff to obtain professional nationally recognised qualifications such as NVQ level 2. EVIDENCE: The acting manager is the home is in the process of completing the Registered Managers Award. Four staff currently have an NVQ level 2 qualification and a further 2 have commenced the training. The manager said that there are more staff wanting to commence the training but insufficient access to NVQ assessors makes this impractical. The deputy manager is currently completing the NVQ assessors training and once obtained, it is hoped that this will speed up the process of staff gaining their NVQ qualifications. The home does not currently meet the target stated in standards of having 50 of staff qualified to NVQ level 2. The manager said that a new induction training pack for staff is about to be introduced. Also that staff receive induction training in matters such as fire safety, first aid, manual handling, health and safety, and non-violent crisis intervention. Training in the Protection of Vulnerable Adults is scheduled to take place for all staff on 28/03/06. Training records kept for a sample of staff were seen. These showed that training takes place as described and also that refresher training in all matters is provided at specified intervals. It was noted that core training does not currently include a component on equal opportunities covering issues such as disability equality, race equality and anti46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 17 racism. The manger said that annual appraisals to identify training needs for individual staff have yet to be completed. 46 London Road DS0000016343.V296058.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The views of service users and their families are valued and influence the way the service is provided. EVIDENCE: The manager said that a meeting with service users takes place every Sunday. The meeting gives service users the opportunity to express their views about things that happen in the home. These meetings are also used to plan activities and holidays. It is not currently practice to keep a record of these meetings. In addition, each month all service users are assisted to complete a questionnaire asking for their views on the service being provided. A sample of questionnaires completed, were seen during the inspection. These showed a high level of satisfaction with the service being provided but also that they are used by service users to bring matters of concern to the attention of the manager. It was noted that the questionnaires do not currently ask for an opinion on all matters that might be of importance to the service users, such as the quality and quantity of food. 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 19 The manager said that a questionnaire is distributed annually to the families of service users to obtain their opinion of the service being provided. The last such survey to be conducted was in December 2005. Responses again showed a high level of satisfaction with some criticism consistently being made about the décor and furnishing in the communal areas of the home. The manager said that the home has responded to these comments with a programme of refurbishment and decoration. The home has a health and safety policy and the manager was aware of the knew that they need to make sure that the home is a safe place for staff and the adults living there. Written risks assessments have been completed for the premises and the grounds and for the activities in which the adults participate. Records kept in relation to fire drills and of tests on the fire equipment in the home show that these are conducted at the correct frequency. The fire risk assessment was not one of the records sampled during this inspection. The home currently has two hoists one is new and has not yet required a service. The second hoist has a sticker showing when the next service is due. No health and safety hazards were noted during a tour of the premises. 46 London Road DS0000016343.V296058.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 3 2 x 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 x 23 x ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 2 33 x 34 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x x x 4 x x 3 x 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 21 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 CH1 Regulation 4 Requirement When the updated version of the service user guide is received from the printers it must be circulated to each of the service users. Sluicing facilities must be provided. (Previous timescales of 31/12/04 and 31/03/06 not met) Timescale for action 30/06/06 2. YA30 23 30/06/06 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 YA7 Good Practice Recommendations Personal Care Plans should state whether or not individual service users have a stated preference as to whether it is a male or female member of staff that attends to their personal care needs. Service user plans should contain details of the service user’s preferred form of address and staff should refer to service users in this manner. The acting manager should work with residents and staff DS0000016343.V296058.R01.S.doc Version 5.2 Page 22 1. 2. YA16 YA17 46 London Road 3. 4. 5. YA24 YA35 YA39 6. YA39 to find extra ways to ensure all residents are content with their food and input from a dietician may help. Personal care plans should also include information about the food that individual service users like and dislike. New carpets, blinds and curtains should be fitted in communal areas as planned. Annual appraisals should be completed for all staff to identify individual training needs. Consultation should take place with service users to determine what other matters they would like to be included in the monthly service user survey. A section seeking the views of service users about the quality and quantity of meals that are served should be included. A record should be kept of the matters discussed in the weekly Sunday night house meetings. 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 46 London Road DS0000016343.V296058.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!