Inspection on 17/05/07 for 53 Cambridge Road

This inspection was carried out on 17th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

53 Cambridge Road 29/05/08

53 Cambridge Road 15/06/06

53 Cambridge Road 03/01/06

53 Cambridge Road 06/09/05

53 Cambridge Road 24/03/05

53 Cambridge Road 07/03/05

53 Cambridge Road 18/03/04

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

CARE HOME ADULTS 18-65 53 Cambridge Road Portswood Southampton Hampshire SO14 6UT Lead Inspector Ms Wendy Thomas Unannounced Inspection 17th May 2007 09:00 53 Cambridge Road DS0000059160.V336237.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 53 Cambridge Road DS0000059160.V336237.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. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 53 Cambridge Road Address Portswood Southampton Hampshire SO14 6UT 023 8055 1551 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.choicesupport.org.uk Choice Support Mr Trevor Mark Ridgewell Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category LD are only to be admitted between the age of 18 years and 60 years 15th June 2006 Date of last inspection Brief Description of the Service: 53 Cambridge Road is a large detached house, which provides care and accommodation to up to six people who have a learning disability. The home has six single bedrooms and has a large garden, which is accessible to all service users. Choice Support took over the home in 2004 and is now the registered provider. Cambridge Road is situated in Portswood, Southampton close to local amenities and has good transport links. The fees at the time of the visit to the home were £1077.31 per week. Items not included in the fees are: contribution to the car, which ranges from £25 to £56 per month dependent on how much the person uses it, personal items such as clothes, toiletries, holidays and personal purchases to enhance the bedrooms e.t.c. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited the home on Thursday 17 May 2007 between 11.30 and 17.30. She met all six of the people living in the home and spoke in more detail with three. She had discussions with two of the care staff and the deputy manager. Records were sampled that related to the standards being inspected and these included medication records, the personal files including care plans of the people living at the home and staff records. Information gathered by the commission since the last inspection including the Annual Quality Assurance Assessment (AQAA) contributed in making the judgements in this report. One of the people living in the home said that the home was, “alright” and that there was “nice food” and “nice beds.” They demonstrated fondness for the staff and particularly enjoyed going to college where they were doing a cookery course. What the service does well: The staff team encourage the people living in the home to take a full role in making decisions about their lives and life in the home. The home is well organised with time tables of activities for the people living there, and rotas that ensure that everybody has the opportunity to help with the chores involved in the running of the home, such as cooking and housework. There are opportunities for people to take part in recreational and educational activities out of the home, and to have individual holidays supported by staff. People were enthusiastic about the activities they were involved in, with two telling the inspector about work (both paid and unpaid) they did, or hoped to do, outside the home. This included cleaning at the Choice Support area office, office work, helping in a charity shop, and taking part on the short-listing and interview panels for the recruitment of new staff for Choice Support. People living at the home described a range of friends and family they enjoyed having contact with. The people living at the home are being encouraged to take increasing amounts of responsibility for the planning and preparation of meals. Menus showed a variety of balanced main courses. Thought has gone into providing a homely environment and the people living there have been able to choose how they have their own bedrooms. One said that they were very happy with their room and pleased to have it painted their favourite colour. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 6 Choice Support are committed to involving the people who use their services in shaping those services, and actively seek out their opinions. What has improved since the last inspection? What they could do better: 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 7 Care plans and risk assessments have been improved. They highlight a range of care needs and how these can be met. The needs of the people living in the home would be met better if more detail was included in the care plans and areas of need were not missed out. At the previous inspection errors had been found in the recording of whether medication had been taken or not. Errors were also being made at the time of this visit to the home. The home must ensure that all medication is accounted for and that records are completed correctly and medication procedures followed. Some healthcare and behaviour issues were not identified in people’s care plans or risk assessments, and there was not enough information for staff to be clear about how to support these needs. In order to safeguard the people living at the home and to ensure that staff are suitable to work there, the home must make sure that staff references include enough information for a judgement to be made about their suitability. Some fire safety equipment is still not being tested at the frequency recommended by the Hampshire Fire and Rescue Service. 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. 53 Cambridge Road DS0000059160.V336237.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 53 Cambridge Road DS0000059160.V336237.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home would spend time getting to know someone who was considering moving to the home, thus ensuring that his or her needs would be met. EVIDENCE: Previous inspections have found this outcome area to be good. As no one has been admitted to the home since the last inspection, and no further admissions are anticipated in the near future, this outcome area was judged on previous information about the home. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved care plans and risk assessments give clearer guidance so that staff are able to support the needs of the people living at the service, however some needs may not be being adequately met because the need has not been documented or enough detail given to support the person satisfactorily. The ethos of the home ensures that the people living there are enabled to make decisions about their lives. EVIDENCE: All of the people living in the home now have an individual care plan as required at the last inspection. Care planning and risk management have been reviewed since the last inspection when requirements were made that this must be improved. A new format is being used which is used throughout Choice Support services. The support plan (care plan) format is particularly effective, however discussions with one of the people living in the home 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 11 brought to light healthcare issues that were not fully covered in their care plan. Care must be taken to ensure that all needs are identified and documented so that staff know how to respond appropriately to people’s needs. The deputy manager explained that she had attended training about person centred planning, and as a result the planning and assessment process in the home now follows a more person centred approach. All the people in the home are offered an annual person centred planning meeting. Two had chosen not to take up the opportunity. The people living in the home each meet with their key worker every six weeks to review the past six weeks. A review sheet tracks the activities they’ve done, whether any risk assessments need reviewing, what contact they’ve had with family, what daily living skills they’ve used, any health or financial issues, any new activities they’d like to try and if there is anything they are unhappy about. This partially satisfies a requirement made in the previous inspection report, although the need to give more detailed instructions as to how the needs of the people who use the service remains. The deputy manager explained that since the appointment of the current manager, about a year ago, there have been developments in the home that have led to the people living there leading more independent lives, being involved in more activities and being supported to make more choices. One such area where they are being encouraged to take more responsibility is housework. One person said that they did not like helping with housework, “I moan, I do. I don’t like cleaning. Its not my job, I have a rest.” But another communicated that they liked using the vacuum cleaner. There is a wellorganised rota allocating tasks to each person, so that everyone has the opportunity to help with each task. The people living in the home have chosen to have a budgerigar as a pet. This lives in a cage in one of the communal rooms. It was explained that three of the people living in the home have independent advocates and two of these attend a self-advocacy group. Those attending the self-advocacy group confirmed this. The home was in the process of updating risk assessments and introducing a format used throughout Choice Support services. Instances were identified where risk issues identified were not adequately addressed in the support plans. This was discussed with the deputy manager. However, on the whole pertinent risks had been identified. One of the files sampled had a mixture of the old and new style risk assessments as the remaining new ones were in the process of being typed up. The deputy manager agreed that some of the language in the old risk assessments could be viewed as devaluing (or did not give enough evidence/explanation for a particular approach) and said that this would not be the case in the new versions. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home benefit from being able to take part in range of social, leisure and educational activities, having support to maintain contact with friends and family, and enjoying a satisfactory diet. EVIDENCE: At the time of the inspection one of people living at the home was attending a college course and another was having support from a member of staff with an activity outside the home. One was getting ready to spend the afternoon at a day service, and the other three planned to stay at home. One of these explained that they did not like to get up early, but that they wouldn’t mind the next day a they would be getting up to go to college and they enjoyed that. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 13 The deputy manager said that in the past year the number of activities most of those living at the home participated in had increased. One person was supported to talk about the work they did in a friend’s office. They were also hoping to help out in a charity shop and had started to work towards this. Another person explained that they were about to start a paid job cleaning at the organisation’s Southampton office. Activities that those spoken with said that they enjoyed included going to church, being part of a self-advocacy group, attending a church group for people with learning difficulties, going to college, eating out with friends, going to the cinema, bowling and shopping. Holidays were also talked about. Activities and holidays are planned and carried out on an individual basis. One of the people living in the home said that they did not do things together as a larger group. One person with support from a member of staff explained how they were hoping to develop the skills to be able to go to the local shop on their own. One of the people living in the home said that they liked to visit one of their friends and two of their relations. Another said that they did not have any family, but they had lots of friends they enjoyed seeing. People’s records included details of their friends and family members. The staff said that over the past year the lunchtime arrangements had changed, with the people living in the home deciding what they wanted to eat and preparing it themselves, individually, with support from staff where needed. This was observed to be happening during the visit to the home. One of the people who use the service commented that they had “nice food.” The meeting to plan the main meals for the following week took place during the visit. All those living in the home were encouraged to take part and contribute. The menus are typed up and