Inspection on 18/12/06 for 46 London Road

This inspection was carried out on 18th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

46 London Road 13/03/06

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 Mr Adam Parker Unannounced Inspection 18th December 2006 & 25 January 2007 09:40 46 London Road DS0000016343.V329877.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.V329877.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.V329877.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 registered manager (if applicable) Type of registration No. of places registered (if applicable) londonroad@tiscali.co.uk Milbury Care Services Limited Mrs Hayley Ruth Clutterbuck Care Home 10 Category(ies) of Physical disability (10) registration, with number of places 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2006 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. Current fees are £1200.00 to £1600.00. Haircuts, toiletries, magazines, holidays, transport and some contributions towards activities are charged as extra. The home makes information about the service, including CSCI reports available to service users through a service user guide and statement of purpose available in the home. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector on two days, one in December 2006 and one in January 2007. The registered manager of the home was present for part of the time on both days. The deputy manager was also present for the inspection visit which consisted of a tour of the premises and examination of service users care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of service users were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Three service users were spoken to during the inspection visits. Comment cards were received from service user’s and staff working in the home. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Service users have received updated versions of the service user guide and their individual plans now contain information about their preferred form of address. There are also records of information regarding individual service 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 6 users food preferences and service users views on meals are discussed and recorded in the monthly summary. The registered manager has undertaken a review to identify individual staff training needs. 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. 46 London Road DS0000016343.V329877.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.V329877.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 This judgement has been made using available evidence including a visit to this service. The home carries out a full assessment of service users’ needs to ensure that these can be met however this process could be further enhanced in service users’ interests by the home obtaining information from funding agencies or other services. EVIDENCE: The information that the home had obtained about a number of service users before they were admitted to the home were looked at. The home had carried out its own assessment of needs which was comprehensive although there was a lack of information from other sources. One service user had previously lived at a residential college and information from this service was still awaited by the home, in addition a copy of an assessment or care plan had not been received by the home from the funding authority although a review had taken place. 46 London Road DS0000016343.V329877.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. This judgement has been made using available evidence including a visit to this service. Service users are regularly and actively consulted about their care and support to ensure that their needs and personal goals are met. Service users are supported to take risks and make decisions in line with living as independent a life as possible. EVIDENCE: A number of service users files were looked at; they contained very detailed and specific information about service users routines at different times of the day to inform staff offering care and support. Service users have a number of documented goals and these are reviewed and recorded on a monthly basis on a monthly summary sheet. In one example looked at the summary was written by the key worker but in a person centred way as though the service user was speaking. Each goal is negotiated with the service user and is subject to ‘goal attainment scaling’ to ensure that it is achievable. In addition one service user had a ‘communication passport’ that 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 10 gave staff information about how to interpret certain forms of communication from the service user and how they should respond in terms of meeting needs. There is information displayed in the home relating to advocacy services if service users wish to contact these. Service users have risk assessments completed for a number of issues such as making hot drinks, using glue and paint for crafts, crossing the road and falling. Risk assessments had been subject to review and were of a nature that supported service users to have as independent a life as possible. The home had prepared a file containing service users details and photographs which was ready for use if a service user went missing, this is good practice. 46 London Road DS0000016343.V329877.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): 12,13,15,16 & 17 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of appropriate activities including education in the local community. Service users are able to maintain links with family members and to meet with people outside of the home. Service users’ rights and responsibilities are recognised and respected. Service users are given a choice of meals and are able to benefit from the opportunity to do their own cooking although in the case of one service user there should be more monitoring of dietary intake. EVIDENCE: 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 12 Service users have been supported to pursue education at the Star College doing an adult learner course. Two service users had also been attending an ‘access’ course at a local college but this had not been too successful. Service users are encouraged to make use of facilities in the local community such as visiting Gloucester for shopping and going to a local bowling alley. Two service users also take part in horse riding at different locations. The home has two vehicles to transport service users including a specially adapted minibus. In addition service users have made use of public transport although staff reported that the use of trains has been more successful