Inspection on 18/08/06 for 59, Lion Road

This inspection was carried out on 18th August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

59, Lion Road 03/10/07

59, Lion Road 04/11/04

59, Lion Road 08/06/04

59, Lion Road 27/11/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Lion Road, 59 59 Lion Road Twickenham Middlesex TW1 4JF Lead Inspector Sandy Patrick Unannounced Inspection 10:00 18 August 2006 th Lion Road, 59 DS0000017379.V307975.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 Lion Road, 59 DS0000017379.V307975.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 Older People and 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. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lion Road, 59 Address 59 Lion Road Twickenham Middlesex TW1 4JF 020 8891 6025 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) Owl Housing Limited Ms D Brenner Adi Anderson Ms Anne Lawn Care Home 8 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Physical disability (0), of places Physical disability over 65 years of age (0) Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That Mr Anderson completes his NVQ Level 4 and acquires the certificate of qualification. 18th October 2005 Date of last inspection Brief Description of the Service: 59 Lion Road is a residential care home for eight service users with learning and physical disabilities. The home is additionally registered so that it can accommodate service users over the age of 65. The building is owned by Thames Valley Housing Trust. The service is managed by Owl Housing Limited. The home is situated in a residential area of Twickenham, close to shops, public transport and other local amenities. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The residents have their places funded by the London Borough of Richmond and their individual fees are needs assessed. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 18th August 2006 and was unannounced. The Inspector met with all the residents and staff on duty and was made welcome by all. The atmosphere at the house was calm and friendly and residents were undertaking a variety of activities supported by staff. The Manager was not on duty at the time of the inspection but the staff gave useful information to assist with the inspection. Shortly before the inspection the CSCI wrote to residents, their representatives, staff and other professionals involved with the home asking for their views and comments about the service through short questionnaires. Seven staff completed questionnaires and returned these. Unfortunately none of the residents or their representatives returned questionnaires on this occasion. All seven staff described thorough recruitment procedures and said that they were well supported and trained. Some of the things that the staff said that they would like to change to improve the service were, less use of agency staff, to employ a gardener because the staff are currently responsible for managing the garden as well as attending to their other duties, redecorate the house and slight adjustments to the rota and the way staff communicate with each other. The staff were asked to comment on what they felt the home did really well. Some of the things that they said were, the team works well together, the residents get a quality service, the home is clean, the residents have nice food and a well balanced diet, the manager is excellent and the staff team is good, team work, the house runs well and the home manages residents’ special needs well. Some of the other things that staff said about the home were, ‘the residents are happy living here and have all their needs met’, ‘the staff give good support’, ‘the service is really well run and there is a good quality of service’, ‘I am very happy in my work place and the residents are well looked after’ and ‘the team works well together’. The residents were not able to have sustained conversations with the Inspector about their care. However, the Inspector observed staff being kind and supportive. Residents were all doing different things and appeared happy and stimulated. Residents are unrestricted in the home and are able to go where they please. The staff demonstrated a good knowledge of individual needs and showed that they genuinely cared for the residents. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: It would be good for staff to do some further work to improve accessible information for residents. Risk assessments need to be reviewed and should be recorded in a clearer way. The Manager needs to make sure all staff are trained to administer medication. The organisation should consider employing a gardener to free up more staff time. The Manager should look at new and innovative ways of measuring the quality of the service. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 7 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. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 8 DETAILS OF National Minimum Standards FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP National Minimum Standards 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP National Minimum Standards 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP National Minimum Standards 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP National Minimum Standards 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP National Minimum Standards 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. There is a range of information for prospective residents and there is a suitable procedure to make sure their needs are assessed. The home works closely with other professionals to make sure the needs of residents are met. EVIDENCE: The home is designed to meet the needs of middle age and older people who have a learning disability and a physical disability. The building has been Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 10 suitably equipped and adapted to fit this purpose. Staff at the home are closely supported by the Community Team for Learning Disabilities. The Inspector saw evidence of health care professional input for staff training and with individual residents. Care plans clearly indicate individual needs. The Registered Person has produced a comprehensive Statement of Purpose and Service User Guide (Tenants Handbook) for the home. These cover the required areas and include key procedures, such as the complaints procedure. Copies of the Statement of Purpose, Tenants Handbook and Licence Agreement have been given to all residents. Copies of these documents were seen. There are appropriate procedures for the assessment of new residents. There were no resident vacancies at the time of the inspection and no new residents had moved to the home since the last inspection. