Inspection on 29/05/08 for 53 Cambridge Road

This inspection was carried out on 29th May 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

53 Cambridge Road 17/05/07

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 27/09/2008.

CARE HOME ADULTS 18-65 53 Cambridge Road Portswood Southampton Hampshire SO14 6UT Lead Inspector Nick Morrison Unannounced Inspection 29th May 2008 11:00 53 Cambridge Road DS0000059160.V363171.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.V363171.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.V363171.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.V363171.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 17th May 2007 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. We were informed by the Area Manager that the current fees at the time of the visit to the home were £4407.39 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. 53 Cambridge Road DS0000059160.V363171.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. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 29th May 2008 and lasted five hours. During this time we toured the premises, looked at the files of four people living in the home and spoke with three people who live there. We also spoke with the Deputy Manager and two members of staff. Since the inspection visit we have spoken and corresponded with the Manager and Area Manager about aspects of the service. All records and relevant documentation referred to in the report was seen on the day of inspection. We have also considered the information provided in the home’s Annual Quality Assurance Assessment (AQAA). What the service does well: What has improved since the last inspection? What they could do better: The home needs to attend to a number of requirements made as a result of this inspection. Care plans, support plans and risk assessments need to be kept under regular review. The information available to service users about the service needs to clearer and more accurate. Medication needs to be managed so that people receive the medication they need and do so safely. The maintenance and cleanliness of the building needs to be monitored and 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 6 managed more closely and the views of service users need to be the focus of improvements and developments planned for the 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.V363171.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs and aspirations assessed prior to moving into the home but would benefit from clearer information about the home prior to moving in. EVIDENCE: On the day of the inspection visit we were shown a Statement of Purpose that was not specific to the home. Since that time the Area Manager has supplied us with a Statement of Purpose that is specific to the home. However, the Statement of Purpose is not clear or specific enough about the items that service users may be asked to pay for while living at the home and so does not give clear enough information to people before they move into the home about what financial commitments they may have. This has a knock-on effect in respect of the rights of people living in the home (see Concerns, Complaints and Protection section of this report). The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does it’s own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users have care plans and risk assessments in place, but would benefit from having these reviewed and updated on a regular basis. Service users are supported to make decisions for themselves. EVIDENCE: There had been a requirement from the previous two inspections that care plans must identify all the person’s care needs and provide full explanations as to how staff can fully support these. This requirement has now been met. The home had introduced new care planning procedures and documentation since the previous inspection. The format was clear and comprehensive. Documentation was presented in a way that might be accessible to people who use the service, including actual photographs of the service users engaged in activities and Makaton symbols where necessary. Service users spoken with were aware of the details of their care plans. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 10 There were examples of care plans not having been updated. One person living in the home, according to her plan, required support when answering the door. When we asked why she had not received this support on the day of our visit we were told that she no longer needed the support but her care plan had not been updated to reflect this. Service users spoken with were of the view that they were able to make their own decisions while living in the home. These was supported by policies and training for staff in the importance of people making their own decisions. Care plans also contained details of how different people made and expressed their own choices. There had been a requirement from the previous inspection that service user plans must include details of what is being done to manage the risks identified in their risk assessments. Since that time the risk assessments had been reformatted and now described what was being done to manage each identified risk. In this sense the requirement has now been met. However, the risk assessments that were in place were not being reviewed as regularly as they were scheduled to be. We looked at a total of twenty risk assessments in three service users’ files. Of these, three had not been dated when they were written so it was not possible to determine how old they were or when they needed to be reviewed. Of the remaining seventeen, only three had been reviewed by the date they should have been reviewed. They had not been reviewed in line with the dates set by the home or within the organisation’s own Quality Standards for reviewing risk assessments. The Provider’s visit of 2nd October 2007 also highlighted the reviewing of risk assessments as an issue. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. EVIDENCE: Evidence from daily records and service users’ files demonstrated that people living in the home were supported to identify the activities they wished to be involved in and had support from staff where necessary to do those things on a regular and planned basis. On the day of the inspection visit we observed that service users were able to plan things they wanted to do and ask for particular members of staff to support them with it. Service users told us they had a lot of choice about what they wanted to do and felt in control of their own time and activities. