Inspection on 18/04/05 for 65 Gloucester Crescent

This inspection was carried out on 18th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

65 Gloucester Crescent 16/10/07

65 Gloucester Crescent 08/03/07

65 Gloucester Crescent 06/06/06

65 Gloucester Crescent 23/08/05

65 Gloucester Crescent 12/11/04

65 Gloucester Crescent 15/06/04

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Southfields

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Dovedale Court

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

CARE HOME ADULTS 18-65 65 Gloucester Crescent Laleham Middlesex TW18 1PN Lead Inspector Kathy Martin Unannounced 18 April 2005 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 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 Stationary 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 Gloucester Crescent Version 1.10 Page 3 SERVICE INFORMATION Name of service 65 Gloucester Crescent Address 65 Gloucester Crescent Laleham Middlesex TW18 1PN 01784 421407 Telephone number Fax number Email 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 Ltd Roisin Donnelly CRH 6 Category(ies) of LD Learning Disability - 6 registration, with number LD(E) Learning Disability - over 65 - 1 of places 65 Gloucester Crescent Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1) Manager works full time and is supernumerary to care staff at all times. 2) That a management structure is in place where a suitably trained and experienced deputy for each home is named for Service Use and staff at all times. 3) Management of the homes will be formally reviewed on an annual basis, to ensure management requirements of both services are met by the arrangement. 4) The age/ age range of the persons to be accommodated will be: Under 65 years, with the exception of one person who may be over 65 years. Date of last inspection 12 November 2004 Brief Description of the Service: 65, Gloucester Crescent is a home for 6 service users with learning disability. The home is situated across another Owl Housing ltd home and service users from both homes meet up regularly and often share the same staff team including the manager who is also the registered manager for both homes. The home offers accommodation for single occupancy with bedrooms on the ground and first floor of the detached property. Car parking is available on the road. Transport is available for service users to go out. 65 Gloucester Crescent Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection this year. There will be another inspection from the CSCI before the end of March 2006. The staff and residents were not notified of this inspection in advance. The inspector was made welcome by the staff and the residents who were introduced to the inspector. The manager was on a late shift at the time of inspection, which took place in the morning. The residents were busy in their own routines of the day; some were out to day care services. The residents were receiving good care from the carers. They offered the inspector relevant information to contribute to this report. Residents appeared relaxed and comfortable. One resident was receiving support from staff for reassurance about getting in touch with a friend, which the staff handled well. Two residents from No. 100, Gloucester Road also come in the home daily and mingle with the others. They also share the same staff team. It was not always possible to communicate verbally with the residents and the Inspector had to talk to staff and look into their care notes in order to gain insight in their lives. The inspector also observed the interactions of the residents in the home with each other and their carers. All residents did indicate that they were happy in the home and had all they needed in their bedrooms. The inspector was concerned about the entrance door, which was open and this will be followed up with the registered manager and Owl Housing ltd. Three requirements made at the last inspection on the 12th November 2004 remained unmet. The CSCI will follow up these issues with the registered providers. The inspector wishes to thank all the staff present and the residents for their hospitality during the inspection. What the service does well: The residents able to verbally say so, expressed that they liked the home and said that the staff was good. Staff were observed to deal with the residents with courtesy. The new care plans were of particularly good standard. Residents’ needs were well written and residents participated in their care. 65 Gloucester Crescent Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 65 Gloucester Crescent Version 1.10 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 Standards Statutory Requirements Identified During the Inspection 65 Gloucester Crescent Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 and 5 The home has a good assessment in place for welcoming new service users in the home. Copied of written contracts/terms of Conditions were not present. EVIDENCE: The inspector discussed this with the staff who explained that the process of introducing a new service user in the home will me managed carefully. This process involves family/ friends, the service user, and the other health care professionals such as doctors, nurses, psychiatrist, day care service and key worker. Staff also confirmed that all prospective residents are invited to visit the home as many times as they wish to integrate gradually and also to ensure the other residents are happy about the new resident. There is currently one vacancy in the home. There were no copies of residents’ contracts available to inspect. A requirement has been made for the home to obtain copies of written contracts/ terms and conditions for each service user and keep these on files 65 Gloucester Crescent Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 There are now very good care plans in use. Risk assessments were mostly clearly written on all aspects of daily life and activities. EVIDENCE: 4 care plans were inspected. These were newly written including photograph of the resident and pictograms to guide the resident and encourage their participation. Residents are not currently signing their care plans which is recommended. Staff have not signed the care plans when they wrote them. Residents attended their review meetings and have a key worker. Also noted was that that the care plans did not include any emotional needs, which is recommended. Residents risk assessments were inspected. Examples included: behavioural patterns/ challenging behaviour, slipping, falling and community awareness. Risk assessments for window restrictors on the first floor were not seen. 65 Gloucester Crescent Version 1.10 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13 and 14 Residents were given opportunity to interact with each other (including residents from the home across the road at no. 100), keep contact with family/ friends, maintain and learn existing and new skills, hold a job and take part in leisure activities within the community. EVIDENCE: The daily activities of each resident were recorded. One resident talked to the inspector about a friend whom the staff tried to contact. Visits to the shops, bank, day care centres were organised. The written information about a planned holiday this year was shown to the inspector. The day centres provide opportunity for residents to be involved in learning skills, use art and craft and socialise. The home also has reasonably well equipped communal areas (2 lounges and a large kitchen/ diner) to encourage them to mingle, enjoy music, watch television or play games. One resident was observed listening to his music. One particular resident, who previously stayed in the home all of the time, has managed to go out with staff’s encouragement, which is commendable. 