Inspection on 04/06/05 for 86 London Road

This inspection was carried out on 4th June 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

86 London Road 03/07/07

86 London Road 19/07/06

86 London Road 27/10/05

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 Bernadatte Little Unannounced 4 June 2005 10:00 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. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service London Road (86) Address 86 London Road Wickford Essex SS12 0AR 01268 562660 01268 562660 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) Estuary Housing Association Limited N/A CRH Care Home 4 Category(ies) of LD Learning disability (4) registration, with number of places London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2005 Brief Description of the Service: 86 London Road offered care to four adults with learning disabilities. The house was detached and in a residential street near to Wickord town. There were four single bedrooms, one of which was on the ground floor. Residents have 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 and a training room for staff. 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) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection that took place on a Saturday at 10am. There were three residents living at 86 London Road at the time of this inspection and one was away for the weekend. During the inspection, time was spent talking with the two residents and four staff that were at home. The acting manager was not on duty that day. All parts of the house were looked at, as were records and documents. The help given by the residents and staff was much appreciated. What the service does well: 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. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 6 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 London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 7 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) 1, 2, 3, 4, 5, Any person interested in a placement at 86 London Road had adequate information provided, as well as opportunity to visit to ensure they made an informed choice. Estuary’s policy and procedure on admission supported a thorough assessment to ensure the home could meet the person’s needs. Contracts confirmed the services to be provided. EVIDENCE: The Service User Guide and resident Statement of Terms and Conditions were in pictorial form to assist resident understanding. A formal licence agreement was also on residents’ files. There had been no new admissions to 86 London Road for some time. Staff confirmed that the views and personalities of current residents would be considered as part of any pre-admission assessment, during trial visits. Staff records sampled showed that staff had had training on communication with people who had a learning disability. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 8 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 ,7, 9, 10 Care plans files available did not provide clear basic information on the care residents needed, and how to provide it. Staff were aware of residents’ right to appropriate confidentiality. EVIDENCE: Several sections of the care plan folders provided were empty. Staff talked of the improved quality of the care plans and the existence of the risk assessments. It was not possible to determine where these care plans and risk assessments were, but they were not available for inspection. Anecdotal discussions with all the staff indicated that appropriate thought had been give to the balance between resident safety and their right to take risks. Some records available supported this. Residents had access to independent advocacy services. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 9 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, 13, 14, 15, 17, Residents had opportunities for activities that offered them dignity and supported their self worth. Subject to known restrictions, residents had a range of foods offered that met their preferences and nutritional needs. Residents’ relationships were supported. EVIDENCE: Residents were encouraged to be independent and assist with household tasks. Two residents attended day resource centres, for which they received some wages. Both said that they enjoyed going there. One resident left to go on a weeks holiday during the inspection and was able to explain where they were going. Discussion with staff and residents, and inspection of the care file and financial records showed that residents used the local library, went to the theatre, horse-riding, ceramics classes, shopping and to restaurants for meals. One resident had gone home for the weekend. There was an adequate supply of food available and residents were seen to be offered choices. Residents said they liked the food at 86 London Road. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 10 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, 20 Residents were supported to gain access to a range of healthcare services, appropriate to their needs. The medication system was well managed. The staff team were not clear about the role of the keyworker. EVIDENCE: All residents at 86 London Road were mobile and required no specialist equipment for moving and handling. Healthcare records were well maintained and informative, with detailed records of outcomes. Medication storage, recording and administration was satisfactory. All staff who administered medication had had updated training, including for the use of rectal diazepam. The protocol for this was up to date. It did not include care instructions to support residents’ privacy and dignity. Discussion with staff clearly demonstrated some disagreement between the staff teams’, and the acting manager’s, view of the role of the keyworker. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 11 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) 23, 23 The complaints procedure was available in a format that supported resident understanding. Staff experience, and knowledge of appropriate actions to take, if they had concern about a resident, varied. Policies and procedures related to protecting people were not readily known/available to all staff. This did not best protect residents. EVIDENCE: Staff spoken with advised that no complaints had been received by the home since the last inspection. Records sampled showed that Estuary provided staff with training on how to protect vulnerable people. The home’s own policy and procedure and the local Protection of Vulnerable Adults guidelines were not readily available. While some staff were aware, not all staff had read and understood these and the whistleblowing policy. A procedure written in clear language, was not available. Discussion with staff and inspection of residents’ financial records showed that all staff also needed to be made aware of which budget Estuary required them to use for various outgoings and what things residents should and should not be charged for. Records showed that Estuary had charged residents for items such as bed linen. The Service User Guide stated the residents own their own bedroom furniture. Records did not confirm whether Estuary had made a financial contribution to providing furniture for residents’ bedrooms. Staff spoken with had received training on managing challenging behaviour and certificates were available. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 12 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, 27, 28, 30 86 London Road provided residents with a spacious and homely living environment that met their needs. The premises were generally well maintained and appropriately clean and hygienic to promote resident wellbeing. EVIDENCE: Communal rooms were homely and well maintained. Residents’ bedrooms were decorated in individual styles and were personalised to each resident. The vanity units in the bedrooms were in poor condition and need replacing. Residents were seen to move freely around the house and to spend time in communal rooms or in their own bedroom. The laundry was appropriately sited and equipped. Staff were aware of the correct temperatures for washing various items. Certificates confirmed that staff had had training on infection control. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 13 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) 31, 32, 33, 34, 35, 36 The stability of the staff team provided consistency of care for residents. Staff training was appropriate and current to meet residents’ needs. Access was not available to assess the safety of the staff recruitment process in relation to protecting residents. Staff were supported with regular training, supervision and team meetings. The relationship and communication between the staff team and management team as a whole needed to be clarified and improved to ensure the best care outcomes for residents. EVIDENCE: Discussion with staff showed they clearly knew residents’ needs and how to meet them. There were four and a half permanent staff posts. The other shifts were covered by regular bank and agency staff. Staff were working some regular and planned long days on permanent and bank shifts. This is not best practice. The metal container containing staff recruitment records was available, but staff did not have a key to allow the records to be inspected. This issue had been raised with Estuary previously. One staff member had a their own original Criminal Records Bureau available and willingly provided it for inspection. Staff explained they were able to access training and supervision records because their service manager had forced the drawers in the metal filing London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 14 cabinet, looking for documents, when the acting manager was not on the premises. Training records were well organised and supported by certificates. They demonstrated that Estuary provide staff with good access to training, which staff spoken with confirmed. Three staff had recently begun NVQ3 training. Supervision records showed that supervision was focused on relevant topics. It did not occur at least six times annually. Staff were honest in expressing a negative approach to supervision and time was spent explaining its’ purpose and benefits to them. Staff meetings were held regularly. Staff advised that minutes were not taken, but a report was written by the acting manager afterwards. They could not give a reason why they did not take minutes if they felt it to be important. Staff stated that they felt that staff meetings were not an open process and they could not discuss all issues they wished to raise. Staff confirmed that they had designated responsibility for various areas within the home, for example, the medication system. Negotiation and agreement on this was seen in a staff supervision record. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 15 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) 37, 38, 41, 42 86 London Road initially presented as well organised, but there was clear discord within different levels of staff, both internal and external, which may have had some negative impact on residents. EVIDENCE: The acting manager has been in post for approximately eighteen months and an application for his registration as manager is progressing. Some records were well organised, while other records could not be accessed or found. The reasons for this were not possible to establish. Staff advised that they feel that there is poor communication and inconsistency from the manager, and their views of what is most important in the home varied from his. Staff advised that occasionally residents had noted the discord but had been reassured, and the care side of the home was running well. The acting manager was not on site to comment. The person registered had not been sending monthly reports on the home to the Commission as required by Regulation 26. A record of regular water temperature checks was available. Safety inspection certificates were not available for inspection. Staff records indicated that staff had had basic mandatory training in health and safety issues including first aid. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 16 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 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 x 1 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 3 x x Standard No 31 32 33 34 35 36 Score 2 2 3 1 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 London Road (86) Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 2 x x 2 2 x I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 17 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 6 Regulation 15(1) Requirement A care plan to be in place for each resident that shows how all areas of their health and welfare is to be met by the staff at the home. Care plans must show that residents had been consulted about their content.( Previous timescale of 31.04.05 not met). Written risk assessments to be available for all issues identified as possible risks to residents. The person registered must ascertain the wishes of residents on serious illness and death. (This is a requirement from the last inspection not assessed on this occasion. It will be carried to the next inspection.) 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) The person registered must maintain the home in a good state of repair. This refers to the vanity units in resident bedrooms. The registered person must Timescale for action 1 July 2005 2. 6 15(1) 1 July 2005 3. 4. 9 21 13(4) b & c 12(3) 1 July 2005 1 July 2005 5. 23 13(6) 1 July 2005 6. 24 23 1 July 2005 7. 31 21(1) 1 July 2005 Page 18 London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 8. 34 17(2) & Schedule 4 9. 37 &38 12(5)a 10. 41 17 11. 41 26 12. 42 23 ensure that there is clarity of roles and support all staff in the home, both internal and external, to understand these to ensure the best outcomes for residents welfare. 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. 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. The person registered must ensure all records required by regulation are maintained and available for inspection Copies of the monthly reports undertaken by the person registered to be sent to the Commission as required. Evidence of the safety of the premises or any equipment, and any certificates of inspection, for example for fire safety, to be maintained and available for inspection. 1 July 2005 15 June 2005 1 July 2005 1 July 2005 1 July 2005 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. Refer to Standard 11 Good Practice Recommendations The person registered should ensure that details are available of planned programmes for the development of residents practical life skills and their involvement in the day to day running and routines of the home.(This are recommendations from the last insepction not assessed on I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 19 London Road (86) 2. 3. 4. 5. 6. 7. 18 23 23 23 28 36 this occasion. They will be considered at future inspections.) The person registered should ensure that there is a clear understaning and agreement on the role of the keyworker, which is known to all of the staff team. All staff to be aware of the contents of the Whistleblowing policy and to have access to the homes poliicy and procedure of the protection of vulnerable people. The whistleblowing procedure to be written in clearer language. A copy of the local multidisciplinary guidelines on the protection of vulnerable adults to be available in the home and known to staff. 50 of staff to achieve NVQ qualification. Staff should be provided with formal supervision at least six times each year. London Road (86) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea 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) I56 I06 S18029 London Road (86) V229284 040605 Stage 4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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