Inspection on 03/05/06 for 57 Bury Road

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

57 Bury Road 23/04/07

57 Bury Road 04/10/05

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Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 57 Bury Road Gosport Hampshire PO12 3UE Lead Inspector Kathryn Kirk Unannounced Inspection 3rd May 2006 10:00 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 57 Bury Road Address Gosport Hampshire PO12 3UE 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) 020 8544 8900 www.caremanagementgroup.com Care Management Group Limited Miss Theresa Ann Porter Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2005 Brief Description of the Service: This service is owned by the Care Management Group and was first registered in 2005. The provider has two houses next door to each other in Bury Road and they are registered separately. The house has been refurbished to a good standard and provides a home for up to six people who have a learning disability. The home is situated close to the centre of Gosport and has good links to public transport. Care Management Group have printed detailed information about this service in their statement of purpose and service user guide, which is available from them. The current range of fees as given in April 2006 is £1.390.67-£1.660.52 per week. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this visit, six service users were living at 57 Bury Road. Their needs are such that they were unable to contribute verbally to the inspection. Evidence gathered for this report was obtained through talking to the homes manager and staff, spending time with residents, touring the building and by looking at some paperwork in the home. Other evidence was gathered from a pre inspection questionnaire, which had been sent to CSCI by the manager, from reports of monitoring visits by senior mangers of The Care Management Group and from information about significant events in the home provided by staff. The findings of the previous inspection report of October 2005 were also reviewed. What the service does well: What has improved since the last inspection? Contracts provide detail about which room is to be occupied. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 6 Training available to staff regarding the management of medication has improved. Some further training has taken place. All staff now have been trained in restraint procedures and about half have completed in depth training in health and safety areas. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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 the following standard(s): 2 and 5. Quality in this area is adequate. This judgement has been made using available evidence, including a visit to the service. Service users benefit from having their needs identified in detail before a move to the home is agreed. Contracts contain useful information about terms and conditions of the home, but could be clearer about what costs are not covered by the fees. EVIDENCE: Assessments of need for four service users were seen at the last visit to the home in October 2005. These had been completed prior to admission by competent people, in consultation with families and professionals who knew the service user well. It was noted that there had been limited input in the assessment process by service users and that this was due to their individual ability to do so. Since the last visit two new service users have moved to the home. One further assessment was seen, this was very detailed and had considered all aspects of needs of the service user before a move to the home had been agreed. The statement of terms and conditions was seen to contain a lot of relevant information to help service users and their representatives to understand their rights and responsibilities. Information contained in them had improved since October as it detailed the room occupied by each service user. Service users needs are such that they are unable to sign to agree contracts themselves. Not all had been signed by service user representatives, but the manager said that this would be addressed at next review meetings. Costs that service users 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 9 have to meet in addition to the fee were given in the pre inspection questionnaire as hairdressing, chiropody, toiletries and any incontinence pads needed as a top up for the supply from the NHS. This information was not provided in the contract and it was discussed with the manager that the inclusion of this information would help to make the contracts even clearer. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Service users benefit from having needs clearly identified in the care planning process. Appropriate risk assessments and guidelines help staff to provide effective care. Staff respect service users rights to make decisions although one procedure relating to the use of residents photographs for publicity purposes needs to be re examined to ensure that it protects service users privacy. EVIDENCE: The care planning process was considered at the last visit in October and was found to be satisfactory. Staff are guided in how to provide care for service users initially from the information contained in the detailed assessment of needs. Once a service user has lived at Bury Road for six weeks a review of all aspects of health, social and personal care needs takes place. Detailed risk assessments and guidelines for staff to follow are drawn up to help staff to provide appropriate and consistent care. There was evidence that action plans contained in reviews are followed through; for example, an identified need for one service user was to improve 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 11 their level of communication. Communication sessions have been set up every Friday to help to achieve this goal and some more staff are being trained in Maketon. Guidelines were seen to have been signed by staff once read and it was observed that they were being followed, for example staff acted in line with the guidance when one service user became agitated. Staff were also able to respond flexibly to any changes in care needs, for example, initial assessment identified that one service user needed two carers to support him with his personal care. It was identified however that if the carer was male, only one person was needed to support the service user effectively. Rotas are drawn up to accommodate this need. Service users were observed to be given choices at mealtimes, one person chose not to eat at the same time as the others and staff respected this. It was evident that staff have given consideration to the most effective way of providing choices for residents, for example, they use pictorial prompts or produce physical objects for service users to choose between. Staff observed assisting a service user with a craft session provided guidance but ensured that the service user had choices, for example what colour they wished to use next. One form seen gives The Care Management Group the right to use photographs of residents for publicity purposes. This was discussed with the manager, as residents had signed to give their consent. The manager said that residents enjoyed having their photographs taken but acknowledged that they would not necessarily understand what they are signing. She said that no photographs of residents from Bury Road had been used for this purpose. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. The service enables service users to maintain appropriate and fulfilling lifestyles in and outside the home. EVIDENCE: Service users interests are recorded as part of the care planning process. Through discussion with staff evident that these activities form part of daily programme .The residents charter says that support workers will respect service users and will help them to use local facilities and to have a full social life. This observed to be the case on the day of inspection. Cultural needs have been identified, for example, one service users religious and dietary needs are detailed in the care plan. Discussion with staff indicated that these issues have been managed sensitively, taking into consideration the service users preferences and the views of family members . Family involvement is encouraged , for example one serive user is escorted to visit their family every month and staff have at least weekly contact with relatives on the telephone. Families can continue to be involved in the care of their relative for example, one family member organises and attends routine 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 13 medical appointments with their relative . Positive comments about the service were seen from family members in the comments book. Service users were observed to choose when and where to eat. Assistance was given by staff in a calm and appropriate manner that suited needs. Menus seen showed that service users were offered a varied diet that reflected preferences identified in care plans. Service users were observed to be given a choice of food and staff said that service users are always provided with an alternative if they do not appear to want the meal provided on that day. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Service users receive appropriate personal support and health care needs are met. Training in medication for staff has improved EVIDENCE: Staff were observed to support service users in a very calm and focussed way. The manager was very clear about how support should be provided and this was mirrored by care staff . In this way, the team were observed to be consistent in their approach. As discussed in earlier sections the service has accommodated the service user who prefers male carers to assist in his personal care. Records and discussion shows that relevent health and social care professionals are involved as needed. Challenging incidents are analysed systematically, where a link is established between challenging behaviour and a possible trigger, staff demonstrated that they are able to work flexibly and adapt to changed guidelines. The home uses a monitored dosage system of medication. There are procedures relating to the safe handling and administration of medicines and records seen reflected that these are being adhered to. At the last inspection a requirement was made that adequate medication training is made available to all staff by 31/01/06. Since then further training has taken place. All new staff 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 15 undertake a baisic training as part of their induction programme. Staff do not administer medication until they have demonstrated their competency by completing further training and the manager confirmed that at least one an appropriately trained staff member was on duty at all times. Since the last inspection “when required” guidelines have been signed by the manager. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22 and 23 Quality for this outcome area is poor. This judgement has been made using available evidence, including a visit to the home. There is an appropriate system in place for managing complaints. The reporting of incidents that have adversely affected service users needs to be more robust. EVIDENCE: There is information in written and pictorial forms about how to make a complaint. No complaints have been mad eabout this service since it opened. in 2005. A record has been kept of comments and complements. These are from care managers, and family members . Positive comments have been made about the staff team, about the home being welcoming and that good information is provided. As the home has had one incidence where resident’s money has gone missing, procedures for handling money were discussed with the manager and records were seen. The incident had been reported to CSCI and the police had been notified but home had not involved social services under the adult protection procedures and instead had conducted their own investigation. The management team acknowledged that on this occasion the correct procedure had not been followed. Care notes indicated service users in the home have challenging episodes and sometimes these involve other service users. For example, on one occasion one service user kicked another on the legs. The total number of incidents are recorded as part of regular monitoring visits made to the home as well as on individuals files It was discussed and agreed with the manager that incidents involving other service users would be reported to CSCI and that there should 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 17 be some written agreement with the relevant social services as to how and when these incidents are reported to them. At the last inspection, it was made a requirement that all staff should receive training in the protection of vulnerable adults by 31/1/06. Records showed that eleven staff have now completed this training and that four others are due to receive training in May. The manager gave an assurance that this training would be completed for all as a priority. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this area is good. This judgement has been made using available evidence, including a visit to the service. Service users benefit from a clean, hygienic and comfortable environment. EVIDENCE: The premises were toured and were found to be clean and comfortably furnished. All bedrooms were furnished to reflect the needs and interests of each service user and were personalised as much as possible. There is an enclosed garden to the rear of the property. One service user who was exhibiting some challenging behaviour was seen to be out in the garden on the day of the visit. They were being supported by staff. Service users share the use of lounge, dining area and kitchen which were spacious enough to accommodate them all comfortably.There is one communal toilet downstairs that is used by service users and staff. Service users all have en suite facilities in their bedrooms. There is a quiet room, one service user who was becomming agitated was observed to go in to this room with a member of staff. This room has padding around the walls and is sparcely furnished. This was discussed with the manager who said that it was so designed to protect service users from harming themselves. She said however 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 19 that there had not been any occasions where this had been needed by current service users and said that the decor in the room would be reviewed. Washing machines are appropriately sited and were adequate to meet laundry needs in the home. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. 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 the service. Staff demonstrate a good understanding of the needs of residents and staff numbers are sufficient to give appropriate support. Thorough Recruitment procedures protect service users. Although some training has been provided in key health and safety areas this remains an area where improvements need to be made. EVIDENCE: The staff team were observed to be enthusiastic and demonstrated a commitment to providing a good service. New members of the team spoken with felt well supported by their colleagues and showed that they had settled very quickly to their role. Records and discussion indicated that three staff are currently studying for NVQ apprenticeship and that two more staff have been nominated for this course. The deputy and seniors are looking into NVQ level 3 courses in care. There has been a reduction in the use of agency staff because recruitemnt has been completed for the regular staff team. No agency workers are employed at the home unless they have been trained in restraint techniques (Digman). Staffing levels appeared to be adequate on the day of inspection and staff were effectively deployed to ensure that each service user received appropriate assistance and support. Gaps in the rota are often filled by members of the regular staff team. Staff asked said that they felt that this improved the 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 21 consistency of service provided and that they felt that they had sufficient breaks. Through discussion it was evident that the manager was also mindful of the need to ensure that staff have enough time off. The file of one staff member was checked and was found to contain all necessary references and evidence of identification. It also had a record of a satisfactory Criminal Records bureau check. At the time of the last inspection a requirement was made that all staff must receive adequate training to fulfil their roles, and that as a minimum this should include food hygiene, moving and handling, fire safety, first aid and restraint training for all staff. The timescale for this to be completed was 31/01/06. The manager said that all staff complete basic health and safety training as part of the induction process. This was confirmed by staff.Records showed that about half the staff team have completed courses in health and safety areas. All staff have completed training in restraint. (DIGMAN) The manager and service manager expressed a comittment to ensuring that all staff receive in depth training in all key areas. It will remain a requirement until this process has been completed. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. 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 the service. The home is well managed and effective health and safety checks are in place. The quality of the service is well monitored by The Care Management Group. EVIDENCE: There is a manager in the home who is in the process of applying for registration. She said that she receives good support from the current registered manager and the area manager. She has nearly completed her registered managers award. During the visit she demonstrated a very good understanding of the needs of service users and offered effective support to the staff team. A senior manager visits the service every month and undertakes a very detailed review and monitoring of the service. It was evident that any shortfalls identified are resolved. Staff have also completed questionnaires regarding their views about the service. At the time of the visit the manager was due to undertake training on how to analyse the data gathered. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 23 Questionnaires for family members and visiting professionals have not as yet been undertaken by the service. Fire records were checked and these were up to date. The manager said that a fire evacuation drill had taken place during a mealtime so that staff could practice assisting a resident to safety who was reluctant to leave their food. Regular maintenance checks were also seen to have taken place. Appropriate records were held in the home for all incidents and accidents. As discussed earlier, there are still some gaps in staff health and safety training. 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 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 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 13(6) Timescale for action The registered person shall make 30/06/06 arrangements by training staff or by other measures to prevent service users being harmed or being placed at risk of harm. 31/08/06 The manager must ensure that all staff receive adequate training to fulfil their roles and that as a minimum this includes food hygiene, moving and handling, fire safety and infection control This was made a requirement at the previous inspection with a timescale date of 31/1/06 Requirement 2 YA35 18(a) 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 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 57 Bury Road DS0000064244.V288678.R01.S.doc Version 5.1 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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