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Inspection on 02/08/06 for 85 Cambridge Road

Also see our care home review for 85 Cambridge Road for more information

This inspection was carried out on 2nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Overall this is an excellent service. The home only admits service users if they can meet their needs and the corporate admissions procedure helps potential service users see if they would like to move to the home. Service users records are well kept and staff know how to meet service users needs. Risks for individuals are identified and steps taken to reduce risk. Care is given according to preferred routines and staff recognise and meet the diverse needs of the service users. Health needs are monitored and staff support service users to access healthcare and to take their medication. Staff help service users enjoy activities and are advocating for them to improve what is on offer. Service users have annual holidays and are helped to keep in touch with their families. The home is good at supporting service users to access community resources and to try new things. Staff help service users to choose what they like to eat and to have a healthy and varied diet. Service users are supported by a committed staff team who are trained to meet their needs. There is an experienced manager who keeps systems up to date and models good care practice. Turnstone Support involves service users, relatives and staff in the development of the service. It has a policies and procedures which are reviewed and updated.

What has improved since the last inspection?

Requirements to replace faulty windows and to repair a fire door have been met. Recommendations to ensure staff know where the complaints book is kept and that all staff have vulnerable adults training have been met.

What the care home could do better:

No areas for improvement were identified on this inspection. The manager and proprietor have already identified some areas of the premises which need improvement and have set timescales for these to be addressed.