65 Gloucester Crescent Version 1.10 Page 11 65 Gloucester Crescent Version 1.10 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The home offers care based on a well-structured care plan, which included personal support from the home staff and also the community professionals. The procedures for medication management have now improved. EVIDENCE: Care plans inspected reflected the fact that staff knew the residents and were able to talk to the inspector about residents’ needs and those involved in their care. Their emotional needs were not however recorded in the new care plans. It was difficult for residents who live in the home to verbally communicate with the inspector during the visit. The inspector had to use the records and talk with the staff to confirm that they knew their residents’ needs and knew how to help them. The medication records were inspected. These were clearly written, with no unexplained gaps. 65 Gloucester Crescent Version 1.10 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The complaints procedure was not updated from the last inspection and may be confusing to the complainant. Service users were observed to freely express themselves to staff on the day although not all verbally. EVIDENCE: The complaints procedure was requested and was found to be outdated and still in draft format although it offered pictorial symbols. This still refers to the local registration unit, which ceased operation under the Care Standards Act 2000. The procedure also does not state that complainants will receive a response within 28 days. Not all residents would be able to use the complaints procedure in its present format, as it was not clear. However staff were observed interacting with several residents and this was particularly good. The staff were able to coax, reassure and attend to the residents’ request in a very calm and attentive manner. The resident was observed to respond well to this interaction. 65 Gloucester Crescent Version 1.10 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The home was generally clean and tidy inside and offered a homely and comfortable environment. The safety of residents and staff was felt to be jeopardised. EVIDENCE: The home was generally clean and tidy inside. The overall maintenance is good. The garden in the front of the house is untidy with the grass being allowed to overgrow which does not look welcoming. The back garden which is a large area laid to lawn is in need of tidying as it does not offer encouragement for residents to use it regularly in view of the spring time. The staff reported that the lawn mower was broken for some time and not replaced or repaired. The front door was left open which was later closed. This was not good as the residents could have gone out on their own without staff assistance and there is a busy road in the front of the home. Likewise leaving the door unlocked may welcome an intruder. The staff explained that the home’s policy (not inspected) was that the front door remains unlocked during daytime hours to allow service users to go out. There was no basis to support this policy however, as the inspector was advised that no service user currently goes out 65 Gloucester Crescent Version 1.10 Page 15 unaccompanied by staff as they were assessed as not safe to do so. Therefore for their safety it was felt that the door should remain locked, as it would otherwise jeopardise the safety of vulnerable service users and staff. This does not mean however that the residents will be discouraged from going regularly. 65 Gloucester Crescent Version 1.10 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The staffing complement has now improved since the last inspection. EVIDENCE: The home has successfully employed 3 new members of staff since the previous inspection. The staff are undergoing induction training. There are Agency staff who are covering the gaps in the meantime. 65 Gloucester Crescent Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The risk assessments need to include window restrictors for rooms found on the first floor. The policy for not locking the front door during daytime hours need to be reviewed as this is not considered safe. EVIDENCE: The risk assessments did not include that window restrictors were assessed to ensure that those who needed the restrictors had them. The home’s policy of leaving the front door unlocked during daytime hours needs to be reviewed as this was not safe. Residents would be able to go out unaccompanied and there is a busy road in the front of the property. The care notes indicated that at present no resident is considered safe to go out unaccompanied. There could also be an issue with intruders. 65 Gloucester Crescent Version 1.10 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 65 Gloucester Crescent 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 x x x Version 1.10 Page 19 16 17 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x 65 Gloucester Crescent Version 1.10 Page 20 Are there any outstanding requirements from the last inspection? Yes. (3 requirements) A letter will follow to the provider seperately 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. 2. 3. 4. Standard 6 24, 42 24 24 Regulation 17 (3) (a) 13 (4) (c) 23 (2) (c) 23 (2) (o) Requirement Staff to sign and date all entries on care plans Review the policy of the front door left unlocked Replace/ repair the broken lawn mover Tidy the front and back garden to render it more welcoming and userfriendly for service users. Timescale for action 18/05/05 immediate 18/05/05 18/05/05 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. Refer to Standard 6 6 Good Practice Recommendations Encourage service users to sign their care plans Include service users emotional needs to the new care plans to demonstrate holistic care 65 Gloucester Crescent Version 1.10 Page 21 Commission for Social Care Inspection The Wharf Abbey Mills Business Park Eashing Surrey GU7 2QN 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 65 Gloucester Crescent Version 1.10 Page 22 - 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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