Inspection on 08/06/06 for 9 Grace Road

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

Other inspections for this house

9 Grace Road 22/09/08

9 Grace Road 31/10/07

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 Leicestershire LE2 8AD Lead Inspector Ruth Wood Unannounced Inspection 8th June 2006 10:00 9 Grace Road DS0000045536.V298198.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.V298198.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.V298198.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 9 Grace Road Address Leicester Leicestershire 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 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.V298198.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. 29th September 2005 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 residents 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 residents can learn cookery skills. Residents are accommodated in single bedrooms with the exception of two people who are happy to share. There are two staircases and a shaft lift to access communal areas and bedrooms on the first floor. The home has 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 £1,800 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection visit took place on a weekday between 9.30am and 4pm. As this was the Inspector’s first visit a full tour of the home was made during which discussion was held with staff members, residents and a visiting professional. The care of three residents was focussed on in detail; this included an examination of their records, discussion with the Registered Provider, observation of care practice and in one instance discussion with a close relative. Staff training and recruitment records were also examined, as were residents’ financial records and some of the home’s maintenance records. What the service does well: What has improved since the last inspection? What they could do better: Some improvements are needed in the documentation of medication. Written guidance should be obtained from GPs as to the use of oxygen for residents for whom it is not prescribed and a homely remedies policy should be implemented in the home following discussion with the pharmacist. This should ensure that none of the remedies that may be used have an adverse affect when taken with residents’ prescribed medication. A formal quality assurance system, which includes regular consultation with residents, their representatives and other interested parties should also be implemented in the home to ensure that standards are maintained and improved. 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 6 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. 9 Grace Road DS0000045536.V298198.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.V298198.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. Residents’ needs are competently assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ case files were examined; all contained an assessment completed by the home covering physical, social and emotional needs. Discussion with the Registered Provider, staff members and a relative of one of these four residents together with observation indicated that what was recorded was an accurate reflection of the residents’ needs. Some files also contained a comprehensive assessment completed by the placing social worker. 9 Grace Road DS0000045536.V298198.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 good. Residents’ needs are accurately reflected in their plans and they are involved in some day-to-day decisions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are currently being updated in line with recent developments in person centred planning; some of the three residents whose care was tracked therefore have two plans in place. Taken as a whole plans were very detailed, explicitly outlining how residents’ identified needs should be met and contained evidence of regular updates reflecting changing needs. Detailed risk assessments, appropriate to individual need were also in place. Discussion with the registered provider, staff and one relative, together with observation indicated that plans were an accurate reflection of care given. Each resident has a diary in which entries (daily records) are made three times per day. These are accessible to residents and form the basis of information passed over during the staff handover. The majority of residents have complex needs and limited communication, which means that opportunities to be involved in complex decision making are limited. Residents are however encouraged to choose between activities in the 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 10 home such as different crafts and games and have also been involved in choosing colour schemes during recent re-decoration in some areas of the home. The registered provider currently acts as appointee for seven residents, the majority of which are placed by authorities outside of the Leicestershire area. One resident can manage some aspects of their finances with support; the remaining residents are fully supported in this task. All residents’ personal allowances are paid into a joint residents’ account administered by Mr Tweddle. A full record of each resident’s expenditure and balance remaining is kept together with receipts. Several balances and receipts held were checked at random and these appeared accurate. 9 Grace Road DS0000045536.V298198.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): 12,13,15,16,17 Quality in this outcome area is good. Residents have the opportunity to participate in daytime, and leisure activities and are able to maintain links, with family and the local community. A varied diet is served in pleasant surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One resident is currently undertaking a work experience placement arranged via his regular college placement. The majority of residents engage in activities within the home. There are two dedicated day care rooms, a ‘training kitchen’ and a ‘sensory’ room where residents regularly receive reflexology from a trained therapist. On the day of inspection most residents were engaged in activities such as drawing or listening to music in the shaded garden, as the weather was unseasonably hot. Good use is made of community facilities with regular outings to pubs, sporting facilities, parks and shops. Care plans of tracked residents gave contact details of relatives. One relative who visited on the day of inspection said that they could ‘drop in at anytime’ and they were always made to feel welcome. Christmas and birthday parties are arranged and relatives and friends are invited to these celebrations. 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 12 Menu records submitted as part of the pre-inspection questionnaire demonstrated that a good range of food is served in the home, which takes into consideration residents’ personal preferences and health needs. Information about residents’ food preferences and needs is also displayed in the kitchen as a reminder to staff members. One resident’s dietary needs arising from religious observance are well met. 9 Grace Road DS0000045536.V298198.