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP National Minimum Standards 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP National Minimum Standards 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP National Minimum Standards 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP National Minimum Standards 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP National Minimum Standards 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) 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 & 9 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The residents needs are recorded within person centred care plans. Assessments of risk need to be updated and reviewed so that they can be used as useful guides to help staff minimise risks. EVIDENCE: Each resident has their own care plan. The staff have worked hard to make these person centred and represent what the residents would want to say about their care. The plans use a variety of different texts, photographs, pictures and other mediums and are original and well thought out. Each care Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 12 plan states what people like and admire about the resident and the people, places, things and routines that are important to them. The information is detailed and clear. Guidelines and additional information from other professionals are incorporated in plans. Staff review care plans regularly and write monthly reports for each resident. Information and updates from other professionals, day centres and the Aromatherapist are included within this information. Some of the information at the home, including care plans, has been recorded in different formats and using pictures and symbols. There is potential for more work in this area to improve the information which residents are given and can understand. The Manager and staff should continue to look at how more information can be made accessible particularly around decision making, seeking advice from other professionals. Residents are supported to take risks and some of these have been assessed. Many of the risk assessments are old and although they have been reviewed, there have been no changes to the assessment reflecting changes in need. One resident recently fell and staff spoke about new guidance to offer support to this person. The mobility needs of this person had also changed. However the risk assessment had not been updated. Some of the information in risk assessments was confusing and the things people needed to do to minimise risks was not always clear. The Manager must review all risk assessments and must make sure they are accurate and appropriately detailed. The Manager should consider changing the way in which risk assessments are recorded so that they are clearer, include better practical guidance and are more person centred. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 – 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP National Minimum Standards 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP National Minimum Standards 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP National Minimum Standards 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP National Minimum Standards 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP National Minimum Standards 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP National Minimum Standards 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP National Minimum Standards 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 14 Residents are supported to pursue a range of activities both within the home and in the community. Residents are supported to maintain relationships with their families and friendships outside of the home. Residents are supported to make choices about their lives. The staff work closely with health care professionals to make sure that nutritional needs are met and that diet has a positive influence on health and well-being. EVIDENCE: Residents pursue a range of individual activities which reflect their wishes and needs. Some residents attend local resource centres, some are supported by day centre staff at the home and some are members of social and leisure groups. All the residents use the local community. On the day of the inspection some of the residents were supported to do a variety of activities at home and other residents went out to the local town centre. There is a pictorial guide to help show some of the activities people regularly take part in. These activities included art, music, swimming, cookery and communication groups. An Aromatherapist regularly visits the home and writes detailed reports of her work. She has worked with staff to help them to understand what they can do to support residents between her visits. Staff support residents to have a positive self image and care plans and guidelines show how staff support residents in this area. All the residents went away on a holiday to the Isle of Wight earlier in the year. The staff said that the residents enjoyed this and that they did a wide range of different things together and individually whilst away. Throughout the year the staff organise special events and parties to celebrate birthdays and other occasions. A summer party was held the week before the inspection. Friends and family were invited. The staff said that the residents all enjoyed the party. The staff told the Inspector that families were encouraged to visit and participate in the care of their relatives if they wish to. Some relatives visit on a daily basis and others are invited for regular meals at the home. Residents have friends outside of the home and see them through social activities. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 15 Menus at the home are designed on an individual basis to meet the various, complex dietary needs of the residents. The Dietician visits the home monthly and has an input into menu production and review. Food is freshly prepared and is prepared according to dietary needs. Strict dietary guidelines are in place where residents have specialist needs. Menus offer choice. There is a wide range of snacks, fresh fruit and drinks available for residents. Meal times are flexible and residents may eat where they chose to. Food storage areas and serving food temperatures are monitored and recorded. The kitchen was well stocked with fresh food. The staff have developed a good understanding of individual dietary needs of residents and how diet and nutrition impact on general health and well-being. The Community Nurse who works with the home was visiting on the day of the inspection. She said that staff were excellent at following planned diets and their hard work to make sure nutritional needs were met had resulted in healthy and happy residents. The residents participate in shopping for food. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP National Minimum Standards 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP National Minimum Standards 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP National Minimum Standards 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP National Minimum Standards 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) 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 & 20 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The staff have worked hard to monitor the health needs of residents and to make sure the residents stay healthy. Medication procedures are appropriate however not all staff are trained in the administration of intrusive medication and must be. EVIDENCE: Personal and health care needs are well recorded within individual care plans and are monitored on a daily basis. The home works closely with a team of Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 17 other professionals to make sure residents are getting all the support they need. The staff on duty demonstrated a very good knowledge of individual needs and knew how to detect if there were any changes in the health of residents. All residents are registered with local GPs and other health care professionals as required. The staff said that they felt well supported by other medical professionals. A visiting Community Nurse offers guidance and support for staff and also helps to make sure the health care needs of residents are met. The Nurse was visiting the home on the day of the inspection. She spoke positively about the work of staff complementing them on their approach and care of the residents. The Community Nurse and some staff were involved in a health awareness day to help promote a better understanding of health care needs and maintaining a healthy lifestyle. The staff are commended for their hard work in making sure the residents stay healthy. The residents have a wide range of dietary, health and mobility needs. All of these need to be carefully managed and monitored to make sure the residents’ health and general well being is maintained. The Community Nurse was clear that staff worked hard in this area. Unfortunately one resident had a fall earlier in the year, but other than this residents had been healthy and not needed to go to hospital. The staff talked about new guidance to support the resident who fell to minimise the risk of reoccurrence. The risk assessment for this resident had not been updated and needs to be. The staff on duty said that they had recently had refresher manual handling training which included the staff hoisting each other. They said that this had been useful and gave them an insight to how frightening it felt to be hoisted. They said that they had used this knowledge as well as the practical information to help improve the way in which they moved residents. There is an appropriate medication procedure and all staff are trained in administering medication. Medication is administered and recorded by two staff working together. The Inspector observed two members of staff giving residents medication during the inspection. Medication was stored appropriately and records were accurate and clear. The staff on duty spoke about how they measured and recorded blood sugar levels and other health conditions relating directly to medication. The staff had been trained and demonstrated a good awareness of procedures. There is recorded information on each prescribed medication and its side effects. Some of the residents have been prescribed intrusive medications which can only be administered by trained staff. Not all the staff had had their training in this area. The rota indicated that some of these untrained staff were responsible for leading a shift with other untrained and temporary staff. The Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 18 Manager must make sure that only staff trained in this area are given the responsibility for leading a shift and that there is always trained staff on duty. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP National Minimum Standards 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP National Minimum Standards 17) Also Service users are protected from abuse. (OP National Minimum Standards 18) Also Service users financial interests are safeguarded. (OP National Minimum Standards 35) 23. The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) 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 & 23 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. There are appropriate procedures regarding complaints and safeguarding residents. EVIDENCE: There is an appropriate complaints procedure detailing timescales and information on how to contact the Commission for Social Care Inspection. The staff on duty were not aware of any complaints made since the last inspection. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults Procedure. Owl housing has its own procedures on protection and whistle blowing. Staff on duty told the Inspector that they had undertaken training and had a good understanding of these areas. The staff at the home help residents to manage their own money. Keyworkers and the Manager are responsible to maintaining records of all transactions and checking balances. The Inspector and one of the staff on duty looked at the Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 20 records and money held for one resident. The systems for recording and auditing were appropriate and the balance was accurately recorded. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP National Minimum Standards 19) Also Service users live in safe, comfortable surroundings. (OP National Minimum Standards 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP National Minimum Standards 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP National Minimum Standards 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP National Minimum Standards 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP National Minimum Standards 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP National Minimum Standards 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP National Minimum Standards 26) 25. 26. 27. 28. 29. 30. The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) 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, 25, 26, 27, 28, 29 & 30 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The environment is suitable to meet the needs of residents. maintained and safe. It is well Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home is purpose built on two floors accessed by a passenger lift and stairwells. Rooms are large and well equipped and the building is appropriately lit and well ventilated throughout. Corridors are wide and equipped with grab rails. There is an attractive, well kept garden, with patio area to the rear. New garden furniture has been purchased since the last inspection. Throughout communal and private areas the home is personalised with pictures, photographs, craftwork, flowers, plants and posters. The home was attractively maintained and was clean and tidy. Each resident has their own bedroom. Four rooms are designed to accommodate wheelchair users. Four of the rooms have direct access to a bathroom and WC. These en suite facilities are shared with another room. Ceiling track hoists lead from three of these rooms directly into the bathrooms. Bedrooms are appropriately furnished and equipped. Residents have personalised bedrooms with décor and belongings of their choices and tastes. The staff on duty said that the Manager was organising for new furniture to be purchased for the lounge. There is a plan to start to refurbish and redecorate bedrooms and communal rooms. Bathrooms, shower rooms and WCs are spacious and equipped with track hoists where appropriate. Rooms are equipped with specialist baths, showers, WCs and washbasins. The kitchen was refurbished in 2005 and is an attractive and easy to use. There are two large communal lounges and a dining room. Additional seating areas are situated at the top of the stairs. One lounge is being developed as a sensory lounge. A range of sensory equipment has been installed and a staff member has painted an attractive mural around the room. This room was being used to store some equipment at the time of the inspection and should be cleared so that it can be used by residents. The staff are currently responsible for maintaining the garden and this can be difficult and take their time away from care of the residents. The organisation should consider employing a gardener to relieve the pressure on staff. The home was clean throughout on the day of this unannounced inspection. There are appropriate procedures for laundering clothes, infection control, Control of Substances Hazardous to Health and disposal of clinical waste. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The staff team are appropriately recruited, supported and trained. EVIDENCE: There were some staff vacancies at the home at the time of the inspection, including the position of Deputy Manager. Staff on duty said that these posts had been advertised. Two members of staff were new to the team. The staff on duty said that it had been difficult at the home with staff shortages and particularly with the lack of a full management team. They said Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 24 that everyone had worked hard together to support the manager and make sure there was not a detrimental effect for residents. A number of temporary staff have been working at the home to cover vacancies. Some staff said that this could be difficult as each time a new temporary staff member came to the home they had to induct them. However, the Manager has tried to keep the same familiar temporary staff to provide a more consistent approach. One temporary member of staff was on duty at the time of the inspection. They said that they knew the home and residents well and had worked there many times. The staff on duty and those who completed questionnaires about the home said that they had been recruited appropriately. They said that a range of pre employment checks, including a criminal record check and references were made. The staff on duty did not have access to staff recruitment files therefore these were not examined at this inspection. However, staff files were found to be complete and appropriately maintained at previous inspections. One member of staff who had been employed for a month said that there had been a very thorough interview and selection procedure. This included a group exercise, written test and formal interview. There is an appropriate procedure for the induction of staff which