than using buses. Service users are entered on the electoral role and are enabled to vote in elections if they wish. Evidence was seen in care plans of good practice in relation to service users being supported to maintain family relationships with this set as a goal for one service user. Service users daily routines are recorded in detailed plans specific for different times of day such as routines for getting up in the morning. Staff knock on doors or ask permission before entering service users rooms and a number of service users have their own keys. Service users have a number of housekeeping tasks set out in their personal goals, these include spring cleaning their rooms, laying tables and drying up after meals. Rules on smoking alcohol and drugs are clearly laid down. The main meal in the home is offered in the evening with the menu chosen on a weekly basis at a service users’ meeting on a Sunday evening. On a daily basis one service user receives one-to-one input from staff to prepare their meal. The home provides for two service users who are vegetarian and service users files contained specific information about their dietary preferences in line with daily routines. During the inspection it was observed that service users were being offered a choice of breakfasts as they came into the dining area after rising. One service user who was taking a vegetarian diet was reported as having nutritional issues in the past and had been prescribed vitamin tablets. There was no record kept of his dietary intake. As discussed at the inspection the home must ensure that there is a record of the dietary intake of any service user who may be nutritionally at risk. One service user spoken to stated “The meals are fine”. 46 London Road DS0000016343.V329877.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal guidance or support is offered to meet service users needs. The health needs of service users are met with the home working with health care professionals for the benefit of service users. Some improvements should to be made to the medication administration recording and storage systems in the home in the interests of service users’ health. EVIDENCE: Personal support needs for service users are recorded in very specific plans that take into account individual preferences as well as needs. One service user’s file addressed gender issues of staff giving support although in a document entitled “All about me” there was no clear indication of whether any particular gender of staff was preferred. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 14 The file of one service user looked at contained information from a physiotherapist supported by photographs of the service user relating to posture and position which is also linked into an individual goal. There was evidence that the health needs of service users were being met One service user’s file contained records of dental check-ups and treatment. Another had input from the local head injury team and the home had received reports regarding this. There was also input recorded in service users’ files from a speech and language therapists and General Practitioners. One service user had a report on file following input from a psychologist in terms of their emotional health needs. The arrangements for medication storage, administration and recording were checked. Medication was stored securely in two locations in the home, however these were both close to radiators and storage temperatures must be monitored to check if medication is being stored at the correct temperature. There were no service users in the home that were self medicating or storing medication in their rooms. It was noted that bottles of liquid medication had not been dated on opening. In addition some but not all handwritten entries in medication administration sheets had been signed or dated by the staff member making the entry or checked and signed by a second staff member. Staff administering medication have completed training in conjunction with the supplying pharmacist and staff are shadowed by another member of staff and then assessed before giving out medication alone. The home has a list of homely remedies agreed by general practitioners displayed on the medication storage cupboard. The home has reported a number of medication errors by staff to the Commission and the monitoring of this is given a high priority in the home in the interests of service users. 46 London Road DS0000016343.V329877.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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to information about the complaints procedure and have other opportunities to air their views on the service. The policies and procedures of the home along with staff training ensure that service users are protected from abuse. EVIDENCE: The home has a record of complaints received but there have been none since 2003. The service users guide contains clear information about the home’s complaints procedure. Two surveys were received from service users and both confirmed that they knew who to speak to if they were unhappy and knew how to make a complaint. Service users meetings are held which enable them to raise any issues. Staff in the home have all received training in protecting service users from abuse provided by an external trainer. All staff have attended non-violent crisis intervention training which gives staff the knowledge and skills to deal with any aggression from service users. It was noted that an ‘alerter’s guide’ from the local adult protection unit was on display in the home. Service user surveys confirmed that the staff treated them well. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained and kept in a clean and hygienic state in the interests of service users. Service Users rooms provide a personalised environment suitable to their needs that also promote their independence. EVIDENCE: The home has been purpose built and service users can access all areas, with doors wide enough to allow access by wheelchair users. A tour of the premises showed that the home had been well maintained. The home is close to local amenities in the City of Gloucester (including the railway station) and surrounding area which are used by service users. The home has a large communal area on the ground floor and gardens to the side and rear of the home that are accessible to all service users. Consideration is being given to providing a covered area in the garden for service users who smoke as this is not allowed within the home. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 17 Service users rooms (known as flatlets) are all single occupancy and have ensuite toilet and shower facilities as well as a small kitchen area fitted with a microwave, electric hob and sink unit where meals can be prepared. One service user spoken to was happy with his room which contained personal items and had been decorated according to the service user’s tastes. Service user’s rooms were also personalised with their own furniture. All service users rooms on the ground floor have patio doors giving access to the garden. Service users flatlets have lockable doors and a number of service users have their own keys. One service user said that the home was “a place that has everything I would want or need”. The premises were clean and free from offensive odours. The laundry which is used by service users and by night staff was in good order with hand-washing facilities provided and readily cleanable wall and floor surfaces. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 32,34 & 35 This judgement has been made using available evidence including a visit to this service. The home’s training programme ensures that service users are supported by appropriately trained and competent staff. Service users are protected by the home’s robust recruitment practices. EVIDENCE: Staff in the home have undertaken training relevant to the needs of service users such as training in dealing with behavioural problems and ‘brain tree’ training relating to head injuries. Staff have also received training in ‘goal attainment scaling’. However the level of care staff trained to an NVQ level 2 is under 50 . A number of staff recruitment files were examined these showed that the home had used robust recruitment checks including obtaining all the required information and documentation to protect service users. Staff applying for jobs in the home had criminal records checks and had provided two references. Service users are involved in the staff selection process through being part of interviews. One service user had used a communication aid during a staff interview. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 19 Staff are given a general induction when they start work in the home as well as a specific induction relating to acquired brain injury. There were however no staff that had been recruited recently to examine current practice. Staff have individual staff training plans and records. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. 37,39 & 42 This judgement has been made using available evidence including a visit to this service. Service users have the benefit of living in a well managed and well run home. Quality assurance systems are in operation, with service users’ views being used in monthly audits so that they may influence the service provided. In general the health and safety of service users is promoted and protected although there is a need for some more work in this area. EVIDENCE: The registered manager has had previous experience working in other care homes and experience in working in 46 London Road starting as a support worker, then a senior support worker and as manager since April 2005. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 21 She has recently completed the registered managers award and is to start an NVQ level 4 in care in April 2007. In addition she has undertaken training in protection of vulnerable adults awareness and non-violent crisis intervention. The home has several quality assurance checks, these include a monthly audit carried out by the operations manager, questionnaires sent to the relatives of service users and a monthly audit specific to each service user. An example of how service users views are able to effect the service provided was given in relation to a change to menus and how one service user wished to treated as a vegetarian. Staff in the home receive training in relevant safe working practices including training in the areas of health and safety, first aid and food hygiene. Heating and electrical systems and appliances had been serviced and maintained. Work had been done in the home by a specialist consultant regarding reducing any risks associated with Legionella. Regular checks are made on the temperatures from hot water outlets in the interests of service users’ safety as well as a check on bath water temperatures which are recorded. A risk assessment has not been completed relating to the security of the premises. Restrictors are fitted to the windows in the home, any faults are identified and action taken although it is recommended that these should feature in regular maintenance checks. The home carries out weekly fire alarm tests and the system was being serviced by an outside contractor during one of the days of the inspection. The home also carries out monthly evacuation tests and keeps a record of these with comments. The home stores cleaning materials in secure cupboards in line with regulations for controlling hazardous substances. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 22 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 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 4 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 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 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 17 (2) Schedule 4 Para graph 13 13 (2) Requirement The registered person must ensure that the dietary intake of any service user who may be nutritionally at risk is monitored and recorded. The registered person must monitor medication storage temperatures in both locations in the home to ensure these are at the correct temperature. The registered person must ensure that a risk assessment is completed regarding the security of the premises. Timescale for action 30/04/07 2. YA20 30/04/07 3. YA42 13 (4) (c) 30/04/07 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. 2. Refer to Standard YA2 YA20 Good Practice Recommendations The home should obtain copies of assessments of service users’ needs and care plans from funding authorities and other services. All handwritten entries in medication administration records should be signed and dated by the staff member DS0000016343.V329877.R01.S.doc Version 5.2 Page 24 46 London Road 3. 4. 5. YA20 YA32 YA42 making the entry and checked and signed by a second member of staff. Liquid medication should be dated on opening. There should be a minimum level of 50 of the care staff trained to an NVQ level 2. Regular checks should be made on the functioning of window restrictors. 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 46 London Road DS0000016343.V329877.R01.S.doc Version 5.2 Page 26 - 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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