Inspection on 27/10/05 for 86 London Road

This inspection was carried out on 27th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

86 London Road 03/07/07

86 London Road 19/07/06

86 London Road 04/06/05

86 London Road 01/02/05

86 London Road 05/08/04

86 London Road 30/03/04

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 London Road (86) 86 London Road Wickford Essex SS12 0AR Lead Inspector Mrs Bernadette Little Unannounced Inspection 27th October 2005 13:20 London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service London Road (86) Address 86 London Road Wickford Essex SS12 0AR 01268 562660 01268 562660 shcllondonroad@estuary.co.uk 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) Estuary Housing Association Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th June 2005 Brief Description of the Service: 86 London Rd offered care to four adults with learning disabilities. The house was detached and in a residential street near to Wickford town. There were four single bedrooms, one of which was on the ground floor. Residents had the use of a separate sitting and dining room. Upstairs there was a separate bathroom and a shower room One room upstairs had been changed into a visitors room as well as a staff training room. The garden was large, accessible and well maintained. The home had its own transport to facilitate access to the community for residents London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection that took place over a three-hour period on a Wednesday afternoon. As all the permanent staff were on training, the home was staffed by two agency staff. Therefore many areas planned for inspection could not be assessed in depth, as the staff did not have the appropriate experience of, or access to, all the required information. Some items on the requirements and recommendations section of this report will therefore be carried to the next inspection Time was spent talking to the two agency staff on duty as well as to the three residents at the home. The premises was inspected as were records and other documents. The assistance given by the staff and residents at 86 London Rd was appreciated. What the service does well: What has improved since the last inspection? What they could do better: The home needs to have a permanent manager in place as there has not been a registered manager at this home for some years. The home also needs to employ some more permanent staff so that there is less use of agency staff who were not so familiar to the residents. More especially, the home needs to make sure that all the records the law says must be available, are actually available, for inspection. Estuary have been told London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 6 many times to put this right and yet staff still did not have a key to open the metal box that contained the staff recruitment records. 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. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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): 1, 2 86 London Road had plenty of information available the told people about the home before they came to live there. EVIDENCE: 86 London Rd had a Statement of Purpose and a pictorial Service User Guide available. A copy of the Statement of Purpose was seen to be displayed in the office. The staff on duty had no knowledge of the statement of purpose and service user guide and it would be appropriate for them to have opportunity to read it to be sure they are aware of the homes aims and objectives and the facilities and services that must be provided to residents. No new residents had come to live at 86 London Road for some time. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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, 8, 9 The care plan sampled contained detailed information on how to provide care to that individual. Staff awareness of the care plans was poor and this did not support consistency of care for residents EVIDENCE: When the care plans were initially requested a document was provided with the residents name but no care plan and very limited detail. Much later in the inspection, when staff were looking for another document, they found the folder containing the care plans and risk assessments for residents. The care plan sampled contained detailed information on the residents assessed need and was of a good standard. It identified that residents were supported to take risks and that these had been considered in terms of resident safety and well-being. However, it was clear that staff caring for residents had not been made aware of the plan of care so that they could ensure appropriate care was offered to each resident in a consistent manner. Residents were seen to be involved in the everyday routines of the house and staff confirmed that they were included to some degree in the preparation and choosing of meals and other household tasks. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 the following standard(s): 12, 16, 17 Residents had some opportunities to take part in appropriate activities. Residents were served a varied range of home-cooked foods from ample food stocks EVIDENCE: One resident was at their day-care facility for part of this inspection. The member of staff in charge at the time of this inspection advised that they were not sure if residents took part in age appropriate activities. Records inspected indicated that residents went shopping, for pub lunches, for walks and to the local library and had beauty sessions, which were thought to occur at home. One residents records showed that they should have been at a swimming activity today but the staff were unaware of it and not sure why this had not occurred. Residents’ right to spend time in their room or in the communal rooms with other people was respected. Residents were supported to make tea or coffee of their choice when they wished. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 11 A four week rotating menu was available. This showed no choice at any meal. The nutrition record however demonstrated that residents have had choices, more especially at lunchtime. A member of staff on duty confirmed that while the resident did have the cereal and coffee identified in the nutrition record, they had also been offered, and had had, toast, although this was not recorded. The member of staff was aware that one resident particularly needed assistance in managing their food and to prevent choking. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 the following standard(s): 18, 21 Residents were supported in personal care at a level appropriate to their needs Residents needs for end of life care had been sensitively considered EVIDENCE: The residents at 86 London Rd did not need assistance with mobility/transfers or continence issues. Staff advised that support was provided with personal care, for example with prompting and supervision for bathing. The files evidenced that the proposed manager for registration had contacted the residents family to seek their views and wishes in support of the resident and end of life practices. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 the following standard(s): 23 Staff demonstrated appropriate knowledge to protect residents. EVIDENCE: The staff on duty were unaware of how to access the homes own policy and procedure or a copy of the local guidelines on the protection of vulnerable adults. The two agency staff on duty at the time of the inspection were able to describe various forms of abuse. One of them had evidence of training undertaken on both the protection of vulnerable adults and Positive Responses. Both had heard of the whistleblowing procedure and described appropriate actions. The agency staff on duty advised that all the permanent staff were undertaking a two-day training course on Positive Responses and that was why there was no permanent staff on duty in the home. It was not possible to consider the issue that was raised in the last inspection report regarding the appropriateness of what residents are charged for, as there is only one weeks receipt available at any time for inspection. This issue will therefore remain in the list of requirements until it can be evidenced as met at future inspections. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 the following standard(s): 24, 26, 29 86 London Road provided a living environment that met the residents needs in terms of space and cleanliness. Better attention was needed to some maintenance and safety issues to ensure residents were protected. EVIDENCE: All rooms used by residents were inspected. The majority were well maintained and decorated. Residents spoken with said that they were happy with their rooms. Staff advised that none of the residents needed any specialist equipment.. Some areas of maintenance needed attention, for example a missing skirting board in resident’s bedroom. The vanity units, identified as needing attention at the last inspection, remain in a similar condition and the doors were missing in all three residents bedrooms. A drawer front was falling off in a resident’s bedroom. Radiators were covered and the premises generally presented as safe. However the key was in the COSHH cupboard. When asked to lock it and make it safe, a member of staff advised that there seemed to be a problem with it and the cupboard could not be locked. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 15 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): 31, 32, 34, 35, 36 Adequate staffing levels were in place. The continued lack of access to staff recruitment records did not best protect residents EVIDENCE: The minimum agreed staffing level was being met at the time of the inspection. As stated previously, two agency staff were on duty, as all five permanent staff were attending training. The roster showed some other occasions when two agency (not bank) staff were on duty. The roster did not indicate which staff was in charge of the shift, but the staff themselves were clear on this.. One of the staff was on her first shift at the home this month and the person in charge of the shift was on her fifth shift in total at his home. It was clear during the inspection that staff needed to be provided with more information prior to being left in charge of the home. However both the staff were confident with the residents and there was no specific concern noted for the care of the residents during this time. The roster showed that a high proportion of the shifts worked by staff were long day shifts. This is not considered best practice. It was not possible to determine the homes progress on NVQ training. Other training records were available and indicated that staff were provided with mandatory training and had also attended service user specific training. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 16 All keys left in the charge of the care staff were considered but none gave access to the staff training records. This is of concern and has been raised as a requirement with Estuary for this home on numerous previous occasions, including at the last inspection. Staff supervision files were accessed. These indicate that staff supervision has not continued during the time that the acting manager has been on suspension. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 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 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, 40, 41, 42, 43 Because of the staffing situation at the home at the time of this inspection, several of the standards could not be adequately inspected nor demonstrated EVIDENCE: As noted at the last inspection Estuary had proposed the acting manager for registration and at that time he had been in post for approximately 18 months. This application has been suspended since June 2005. While a temporary acting manager had been proposed, appropriate and prompt action must be taken by Estuary to propose a suitable manager for registration at 86 London Rd. In the main, the home presented as running well, but as stated above many areas could not be inspected in any great depth as the staff on duty were not in a position to provide the required information, for example in relation to quality monitoring. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 18 One of the agency staff on duty had worked with the temporary acting manager and found them to be approachable and said that all the staff at London Road were very good.. Estuary have failed to send copies of the monthly inspections of the home as required under Regulation 26. This issue was identified at the last inspection and a requirement to comply included in the report. The homes policies and procedures could not be accessed by the staff on duty although a search of the office was undertaken and observed. Accident records were located by the inspector and were well maintained. A record of visitors was maintained. The roster was not maintained to the required standard, for example it did not identify the person in charge of the shift. Current certificated of liability insurance was displayed. There was no evidence to suggest that the home was and in other than financially viable. Current safety inspection certificates were available for the electrical fixed wiring, gas, emergency lighting, fire alarm and fire equipment. A recent inspection by the fire service required a fire risk assessment to be undertaken, maintenance of the fire doors/self closures, and fire training for staff with records kept. A record of fire drills was not available. London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 2 2 X 1 3 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 London Road (86) Score 3 X X 3 Standard No 37 38 39 40 41 42 43 Score 2 2 2 1 2 2 3 DS0000018029.V262273.R01.S.doc Version 5.0 Page 20 Yes 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 YA17 Regulation 17(2) Schedule 4 13(6) Requirement The nutrition record must be maintained as an accurate record of the food served to residents. The person registered must ensure the protection of residents by ensuring the appropriate use of their finances.(Previous timescale of 1.02.04 not met This was unable to be inspected on this occasion will be carried to future inspections ) The person registered must maintain a home in a good state of repair. This includes reference to the vanity units in the residents bedrooms (Previous timescale of 01.07.05) not met The person registered must ensure that all equipment in the home is safe. This refers to the lock on the COSHH cupboard being in working order to ensure resident safety. The person registered must ensure that there is clarity of roles and responsibilities, and support for all staff in the home, DS0000018029.V262273.R01.S.doc Timescale for action 01/12/05 2 YA23 01/12/05 3 YA24 23 01/01/06 4 YA24 23(2)(c) 01/12/05 5 YA31 21(1) 01/12/05 London Road (86) Version 5.0 Page 21 6 YA34 17(2) & Schedule 4 7 YA37YA38 12(5)a 8 YA38 8&9 9 YA39 26 10 YA42 23(4) both internal and external, to ensure the best outcomes for residents welfare (This is a requirement of the last inspection unable to be assessed on this occasion. It will be carried to future inspections) The person registered must ensure that a system is in place to ensure that all required records relating to staff are available for inspection, to evidence robust recruitment practices to protect residents ( Previous timescale of 01.07.05 not met). The person registered must ensure effective management of the home, both internal and external and support the staff team to develop appropriate and effective communication. (This is a requirement of the last inspection unable to be assessed on this occasion. It will be carried to future inspections) The person registered must appoint an individual to manage the home where there is no registered manager and ensure that the person is fit to manage the home The person registered must ensure that monthly inspections of the home are undertaken on its behalf and copies of these are sent to the commission as required by Regulation. ( Previous timescale of 01.07.05 not met) The person registered must, after consultation with the fire authority, take adequate precautions against the risk of fire. this refers to the requirement for a fire risk assessment and maintenance of the fire doors/self closures DS0000018029.V262273.R01.S.doc 01/11/05 01/11/05 01/12/05 01/11/05 01/11/05 London Road (86) Version 5.0 Page 22 11 YA42 23(4) The person registered must make arrangements for people working at the care home to receive suitable training in fire prevention and to be involved in fire drills and fire practices, with appropriate records kept 01/11/05 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 3 Refer to Standard YA6 YA12 YA18 Good Practice Recommendations All staff need to be informed of the existence of the care plans and where to find them, and have ample opportunity to read them prior to providing care to the residents. Changes to the residents care plan/plan of activities, planned or otherwise, should be identified and recorded The person registered should ensure that there is a clear understanding and agreement on the role of the key worker, which is known to all of the staff team .(This is an outstanding recommendation from the last inspection carried to future inspections) A copy of the home’ policy and procedure on the protection of vulnerable adults, whistleblowing policy, and a copy of the local protection of vulnerable adults protocol should be available in the home The whistleblowing procedure should be written in clearer language. (This is an outstanding recommendation from the last inspection carried to future inspections) At least 50 per cent of care staff should achieve NVQ training Staff should not work excessive hours/long days Staff should be provided with formal supervision at least six times each year (This is a recommendation carried from the previous inspection that had not been met) The person registered should ensure that all staff in the home have access to a range of appropriate policies and procedures. The person registered should ensure that the roster identifies who is in charge of the home. DS0000018029.V262273.R01.S.doc Version 5.0 Page 23 4 YA23 5 6 7 8 9 10 YA23 YA32 YA33 YA36 YA40 YA41 London Road (86) Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 London Road (86) DS0000018029.V262273.R01.S.doc Version 5.0 Page 24 - 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. 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