Inspection on 06/03/07 for 64 Stagsden Road

This inspection was carried out on 6th March 2007.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

64 Stagsden Road 09/03/09

64 Stagsden Road 17/01/06

64 Stagsden Road 16/08/05

64 Stagsden Road 11/03/05

64 Stagsden Road 13/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 64 Stagsden Road Bromham Bedfordshire MK43 8PU Lead Inspector Dragan Cvejic Unannounced Inspection 6th March 2007 15:00 64 Stagsden Road DS0000014973.V331171.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 64 Stagsden Road DS0000014973.V331171.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. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 64 Stagsden Road Address Bromham Bedfordshire MK43 8PU 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) 01234 826106 F/P 01234 826106 Walsingham Steven Iodice Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: 64 Stagsden Road is a detached residential house for five service users with learning disabilities. The home is managed by Walsingham organisation. The accommodation consists of four single bedrooms, a lounge, dining room, staff office, kitchen, and laundry. The bathroom was on the first floor and there was a toilet on the ground floor. Linked to this was a two bedroom semiindependent unit in what had been the garage. This unit had a lounge/diner kitchen and bathing facilities with a shower. One service user occupied the unit and the other bedroom was used for staff sleeping in. room. There was a good-sized enclosed garden to the rear of the property, which had a greenhouse, vegetable patch, lawn and flowerbeds. The house was located in the riverside village of Bromham. The village had a post office, take away shops, a small supermarket, two churches, a library and several pubs. The fee for the service was £923.67. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out in the afternoon hours, when all service users had returned home after attending their daily programmes. The main methodology was case tracking two service users, although all service users’ files were inspected and all users were spoken to. Three staff members were asked about their work in the home. . The deputy manager was in charge at the time of site visit and helped with the inspection. A preinspection questionnaire and 3 service users’ surveys were also used to inform this inspection. A partial tour of the home and checking some documents helped inform this report, too. At the time of the site visit, four service users resided in the home. What the service does well: What has improved since the last inspection? The home’s actions in responding to the changing needs of service users were bringing appropriate improvements. A raised toilet seat was installed for a user on the day of the site visit. Refurbishment for the kitchen was planned and was going through the financial approval process and included plans to replace the cooker with a split level oven. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 6 A staff member devised a questionnaire for quality assurance review that was appropriate for service users. 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. The summary of this inspection report can be made available in other formats on request. 64 Stagsden Road DS0000014973.V331171.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 64 Stagsden Road DS0000014973.V331171.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): 2,3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home was constantly monitoring users’ needs in order to determine the environmental factors that would potentially reduce users’ independence and planned actions to prevent loss of users’ independence. EVIDENCE: The home provided information about the service describing what was offered. They hope to attract new users, especially as there was one vacancy at the time of the site visit. Existing users had a Service user’s guide, although their files stated who could use it effectively and who could not. It also stated that one of the users was not keen to have pictorial type information, while another could not understand even if documents were produced in picture format. All four files were inspected and contained evidence of the initial assessment of needs. The home was assessing their abilities to meet the users’ needs and concluded that at the present time they had the capacity, but identified potential problems for the near future, as one user’s needs were deteriorating rapidly. The home responded by planning a big review with involvement of relevant external professionals. It was decided that the home would not be able to meet 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 9 the needs of a user when he reaches the level of needs that would include the use of a hoist. At this time, the home was considering moving users on the ground floor, in a flat, where mobility would be a less affecting factor. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual needs and choices were highly respected, well documented and constantly and continuously promoted making users feel respected and treated as individuals. EVIDENCE: All four users’ files were checked. Each of them clearly identified the assessed needs and how these would be met. One of the users’ plans stated that he did not want a care plan in picture format. The plan for another user was produced in picture format, although this version was still on computer rather than added to his printed file. Care plans were constantly and regularly updated. This was visible in the plan of a user whose needs were deteriorating fast in the last period. Due to a number of changes for one user, his care plan was totally re-written rather than just recording changes under the reviews section. This user was regularly 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 11 checking his care plan. Another user showed no interest in what was written about him and in his care