Inspection on 07/04/05 for 49 Almond Close

This inspection was carried out on 7th April 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

49 Almond Close 23/02/09

49 Almond Close 25/03/08

49 Almond Close 20/03/07

49 Almond Close 04/08/06

49 Almond Close 23/08/05

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) Bellfields Estate Guildford Surrey GU1 1NW Lead Inspector Susan McBriarty Announced 7 April 2005 10.00 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 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 Stationary 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) Version 1.10 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Royal Mencap Society Alison Jelley Care Home 8 Category(ies) of LD Learning Disability (7) registration, with number LD(E) Learning Disability - over 6 (1) of places Almond Close (49) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 19-65 years of age. 2. One named person may be over the age of 65. Date of last inspection 3 November 2004 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 residential close of similar properties. All rooms are for single occupnacy, none with en-suite facilities. The home offers a sitting room equipped with television and music syaytems, a dining area, kitchen, utility room for laundry and toilet and washing facilities. There is a garden to the rear of th eproperty and some off road parking to the front. The registered providers are the MENCAP organisation and the Local Authority owns the premises. Almond Close (49) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the first inspection for 2005 – 2006 and the first inspection with a new manager in place. Previous inspection reports are available form CSCI on request. During the course of the inspection 4 staff were seen and two spoken to at length, 5 service users were met and 3 spoken to. The remaining 2 did not choose to discuss their views. 1 family member was also spoken to. Documents including care plans, risk assessments, policies and procedures and personnel files were sampled. The manager had completed a pre-inspection report and comment cards had been received from a variety of sources. This inspection report will note the changes that are already taking place with new management in place and staff and service user views on those changes. There have been concerns about this service previously as it had been some time since there had been a permanent manager, staff changes had also been an issue. This was a very positive inspection with evidence of good progress being made. What the service does well: What has improved since the last inspection? What they could do better: Some repairs had taken a long time to complete, for example the broken magnetic holder was reported in November 2004 and repaired in April 2005. The people living in the home had not been able to use a bathroom for four weeks with no date had been set for the repair. Almond Close (49) Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Almond Close (49) Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Almond Close (49) Version 1.10 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 standard(s) 1,2,3,4,5 Information about the home was available for new service users and they would be able to visit the home before making a choice about living there. There was no evidence of assessments being undertaken prior to a new service user moving into the home. Contracts were in place for service users. EVIDENCE: MENCAP’s own policy and procedure for a new admission was clear and forms to complete such an assessment were provided. There was no evidence that these had been completed. The home was unable to evidence that they would be able to meet the needs of the service users on admission. It was recognised that a new manager was now in place and she confirmed that it would be an expectation that such an assessment must be provided for any new service user. This situation will be monitored by the CSCI, no requirement has been made at this stage. Almond Close (49) Version 1.10 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 standard(s) 6,7,8,9,10 Service users had been consulted about their new care plans and had regular weekly meetings in the home. All aspects of daily living and risk assessment formed part of the care plan and confidential information was stored securely. EVIDENCE: The new care plans were seen. The plans were detailed and showed service users preferred ways of being supported and also included their likes and dislikes. The plans would enable staff to be clear about how to support someone in the way they wished. One care plan was not in place. The risk assessments were being updated however those seen reflected the needs of the service users. None of the documents had been signed by the service users although it was evident that they were aware of them and had been part of the discussion in drawing them up. In discussion with the manager it was agreed that staff would talk to the service users about this and use it as an opportunity to review the care plans as well as gain their signed agreement about the content. This will be completed before the next inspection. Service users stated that they no longer felt they had to meet any conditions before being allowed to do what they wished. Interest was being shown by service users in taking part in the running of the home and it was hoped that the weekly meetings will introduce this option in a clear way that enables the service users to take full part. Progress will be monitored by the CSCI. Almond Close (49) Version 1.10 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 The service users said they were able to take part in activities and were aware of what they would be doing during the course of the day. The people living in the home were provided with a varied and nutritious diet. EVIDENCE: Service users spoke of the changes taking place within the home including knowing which staff were going to be there and when. The discussions made it clear that they had been very anxious previously and preferred to know the staff that would be supporting them. Many other positive changes had been taking place and the service users were enthusiastic about all aspects of those changes. In particular they now were able to go out when they wished and stay with friends and family as they chose. Comment cards received by the CSCI noted that there were concerns regarding activities and a desire for them to be provided in the way preferred by the service user. The manager stated that she would write to everyone involved in the support of service users regarding available activities. Toilets were now unlocked, a new wardrobe had been ordered having been chosen by the individual and kitchen cupboards were also unlocked. The atmosphere in the home was relaxed and the people, staff and service users, were keen to discuss how much happier they were. A new approach to menu Almond Close (49) Version 1.10 Page 11 planning was seen. This encouraged the use of pictures and ensured that when service users chose what they wished to eat it would offer a good variety. If food is provided that anyone prefers not to have they can choose another option and either cook it for themselves or receive support if needed. Holiday options were being discussed and the service users were all interested in going to different places and staff were supporting them to make their choices about where they wished to go. Two of the service users talked about their preferences and they were very different from each other. Transport was an issue as the only option is an ageing mini bus. MENCAP do not supply transport and there is a need to consider options. Almond Close (49) Version 1.10 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The home had made good progress in many areas. Personal care needs were being met in the way preferred