Inspection on 31/10/07 for 9 Grace Road

This inspection was carried out on 31st October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

9 Grace Road 22/09/08

9 Grace Road 08/06/06

9 Grace Road 29/09/05

9 Grace Road 24/05/05

9 Grace Road 16/11/04

9 Grace Road 04/05/04

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

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

CARE HOME ADULTS 18-65 9 Grace Road Leicester LE2 8AD Lead Inspector Ruth Wood Unannounced Inspection 31st October 2007 09:30 9 Grace Road DS0000045536.V353863.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 9 Grace Road DS0000045536.V353863.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. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 9 Grace Road Address Leicester LE2 8AD 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) 0116 2331035 0116 2331005 tweddle7@aol.com 9 Grace Road Limited Mr Robert Philip Tweddle Care Home 17 Category(ies) of Dementia (2), Learning disability (17), Mental registration, with number disorder, excluding learning disability or of places dementia (7), Physical disability (17), Sensory impairment (6) 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person falling within category PD, SI, MD or DE may be admitted to the home unless that person also falls within the category LD I.e. multiple disability . No person to be admitted to the home in categories LD/SI when 6 persons of categories LD/SI are already accommodated in the home. No person to be admitted to the home in categories LD/DE when 2 persons of categories LD/DE are already accommodated in the home. No person to be admitted to the home in categories LD/MD when 7 persons of categories LD/MD are already accommodated in the home. 8th June 2006 2. 3. 4. Date of last inspection Brief Description of the Service: 9 Grace Road is situated in a quiet area on the outskirts of Leicester, close to a variety of community amenities and transport links. Care and support is provided to seventeen adults who have a learning disability and associated communication difficulties. Some service users also have physical disabilities, dementia and/or sensory impairment. The communal areas consist of a large, attractive lounge/dining room, two day-care rooms and a sensory room. The home also has a training kitchen where service users can learn cookery skills. Currently all service users are accommodated in single bedrooms. There are two staircases and a shaft lift to access communal areas and bedrooms on the first floor. The home has a specially adapted bath and shower rooms to meet the needs of people with physical disabilities and a large, enclosed garden, which again is fully accessible. Current fee levels range from £700 to £1,870 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection visit the registered person returned a self-assessment questionnaire giving information as to how the home provided good outcomes for service users. The Commission issued a number of questionnaires asking for people’s views of the home and two service users and two relatives returned these prior to the inspection visit. The inspector also consulted two commissioning social workers and a specialist health worker directly. Information from all these sources was used in addition to that gained on the inspection visit to produce this report. The inspection visit took place on a weekday between 9:30am and 4:30pm. The support of four service users was focused on and their support plans were examined and their care needs discussed in detail with the care and general manager. Staff support and interaction with service users was observed and the inspector was also able to communicate directly with several service users. Medication, staff training and recruitment records were also examined and the majority of communal areas and service users’ bedrooms were seen. What the service does well: What has improved since the last inspection? No requirements were made at the previous inspection but two recommendations made in relation to medication have been met. The general practitioner has placed in writing their directions regarding the use of oxygen 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 6 in the management of epileptic seizures and a homely remedies policy has been drawn up and implemented. 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. The summary of this inspection report can be made available in other formats on request. 9 Grace Road DS0000045536.V353863.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 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is adequate Good assessment procedures are in place to ensure that service users’ needs can be met but improvements are needed in the way information about the home is made available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each case-tracked service user had a comprehensive assessment on file from their placing authority as well as an assessment completed by the home’s care manager. In all cases this assessment had been regularly reviewed by the home’s staff and updated to reflect the service users’ changing needs. The admission of the most recently admitted service user had included visits by Grace Road staff to their existing placement, trial stays and a trial period before the placement was confirmed. A Statement of Purpose and Service User Guide, giving accurate information about the home’s services is available in a standard written format. Discussion was held with managers re offering these in alternative formats to make the information more accessible to the home’s service user group. The acting manager said that they had considered making use of DVD-Rom technology to make the guide interactive. 