Inspection on 11/08/06 for Aldenham Road (122)

This inspection was carried out on 11th August 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aldenham Road (122) 23/07/08

Aldenham Road (122) 23/01/08

Aldenham Road (122) 13/01/06

Aldenham Road (122) 23/07/05

Aldenham Road (122) 22/11/04

Aldenham Road (122) 17/06/04

Aldenham Road (122) 05/05/04

Aldenham Road (122) 19/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Aldenham Road (122) 122 Aldenham Road Bushey Hertfordshire WD2 2ET Lead Inspector June Humphreys Key Unannounced Inspection 11th August 2006 10:00 Aldenham Road (122) DS0000019263.V308235.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 Aldenham Road (122) DS0000019263.V308235.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. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldenham Road (122) Address 122 Aldenham Road Bushey Hertfordshire WD2 2ET 01923 237770 01923 237770 FP 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) Walsingham Mr Albert Adomakoh Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 2006 Brief Description of the Service: 122 Aldenham Road is a large, two-storey, detached, family style house located in a residential area of Bushey. It offers accommodation to six adults who have learning disabilities. On the ground floor, accommodation comprises a large entrance hall, a bedroom, and a bathroom with toilet, the lounge, a kitchen/dining room and a conservatory. The first floor consists of the remaining five bedrooms, a bathroom, a toilet and a small office/sleeping-in room. There is a covered outdoor area where service users may smoke if they choose, a small recreation room and an outhouse that houses the laundry and the freezers. There is a mature garden to the rear of the property and a small garden with additional space for four cars to park at the front. The house is situated on a main road and has easy access to Watford town centre. There are also local shops that are within walking distance. The approximate weekly cost of a placement at this service is £969.83 this is variable and dependent on assessed need. (This is due to be reviewed) Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this inspection year (April 2006/2007), which was carried out over two visits to the service. There were many positive aspects to the inspection, and several areas of significant improvement. All requirements except one from the previous inspection have been met. The requirement with regard to greater advocacy involvement remains. Evidence gathered during the inspection including observation, discussion with residents, care staff and deputy manager. The registered manager was also spoken to on several occasions over the telephone. Service users have limited communication skills and it sometimes difficult to ensure that their views are reflected. However the three spoken to expressed satisfaction with the food they eat, and the staff that work with them. The atmosphere in the home on both visits felt relaxed, and calm and staff interaction with service users was good; patient and caring. What the service does well: The service users all said they liked the home and were very positive about the performance of staff. They said they enjoyed the activities they were involved in, and that the accommodation was nice. The service users enjoy a healthy diet, offering a range of different foods. Mealtimes are unhurried and socialable. The menu is planned with service users, taking into consideration individual likes and dislikes The member of staff on duty was very knowledgeable about individual needs and confident in following the policies and procedures of the home. There was obvious mutual trust and respect between the support worker and the service users. Service users are listened to, and every effort is made to ensure they are protected from abuse. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 6 Based on this inspection visit and information received since the last inspection visit, the overall quality of this service is good. What has improved since the last inspection? A new service user guide has been written in a basic format allowing access, and understanding to most service users. Care plans have improved. The individual files now hold a range of significant information, which is stored in an accessible format. Person centred planning has been introduced, and is evident in practice. Routines in the home are flexible, and varied according to individual choices, and needs. Some service users attend day centres, whereas others have chosen not to do this and remain at home. Staff clearly have worked hard to try to offer an alternative range of activities for those who had opted out of the use of day centres. This could be further improved if three members of staff were available at all times. The registered manager has produced a renewal and redecoration plan. On going maintenance ensures that all areas of the home continue to remain clean and safe. Medication that is not supplied to the home in blister packs is marked with the date upon which it was opened. An auditing process is now in place that is excellent, and any errors can now be ‘picked up’ almost immediately. Considerable improvement has been seen in this area of work over the last two inspections. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 7 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. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 8 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 Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 9 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): 1,2 and 5 Sufficient information about the aims of the home, and the service to be provided is available to prospective and current service users. A new service user guide has been developed, which clearly defines the service in a pictorial format. Each service user has a statement of terms and conditions, which forms part of their individual contract. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A detailed Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The Statement contains information for the service user to make an informed choice about if they would like to live at the home. The new service user guide is written in a basic format allowing access, and understanding to most service users. Three contracts were looked at as part of the inspection; these are kept on individual files. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 10 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): 6,7,8,9 and 10 Service users have their needs assessed and have care plans outlining how their needs must be met. Service users are appropriately placed, and care is taken regarding the matching process. Individual needs and choices within the home are being promoted to encourage and empower the service users. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Three care plans were looked at as part of the inspection process. There has been an improvement since the last inspection in this area of work. The individual files held a range of significant information regarding Service users changing needs, which are identified within a named file. The information is stored in an easily accessible format. Service users appear to have greater involvement in the process of planning and delivery of their care and are encouraged to participate in decisions that Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 11 affect their lives. Activities that pose a possible risk are effectively managed through the risk management process. Service users can be assured that information about them is handled appropriately and files are stored in a locked filing cabinet. A Person Centred Planning approach is being introduced, together with appropriate staff training, however for this to be successful with service users with such high complex needs, greater involvement from advocates and outside agencies is required. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 12 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 Care plans demonstrate a high level of commitment to support service users in a wide range of activities, both within the home and outside in the community. Service users are involved in selecting the food they wish to eat; and staff support by providing information relating to varied, healthy eating. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Care plans; discussions with service users, and the staff on duty provided evidence of the use of a range of community facilities such as libraries, pubs and cafes. Visitors are welcomed into the home; information regarding family and friends is noted on file. The inspector observed that routines in the home are flexible, and varied according to individual choices, and needs. Some service users attend day centres, whereas others have chosen not to do this and remain at home. Staff clearly had worked hard to try to offer an alternative range of activities for Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 13 those who had opted out of the use of day centres. Staff had really demonstrated a commitment to find different activities for on person in particular both in the community and at home. Documentation showed clearly the outcomes, and how any difficulties were worked with. Menus are offered on a flexible basis, with service users making choices over the meals daily. Service users are involved in meal preparation, with appropriate support provided; this is very much geared towards service users ability. Some service users had eaten at the day centre and therefore were offered a snack; this was managed extremely well by staff. One service user said, “I like the food”. Another was observed making a cup of tea. It was a nice relaxed time for everyone. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 14 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 All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. The standard of medication practice is good. The date of opening of medication is supplied where blister packs are not routinely used. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: All care provided is individual and tailored to each person needs, with service users choices and preferences being promoted. Assessments and reviews are completed. Each service user has a notebook where daily recordings are made, these notes need to be reviewed regularly and a summary kept on the main file. Service users are supported with all aspects of their physical and emotional health, and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice that has been provided, is well documented to enable health issues to be properly monitored. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 15 Medication records of three service users were checked and found to be correct. Medication that is not supplied to the home in blister packs is marked with the date upon which it was opened. An auditing process is now in place that is excellent, and any errors can now be ‘picked up’ almost immediately. Considerable improvement has been seen in this area of work over the last two inspections. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 16 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 A keyworker system is in operation in the home, which offers regular opportunities for Service users to have one to one time where they can be listened. Every effort is made to ensure service users are protected from abuse. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A comprehensive complaints procedure is in place. A record is maintained of complaints made detailing actions and outcomes as necessary. The home has an Adult Protection Procedure, and a whistle blowing policy to enable staff to understand the issues around adult abuse and to act appropriately in the event that it is suspected to have taken place. As an organisation Walsingham offer regular training, and updates regarding working with vulnerable adults. Several staff was interviewed, and both were aware of the policy and how to use it. Aldenham Road (122) DS0000019263.V308235.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 Many areas of the unit have been re-decorated as part of the redecoration plan. The home felt more homely and comfortable. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The registered manager has produced a renewal and redecoration plan. On going maintenance ensures that all areas of the home continue to remain clean and safe. The service users have high complex needs, and despite previous difficulties, on the day of inspection the home was pleasantly well maintained, with service users bedrooms being individualised. The home has improved in this area over the last two inspections. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 18 Window restrictors have now been placed on the windows upstairs that were of concern. Aldenham Road (122) DS0000019263.V308235.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 The home operates a robust recruitment process which should provide confidence and protection to service users. A recognised induction programme is in place for all new permanent members of staff, and the number of agency staff has been reduced. Those agency staff who remain appear to know service users needs well. Supervision is in place for all permanent staff. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A separate visit was undertaken to access the recruitment file for a recently employed member of staff. This was inspected and found to contain the required information. Basic C.R.B information needs to be available in the home to assure C.S.C.I that the necessary checks are being carried out. Walsingham offer all newly appointed staff a detailed and well-structured induction and foundation-training programme. This covers all mandatory training including, food hygiene, manual handling, first aid, risk assessment, fire safety and understanding of service users with a learning disability. Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 20 The support worker on duty had a clear understanding of the aims of the home and his responsibilities in supporting service users to act independently within a risk assessment framework. He also clearly had good relationships with the residents and was familiar with their individual needs. The support worker on duty said that Walsingham provided good training opportunities, by reference to the training schedule available within the home. He was in the process of completing his N.V.Q 3 in care. Permanent staff appears to be offered this opportunity after a period of 12 months. The staff member also said that generally he did feel well supported by the management team in the home, and that as the team was small everyone worked well together. His line manager offered regular supervision. There is usually two care staff, plus a manager on during the day. Due to the high demands of service users it is important that the back up of a third member of staff is available where ever possible. Aldenham Road (122) DS0000019263.V308235.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 The home is run and managed by a management team who work well together and are fully able to manage, and discharge the responsibilities with the home. The home is run in the best interests of the residents. The home has a full range of policies and procedures that safeguard service users’ interests. Record keeping has improved, and care plans are of a satisfactory standard. It is important that daily care notes are linked to the assessment and review of personal needs. The home is operated in a way that maximises the service users’ control over their lives within a well-developed risk assessment framework. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 22 EVIDENCE: The standard of care offered within the home is good; both in the delivery of care, and the recording of information. As previously stated care plans and overall written information has improved. Service users’ meetings take place regularly, approximately every month. Service users are encouraged to bring up suggestions and any concerns that they might have. Service users stated that they felt the staff are keen to listen to their views, and do act on any concerns they may have. However greater outside advocacy would be beneficial, especially at this time of possible change. Staff stated that communication and support is good and this included handovers at every shift change and regular staff meetings. Records seen at this inspection were well maintained and included health and safety practices in the home, regular tests of fire alarms and equipment, electrical and equipment maintenance. There has been an improvement in the way in which this information is stored, with greater ease in finding significant information. COSHH products are now kept in a cupboard, which has a lock on it. Staff ensures products are put away when not in use. Policies, procedures and protocols were in place at the home to protect the financial interests of service users. Aldenham Road (122) DS0000019263.V308235.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 3 2 3 3 X 4 X 5 3 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 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 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES 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 Daily recording notes must form part of assessment and review of service users changing needs. The registered manager must involve advocacy services within the home for those with limited networks, especially at this time of possible change. Timescale for action 31/10/06 2. YA7 13(4)(c) 31/12/06 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 Aldenham Road (122) DS0000019263.V308235.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Aldenham Road (122) DS0000019263.V308235.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. 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