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 12 Records showed that people were involved in a wide range of different activities, according to their own wishes. Two people living in the home have jobs and one person was being supported to plan to move on to a more independent living situation. Menus showed that people living in the home had varied and nutritious meals. Individual dietary requirements were catered for and people could choose alternatives to the daily menu if they wanted to. There were choices on the menu including choices about breakfast. As service users spend time out of the home, individual packed lunches were prepared according to individual preferences and needs. Snacks were available to people outside of set mealtimes. Service users spoken with said the food in the home was good and that they always had sufficient amounts of food. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from having personal support in the way they prefer and from having their health care needs met. The management of medication in the home needs to be improved to ensure the safety of service users. EVIDENCE: There had been a requirement from the previous two inspections that Procedures must be followed for the receipt, recording, and administration of medication. This requirement had not been met at the time of this inspection visit. The staff in the home thought they had lost some controlled drugs on the day of our inspection visit. This was later investigated by the Area Manager who assured us that there were no drugs missing and that the person having that medication had received all their medication as prescribed. The tablets had been supplied in two different doses for different combinations at different times of the day. Staff had administered the correct dosage but had used the wrong combinations at times, which made it appear that there 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 14 were insufficient tablets left in the medication cupboard. Additional tablets had to be ordered on the day of our inspection visit to ensure that the person had the correct amount and combinations for the remainder of the week. There was also confusion as to whether or not this particular medication should be regarded as ‘controlled drugs’. The home had received different advice from different people. They were treating the medication as controlled as they were storing it in the appropriate part of the medication cupboard for controlled drugs, but they were not using a controlled drugs register to monitor the amount of medication given and the amount that should be left. The home needs to follow the Royal Pharmaceutical Society Guidelines for the Handling of Medicines in Social Care, which treats all controlled drugs in the same way and specifies how they should managed within a care home. During this inspection visit we found examples of service users not receiving their medication as it had been prescribed. There were occasions where medication had been signed for but not given and occasions where medication had been given but not signed for. The Provider’s visit on 7th February 2008 also highlighted two occasions where medication had not been signed for. The staff meeting at the home on 21st April 2008 highlighted that one service user was not receiving her medication as prescribed. One person living in the home administers some of her own prescribed medication. The risk assessment that had been put in place to identify that she was able to do this safely was out of date and no records were kept of any monitoring of her ability to continue to administer this medication safely. As a result of this inspection we have written a requirement about the safe handling of medication in the home. This is the third consecutive inspection where we have needed to make such a requirement. There had been a requirement from the previous inspection that care plans must include details to support the people who use the service with their physical and emotional health, and behaviour others might find challenging. Examination of service users’ files showed that support plans for difficult behaviours had been put in place as a result of this requirement. However, there was further evidence to suggest that, although these plans had been written, they were not being monitored, reviewed and updated as necessary. (See Concerns, Complaints and Protection section of this report.) Care plans contained details about how each person living in the home preferred to be supported with personal care. Service users spoken with confirmed that staff were good at supporting them with their personal care needs and that they received all the support they needed. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users have their views listened to. They would benefit clearer information about their financial responsibilities and from better records relating to their finances. Their rights would be improved by the service responding to their needs more effectively. EVIDENCE: The lack of information for service users about their financial responsibilities within the home (see Choice of Home section of this report) means that service users pay for items that were not made clear to them or to their representatives at the time they moved into the home. It was explained to us during the inspection visit that service users have to pay a contribution to the running of the house vehicle and also that they have to pay for staff expenses to support them in the community at times when the budget for this has run out. There was no information in the Service User Guide or Statement of Purpose to inform service users that they will have to pay these additional costs. The records for service users’ money that is looked after by staff in the home were unclear and badly written. There were instances where the records had been crossed out and overwritten; there were entries that had been added to in an attempt to make them clearer and there were entries that had been amended when the records had been checked, in order to make the records tally. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 16 Behavioural support plans were in place where they were necessary and these described how staff needed to support people with particular behaviours that caused problems for other people in the home. One person’s behaviour had resulted in a referral to the Specialist Healthcare Team. The Specialist Healthcare Team had written to the home on 17th April 2008 in response to the referral and made recommendations to decrease the likelihood and the impact of this person’s behaviour. At the time of our inspection visit, six weeks later, the person’s behavioural support plan had not been updated in line with the recommendations. The report from the Healthcare Team had also recommended that the person needed a medication review. At the time of our inspection visit we were told that, despite this clear recommendation, a medication review had not yet even been planned. The Health/Behaviour Monitoring section of this service user’s file was empty. The Manager of the home later informed us that this meddication review had in fact been carried out. The housing association had previously written to this service user to explain that her behaviour might result in her not being able to remain living in the home. The fact that the home had not responded in good time to some of the recommendations made by the Specialist Healthcare Team increases the likelihood of further behaviour that will affect the other people living in the home and increases the likelihood that this particular person may continue to display behaviours that might be responded to with further warnings about having to leave the home. Staff have not received updated training in responding to challenging behaviour, but we were told that this has been booked for all staff. The home had a complaints procedure in place and service users spoken with were aware of how to complain. The procedure had been printed in a pictorial version so that service users might find it easier to understand and refer to. There was evidence in the correspondence section of service users’ files that they had been supported by staff to make use of the complaints procedure and that the organisation had responded appropriately to the complaints made. Staff had received training in protecting vulnerable adults and understood their responsibilities within this. The home had policies and procedures in place designed to protect people who live in the home. Service users spoken with said they felt safe living there. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 17 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 adequate This judgement has been made using available evidence including a visit to this service Cleanliness and Infection Control are not well monitored and managed in the home. EVIDENCE: During our visit we found that the home was not being kept as clean as it should be. In the lounges there were dirty walls, dust, cobwebs and some of the furniture needed to be cleaned. In the bathrooms there was dirty and dusty pipe work. The scales in the downstairs bathroom also needed cleaning. The sink in the laundry area and some cupboards in the kitchen also needed to be cleaned. There was liquid soap in place around the home, which was positive in respect of infection control. To improve on this the home would benefit from having paper towels rather than the shared hand towels we saw during the inspection. In one of the bathrooms there was also a bar of soap on the bath that did not 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 18 appear to belong to one particular person and may have been used communally. There were some issues relating to the building that need some attention. There was plasterwork that needed repairing in one of the bathrooms and on the upstairs landing. People living in the home highlighted this to us during our inspection visit and wanted to know when it would be repaired. The plasterwork was highlighted as an issue during the Provider’s visits on 22nd August 2007 and 7th February 2008. We were told that the issue had been highlighted to the housing association that owns the building but had not yet been resolved. There was also paint peeling off the walls in the bathrooms and the upstairs bathroom needed to have the grouting and bath sealant replaced, as it was dirty and mouldy. There were missing tiles in the bathrooms. The doors on some service users’ rooms were not shutting properly. We were told that this had been reported to the housing association but was still unresolved. This affects service users’ privacy and affects the safety of the building, as these are fire doors. The handle on the fridge was broken, as were some of the knobs on the kitchen cupboards. The Manager of the home later informed us that these issues were reported to the housing association in a timely manner. The organisaton needs to ensure that its agreement with the housing association is robust enough to ensure that buidling issues are dealt with in a timely manner once they have been reported. In the garden there had been some recent improvements made including a new pond and a seating area. Service users spoken with thought the improvements were good and said they enjoyed going into the garden. There was some old equipment in the garden that needed to be cleared out in order to improve the area and maintain safety. These included two old chairs, an old wooden handrail and an old garden umbrella. There were also so me tripping hazards in the garden, including a fishing net, broom and hosepipe laying on the ground next to the old pond. We were told that none of the people living in the home smoked, but there was an area of the garden at the side of the house designated for staff to smoke. Ashtrays had been provided but there were still cigarette ends left on the ground in this area. We also found cigarette ends in other parts of the garden including the flowerbeds and the edge of the patio. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 19 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): 31, 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by adequate numbers of trained and supported staff and are protected by the home’s recruitment practices. EVIDENCE: There had been a requirement from the previous inspection that members of staff employed must have a minimum of two references in sufficient detail that a judgement can be made about their suitability for the work. From looking at the recruitment records for staff it was clear that references were now clear and detailed. The home had a checklist system in place for ensuring that pre-employment checks had been carried out and had pro formas in place to record all pre-employment information for each member of staff. The number of staff highlighted on the rota was sufficient to meet the needs of people living in the home and the staffing on the day of our visit reflected the rota. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 20 Staff appraisals were in place and staff had regular support and supervision sessions. A training plan was in place and records showed that staff training was kept up to date. The staff observed on the day of the inspection were skilled in communicating with people living in the home and provided support in an effective and sensitive manner. Service users spoken with said that staff in the home were supportive and that they listened to them and supported them with the things that were important to them. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The views of service users do not directly influence the development of the service. Health and safety in the home needs to be improved. Service users would benefit from the service being managed more effectively. EVIDENCE: There had been a requirement from the previous two inspections that the service 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 has now been met. We looked at the home’s fire records, which were up to date and clear and checks were regular. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 22 The home has regular service user meetings where people living in the home have an opportunity to identify issues. There were good records of these meetings that made use of diagrams and photographs so that people living in the home might understand them better and be able to refer to them in the future. Apart from this, the quality assurance systems in the home are not particularly effective. The home told us they consult with service users about the service they receive and respond to the issues they identify. They gave us an example of service users highlighting that staff sometimes use mobile phones on duty and the organisation had responded to this by implementing a zero tolerance policy on the use of mobile phones. The same example had been quoted as an example of good practice in the information we received from other homes owned by the same organisation. However, when we asked about this at 53 Cambridge Road we were told that it had never been an issue there and had not been highlighted by anyone living in the home. The information given to us reflected what consultation had been carried out on an organisational level rather than what was happening in this particular home. There had been a recent assessment of the service carried out by an independent consultant for the organisation to provide a tool and focus for the Manager. The assessment identified external pressures on the service but had no input from people living in the home. An action plan had been devised for the service in response to this assessment. The home needs to ensure that the process of action planning for the development of the home is based on the views of people living in the home. The Annual Quality Assurance Assessment (AQAA) the home sent us was not written specifically for the home but was copied from previous AQAA’s that had been written for other services within the organisation. As such it gave us information that was not relevant to the home and also gave us some inaccurate information. We have discussed with the Area Manager the need for AQAA’s to be written specifically for each service rather than being corporate documents relating to a number of services. A difficulty for the service is that the house is owned by a housing association that is responsible for the maintenance of the building. This has resulted in a number of maintenance issues being outstanding for long periods of time. The service needs to deal with these issues through the agreement they have with the housing association. They need to ensure that they use the agreement in order to ensure that the building is maintained appropriately and that identified issues are dealt with in a timely manner, particularly where those issues directly affect the safety or privacy of people living in the home. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 23 Health and safety records in the home were generally good, but there were some workplace risk assessments that were out of date and need reviewing and updating. The safety of the garden area (see Environment section of this report) needs to be reassessed and measures put in place to ensure the safety of people living in the home. Our judgement on the effectiveness of the management of the home has been influenced by the range of issues highlighted throughout this report, as we believe many of these relate directly to ineffective management. There is a clear lack of effective monitoring of a number of areas of the service including medication, cleanliness, risk assessments, behaviour support plans, care plans and liaison with the housing association. More effective monitoring of these aspects of the service would result in the home identifying and resolving those issues themselves rather than needing them to be pointed out through the inspection process. This could be supported by quality assurance processes that focus on the views of people living in the home. 53 Cambridge Road DS0000059160.V363171.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 2 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 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 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 3 2 2 X 1 X 2 X X 2 X 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4(1) (b) 5 (1) 6 (a) and (b) 15 (2) (b) Requirement The home must produce a clear Statement of Purpose and Service User Guide that ensure people moving into the home have the information they need. The Manager must ensure that service users’ care plans and support plans are kept under regular review. The Manager must ensure that risk assessments are kept under regular review. The Manager must ensure that medication in the home is managed in line with the Royal Pharmaceutical Society Guidelines for Social Care services. The Manager must ensure that all people living in the home receive their medication as prescribed. The Manager must ensure that the records relating service users’ money are clear and accurate The Manager must monitor the cleanliness of the building The Manager must monitor the building issues that affect service DS0000059160.V363171.R01.S.doc Timescale for action 22/07/08 2. YA6 22/07/08 3. 4. YA9 YA20 13 (4) (b) and (c) 13 (2) 22/07/08 22/07/08 5. YA20 13 (2) 22/07/08 6. YA23 YA41 17 22/07/08 7. 8. YA24 YA24 23 (2) (d) 23 (2) (b) 22/07/08 22/07/08 53 Cambridge Road Version 5.2 Page 26 9. 10. YA42 YA24 YA39 23 (2) (o) 13 4 (a) 24 (3) users and ensure they are dealt with in a timely manner The Manager must ensure that the garden area is kept safe and free from hazards The Manager must improve the quality assurance and planning systems in the home to ensure they reflect the views of people living there. 22/07/08 22/10/08 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 YA30 Good Practice Recommendations The Manager should seek to improve infection control in the home by using alternatives to communal soap and towels. 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 53 Cambridge Road DS0000059160.V363171.R01.S.doc Version 5.2 Page 28 - 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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