CARE HOME ADULTS 18-65 85 Cambridge Road Crowthorne Berks RG45 7EP Lead Inspector Jill Chapman Unannounced Inspection 2nd August 2006 09:05 85 Cambridge Road DS0000062396.V297876.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 85 Cambridge Road DS0000062396.V297876.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. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 85 Cambridge Road Address Crowthorne Berks RG45 7EP 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) 01344 780183 01753 747399 dorothy.abrey@turnstone.org.uk Turnstone Support Limited Ms Dorothy Abrey Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: 85 Cambridge Road is a 5 bedded residential care home for adults with learning and associated physical disabilities. The home is in walking distance of Crowthorne village centre, with a range of cafes, pubs, and shops. The proprietors are Turnstone Support who provide staff support, 24 hours a day 52 weeks a year. The current contributions that service users make towards the fees range from £49.35-£62.35 per week. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out on a weekday over a period of five and a half hours. The focus of the inspection was to follow up progress from the last visit and to inspect the key standards. There are four service users living in the home at present and all were seen during the inspection. One was able to give verbal feedback and staff helped others tell about their daily lives in the home. Care records were sampled and some of the morning routine was observed. The inspector had discussions with the manager and three staff on duty. Staff and health and safety records were sampled. A tour of the house and garden was carried out. Prior to the inspection the manager offered to support the four service users to fill in pre inspection surveys but they declined. A Pre Inspection checklist was completed by the manager prior to the inspection and forms part of the evidence for this report. What the service does well: Overall this is an excellent service. The home only admits service users if they can meet their needs and the corporate admissions procedure helps potential service users see if they would like to move to the home. Service users records are well kept and staff know how to meet service users needs. Risks for individuals are identified and steps taken to reduce risk. Care is given according to preferred routines and staff recognise and meet the diverse needs of the service users. Health needs are monitored and staff support service users to access healthcare and to take their medication. Staff help service users enjoy activities and are advocating for them to improve what is on offer. Service users have annual holidays and are helped to keep in touch with their families. The home is good at supporting service users to access community resources and to try new things. Staff help service users to choose what they like to eat and to have a healthy and varied diet. Service users are supported by a committed staff team who are trained to meet their needs. There is an experienced manager who keeps systems up to date and models good care practice. Turnstone Support involves service users, relatives and staff in the development of the service. It has a policies and procedures which are reviewed and updated. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 85 Cambridge Road DS0000062396.V297876.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 85 Cambridge Road DS0000062396.V297876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The home only admits service users if they can meet their needs. They have an opportunity to see if they like the home before they move in. This judgement has been made using available evidence including a visit to the service. EVIDENCE: No new service users have been admitted yet but a service user may be moving from another home. In discussion with the manager and staff it was found that there are plans to gradually introduce him to the home by visits and overnight stays. Turnstone Support has an admissions policy, which includes carrying out a full assessment of need. Discussion with the manager showed that this will be carried out if he decides to consider the move. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. The documentation of service users care sampled is well written and detailed. It was clear that staff are knowledgeable about service users needs and preferences and that their needs are met. Risk assessments are up to date and help staff to keep service users safe. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The care records of two service users were sampled and show that there are up to date Personal Care Plans in place. These include communication plans, support routines and preferences, likes and dislikes and a pen portrait of the service user. The records are written in a clear respectful style. Staff described their role as key workers to individual service users. Staff described in detail the care routines for service users and how they help them make day-to-day choices. When staff have to limit service users choice care plans or risk assessments to show why. For example all service users are 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 10 registered to vote but cannot do so because they are unable to understand the process. There are individual risk assessments in place that cover key risk areas such as bathing, seizures, fire, community access, sharp knives, having a befriender, finances, having keys to their rooms and wardrobe, access to COSHH materials and holidays. Risk assessments were up to date and showed evidence of review. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. Staff help service users to enjoy a good access to leisure activities and the local community. They help them access their rights as citizens and they are treated with respect. They are supported to keep in contact with their families and friends and help choose their meals. Recorded and verbal evidence in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. EVIDENCE: None of the service users would be able to take up formal education or employment due to their disabilities, but they do have access to formal day services. The manager said that they have been unhappy with the services on offer recently because they are not meeting the needs of the individual service users. She and other managers from Turnstone Support are looking at ways to develop services that would meet the needs of their service users better. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 12 In discussion it was found that service users enjoy visits from a music entertainer who visits the home every two weeks. They go to challenge club, art and craft and sensory sessions. Staff take them out for meals or coffee, pub visits and shopping. Staff were aware of service users rights of social inclusion and told how they help service users be accepted in public situations such as meals out. They also described how they help service users get used to new places (e.g. different restaurants) to widen their experiences. It was seen that Personal Living Guidelines help staff know how to manage service users in the community according to their preferences and disability. Staff support service users to enjoy activities of their choice and access the local community. In house activities include TV, video, CDs, puzzles, games, colouring books, being in the garden, barbeques, paper folding, model train and helping with household tasks. Staff support service users to have an annual holiday. They helped service users tell of recent or planned holidays to Holiday parks in the New Forest and Somerset. Photos are displayed to remind everyone of the holidays. Staff helped service users tell how they keep in touch with family and friends. One service user has no family contact but has a befriender. Staff help service users access their rights and they were seen to respect service users privacy and dignity. Records show that service users are offered keys to their rooms and risk assessments show if it is not safe for them to hold these. One service user showed how he is able to lock his wardrobe to keep his belongings safe and one service user uses his room key. Service users records show that they are consulted about all aspects of their lives. Staff recognise and respond to the diverse needs of the group, for instance one service user has set routines due to his disability. His health care appointments are always made for the afternoon to prevent unnecessary anxiety. Menus were sampled and the service users choices clearly indicated. Staff take turns to be responsible for drawing up the monthly menu and there is a suggestions list and pictorial prompts to help service users be involved in the choice. Menus include planned takeaways and meals out. Weight charts are kept and staff encourage service users to eat healthily. The storage and rotation of food is good, with a stock list of freezer contents, which is updated when food is added or taken out. Fridge freezer temperatures are checked daily and recorded. Staff have been trained in food hygiene and nutrition. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. Service users benefit from personal care and support given according to their preferences. They are supported to keep healthy and to access healthcare. There is a safe system for storing medication and staff help them to take their medication. This judgement has been made using available evidence including a visit to the service EVIDENCE: There is good documented evidence of service users preferred routines and this was supported in discussion with service users and staff and observation of the morning routine. One staff helped a service user describe how he communicates his choices in his morning routine, whether he wants to bath or have breakfast first and what he wants to wear. Service users health care needs are well documented and separate records are kept of visits to health professionals. One service user was supported to see the GP on the inspection morning. In discussion with staff it was clear that they monitor service users well being and call in professional help when needed. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 14 The arrangements for medication were seen. The home uses the nomad system and they check that this is accurate when it is delivered and get the pharmacist to rectify any errors. Staff are trained and assessed for competency before they are allowed to give medication. There is a stock control system and medication is stored in a locked cabinet. 85 Cambridge Road DS0000062396.V297876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good.. Staff know how to deal with complaints and to protect service users from abuse. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is a complaints procedure in place but no complaints have been received since the last inspection. Staff spoken to know how to deal with complaints. Compliments were received on 7-02-06 from relatives of a service user who died following an illness. The family was pleased with the care he received from the staff when he was ill and the way the funeral was handled. There is a Vulnerable Adults procedure in place and staff are trained to know how to protect service users from abuse. There is a system for the safekeeping of service users money. This was checked and monies found to be accurate. 85 Cambridge Road DS0000062396.V297876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. Service users benefit from comfortable and homely accommodation. Plans for new communal carpeting, the refurbishment of the kitchen and new lounge furniture will further improve the environment for service users. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The communal areas and service users bedrooms were seen. A tour of the premises showed that it is well cared for by staff and homely. There are some plans to improve the environment for service users. Following an inspection by the Environmental Health Officer, repairs to the kitchen have been carried out. The new cupboard fronts do not match the old ones and manager said that the landlords, Windsor Housing, have agreed to replace the whole kitchen this financial year. Quotes are being obtained to replace the stairs, hall and landing carpet. New lounge furniture is planned for the financial year 2007-2008. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 17 Service users bedrooms are well kept and spacious. One service user was pleased to show the inspector his room and how he likes to organise his belongings. The home is kept clean and hygienic. Staff receive training in hygiene and the prevention of infection. 85 Cambridge Road DS0000062396.V297876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is excellent. Service users are supported by staff who are trained how to meet their needs and who treat them with respect. Employment checks help make that sure staff are suitable to work with vulnerable people. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is a stable staff team who know the service users well. From observation of some of the daily routine it was seen that staff relate well to service users, understand their communication and treat them with respect. In speaking with staff they had a good understanding of the service users disabilities and how it affects their lives. This was supported by care records seen and practice observed. They had patience and were consistent in their responses to service users repetitive routines and conversations. There was evidence from records seen and observation of practice that staff liaise well with health professionals about service users health needs. Rotas were sampled and show that there are 3 staff on daytime shifts plus the manager Monday- Friday. There is one waking night staff and one sleeping staff who is available to help if needed. Although there are not many drivers in 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 19 the staff team, rotas take into account times when drivers are needed to support service users in the community. Turnstone Support has a recruitment procedure, which includes CRB & health questionnaires and carrying out references. Identity is checked via passport or birth certificate. Staff records were seen for one new member of staff and it was clear that the procedure had been followed. There is a training plan for the home and individual staff training records were sampled. Staff receive induction and foundation training and training related to service users needs. Currently Disability and Equality training is being provided. There is a programme of NVQ in place, with six staff having completed this and one staff in the process of completing a course. 85 Cambridge Road DS0000062396.V297876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. Quality in this outcome area is excellent. The home is well managed by an experienced manager. Turnstone support provides service users and others the opportunity to influence the service and keeps its policies and procedures up to date. Health and safety systems are kept up to date. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is an experienced manager in post. She has the NVQ4/Registered managers award and has many years experience working with people with a learning disability. The manager has developed care practice and systems in the home to ensure that service users are treated in the way they wish and with respect. It was observed that she leads by example in the way she responds to service users. 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 21 Records are well organised and there are guidelines in place to make sure everything gets done. The manager has been proactive in helping the organisation to begin to address the current shortfalls in the contracted day care provision for service users. Turnstone Support has a quality assurance system, which includes seeking the views of service users and their relatives. This includes service user and staff forums and an annual unannounced observation of staff practice. The manager showed evidence that all of the company’s policies have been reviewed and updated recently. Health and safety records sampled were up to date. Health and safety issues have been identified and appropriate action taken. 85 Cambridge Road DS0000062396.V297876.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 x 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 4 3 x x 3 x 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 23 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. Refer to Standard Good Practice Recommendations 85 Cambridge Road DS0000062396.V297876.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 85 Cambridge Road DS0000062396.V297876.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!