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate Improvements are needed in service users’ support plans to ensure that they identify how to meet individual’s assessed needs, how to manage identified risks and that they are in a format accessible to staff and service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All four support plans examined contained assessments, regularly reviewed which detailed service users’ needs. However they did not offer explicit, clear guidance as to how individual needs should be met in a format easily accessible to care staff and service users Neither did the plans use a personcentred approach. Managers said that some training had been undertaking in this area and changes to the system were planned. Risk assessments relating to individual service users also require improvement, as these did not clearly state how identified risks should be managed. These assessments should also be an integral part of the support plan rather than being stored and managed separately as they are currently. The majority of service users have complex needs and restricted communication, which can limit their opportunities to be involved in complex 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 10 decision making. Service users are however encouraged to choose between activities in the home such as different crafts and games and are involved in choosing colour schemes and décor particular in their own rooms which are all highly personalised. Information contained within the home’s statement of purpose about advocacy needs updating, as the advocacy service quoted is no longer operating. This should be modified and the availability of independent advocates promoted. The registered provider currently acts as appointee for several service users. One service user can manage some aspects of their finances with support; the remaining service users are fully supported in this task. All service users’ personal allowances are paid into a joint service users’ account administered by Mr Tweddle. A full record of each service users’ expenditure and balance remaining is kept, together with receipts. The accounts of three service users were checked at random and appeared accurate. 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good Service users have opportunities to participate in vocational and leisure activities and are able to maintain links with family and the local community This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users use the in-house day care facilities and there are separate rooms set aside containing equipment such as computers, games and craft materials for this purpose. A member of the care staff acts as the day care coordinator and attempts have recently been made to offer a more structured programme for individual service users. Three service users are also currently attending college courses. Good arrangements are in place to ensure that service users maintain contact with relatives; for example key workers ensure that people are supported in purchasing and sending birthday cards and social events are held to which relatives and friends are invited. The two relatives who responded to the Commission’s survey said that they felt that the home always or usually helped their relative maintain contact with them. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 12 The home makes an effort to celebrate major cultural and religious festivals such as Halloween, Diwali and Christmas. On the day of the inspection the home was colourfully decorated and staff and some service users (who had chosen to be) were dressed in various costumes. A party was planned for the evening to celebrate. Arrangements were being made for a weekend visit to Butlins to celebrate Bonfire Night and a visit to watch the Diwali lights being switched on in Leicester. The home has a dedicated cook who oversees the purchasing and menu planning when she is not on duty. Training files showed that she has received training in food hygiene and nutrition. Menu records were not seen. 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good Health, personal care and medication needs are generally well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The support plans and assessments of four service users were examined; these outlined health, personal care and medication needs and contained information about the external professionals involved in their care. These included general practitioners, district nurses, community psychiatric nurses, speech and language therapists and consultant psychiatrists. Optical prescriptions and letters indicated that service users had access to regular input from opticians and dentists (two service users visited the dentist on the day of the inspection). One service user had recently had dentures fitted and these had made a positive difference to their general appearance. Service users also have access to a private physiotherapist, chiropodist and reflexologist. Service users who have to attend hospital are accompanied by at least one member of the home’s support staff and a service user recently admitted to general hospital was supported by a member of the home’s staff on a 24 hour basis as their needs were too complex for the general nurses to meet unaided. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 14 Two recommendations made in relation to medication at the previous inspection have been met. The general practitioner has placed in writing their directions regarding the use of oxygen in the management of epileptic seizures and a homely remedies policy has been drawn up and implemented. Improvements have also been made in the documentation relating to ‘as required’ medication; it is now clearly stated under what circumstances this medication can be given and who has given the authority for it to be administered. The administration of medication was observed at lunchtime; two staff who have received appropriate training administer medication and practice and recording were observed to be good and accurate. One service user is supported to be actively involved in the management of their own medication. 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate Systems are in place to ensure service users are protected but some staff need additional guidance on how to consistently support service users in an appropriate manner which maintains their dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training files demonstrated that care staff and managers had received training in the procedures around the protection of vulnerable adults and understood their responsibilities with regards to reporting of incidents and keeping people safe. Recruitment records demonstrated that staff have an enhanced Criminal Records Bureau check and their names are checked against the vulnerable adults register are obtained before they begin work at the home. This helps to ensure that unsuitable people do not work with vulnerable service users. Staff have received training in intervention techniques for dealing with challenging behaviours. Not all staff observed interacting with service users did so in an appropriate manner, which took account of the relationship between them and the age and status of the service user. At times communication observed was inappropriate (tickling and kissing) and did not respect the dignity of the service user. Although both service users who responded to the Commission’s survey said that they knew who to speak to if they were not happy they said that they didn’t know how to complain. One of the two relatives who responded also said that they did not know how to complain. The complaints procedure is part of the home’s statement of purpose and is available in a standard written format. It is recommended that the home make the procedure available in 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 16 other formats as well as ensuring that all relatives are aware of the procedure as are service users were possible. The Procedure should also be updated to include the contact details of the local authority. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Quality in this outcome area is good Service users live in a clean, comfortable and well-maintained environment, which meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a dedicated housekeeper who oversees all cleaning and laundry. All areas of the home were clean and tidy and fresh smelling on the day of the inspection; the two relatives and two service users who responded to the Commission’s survey said that the home was usually or always fresh and clean. Evidence was seen (certificates) that staff had undertaken training in infection control and procedures were discussed with the care manager and appeared satisfactory. Service users’ rooms are highly personalised and appear to reflect their personalities and interests as well as containing equipment and furniture appropriate to their individual needs. Several improvements are currently taking place in the home; a new kitchen and bathroom are being installed and some service users’ rooms are due to be redecorated. Managers and staff commented that it was good to have a maintenance person on site so that any repairs needed could be quickly dealt with. 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good Service users are supported by well-trained staff and protected by effective recruitment practices This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff records were examined, including those of the most recently appointed staff member. All contained an application form, two written references, and evidence that criminal records checks had been prior to the applicant starting work. Each staff member also has a training portfolio containing evidence of induction and ongoing training; staff also undertake National Vocational Qualifications and nine staff currently hold this qualification in care at level 2 or above. The home takes part in Leicester City Council’s workforce development programme and has developed a training matrix which ensures all staff have access to key training in supporting people with learning disabilities. The two relatives who responded to the Commission’s survey felt that care staff usually have the right skills and experience to look after people. All staff receive regular supervision, which is documented, and addresses issues relating to training and development and meeting the home’s practice 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 19 standards. Staff meeting minutes indicate that the vast majority of staff attend these meetings which occur every two to three months. The two service users who responded to the Commission’s survey said that staff always treated them well and always listened and acted on what they said. 9 Grace Road DS0000045536.V353863.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate Good systems are in place to ensure both service users’ and staff’s health and safety but a formal quality monitoring system must be implemented to ensure that the home is consistently run in the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Provider is also the registered manager for the home and holds a professional qualification in social work. The finance/general manager and the care manager undertake general day-to-day management of the home. The care manager is currently completing her Registered Manager’s Award and the general manager holds a post-graduate qualification in management. A formal quality assurance tool has been purchased but has not yet been implemented within the home neither is there any formal system in place to consult with service users, their relatives or other interested stakeholders. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 21 Certificates evidence that staff have received training in food hygiene, manual handling, first aid and infection control. Radiators within the home are covered and water temperatures are regulated so they do not exceed the safe level of 43°C. 9 Grace Road DS0000045536.V353863.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 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Service users’ plans must detail how to meet service users’ identified needs and be written in a format that ensures they are accessible to care staff and where possible, service users. The registered person must encourage and assist staff to communicate with service users in a manner, which maintains the service users’ dignity and promotes an appropriate personal and professional relationship. The registered person must establish and maintain a system for evaluating the quality of the services provided at the care home, which takes into account the views of service users and their representatives. Timescale for action 31/01/08 2 YA23 12(5) 31/01/08 3 YA39 24 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 24 No. 1 2 3 4 5 Refer to Standard YA1 YA6 YA6 YA6 YA22 Good Practice Recommendations Alternative formats for the service users’ guide should be explored and produced to ensure that the information is accessible to the home’s target service user group. Support plans should reflect developments in personcentred planning to enable service users to take as active a role as possible in developing their plans. Risk assessments should clearly state how to meet the risk identified Service users’ risk assessments should be an integral park of the service users’ plan rather than being stored and managed separately as present. The Complaints procedure should be made available in different formats to ensure access to this information by as many people as possible. All service users, their relatives and other stakeholders should be made aware of the procedure. 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 9 Grace Road DS0000045536.V353863.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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