Inspection on 30/08/06 for 993 Oxford Road

This inspection was carried out on 30th 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

993 Oxford Road 06/10/05

993 Oxford Road 23/05/05

993 Oxford Road 16/12/04

993 Oxford Road 12/07/04

993 Oxford Road 01/03/04

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

CARE HOME ADULTS 18-65 993 Oxford Road Tilehurst Reading Berkshire RG31 6TL Lead Inspector Jill Chapman Unannounced Inspection 30 August 2006 9:25 th DS0000011060.V305547.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 DS0000011060.V305547.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. DS0000011060.V305547.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 993 Oxford Road Address Tilehurst Reading Berkshire RG31 6TL 0118 945 3821 0118 941 5290 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) www.sense.org.uk Sense Mrs Lisa Jayne Faulkner Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000011060.V305547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: 993 Oxford Road is a service, which provides twenty four hour care for five adult, male service users who have learning and associated sensory disabilities. It is a two-storied building that is owned by a housing association and the care is provided by SENSE (a national charitable organisation). The home is located approximately ten minutes, by car, from Reading Town Centre and is within easy reach of several other towns, which increases the availability of a variety of leisure and community facilities. The home has its own transport and is on a public transport route. The current fees range from £90,887.96-£130,282 per year DS0000011060.V305547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out on a weekday morning to mid afternoon over a period of six and a half hours. The focus of the inspection was to follow up progress from the previous visit and to inspect the key standards. A tour of the house and garden was carried out and time was spent speaking with staff and the manager. None of the service users were able to give their views about the home due to their communication and learning disabilities. Some of the morning routine was observed and their views and choices were well represented in records seen. Service user surveys were sent out prior to the visit but the advocates had not returned these in time to be represented in this report. A pre inspection checklist provided additional evidence to that seen on the site visit. What the service does well: The home would carry out an assessment of need to make sure it could meet the needs of a new service user. The quality of service users care records is excellent; they show that service users have choice and how they like their needs met. Risk assessments help keep them safe. Care records help staff meet the diverse needs of the service users. Service users benefit from good access to leisure facilities and the community and staff are well trained to facilitate this. Staff support service users to keep in touch with families and friends and to eat healthily. Service users receive care in the way they prefer and that takes into account their diverse needs. Staff help them to keep healthy and their medication is well looked after. Staff know about the complaints procedure and who to pass concerns on to. Staff are trained to know how protect service users. DS0000011060.V305547.R01.S.doc Version 5.2 Page 6 Service users benefit from spacious accommodation and the home is kept clean and hygienic. Service users are supported by a staff team who are trained to meet their needs. Recruitment checks are carried out to make sure that suitable staff are employed The home is being actively managed and there is good corporate support. Service users and others can give their views on how the service is delivered. Safety checks and services are carried out to keep the environment safe. 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. DS0000011060.V305547.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 DS0000011060.V305547.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 The home would carry out an assessment of need to make sure it could meet the needs of a new service user. This judgement has been made using available evidence including a visit to the service. EVIDENCE: No new service users have been admitted since the last inspection, however the Admissions policy was seen and shows that assessments of need are carried out prior to admission. This standard was inspected at the last inspection and a service users file was sampled and showed that this had been carried out. DS0000011060.V305547.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 excellent. The quality of care records seen is excellent. There is good information to help staff meet service users needs and to keep them safe. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The files of three service users were sampled and show that there are up to date Person Centred Care plans. These show detailed information about service users needs and how they can be met. Service users key workers review the care plans in a monthly summary. In discussion with two key workers it was clear that they know the needs of the service users. Annual reviews are held and some were seen on files sampled. It was clear that the manager liaises with care managers, advocates and families about service users care. Care plans show details of service users choice and preferences in how their care needs are carried out. DS0000011060.V305547.R01.S.doc Version 5.2 Page 10 There were a variety of appropriate individual risk assessments on files seen. Risk assessments are in place for measures taken to keep service users safe but which restrict their choice or freedom, for example locks on doors and wardrobes. From observation and from discussion with staff it was seen that measures taken were appropriate. Risk assessments seen were up to date. Bathing risk assessments do not specify the risks of scalding or drowning, however bathing guidelines do. It is recommended that these be reviewed in line with the guidelines. DS0000011060.V305547.