by service users. The people living in the home will need ongoing reassurance and support to reduce their worries about the management or staff team changing again. EVIDENCE: The new care plans and improving risk assessments evidenced the changes that were continuing to take place. Service users were very positive about the improved support and a more stable staff team. It was evident that reassurance was required. The changes were very recent and remained very new to the service users however they wanted to ensure that their views were heard about the improvements. Although medication was not fully assessed during this visit the manager stated that she had taken action to review staff training needs and the pharmacist was due week commencing 11th April 2005 to review the present procedure and also to agree staff training provision. This requirement has not been met from the last two visits, although it was recognised that progress was being made. The requirement for staff training in medication will remain. Service users access the local doctors and other community based health services in order to ensure their health needs are met. The care plans evidenced access for regular health checks such as dentist and opticians. The home is no longer using pencil on any documentation as it did on previous visits. Almond Close (49) Version 1.10 Page 13 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 standard(s) 22 Although a complaints procedure was in place a number of people involved in supporting service users to make their views heard were unaware of this and therefore the arrangements for service users to complain within the home could be improved. EVIDENCE: MENCAP had developed a new accessible complaints procedure and the details of local services such as the name of the care manager and the address of the CSCI needed to be put in by hand for each service user. The home had completed these and a completed copy had been given to each service user. Since the new manager had been in post no complaints had been made. No records could be found of a complaint book prior to this manager being in post. However comment cards received by the CSCI did note that at least one complaint had been made previously. The cards also noted that many people involved with the support of the service users were unaware of a complaints procedure. The manager stated that as part of the letter to those involved with supporting the service users she would ensure that they are made aware of the new complaints procedure. Progress will monitored by the CSCI. Almond Close (49) Version 1.10 Page 14 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 standard(s) 24, 27, 28, 30 Thee are a number of areas in the home, which require repair and attention, and more work could be done to make it safe, homely and well presented for the people living there. EVIDENCE: The home was toured during the visit and all but the bedrooms were seen. Services users said that the home was cleaner and nicer now and the manager was also looking at how she might support the service users to make the communal spaces more homely. Whilst flooring, furniture, television and music systems were in place the room was not personalised by any of the service users. The kitchen was clean and tidy and evidence was seen of the temperatures of the fridge and freezer being taken. Dates had been put on food being stored in the fridge to reduce the risk of food poisoning. The service users were seen preparing their lunches and receiving appropriate support where needed. The second bathroom was not in use and was in need of repair it has been out of action for over four weeks and this must be attended to, four weeks with only one bathroom available for eight people is not acceptable. The directors of MENCAP had toured the home the day before this visit and were aware of the Almond Close (49) Version 1.10 Page 15 repairs and work needed. The magnetic holder required to be repaired or replaced was completed on the day of this visit, as was the check on the fire alarms. The wardrobe that required replacement has been ordered, the service user chose the style and colour, it is expected to arrive within the next two months. The length of time being taken was stated to have been due to its being built to order. The garden was overgrown with the grass requiring cutting and ivy requiring cutting back. Ivy was growing through the window of the dining area and in one upstairs bedroom. The paving stones to the front and rear of the building not straight and were seen as a trip hazard. The washing line also required some work to ensure that washing would not drag on the grassed area. The repair of the bathroom is required as is work on the external grounds. Almond Close (49) Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 A great deal of work had taken place since the last inspection although it is recognised that the home still has a great deal to do to ensure all these standards are met. EVIDENCE: The staff team is more stable than it has been for some time and it was hoped that this will ensure that training needs will be met in full. Only one has the appropriate Level of NVQ training. The manager must apply for the Registered Managers Award. All the staff have a current Criminal Records Bureaux check apart from the manager who application is being processed. The recruitment policy meets the standard. Supervision had just started and each member of staff had received one supervision session these were now being provided on a monthly basis. The staff team stated that they were clearer about their roles and how they should support the service users. The relationship between staff and service users was observed to be calm, supportive and warm. A training plan to include access to at least NVQ Level 2 is required. Almond Close (49) Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42, 43 Some work is still needed in respect of management of the home and the standards assessed. It is noted that good progress was being made by the new manager. EVIDENCE: Staff, service users and others noted the change in ethos, stable staff team including the manager and that their views were being heard. It is difficult to state that the service users are confident that their views underpin selfmonitoring, review and development within the home. Those spoken to felt these were still new to them and were seeking reassurance that the situation would stay the same. Records and discussions show that the health safety and welfare of service users was promoted and protected. Almond Close (49) Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 2 2 x 3 Standard No 11 12 13 14 15 Almond Close (49) 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3 Version 1.10 Page 19 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 3 x x 2 3 Almond Close (49) Version 1.10 Page 20 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 YP20 Regulation 13(2) Requirement The manager must ensure that adequate training in medication management is provided to ensure staff competancy in safe medication administration. (Timescale of 18.08.04 not met). The manager must ensure that the grounds including paving are maintained and kept in good order. The manager must ensure that a training plan is provided, the plan to include qualifying training. The manager must register to undertake and complete the registered managers award. Timescale for action 27th May 2005 2. YP27 and 42 YP35 23(2)(b) (o) 18(1)(a) (c)(i)(ii) 9(b)(i) 10(3( 29th July 2005 30th June 2005 30th June 2005 3. 4. YP37 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 Good Practice Recommendations Almond Close (49) Version 1.10 Page 21 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Almond Close (49) Version 1.10 Page 22 - 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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