Inspection on 14/01/08 for 65 Churchill Road

This inspection was carried out on 14th January 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

65 Churchill Road 02/03/07

65 Churchill Road 07/02/06

65 Churchill Road 21/07/05

65 Churchill Road 03/03/05

65 Churchill Road 13/04/04

65 Churchill Road 14/11/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 65 Churchill Road 65 Churchill Road Forest Green Nailsworth Glos GL6 0DE Lead Inspector Mr Tim Cotterell Unannounced Inspection 14th January 2008 10:00 65 Churchill Road DS0000016351.V355009.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 65 Churchill Road DS0000016351.V355009.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. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 65 Churchill Road Address 65 Churchill Road Forest Green Nailsworth Glos GL6 0DE 01453 833299 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) jo@ggh.org.uk Gloucestershire Group Homes Joanne Wheeler Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2007 Brief Description of the Service: 65 Churchill Road is a detached house that is registered to accommodate three residents with Aspergers Syndrome. Currently the home only has two residents living there. The organisation offers a very specialised, individual service for people with Aspergers Syndrome, and staff receive training to support service users appropriately. The home is conveniently situated in Nailsworth, which enables residents to access local community facilities. Residents also have access to transport that is provided by the home and this enables them to access facilities in several other local towns. Family and friends are welcome to visit the home at any time and residents can meet them in private if they wish to. Residents attend various activities, which include Day services provided by Gloucester Group Homes, and they are given the opportunity to attend College courses if they wish. The Inspector has visited the day service that is provided by the organisation, it has been developed specifically for people who have Aspergers and offers residents very individual programmes to meet their needs. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service This was an unannounced inspection undertaken in one day by one Inspector. The inspection consisted of talking to four support staff, to include the senior support worker, and the two residents. The accommodation was seen and records inspected in relation to medication, care plans, personal monies and health and safety matters. We (The Commission) received three completed surveys, two from relatives and one from support staff. Staff were providing an individual service to the residents based on their specific needs and wishes, and the inspector saw many examples of the support and patience provided. The fees of the home are in the range £850-£1250. What the service does well: The home was seen to be providing support in a calm and professional manner and in a way which safeguarded the rights of the residents. The residents in the home may not have the verbal ability to determine how the care is provided, but staff ensure that the principles of privacy and dignity are assured. There are clear individual care plans for residents, to include their autistic needs. Staff were clear about the aims and objectives of the plans and they were being constantly updated to ensure they had a practical meaning for the day to day support of the residents. The home provides an environment which is clean, comfortable and safe and the home had recently been redecorated. The home was seen by the residents as something which belonged to them. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 6 All of the staff who were seen during the inspection were good listeners. We` made this view after watching their interactions in the home and this was also confirmed by the residents. The home has staff who supportive in a caring environment. All of the staff seen during the inspection were competent and this was evidenced by their knowledge of the residents and their understanding of matters like identification of abuse, and the principles of privacy and dignity for the residents. Support towards greater independence is always present. This was evident in the travel arrangements in the local community where specific plans encouraged and supported residents to travel independently with appropriate safeguards. The relatives of the residents completed the surveys provided by us and were pleased with the service provided by the home. The specific comments are in the section of the report entitled “lifestyle”. What has improved since the last inspection? What they could do better: 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 7 Provide a dedicated staff team to reduce the use of bank staff this would hopefully provide greater consistency and less anxiety for residents who are not comfortable with change. The home hopes to develop a better understanding of the ageing process. The ageing process is being recognised and the Trust intends to provide staff with appropriate training. The home intends to introduce POVA training to ensure staff are updated with the changing world for the protection of vulnerable adults. The home hopes to maintain a consistent approach to Reg 26 visits and it would be helpful if the home maintains a record of the monthly visits. 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. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides enough information for prospective residents/advocates to make an informed decision about coming to the home. EVIDENCE: The home provides all prospective residents and their relatives/advocates with their philosophy statement and Service Users Guide. It provides full details about the home to include the accommodation, daily routines, finances and the role of the personal co-ordinator. There is also information on the staffing structures of the Trust and home. There is also information in respect of the complaints procedure and how the placement will be monitored. We feel that there is sufficient and relevant information passed to prospective residents and that this will enable them to make an informed decision. No placements have been made since the last inspection 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 10 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 11 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 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the residents are identified in the plan of care and subsequently met in a sensitive and caring manner by the support staff in the home. EVIDENCE: Residents have an Individual Personal Programme and this indicates specific areas where staff support/intervention may be required. The plan, which is reviewed every three months includes a goal, an objective and the actions required to meet them. The evaluation is detailed and included in the plan. There is also a general risk policy and personal profile, which provides staff with details of the risk assessments and any special measures required for an activity. It is recommended that personal profiles are reviewed with dates of the review provided. The Individual Personal Programmes were seen as plans of care as they are attempting to meet specific goals, however, the model used could be improved by have an annual assessment of need followed by specific plans which are 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 12 identified from the assessment. This would ensure that all, and sometimes changing needs, are identified and provided with a specific and measurable goal. One resident told us about some aspects of his plan of care, which included one to one time at various points in the week. It was evident that this knowledge and acceptance of the plan was critical to his wellbeing. The records showed that other healthcare professionals are involved in the preparation of advice and guidance when care plans are being prepared. The present arrangements made through The Individual Personal Programmes for residents are only undertaken after full consultation with the resident/relative who contribute to the plan and all subsequent reviews. There is also an annual review of the placement. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 13 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. Residents live in a home, which supports and encourages them, and this helps them to take an active role and enjoy a caring and stimulating environment. EVIDENCE: The staff in the home provide appropriate support and guidance to enable residents to develop personal and social skills. This includes one to one sessions where the time of staff is devoted to a resident without the pressures of the supervision of others. Relatives surveys returned to us included the following comments “staff were wonderful” and that they were “happy with the service provided by the home”. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 14 Residents have individual weekly programmes and they are completed after consulting with the individual about how they would like to spend their time. One resident enjoys going to the social centre provided by the Trust and we visited him at the centre. Whilst the conversation was limited it was clear that he enjoyed going to the centre and had a good relationship with staff. Residents are encouraged to become involved and use the facilities of the community and this includes visits to the local shops and cafes. Families are active in the support of the residents with all of them having frequent contact with parents. The home continues to provide help and guidance to maintain family links if and when this is needed. The house rules in the home are kept to a minimum and generally only refer to the health and safety of the residents. Daily life is flexible and based on the needs and wishes of the residents. Menus are based on what resident like, however the staff make great efforts to encourage resident to eat healthily, this is often a difficult balance but one that seems to be achieved. The residents said that they liked the food provided and are able to exercise choice. Residents have access to the kitchen to prepare drinks and snacks. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 15 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. The healthcare needs of the residents are reviewed and met and all of the relevant community services are used. EVIDENCE: After the comments in the last inspection report the home has now introduced a new system, which records the administration of medicines and the member of staff who has done this. The new system, which was inspected, provides a better audit trail and safety for the residents. The staff have recently completed training in the management of medicines. There is no self-medication at present, although one resident holds a nasal spray and one resident is given his night medicines to hold for self-medication later. We were informed that the Trust is compiling a “homely remedy” policy. There are written protocols for any “as required medicines” and staff must consult the on call senior before any administration. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 16 Whilst the home has introduced a more detailed administration sheet we were informed that the dispensing pharmacist is to provide a detailed model for future use, and this will ensure an even better audit trail for the prescribed medication. All residents have their medication formally reviewed annually, however where specialist services are used, the review is every three months or more frequently if required. We saw evidence of the guidance provided by a consultant in respect of medication and staff were conversant with the details. Records of healthcare were seen they were clear and detailed and included all the healthcare professionals used in the community. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in an environment, which ensures they are supported in a private and dignified manner and where any form of abuse would not be tolerated. EVIDENCE: Staff were clear about the identification of abuse and what to do if concerns are raised. The residents have access to staff in the social centre, the home and at the headquarters of the Trust, resulting in numerous avenues to pursue any concerns they may have. Whilst there is a written complaints procedure we feel that most matters would be dealt with quickly and in informal way through the avenues mentioned. The details on the complaints procedure need to be updated and reflect the new address of the Commission. The home has not received any complaints since the last inspection. We saw many exchanges between staff and residents and was impressed by the listening skills, patience and the unhurried and dignified manner in which they dealt with each matter. The records kept in respect of personal allowances were seen. There is a record of the receipt of the weekly personal allowances, which are passed in cash to the residents as they are received 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 18 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been maintained to a good standard and provides a comfortable physical environment. EVIDENCE: The inspector saw all of the accommodation and it was found to be clean, pleasantly decorated and furnished with appropriate and domestic furniture. The communal area had been decorated by staff recently and was seen as a bright and cheerful environment. The bedrooms had been personalised and reflected the interests of each resident, and new bed mattresses had recently been provided. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 20 The kitchen was clean and organised. The bathroom on the first floor requires attention; the sealant around the bath is mouldy and should be replaced. The issue of adequate toilets was discussed with staff who felt that the current facilities were adequate for the needs of the residents. We noted that a repair required to the electrical power system was still outstanding. The matter was passed to Spring Mill in August 2007; in the circumstances the matter should be dealt with without further delay and the repair/replacement procedures should be reviewed. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported by caring and competent staff who see the needs of the residents as paramount. A dedicated staff team is likely to improve the continuity of care provided. EVIDENCE: The home is now staffed 24 hours a day as the needs of the residents were seen to need this level of support. The staff rota was seen and indicated that the gaps in cover were filled by bank staff of the Trust. The completed relatives surveys said that staff were providing an excellent service, were approachable and meeting the needs of the individual residents. During the inspection the senior support worker and two support workers were seen independently in the home. It was felt, and evidenced by their 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 22 interactions with residents, that they were competent and caring and providing a service where the needs of the residents were seen as the most important. The home is at present advertising for additional support hours. The shortfall is and has been for some time met by bank staff from the Trust and whilst residents know them the present system of not having a dedicated staff team for the home could result in a fragmented service, and reduce the ability of staff to be aware of and meet specific needs. The question of staffing and how it is provided should be reviewed to ensure that the best option is adopted. The registered manager who is not on the rota of the home provides support to the senior support worker and he felt that he could access the resources of the Trust at any time. The question of supervision by the senior support worker was raised and it was evident that he was not able to meet the standards set by the Trust. The Trust appraises all care workers annually. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 Registered Manager and staff were seen as competent and helping to provide an environment that is safe and comfortable; and where staff and residents are consulted over how their lives are spent. EVIDENCE: The Registered Manager of the home is responsible for more than one home and the day-to-day matters at 65 Churchill Road are managed by the senior support worker, who was present at this inspection. Staff in the home informed the inspector that they were adequately supported by the senior support worker and felt they were able to contact him at any time, It is recommended that individual supervision is undertaken and recorded at the frequency suggested by the Trust and complimenting the national minimum standards. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 24 The Registered Manager keeps close contact with the home and meets the senior support worker several times each week, and was seen by staff in the home to be providing appropriate support and guidance. However it is recommended that the support provided by the Registered Manager is formally reviewed by the Trust annually to ensure the needs of staff are met. The records in respect of the maintenance of the fire equipment were seen. The last inspection was in November 2007. The reports in respect of the Regulation 26 visits by the Trust were seen. The last visit was December 2007, however, the previous record was dated January 2007. It would be helpful if the records were maintained as and when the monthly visits were done. Fire procedures were discussed with staff and the last fire drill was recorded as being on 26th November 2007, completed with one resident. It is recommended that the home ensure that the night time procedures are reviewed to ensure the safety of the residents. 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 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 3 X 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 4 5 Refer to Standard YA42 YA36 YA6 YA33 YA37 Good Practice Recommendations Electrical repairs which may include non-essential items should be completed without undue delay. Staff should receive supervision in accordance with the National Minimum Standards All Personal profiles to be reviewed Staffing of the home to be reviewed Support by Registered Manager should be reviewed 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 65 Churchill Road DS0000016351.V355009.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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