Inspection on 03/08/06 for 97 Monmouth Road

This inspection was carried out on 3rd August 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

97 Monmouth Road 01/12/05

97 Monmouth Road 22/06/05

97 Monmouth Road 24/02/05

97 Monmouth Road 30/09/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Monmouth Road (97) Dorchester Dorset DT1 2DF Lead Inspector Marion Hurley Key Announced Inspection 3rd August 2006 09:30 Monmouth Road (97) DS0000026755.V296596.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 Monmouth Road (97) DS0000026755.V296596.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. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Monmouth Road (97) Address Dorchester Dorset DT1 2DF 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) 01305 266430 01305 250138 www.leonard-cheshire.org.uk Leonard Cheshire Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: 97 Monmouth Road is a care home registered to provide care and accommodation to three people who have learning disability. The home is one of seven similar services in Dorchester that are owned and operated by the Leonard Cheshire Foundation, a not for profit organisation providing services to people with disabilities. The property is a semi-detached house, located in a quiet residential street, close to Dorchester town centre. All service users have single bedrooms, and share the communal lounge, dining room, kitchen and bathroom. There is a large rear garden with a summerhouse utilised as an art room by residents from all the Leonard Cheshire Homes in the Dorchester locality. The home is staffed 24 hours a day, with usually two staff during the day and one member of staff on duty in the evening and sleeping in at night. Day activity programmes are arranged for the service users, which include leisure and community activities. Fees are individually negotiated according to the residents needs. Copies of inspection reports are available upon request from the Leonard Cheshire Home administration Office in Dorchester. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key announced inspection that took place at the home over a period of three hours. Additionally, time was spent in preparation for the visit looking at previous inspection reports and Regulation 37 and 26 reports and other relevant documents. At the time of this inspection this home does not have a Registered Manager or allocated team leader. However, the Regional General Manager advised that the organisation would shortly be recruiting for the team leader post. Two experienced support workers and a third member of staff who has been acting team leader were available. All three residents were seen at various times during the inspection. Records and documentation were inspected and there was a tour of the premises. One service user’s records were examined in detail. A pre inspection questionnaire was sent on May 23rd but not completed or returned prior to the inspection. What the service does well: Monmouth Road provides residents with a good standard of personal care, which is delivered by experienced and well trained staff. Residents are encouraged and supported to lead a varied lifestyle and are appropriately supported to make use of local facilities. The service is focused on understanding the needs and wishes of the residents and encouraging them to lead active and fulfilling lives. The staff demonstrated a good understanding of the residents’ behaviour. The level of activities with residents is widespread, age appropriate and aimed at integrating residents into the wider community. The residents’ days are mostly structured and include vocational and social activities. Within the home, the residents are encouraged to be involved in maintaining and improving their life skills. The staff rotas were designed around the needs of the residents. The residents’ health and well being were being handled professionally and sensitively and the residents were being protected from abuse and harm. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Monmouth Road (97) DS0000026755.V296596.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 Monmouth Road (97) DS0000026755.V296596.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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been no recent admissions to the home. Reviews are completed. However, outcomes from these need to be more explicit reflecting any changes for the resident. Each resident must have a written and signed contract and or terms and conditions that reflect where they live and the services they receive. EVIDENCE: Staff confirmed their knowledge and understanding of the principles and good practice for admission procedures. However, they were not fully aware of the Leonard Cheshire Homes’ policies and formal procedures for admissions. The staff explained that previously the Cheshire Home’s Service Manager has dealt with all enquiries, referrals and admissions. Not all the residents have completed contracts and or terms and conditions and this is in part due to the fact that this group have lived and been supported though the Leonard Cheshire Home Services for over 20 years, but each resident must have an individual written contract or statement of terms and conditions. Monmouth Road (97) DS0000026755.V296596.