those for the last few weeks were seen and offered a range of balanced and nutritional main meals. It would be easier to monitor if everyone was getting a sufficiently varied and balanced diet if more detail was included of lunches and any desserts. In his response the manager has reported that the people living in the home usually choose not to have dessert, but help themselves to fruit which is freely available. The people spoken with were clear that they chose when they got up and went to bed. This was witnessed at the time of the visit to the home, with some people being up and out, and others still in the process of getting ready for the day. A member of staff explained that some were not morning people and chose to start the day at a gentle pace. People were seen to be moving freely around the building. One person was supported to explain that they liked to spend their time in one of the two lounges because it was quieter, which they liked. Another person said that they preferred the other lounge so they could see from the window what was happening in the street. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More detailed information about emotional and behavioural needs, and how support with this should be given, would lead to these needs being met more effectively for people. Medication procedures do not safeguard people who use the service. EVIDENCE: Records of contact the people who use the service have with healthcare professionals were sampled. These gave sufficient detail and any follow up actions required were noted. Where specialist healthcare input was required, such as podiatry or speech and language support, it was noted that the person’s file contained details of this and any reports or recommendations made. The home seeks support from the specialist health care team as the need arises. In consultation with the specialist healthcare team the staff at the home were developing creative solutions for supporting people. Such as a set of cards for one of the people, with symbols to help them identify their feelings, and suggestions of activities 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 15 they could do to help alleviate any discomfort this led to for them or those around them. Choice Support had produced a document called “Considering Self Medication”. This outlines the company’s policy regarding self-medication and included an assessment chart. Following on from a requirement in the previous inspection report, these had been completed for all the people living at 53 Cambridge Road. The deputy manager explained that risk assessments had now been completed for two people who were going to have support to look after and administer their own medication. (These were unavailable at the time of the inspection as they were being typed up.) The previous inspection report contained a requirement that procedures must be followed for the receipt, recording and administration of medication. Inspection of the medication cabinet and records found that these issues had not bee satisfactorily addressed. There was an incomplete audit trail of drugs through the home with miscellaneous tablets, capsules and sachets in a plastic bag in the medication cabinet. These were awaiting disposal, yet there was no record of what the bag contained. Some medication administration record sheets had gaps in them where medication had not been taken and/or not recorded. There was a “weekly medication chart” where the amount of medication held in the home could be recorded. This was only being completed approximately once a month. There was no risk assessment for the person living in the home who sometimes declines to take their medication. It was not clear what action staff should take, or if there was any detriment to the person’s health and well-being. A member of staff explained that if staff were unclear about the consequences of someone missing their medication, they would phone the GP for advice if a dose was missed/refused. It was explained that staff had in-house medication training as part of their induction, and annual refresher training. A document was seen outlining medication training during induction. This included the new member of staff shadowing an experienced member of staff and being assessed before they themselves administered medication. The care plans sampled contained detailed descriptions of what support people liked to have when getting up in the morning. These gave sufficient information for a member of staff unfamiliar with that person to support them successfully. A person living in the home, who was asked, said that they were happy with support that staff gave them. Not all areas covered by the care plan were in such detail, and discussions with staff and the people living in the home revealed support needs that were not adequately covered in the care plans. Such as behaviours that others might find a problem. One of the people living in the home described issues relating to their health that were not included in their file. This identifies that although care planning and risk management has improved greatly since the last inspection in June 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 16 2006, there are still gaps where care or risk issues have not been fully identified and documented. 53 Cambridge Road DS0000059160.V336237.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at 53 Cambridge Road have benefited from being made aware of the complaints procedure and by having training about adult protection. The safety and well-being of people living in the home is promoted by staff who have training about adult protection. EVIDENCE: At the time of the last inspection a requirement was made that the people in the home must be issued with a copy of the complaints procedure that they could understand. All staff spoken with said that this had been discussed in detail at residents meetings. One of the people living in the home said that they had lost their “paper” about the procedure, however it was clear from their level of awareness, that this had been discussed. They were clear that they would tell a member of staff if they were hurt or upset. They weren’t so clear about what to do if it was a member of staff who had hurt or upset them. Another person said that they would tell the police. A Choice Support complaints procedure was seen. Attempts had been made to make it understandable to people using Choice Support services. The deputy manager explained that she hoped to make this available on audiotape. The complaints log showed that no complaints had been made to the home. The Commission for Social Care Inspection has not been notified of any concerns about the home. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 18 A copy of the local authority’s Adult Protection Procedure had been obtained by the home, following a requirement made at the last inspection. Staff had also received training as was also required at the last inspection. The training had taken place earlier in the week of this visit to the home. One of the people living in the home was supported to explain that they had also been involved in the training. Another of the people living in the home showed the inspector a document that had been given out and discussed at a resident’s meeting. It was called “Adult abuse is wrong” and was published by the local authority. The deputy manager explained that through discussions in residents’ meetings it was hoped to raise people’s awareness of their rights and help them to recognise and speak out if abuse occurred. The home keeps records of money that the people living there withdraw from their bank accounts. Most take care of and manage this money themselves. One person prefers their money to be held for them. The record of amount held tallied with the actual amount, and money spent was accounted for. Everyone had been provided with secure storage for valuable in their bedrooms since a requirement in the last inspection report. The inspector was informed that one person had found this unacceptable and had removed it. Another of the people living in the home explained that they didn’t actually use their secure storage. It was suggested that support might be needed for people to start storing their valuables more securely. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at 53 Cambridge Road benefit from a clean, homely and comfortable home. The planned alterations to the downstairs bathroom will ensure that the people using the service have bathing facilities that meet their needs. EVIDENCE: It was evident that effort had gone into trying to make this purpose built care home as homely as possible, with pictures, ornaments and domestic style furniture and décor. Individuals had expressed their personal tastes in their own rooms, with one person explaining that theirs was painted their favourite colour. It was a good-sized room with plenty of space for the personal possessions they had acquired. They said that they were happy with it. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 20 The home has established cleaning routines, which are being followed, with acceptable standards of cleanliness and hygiene throughout the home. The monitoring system indicates where there have been shortfalls, such as the grass hadn’t been cut because it had been raining. Window cleaning did not appear on the cleaning schedule and would benefit from being included. On the day of the visit to the home the weather was fine, and later on in the day people were using the garden as an extension to the home, sitting outside and moving freely around the garden. A gazebo had been erected to add to their outdoor comfort. The home is well maintained, although plans should be made for the replacement of worn carpets and repair of water-damaged paintwork in the bathrooms/toilets. The problems with the downstairs bathroom identified at the last inspection in June 2006 have not been resolved, although some progress has been made. The housing association has agreed to replace the inappropriate bath with a walk-in shower. It was explained that the home were now waiting for an occupational therapist to advise on the shower needed to meet the service users’ needs. It seems certain that this will happen although it is unclear how long it will take. Soap and towels were seen in the bathrooms and toilets as required at the last inspection. The home had decided not to provide paper towels in bathrooms and toilets as had been recommended at the last inspection. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at the home benefit from having a staff team who are qualified and receive training from the organisation to be able to meet their needs. Recruitment practices need to be tightened up to ensure that staff appointed are properly vetted so that the people who use the service are protected from staff unsuitable or insufficiently experienced for such work. EVIDENCE: The deputy manager said that rotas were planned around the activities that people wanted to be involved in. (One of the actions coming out of the service user surveys was that people wanted to go out more in the evening.) A member of staff confirmed that there was no regular shift pattern and that staff’s work pattern varied. The staff spoken with demonstrated a commitment to the people living in the home. They willingly support people to go away for holidays. Several people living in the home spoke about their holidays with several looking forward to going away soon. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 22 Although the home has its full staff complement the information supplied in the Annual Quality Assurance Assessment (AQAA) stated that in the last three months 48 shifts had been covered by other staff. The deputy manager explained that this was because of staff sickness, staff supporting people away on holiday whilst other staff were on annual leave, and occasions when the whole team had training together. Choice Support has a bank of staff recruited by the organisation, who work on a casual basis to cover staff shortages. The people at 53 Cambridge Road know them and they would usually cover any shortfalls in the rota. Only occasionally would agency staff be needed. One of the people who use the service who spoke about the staff said that they were “alright”. Another told a member of staff that, “I’ll miss you” when they went home. The people who live at the home thought that there were enough staff. One said that they liked it when, “They watch telly with me.” The staff agreed that the staffing ratio was satisfactory. At the time of the visit the staffing levels supported the people present in their planned activities. It was explained that most of the staff had worked in the home for a number of years and that staff turnover was low. Staff were observed