Inspection on 25/03/08 for 49 Almond Close

This inspection was carried out on 25th March 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

49 Almond Close 23/02/09

49 Almond Close 20/03/07

49 Almond Close 04/08/06

49 Almond Close 23/08/05

49 Almond Close 07/04/05

49 Almond Close 03/11/04

49 Almond Close 02/08/04

49 Almond Close 03/02/04

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

CARE HOME ADULTS 18-65 Almond Close (49) 49 Almond Close Bellfields Estate Guildford Surrey GU1 1NW Lead Inspector Andrea Leverett Unannounced Inspection 25th March 2008 2:30 Almond Close (49) DS0000013506.V348409.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 Almond Close (49) DS0000013506.V348409.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. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Almond Close (49) Address 49 Almond Close Bellfields Estate Guildford Surrey GU1 1NW 01483 575806 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) www.mencap.org.uk Royal Mencap Society Vacant Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 19 - 65 YEARS OF AGE one named person may be over the age of 65 Date of last inspection 20th March 2007 Brief Description of the Service: 49 Almond Close, Guildford is a detached property developed to provide accommodation for eight adults with learning disabilities. The home is set in a road close of similar properties. All rooms are for single occupancy, none with en-suite facilities. The home offers a sitting room equipped with television and music systems, a dining area, kitchen, and utility room for laundry and toilet and washing facilities. There is a garden to the rear of the property and some off road parking to the front. The registered providers are the MENCAP organisation and the Local Authority owns the premises. The weekly charges range from £62.35- £94.45. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. This unannounced Key inspection took place on the 25th of March 2008. 3 people who use the service were spoken with as well as 1 staff member and the acting manager. A tour of the premises was undertaken during the site visit and 2 people who use the services files and staff files were inspected. Judgements about quality of life and choices were taken from direct conversations with and observations of people who use the service, followed by discussion with support staff and evidencing records held at the home. Overall the inspector concluded that people are given an adequate service at Almond Close although a good standard of support and access to health services is provided as well as a range of community-based activities. 1 requirement remains outstanding from the previous inspection regarding offensive odour in one of the bedrooms. 2 further requirements and 1 recommendation have been made regarding the need to improve the decoration, fixtures and fittings and general deep cleaning of the Home. What the service does well: The Home has a person centred planning system in place and staff undergo very detailed training to enable them to carry out this work. Files seen showed that People living in the Home and prospective new people benefit from being provided with information such as the service user guide, which are available in accessible formats, such as signs and symbols. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 6 People who use the service take part in a range of activities including Jobs and community activities and their rights are respected and responsibilities recognised in their daily lives. The atmosphere in the Home was relaxed and friendly and staff were observed supporting people to make their own choices in a respectful and sensitive manner. The Home also has its own transport for the benefit of people who use the service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 7 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. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 8 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 Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 9 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 People who use this service receive good quality outcomes in this area. People who use this service can be confident that their needs and aspirations will be fully assessed before they move in to Almond Close and the Home will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home have not had any new admissions for several years but records and assessments seen relating to the current client group showed that appropriate assessment and admission procedures were followed. The acting manager confirmed that the organisation have clear protocols for admitting new people into the service and no one would move in unless their needs were assessed and the Home could meet their needs. Opportunities are taken to encourage prospective new people to visit the Home and sample the service before deciding to move in. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 10 Assessment documentation included care manager assessments and the homes own assessments. In addition the Home has a person centred planning system in place and staff undergo very detailed training to enable them to carry out this work. Files seen showed that People living in the Home and prospective new people benefit from being provided with information such as the service user guide, which are available in accessible formats, such as signs and symbols. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 11 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 and 9 People who use this service receive good quality outcomes in this area. People who use this service can be confident that their assessed and changing needs and personal goals are reflected in their individual plan and that these enable people to exercise choice and control over their lives. People who live at Almond Close know that they will be supported to develop independent living skills and will be enabled to take risks as part of an independent life style. People who use this service know that they will be consulted and encouraged to take part in all aspects of life at the Home and that decisions are taken in their best interests. This judgement has been made using available evidence including a visit to this service. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 12 EVIDENCE: 2 peoples assessments and care plans were inspected. Assessments are detailed and include risk, general care, and relevant life history and health assessments. Person Centred plans seen reflects peoples needs as detailed in their assessments and are signed by the person to say they have agreed to the plans. Records showed that both these documents are regularly reviewed. Risk assessments are in place to promote independence whilst keeping people safe and discussions with people who use the service and observation during the site visit evidenced this approach. Discussions with people who use the service and staff in the Home evidenced that regular meetings are held to plan menus and explore their needs and wishes in terms of the day-to-day running of the Home. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 13 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 and 17 People who use the service experience good quality outcomes in this area. People who use the service take part in a range of activities including Jobs and community activities and their rights are respected and responsibilities recognised in their daily lives. Time is taken to encourage and support people to maintain personal and family relationships. People are encouraged and supported to maintain a healthy diet and their needs and wishes are sort and respected in this regard. This judgement has been made using available evidence including a visit to this service. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 14 EVIDENCE: Peoples care plans; daily activity records and feedback from people who use the service showed that people have access to a broad range of activities that are in keeping with their therapeutic needs and wishes. 2 people spoken to had jobs and others attended day centres as well as community leisure activities? In addition people undertake a range of leisure activities including, trips out, shopping trips and annual holidays. Daily records showed that activities are consistently provided and regularly reviewed to ensure they are in keeping with people’s needs and wishes. Discussions with staff and observation on the day of the site visit showed that staff actively encourage and support people who use the service to be independent, to make their own choices and to live their lives as they wish. Household routines are kept to a minimum and feedback from people who use the service showed that they were happy with the range of activities provided and day to day living arrangements. The atmosphere in the Home was relaxed and friendly and staff were observed supporting people to make their own choices in a respectful and sensitive manner. The Home also has its own transport for the benefit of people who use the service. Records seen and discussions with people who use the service and the acting manager showed that relationships with families and friends are valued by the Home. A range of nutritious food is provided which people help shop and cook for. Regular meetings are held to explore people’s wishes in terms of food provided and information from these meetings is used to plan menus. A pictorial communication board is used in the Home and includes picture menus. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. People receive a good standard of support to maintain their personal care in the way they prefer and require. People can be confident that their physical and emotional health needs will also be met. People are protected by the homes policies and procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Person Centred Plans and health records seen and observation on the day of the site visit showed that the Home met people’s health and personal care needs. Details of individual needs were recorded clearly in care plans and reviewed regularly. Staff were seen interacting and supporting people who use Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 16 the service in a respectful and sensitive manner and discussions with staff showed that peoples plans are followed. Health records and discussions with the acting manager showed that people have access to routine and specialist health services including Doctors, dentists, consultants, and chiropodists. A sample of medication and medication recording sheets were inspected, these showed that medication was being administered and stored appropriately. Medications are stored in a locked metal cabinet secured to the wall in the staff office. Discussions with staff and records seen evidenced that medication administration training is provided and the community pharmacist audits the homes medication systems once a year. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. People know that their concerns will be listened to and acted upon and they will be protected from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home has had no complaints since the last inspection and copy’s of the complaints procedure are available to people who use the service in an understandable picture format. As stated previously the Home holds regular house meetings and people spoken to felt able to raise concerns and thought their concerns would be listened to and acted upon. The home has a policy on abuse and a whistle blowing policy and staff had training in protection of vulnerable adults. Discussions with one staff member showed that they had a good understanding of adult protection issues and training was provided. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 18 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, 27 and 30 People who use the service experience poor quality outcomes in this area. More needs to be done to ensure that People live in a clean environment, which is decorated, furnished and maintained to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken and this showed that the Home was generally tidy and the lounge/diner and peoples bedrooms were nicely furnished and welcoming. Records showed that Gas and electricity supplies and heating systems were being maintained and serviced appropriately. Fire equipment was being maintained and tested and fire procedures and drills were being undertaken. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 19 Several requirements made at the last inspection regarding the environment have been complied with and feedback from people living in the Home evidenced that they liked living here. However in some significant key areas the Home was not being maintained to a good standard. The homes kitchen and bathrooms were in need of a deep clean and redecoration. For example skirting boards and walls were stained and dirty in places, cobwebs had been allowed to gather around some of the ceiling areas in the kitchen, radiators throughout the Home needed cleaning and some in the bathroom areas showed signs of rust. Some of the furniture and fittings around the Home are in need of repair or replacement. For example several of the kitchen unit cupboard doors were loose or broken of all together, the toilet seats in two of the toilets were not secured properly to the toilet basin and the down stairs shower cubicle had a lot of black mould in it. Several of the windows and one patio door facing the back of the property had no blinds or curtains and could be viewed from the main road. There was a requirement made at the last inspection that the offensive odour in one of the bedrooms should be addressed. An inspection of this room showed that this has not been complied with and the requirement regarding this remains outstanding. Several further requirements have been made regarding the environment issues identified at this visit. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 People who use the service experience good quality outcomes in this area. People who live at Almond Close are supported by a sufficient number of staff that are competent and qualified and are supervised appropriately. People can be confident that they will be protected by the homes recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation on the day of the site visit, records seen and discussions with staff showed that the Home maintains good staffing levels. The Home has 2 staff on duty at all times during waking hours and 1 member of staff sleeping in during the night. The Home also operates an on call system in case of emergencies. Staff support people in the Home in a sensitive, dignified and considered manner. Staff were observed having the time to talk with people and explore their wishes regarding daily activities and day-to-day living tasks. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 21 Discussions with staff and training records seen showed that staff have undertaken a range of training, including Moving and Handling, First Aid, Fire safety, Person Centred Planning, Infection Control and Safe Guarding Adults. Records seen and observation on the day showed that staff had the skills and expertise to meet the specialist needs of people who live at the Home. A sample of staff files seen showed that the Home undertakes robust recruitment procedures and practices to safe guard people who use the service. Files included application forms, 2 written references, Criminal Record Bureau checks, induction records, supervision records and training plans and certificates. Typical comments included: “ Staff are nice, they go on holidays with us” “ Staff are lovely, I like it here.” Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 22 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 and 42 People who use the service experience adequate quality outcomes in this area. A staff team that is led by a competent and experienced acting manager, who ensures on the whole, that the home is run well but more needs to be done to ensure that people benefit from a well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has several years experience of supporting people with a learning disability and has been the deputy manager of the Home for several years. The home has practices for quality assurance and uses questionnaires to obtain feedback about the home. The acting manager informed the inspector Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 23 that people who use the service and relatives and other professionals involved in providing care and support are consulted annually about the quality of the service provided and this information is used by the wider organisation to guide practice. Feedback from people during the site visit and the homes own assessment showed a high satisfaction with the service. Monthly-unannounced monitoring visits are undertaken to assess the standard of care and support provided and records are kept to evidence that this is being done. Records seen showed that appropriate risk assessments are in place for people who live at the Home and the general environment and monitoring systems are in place to ensure health and safety is maintained. The acting manager informed the inspector that the Home does not have a designated budget for decoration and furnishings and a recommendation has been made that a programme of routine maintenance and renewal of the fabric and decoration of premises is produced and implemented with records kept. Staff have mandatory training in fire, food hygiene, moving and handling, and first aid. Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 1 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 25 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 YA24 Regulation 12(4)(a) Requirement The registered person must ensure that the windows and patio door identified in this report have suitable curtains or blinds to ensure privacy. Timescale for action 30/04/08 2 YA24 23(2)(b)(c) &(d) a) The registered persons must ensure that the two toilet seats are repaired. b) The mould in the down stairs shower cubical is attended to and the floor tiles are made good. c) The rust on the bathroom radiators is attended to. d) The kitchen cupboard doors are replaced or made good. e) All parts of the Home are kept clean and reasonably decorated. 30/05/08 Almond Close (49) DS0000013506.V348409.R01.S.doc Version 5.2 Page 26 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 YA39 Good Practice Recommendations It is recommended that a programme of routine maintenance and renewal of the fabric and decoration of premises is produced and implemented with records kept. 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