plan. Restrictions were recorded for two users who did not have road awareness and could not go out unaccompanied, while two other users did not have restrictions and, as one file showed, a user was going out to buy newspapers. The home provided opportunities to service users to make their own decisions, but some user’s capacity did not allow them to do so. However, a relative responded in a questionnaire: “ He cannot directly respond, but as I know him well, I know his choices are respected. His choices are incorporated into his care plan.” One of the users had an advocate who helped him present his interests. Two users had support to manage their finances, for the other two, their finances were managed by the organisation’s representative and transactions were signed each time by two staff members. Users had their meetings regularly, monthly, and the minutes were produced in picture format, to make it easier for 2 users to understand at least some of the minutes. Users were supported to explore their abilities and take some extra risks. An example was using knives in the kitchen. Two users were going out unaccompanied and the risk assessment for that was drawn up and regularly reviewed. The other two were going individually to the garden, which was relatively safe, but not to the street, which presented an excessive hazard and where they would have been exposed to a very high level of risk. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ lifestyle was structured according to their needs and wishes, allowing them to express their individuality and use all their capabilities. EVIDENCE: Three questionnaires returned to the CSCI indicated that service users could not make decisions on how they spend time during the day, while they were happy and decided on their time in the evening and weekends. Daily routine was, however, decided during care planning meetings and meant some structured and organised activities were taking place on weekdays. Two users were attending college. All users were connected with their families and had regular visits to families arranged. One user was going to his parents on weekends, the other user fortnightly. Two users were regularly visited in this home. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 13 One user was regularly going to church on a weekly basis. Even his niece commented: “If he does not want to go to church, there was no pressure from staff.” A user who deteriorated temporarily stopped his swimming, but alternative activities were already sought for him. Service users attended day centres and staff from the home were constantly checking the day centres’ observation of users. Service users were using knives, the toaster and kettle, and were making their own snacks for day centres. A bathroom needed some extra facilities to ensure safety for a user who deteriorated. An OT was engaged to help with identifying the best solution. The weekly menu was sent to the CSCI prior to the site visit. All extra ordered meals were recorded. Service users had a choice and also contributed in drawing up a shopping list for ordering ingredients on-line. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefited from a proactive and preventative approach staff had when they considered users’ healthcare support. Medication process was appropriate. EVIDENCE: A user relative commented: “They listen when he has aches and pains. They keep him in touch with his GP and organise referrals to a consultant. As my relatives health has changed, they have been on to it and acted proactively.” The records confirmed this statement; deteriorating continence was referred to the continence nurse; mobility was assessed by a physiotherapist. Staff were trained to deal with users’ medication. No-one was able to self medicate completely, but one user was training towards it. Staff were giving him his medication in the morning for the whole day. He was still taking medication in front of the staff. Staff also carried out regular audits of the medication held in the home. No one was prescribed controlled drugs. Medication procedure and records were accurate and the recent mistake was thoroughly investigated, although it referred to a lost tablet. 64 Stagsden Road DS0000014973.V331171.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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although some users did not have the capability to make a complaint, staff and involvement of external professionals and users’ relatives ensured that any unhappiness would be reported and taken seriously by the home, offering good protection to service users. EVIDENCE: The home had a clear complaints procedure. The deputy manager checked records when asked about the number of complaints since the last inspection and did not find any new entries. The home did not have any complaints and no complaints were sent to the CSCI. Records showed that even informal concerns were recorded, especially when “service users did not understand the procedure due to their learning disability”, as a relative explained. She continued: “…He would complain if he was unhappy.” In another questionnaire it stated: “She would show if she was not happy with something.” Both care plans indicated potential difficulties and explained the signs that demonstrated when one of them was not happy with something. The manager reported that there were no allegations and POVA referrals. The deputy manager confirmed this during the site visit. Service users were protected by clear protection policy and by working practice. The staff dealt successfully with occasional anger outbursts of a service user toward another user. These events were reported to external medical professionals and were well managed. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 16 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): 24,26,27,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The house was well maintained, but did not fully meet the needs of service users. However an analysis with the multi-disciplinary team was currently being undertaken hence no requirements were made on this inspection. EVIDENCE: Two service users showed their bedrooms and indicated that they were happy the rooms were theirs. A tour of the house demonstrated that the house was bright and clean. The laundry room was used by users with staff supporting them. The kitchen was open to service users and they used it to prepare their snacks and drinks. A list with house jobs was displayed in the kitchen, showing that users were encouraged to use the house as their own. A new boiler was to be installed in the kitchen the day after the site visit. A new cooker with a split-level oven was ordered and was to be installed as part of the kitchen refurbishment. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 17 A hand-rail in the bathroom showed signs of wear and tear, but the deputy manager stated that it would be replaced as it did not meet the needs of one of the users and that an occupational therapist was involved in the assessment for finding the most suitable one. The house did not fully meet the needs of a user whose mobility deteriorated and the deputy stated that this was currently being analysed by the multi-disciplinary team. The home’s response was seen through moving users to different bedrooms, thus positioned more appropriately to users’ changing needs, while awaiting the full assessment. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 18 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): 31,32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the staff team was achieving its’ aims and objectives with their commitment, the staffing number was critical for meeting increased needs in the home and the agency staff were used until a review takes place and a permanent solution found. As the process has already started, there were no requirements related to the staffing level. The level of NVQ trained staff was under National Minimum Standards. EVIDENCE: Staff were clear of their roles. In addition, their commitment and knowledge of service users helped them meet their needs in difficult conditions, when the needs were increasing daily due to deterioration in the mobility of a service user. The home created a short, brief list of needs allowing agency workers to quickly learn the basic needs for all users. The home deployed agency workers as extra staffing temporarily, until the assessment of a user takes place. Although staff attended various training, the level of NVQ trained staff was under the required national minimum standards level. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 19 A staff member spoken to stated that she was more than happy with training and added: “The organisation is very “hot” on training”. The home relied on electronic records and staff were appropriately trained to use the computerised system. Two staff files checked contained all required documents. There was a link to CRB and POVA checks, as the originals were not kept in the home. Staff details were organised in file designed according to National Minimum Standards. Staff supervision was regular and the manager and the deputy were also regularly supervised. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 20 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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was successfully managed by the temporary manager, staff and the organisation and ensured undisrupted care for service users. Safe working practices were in place and protected existing service users. EVIDENCE: The service was currently run by the manager of another home, while the home’s manager was transferred to that service on a temporary basis. A deputy role was emphasised and she was involved in all management aspects. Between them the deputy and the temporary manager ensured that the aims and objectives of the home remained the same and that staff were working towards them. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 21 A staff member devised a new service users questionnaire for quality assurance purposes. The results collected locally would go through the line management structure and would also be analysed and fed back to participants from the home. The yearly budget was planned in the home, as a part of the business plan. The views of users’ relatives were given particular attention, especially for non-verbal users. Safe working practices were in place. The records of checking temperatures, checking the water against Legionella and fire checks were regularly carried out and appropriately recorded. A general risk assessment was drawn up, but did not address uncovered radiators, as the deputy stated that the current risk to existing service users was minimal. As the home was planning to admit new users, it should assess the radiators and record this potential hazard. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 22 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 X 29 2 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 3 X 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 23 No 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 YA32 Regulation 18 Requirement The level of NVQ trained staff must be increased to at least 50 . Timescale for action 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA27 YA24 YA42 Good Practice Recommendations The handrail in the bathroom should be replaced with an appropriate one for the user’s needs and improve the general look of the bathroom. The home should complete the planned assessment of the environment in relation to being suitable for a service user and arrange for agreed adaptations to be carried out. The radiators should be risk assessed in relation to potential hazard for planned new admissions. 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 64 Stagsden Road DS0000014973.V331171.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!