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 good. Residents receive appropriate personal support and their health needs are well met. Medication is generally well managed but some improvements are needed in documentation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ personal support needs are detailed in care plans. Residents have access to a full range of healthcare support including regular private physiotherapy, reflexology and chiropody. They are also well supported by local GPs and by consultant psychiatrists. Good systems are in place to monitor pressure area care; district nurses are actively involved in this area and the home supplies appropriate equipment such as airflow mattresses. If a resident has to be admitted to hospital they are always accompanied by at least one staff member. This was confirmed by the visiting relative who also commented that they were always kept informed if their relative was ill. Residents’ medication is detailed in their care plans as well as on medication administration records. Medication is stored appropriately and systems are in place for ordering, receiving and returning medication. These are all documented appropriately. One resident with epilepsy has been prescribed oxygen to be used following a severe seizure. The member of staff with designated responsibility for medication said that the GP had informed staff 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 14 verbally that it was acceptable to use this oxygen for other residents with epilepsy should it be required. This instruction was not documented; neither had oxygen been prescribed for these residents. It is recommended that written guidance be obtained from the GP on this matter. The Medication Administration Record showed that one resident had recently been given a homely remedy for diarrhoea. Again the designated staff member stated that this had been agreed verbally with the GP. It is recommended that a ‘homely remedies’ policies be put in place following consultation with the home’s pharmacist to establish that there is no contra –indication between any of the remedies used and prescribed medication taken by the residents. The recording of information regarding one resident’s ‘as required’ medication could be improved and the date when creams or lotions are opened should be recorded on the item itself rather than (or as well as) in residents’ diaries. 9 Grace Road DS0000045536.V298198.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. Residents’ communication is responded to appropriately and good systems are in place to protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff members spoken with agreed that residents were able to make their concerns known even if they did not use formal methods of communication. Staff were observed to respond appropriately to residents. Information received prior to the inspection visit suggests that the management team is aware of the home’s responsibilities under protection protocols and in matters in this area the home has acted appropriately in the past. During discussion a staff member displayed a good understanding of whistle blowing and said that they had received training in this area during induction. 9 Grace Road DS0000045536.V298198.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, 26, 30 Quality in this outcome group is good. Residents live in a clean, comfortable and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas of the home were clean, well decorated and maintained. Staff demonstrated a good understanding of infection control and stated that they had received training in this area. Residents’ rooms are spacious and highly personalised and many contain special beds and other items of furniture to meet their physical needs. These however are stylish and blend in well with the remaining furnishings and décor. Communal areas are accessible to all residents. The home’s garden is used extensively; garden furniture and shaded areas are in place here. 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 17 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 good. Residents are supported and protected by well-trained staff and effective recruitment practices. This judgement has been made using available evidence including a visit to this service EVIDENCE: Prospective staff complete an application form and two written references are obtained as part of the recruitment process. An enhanced criminal records bureau check is obtained for all staff before they commence work in the home. Evidence of identity was present on all staff records. Staff undertake a formal induction and each staff member has a training and development record. Training is regular and ongoing; discussion with the provider and staff indicated that recent training had included food hygiene, management of diabetes, equality and diversity and Makaton for beginners. The home has experienced some difficulty in finding assessors for staff completing National Vocational Qualifications (NVQ). Some senior staff members are therefore undertaking the assessor’s award to enable training to be verified ‘in-house’. Five care staff hold an NVQ award in care at level 2 or above and 8 staff are currently engaged in this training. 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 18 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): 37,39,42 Quality in this outcome area is good. The health and safety of residents is promoted but a systematic quality monitoring system should be developed to ensure standards in all areas are continually monitored and improved. 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. There is currently no formal system of quality assurance within the home although staff opinion on the running of the service is invited during regular one to one supervision sessions and staff meetings. There is evidence however that systems and procedures are regularly evaluated and updated; for example care plans are currently being updated in line with person centred planning. Ways should be examined of implementing a formal quality 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 19 assurance system, which includes regular consultation with residents, their representatives and other interested parties. A new fire alarm system and on-call system were installed 13 months ago and these are now due to be serviced. The home’s shaft lift was serviced during the inspection visit. All safety data sheets are in place for the home’s Control of Substances Hazardous to Health (COSH) assessment. Locks have been changed on one bedroom door to prevent access by one resident to potentially harmful substances. Radiators within the home are covered and water temperatures are regulated so they do not exceed the safe level of 43°C. Staff stated that they have regular training in moving and handling and the Provider stated on their pre-inspection questionnaire that 14 people hold a current first aid certificate. 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 20 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 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 21 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. 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. 1 2 3 Refer to Standard YA19 YA19 YA39 Good Practice Recommendations Written guidance should be obtained from GPs as to the use of oxygen for residents for whom it is not prescribed. A homely remedies policy should be implemented in the home following discussion with the pharmacist. A formal quality assurance system, which includes regular consultation with residents, their representatives and other interested parties, should be implemented. 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 9 Grace Road DS0000045536.V298198.R01.S.doc Version 5.2 Page 23 - 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!