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, 14, 15, 16 & 17. Quality in this outcome area is excellent. Service users benefit from good access to leisure facilities and the community and staff are well trained to facilitate this. Staff support service users to keep in touch with families and friends and to eat healthily. This judgement has been made using available evidence including a visit to the service. EVIDENCE: This is evidenced by discussion with staff and from sampling activity records. One service user goes to Henley College. Staff support service users to go swimming, Jacuzzi, trampoline, horse riding. One service user has paid employment at another Sense establishment. Staff take service users out for walks, car rides, meals out, Thursday club, social club and Stepping Stones. One service user likes trains and staff take him for train rides. Induction training covers guiding techniques to help staff DS0000011060.V305547.R01.S.doc Version 5.2 Page 12 know how to support service users in the community. Staff said they are shown several scenarios that could occur and how to cope with them. The organisation has produced ID/Information cards for staff to give to members of the public if they become concerned about service users behaviours or staff responses when out in the community. This gives general information about the organisation and the needs of people with learning disability; they are invited to contact the organisation if they are concerned. Service users are supported to go on an Annual Holiday The organisation pay a lump sum towards the cost of the holiday and the service user pays the balance. Service users have been on day trips at the seaside and a trip to Alton Towers is planned. Staff said that they get out a lot because there are a lot of drivers in the staff team and there are two homes vehicles. There are recorded details about important family or other contacts. Staff described how they help service users keep in touch with family and friends. Service users are all non-verbal and some have sight or hearing disabilities. It is positive that all service users have advocates and there is evidence that the manager chases the organisation if advocates fail to turn up. Personal care plans include how service users should be respected and the manager said that issues of privacy and dignity are covered in induction. Post is opened in service users presence and there is a policy of seeking service consent before entering their bedrooms. Generally practice seen was appropriate but it was apparent that some staff need reminding of this. Menus were sampled and show that service user benefit from a varied and nourishing diet. There are mealtime support guidelines and staff were seen to help service users at a lunchtime meal. Meals are planned with service users likes and dislikes taken into account. Consideration could be given to looking at ways to more directly involve service users in meal planning and food shopping. DS0000011060.V305547.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. Service users receive care in the way they prefer and take into account their diverse needs. Staff help them to keep healthy and their medication is well looked after. This judgement has been made using available evidence including a visit to the service. EVIDENCE: From looking at service users files and in speaking with staff it was seen there are detailed guidelines on how to help them with their personal care and daily routines (Independent lifestyle needs). Communication profiles help staff understand service users non-verbal communication. These are detailed and for blind service users include tactile prompts to help the service user communicate and understand how staff are helping them. There are tactile prompts in the environment. There are tools for monitoring behaviour and how to respond to situations. Staff spoken with were aware of service users needs and how to respond to them. DS0000011060.V305547.R01.S.doc Version 5.2 Page 14 Service users health records are kept and these show details of appointments with health professionals, GP visits, dentist, audiologist and optician. Service users have a three monthly health review with the GP and their weight is checked. The home uses the Boots MDS system, staff receive in house training from the manager or deputy manager and training from Boots. There are guidelines in place regarding storage of medication, which were recently reviewed. The medication storage was seen and appropriate DS0000011060.V305547.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 adequate. Staff know about the complaints procedure and who to pass concerns on to; but need to know how to record a complaint. Staff are trained to protect service users but also need to know about the Berkshire Vulnerable Adult Procedure. This judgement has been made using available evidence including a visit to the service. EVIDENCE: This section was evidenced by discussion with staff on duty and from looking at records. There is a complaints procedure in place and staff were aware of this and who to tell if someone expressed a concern to them. They were not all familiar with where the complaints record is kept and that they should record the complaint if a manager is not on duty. It is recommended that refresher training on this part of the complaints procedure be carried out. There have been three complaints since the last inspection and these have all been investigated and outcomes reached. A complaint dealt with by senior managers is not yet in the homes record. A recommendation that staff are trained in Adult Protection Issues is mostly met. It was seen from records that staff receive POVA training and staff spoken with were familiar with Sense’s policy and what to do if they were concerned about a service user. Staff were not familiar with the Berkshire local protocols and a copy of the procedure could not be found in the home. There is DS0000011060.V305547.R01.S.doc Version 5.2 Page 16 a system in place for the safekeeping of service users money; staff check this at the handover meeting. It was seen that the monies were accurate. DS0000011060.V305547.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 & 30 Quality in this outcome area is adequate. Service users benefit from spacious accommodation, which will be further improved when planned works are completed. The home is kept clean and hygienic. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A tour of the premises was carried out and discussion with staff and the manager. The home was clean and well looked after. Service users bedrooms are large and furnished to meet their diverse needs. Some bedrooms appear rather bare due to the need to keep some service users and their belongings safe. Locks on wardrobes and doors are supported by written risk assessments. A sign with raised lettering helps a blind service user identify his room. In communal areas some carpet is soiled and worn and the furniture shabby. The kitchen flooring is torn and temporarily made safe. Some re-carpeting has already taken place and the manager said that new lounge carpet and new lounge furniture is being provided. The kitchen floor is due to be replaced and the two bathrooms are going to be refurbished. Staff described plans to improve the DS0000011060.V305547.R01.S.doc Version 5.2 Page 18 conservatory/sensory room. It was seen that metal cabinets housing staff and other admin records are temporarily kept in this room and they should be removed as soon as possible. The garden is well kept with new garden furniture. A requirement to provide specialist equipment for a service user has been met. The home was seen to be clean and hygienic. There is a contract for the disposal of soiled waste and the washing machine has a sluice programme. Staff confirmed they had received training in Hygiene. DS0000011060.V305547.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 & 35 Quality in this outcome area is good. Service users are supported by a staff team who are trained to meet their needs. Recruitment checks are carried out to make sure that suitable staff are employed This judgement has been made using available evidence including a visit to the service. EVIDENCE: Rotas were seen and staff and manager spoken with. The minimum daytime staffing levels are three staff. An additional staff from 9.00 to 4.30, who used to be deployed to enable activities, has been reduced due to the need to work within budget and sgreed staffing levels. Rotas show however that on some days the manager or administrator are available to cover and on others a fourth staff is deployed to enable activities. The manager said that this post would be reinstated as soon as possible. Some staff were concerned that this reduction has restricted the flexibility of activities and did not leave sufficient staff to look after service users however no evidence was found to support this on the day. At night there is one waking night and one staff sleeps in. There are some vacant hours but these have been advertised. There is minimal use of agency staff. There are good communication systems in place which includes a handover sheet which logs daily tasks, service user activities, domestic tasks, DS0000011060.V305547.R01.S.doc Version 5.2 Page 20 medication, finance checks and names who is to support each service user on shift. Staff spoken with had a good understanding of service users needs and had received training to meet the specific needs of the service users. Feedback from staff is that mostly morale is good and that the team work well together. There is a recruitment policy in place, which includes carrying out CRB check, two references and other checks. In discussion with one staff and from sampling recruitment records it was found that the procedure had been carried out fully. From speaking to staff and from sampling records it was seen that staff are given an appropriate induction and foundation training. Staff said that the organisation is developing induction training to cover a period of 12 days. This will be carried out prior to staring the job and include all mandatory training. There is a programme of NVQ in place with 56 of staff having achieved NVQ 2 or above. DS0000011060.V305547.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 & 42 Quality in this outcome area is good. The home is being actively managed and there is good corporate support. Service users and others can give their views on how the service is delivered. Health and safety is mostly good but some improvement is needed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager has completed the Registered Managers Award and is in the process of completing the NVQ level 4 and A1 Assessors Award. There is evidence from records seen that she is actively managing the home and is dealing with any poor practice. The company are supporting her to develop her management skills and to work with some issues in the staff team. Some staff felt that communication between managers and staff could be improved. A requirement to develop a Quality Assurance System is met. It was seen that there is corporate system in place that includes an inspection by a corporate DS0000011060.V305547.R01.S.doc Version 5.2 Page 22 QA team, a self audit, relative, advocate, care manager, service user and staff questionnaires. In discussion with staff and from looking at records it was seen that there is generally good attention to health and safety matters, with regular checks and services being carried out. Most health and safety records were up to date but the weekly fire alarm test record had not been filled in since 25-07-06. There is a system for recording and monitoring accidents and incidents. DS0000011060.V305547.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 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 2 23 2 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 4 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 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 3 x x 2 x DS0000011060.V305547.R01.S.doc Version 5.2 Page 24 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 YA42 Regulation 13 Timescale for action Weekly fire alarm tests should be 30/09/06 carried out. Requirement 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 YA23 YA22 YA9 Good Practice Recommendations Staff need training in the Berkshire Vulnerable Adults procedure. Staff need to know to record a complaint. Risk assessments should show that the risks of scalding and drowning have been assessed. DS0000011060.V305547.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 DS0000011060.V305547.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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