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, and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their care assessed and thoughtfully planned in a way that reflects their individual preferences and abilities. However, the monitoring and reviewing of care is not always explicit. The service focuses on understanding the needs and wishes of the residents. Residents are encouraged to participate in all decision making which affects their lives and how they spend their time. EVIDENCE: One resident’s care/support plan was examined in detail. The records were personalised to the individual’s needs and were informative giving a good insight into the background of the person. All areas of daily living were detailed including likes and dislikes, personal interests and physical Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 10 and psychological health and behavioural management guidelines, although many aspects were in need of reviewing and updating. The staff spoken with demonstrated a good knowledgeable of the residents’ needs and abilities. Needs were assessed in relation to daily activities and relevant risk factors were taken into account. Daily activities are recorded in the resident’s own diary and staff may wish to consider completing a monthly summary which could be used as a basis for periodic reviews. The interaction between the staff and the residents is very positive and staff respond to the different methods of communication each resident uses. Discussions with staff illustrated their awareness of the needs of the residents and the depth of their knowledge and understanding in supporting them individually and as a “family group”. Most risk assessments have been reviewed and updated. However, no comments or information are added by the review dates. A member of staff who is based at the Leonard Cheshire Administration office and who is not employed as a carer completes the risk assessment reviews. It is recommended that support workers who are living and working with the residents should review risk assessments and the information should crossreference with information contained in the residents’ support/care plans. The need for satisfactory risk assessments was highlighted at the last inspection and although some progress has been made there is still a need to emphasise the individual hazards and risks as they present to each resident in their daily lives and to describe the action to minimise the risk for the individual resident. It was noted that all the risk assessments are standardised using templates, produced by the organisation, which indicates that some risk assessments, are being completed as a matter of course rather than being person centred and specific to individuals. Risk assessments must be personalised according to the residents’ abilities and needs. Monmouth Road (97) DS0000026755.V296596.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a varied and fulfilling lifestyle, which encourages them to maintain and develop their life experiences and “interdependence”. Residents are offered a healthy diet based on choice. EVIDENCE: From the details in the care plan and discussions with staff it was clear that there was a good base of knowledge on each residents’ competencies, interests and needs and these were linked with recreational and developmental opportunities. The three residents all have different needs and interests and one person enjoys going to reflexology, having massages and weekly cranial osteopathy, another likes more physical activities and enjoys horse riding, swimming and walking. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 12 Local amenities are within a reasonable distance from the home including pubs and restaurants, shops, cinema, theatre and libraries. One resident goes to the library weekly and is assisted to chose DVDs. The home has a vehicle to support outings though staff encourage residents to walk whenever possible. Records of all individual and “household” activities are recorded in each resident’s diary. Appointments and planning information are noted in the staff communication book. Visitors are always welcome at the home and there are no restrictions. Telephone contact as well as regular visits to the home are encouraged and supported. The menu is planned a month in advance and is seasonally adjusted. A record of all meals eaten by the residents is kept in their diaries. Residents are generally not involved in the preparation of meals; however, staff take time to enjoy some simple cookery sessions with them on a one to one basis. Other records relating to the cleaning rota, fridge and freezer temperatures were all being maintained. Monmouth Road (97) DS0000026755.V296596.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and well-being were being handled professionally and sensitively. Residents are safeguarded by the medication procedures within the home. EVIDENCE: There was evidence of residents’ health and medication being monitored and appropriate consultation with other health and social care professionals. Residents are registered with a local GP and also receive regular dental, optical and chiropody treatment. Baths/showers are carried out at flexible times according to the preferences of each resident. Residents’ have complex emotional and social needs and these were fully discussed with the staff and acting team leader who detailed their working relationships with other agencies and consultants. Details were also evidenced Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 14 from the care /support plans. A record of appointments, consultations and outcomes were kept with the residents’ health care plan. Staff spoken with confirmed that the routines at the home are flexible and focused on the needs and safety of the residents. All members of staff are involved in the administration of medicines and the two staff on duty confirmed that they had received specialist training. Records of drug administration were viewed and were satisfactory as were storage arrangements and stock levels. Monmouth Road (97) DS0000026755.V296596.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable staff to complain about the service and to contact outside agencies for support. Procedures are established for the reporting and recording of any potential abuse. EVIDENCE: There is a complaints procedure available at the Leonard Cheshire Homes Administration Offices in Dorchester. This document, which has not been reviewed since 2004, needs amending to include the contact details of the local CSCI offices. The staff explained that the Service Manager or Regional General Manager would deal with any concerns or complaints. It is therefore important that all members of the senior management team are up to date with the procedures especially relating to Vulnerable Adults and how these link into the local multiagency adult protection procedures. It was noted that body maps were used to record any marks noted on the residents and this information cross referenced with details record in the resident’s diaries and care/support plans. All residents have their own bank accounts but are reliant on the staff to manage their monies. There are clear records of all financial transactions completed with and on behalf of each resident. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 16 The residents do not have the depth of verbal skills to communicate any concerns and staff described how they observe any changes in their behaviour both for positive reinforcement and for negative reactions to situations or people. Monmouth Road (97) DS0000026755.V296596.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Monmouth Road presents as a clean and homely place to live. Residents were relaxed and at ease in the home environment, which was clean and comfortable despite the outstanding work required to the bathrooms and external aspects of the property. EVIDENCE: All residents have single bedrooms; there is no stair lift so the home is only suitable to those with good mobility. There is a large lounge and separate dining room. All areas were noted to be clean. Residents’ bedrooms are personalised to individual preferences and are “special places” for each resident. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 18 The garden is a safe space for the residents to use and in the summer months this extra space impacts in a positive way on the daily lives of residents. All staff share the responsibility for keeping the home clean and hygienic and doing the residents’ laundry. The front door needs to be replaced. One maintenance person is employed by Leonard Cheshire Homes Dorchester. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 19 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the support of the experienced staff group at this home. Residents are protected by the Leonard Cheshire Home’s recruitment policy and practices. EVIDENCE: Two staff files were examined and were found to contain all elements required by current regulations, regarding recruitment practices. The files provided evidence of induction training to Learning Disability Award Framework (LDAF) standards and all references and required checks for recruitment. Discussions with staff on duty demonstrated their strong commitment to each resident and depth of knowledge and understanding for each person. Two staff have been recruited since the last inspection whilst other members of the team have worked together for many years. Staffing levels remain in line with the needs of the residents and are flexible enough to facilitate resident activities. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 20 The majority of staff have started / completed mandatory care courses such as moving and handling, basic food hygiene and first aid. Staff spoken with said that despite not having a Registered Manager since December 2005 they had been well supported by the Service Manager who had been “always available”. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 21 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a warm, professional and friendly atmosphere at the home, which encourages residents to communicate their needs. Residents’ health, safety and welfare were generally being protected EVIDENCE: The responsible person representing Cheshire homes undertakes monthly monitoring visits “Regulation 26” and these comprehensive reports are sent regularly to the CSCI offices. There were no obvious hazards noted within the home. Residents’ records were safely and securely stored. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 22 From observations of the residents, it would seem that they felt comfortable in the home and were looked after by staff that genuinely cared and understood their needs and responded to them. Fire safety records were satisfactory and it was clear that staff had taken responsibility for ensuring the equipment was regularly tested and they remained up to date with their own training. Other health and safety checks and servicing records were all satisfactory. These had been checked with the maintenance employee at the Leonard Cheshire Homes administration offices in Dorchester. Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 23 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 2 3 X 4 X 5 2 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 2 25 X 26 X 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 2 2 X 2 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 3 X 2 X 2 X X 3 X Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 YA5 Regulation 5 (1)(b) (c) Requirement The registered provider/manager must ensure that all residents have a written and costed contract/statement of terms and conditions. The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The plan must be reviewed at least every six months and updated to reflect changing needs. The home’s premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users’ individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. The front door needs to be replaced. DS0000026755.V296596.R01.S.doc Timescale for action 30/11/06 2 YA6 15(1)(2) (a)(b)(c) (d) 31/10/06 3 YA24 13(4)(a) 30/11/06 Monmouth Road (97) Version 5.2 Page 25 4 YA37 8(1) 9 (1) (2) 5 YA39 24 (1) (2) (3) The registered provider must 30/11/06 appoint a manager who is suitably qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Effective quality assurance and 30/11/06 quality monitoring systems, based on seeking the views of service users, must be in place to measure success in achieving the aims, objectives and statement of purpose of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Monmouth Road (97) DS0000026755.V296596.R01.S.doc Version 5.2 Page 27 - 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!