to treat the people living at the home respectfully and sensitively. They were happy with the training they received and said that the organisation provided well for their training needs, arranging courses relevant to the work situation, such as bereavement and working with families, as well as mandatory training such as fire, first aid, food hygiene and health and safety. The staff said that it was helpful having an area office in Southampton so that they did not have to travel far for training events. Staff training records showed that staff had attended a variety of training. Information returned for the AQAA stated that ten of the fourteen permanent care staff had, or were currently undertaking, NVQ qualifications at level 2 or above i.e.71 . (The National Minimum Standards recommend 50 .) The deputy manager and members of staff confirmed that there were monthly staff meetings. All staff could add items to the agenda and notes were taken. They said that any subject could be discussed at a staff meeting and topics covered included; the people living in the home, health and safety, holidays, staffing issues and the Commission for Social Care Inspection. The rotas ensured the attendance of all the staff at staff meetings. Staff recruitment records were seen. Pre-employment checks were inadequate to ensure that two of the three staff whose files were examined were suitable for the work, as they only had one reference from a previous employer that included enough information upon which to base a judgement. Good employment practice stipulates a minimum of two satisfactory references. A requirement is made regarding this. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 23 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): 7, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at 53 Cambridge Road benefit from a home that is well run and effectively led by the manager, their opinions influence developments within the home. Their health and safety could be compromised by inconsistent checks to some of the fire safety equipment. EVIDENCE: Since the last inspection the acting manager has been registered with the Commission for Social Care Inspection as registered manager of the home. He is working towards the registered managers award and has NVQ 3 in promoting independence. Staff described him as being someone who was 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 24 approachable, supportive, would explain his reasons for doing things, and had brought positive developments to the service including greater independence for the people living there. One of the staff team said that some of the people who use the service were now doing things a few years ago they would never have thought possible. Rotas, timetables, schedules for household tasks and support needed by those living in the home indicated that the organisation of the home was well run. The staff and people living in the home said that they were happy with these routines. Choice Support are proactive in seeking the views of service users and using them to shape their services. A survey of all their homes in London and Southampton has lead to changes in how things are done. One example being that staff are not to discuss their personal lives or talk on their mobile phones whilst at work as this was something that people using the services objected to. Staff and the deputy manager described the meetings for the group of people living in the home as being an important vehicle for consultation and feedback from the group as to their views of life in the home. The deputy manager explained that the last survey the people at 53 Cambridge Road had been involved in had been about a year ago. The surveys are produced by an outside organisation and where people need help to complete these, this is done by relatives and advocates, but not staff. In this way the people living in the home are encouraged to express their true opinions in ways they might be unwilling to with staff. One of the people living in the home was supported to say that they had been involved in interviewing new staff. They confirmed that they had received training, and that they got paid for this. There were gaps in the weekly records of tests to the fire detection alarm system indicting that only 50 of tests were being done. The home must follow Hampshire Fire and Rescue Service guidelines on the frequency of tests to fire fighting and detection equipment. Other fire and health and safety related checks sampled were satisfactory. 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 25 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 2 2 X 3 X 3 X X X 2 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15 (2) (b) (c) Requirement Care plans must identify all the person’s care needs and provide full explanations as to how staff can fully support these. This is a partial restatement of a requirement made in the last inspection report which has not been fully met Service user plans must include details of what is being done to manage the risks identified in their risk assessments. Timescale for action 10/08/07 2. YA9 12(1) 10/08/07 3. YA19 15 (1) 4. YA20 13 (2) This is a partial restatement of a requirement made in the last inspection report which has not been fully met Care plans must include details 10/08/07 to support the people who use the service with their physical and emotional health, and behaviour others might find challenging. Procedures must be followed for 15/06/07 the receipt, recording, and administration of medication. This requirement remains outstanding from the inspection 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 27 of 16/6/06. 5. YA34 19 schedule Members of staff employed 2 must have a minimum of two references in sufficient detail that a judgement can be made about their suitability for the work. This is a partial restatement of a requirement made in the last inspection report which has not been fully met You must seek the advice of Hampshire Fire and Rescue regarding the frequency of checks to be carried out on fire fighting equipment and take action appropriately. This requirement remains outstanding from the inspection of 16/6/06. 15/06/07 6. YA42 13 (4) (c) 15/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 53 Cambridge Road DS0000059160.V336237.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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