includes basic training in key areas, shadowing staff, learning organisational procedures and principles of good care practice. The new member of staff who spoke to the Inspector said that they were well supported through this induction by the team and Manager. All the staff who spoke to the Inspector said that the team worked well together and supported each other. They also said that the Manager was very supportive and approachable. Regular staff meetings take place and all the staff are invited to contribute and take their turn at chairing the meeting and minute taking. The minutes for the staff meetings are not appropriately filed and took the staff on duty some time to find. The Manager must make sure minutes are appropriately documented and accessible to staff at all times. There are good systems of communication between staff, using the house notice board, diary, shift plans and communication books as well as team meetings. Each day a member of staff is assigned to be responsible for running the shift and organising who does what task. The staff on duty said that this works well. In addition to this each staff member is allocated additional responsibilities which they have agreed to. These include checking health and safety and making sure medication procedures are followed. The staff have developed their own guidelines for these roles. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 25 There is evidence of regular individual supervision meetings for each member of staff. There is a planned programme of training which all staff can participate in. The training records could not be accessed by staff on duty during the inspection. However they said that they were happy with the training they received and felt that this covered the aspects of their role. The home works closely with the local Community Team for Learning Disabilities and staff receive training from various professionals within the team. The Manager must make sure training records are available for inspection and must make sure all staff have undertaken training, including refreshers, in all key areas. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) 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, 38, 39, 41 & 42 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The service is well managed and the management approach is open and inclusive. There are appropriate procedures for checking health and safety. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Manager is qualified to NVQ Level 4. He has managed the home since 2002. Prior to this he was a Deputy Manager in another home. He is experienced in working with people with learning disabilities, and has consistently demonstrated an in-depth knowledge of the service. The staff on duty and those completing questionnaires said that they were well supported and were able to contribute their ideas and opinions. Owl Housing have a quality assurance procedure and the area manager undertakes monthly quality inspections at the home. The Manager involves staff in monitoring day to day needs of residents and the home and consults them informally and formally. There is potential for more in depth work in monitoring the quality of the service. The Manager should make use of the London Borough of Richmond Quality Assurance Framework standards and should consider how best to involve residents, their representatives and staff more in quality monitoring. There should be a plan for continuous improvement which outlines actions for the home. Records are appropriately maintained and there is a well organised and clear filing system. There are clear systems for checking health and safety including fire safety, electrical and water safety. Checks are recorded and monitored. Records are accurate and clear. There is evidence that falls and accidents are monitored and recorded. There is evidence of regular fire drills. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 3 40 X 41 3 42 3 43 X 4 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lion Road, 59 Score 3 4 2 X DS0000017379.V307975.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 YA9 Regulation 13(4) & (6) Requirement Timescale for action The Registered Person must 30/11/06 review all risk assessments making sure they are updated and clearly record all risk and the action staff should take to minimise these risks. The information must be clearly recorded and updated following changes in need. The Registered Person should consider using a clearer and more person centred tool for recording risk assessments. 2. YA20 13(2) The Registered Person must 30/09/06 make sure all staff responsible for leading a shift are trained in the administration of rectal diazepam. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 30 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 YA7 Good Practice Recommendations The Registered Person should consider how more information can be made accessible and meaningful for residents. The Registered Person should consider purchasing and using a digital camera in the work to help service users making informed choices. The Registered Person should make sure the sensory room is cleared of unnecessary equipment so that it can be safely and pleasantly used by residents. The Registered gardener. Person should consider employing a 2. YA7 3. YA24 4. YA24 5. YA35 The Registered Person should make sure staff training records are available for inspection. The Registered Person should make sure that the minutes of staff meetings are available for all staff to access as required. 6. YA36 7. YA39 The Registered Person should make use of the London Borough of Richmond Quality Assurance Framework standards and should consider how best to involve residents, their representatives and staff more in quality monitoring. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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. Lion Road, 59 DS0000017379.V307975.R01.S.doc Version 5.2 Page 32 - 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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