Inspection on 13/01/06 for Aldenham Road (122)

This inspection was carried out on 13th January 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 7 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) 11/08/06

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 Unannounced Inspection 13th January 2006 13;0 Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 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.V277001.R01.S.doc Version 5.1 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.V277001.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Aldenham Road (122) Address 122 Aldenham Road Bushey Hertfordshire WD2 2ET 01923 237770 01923 237770 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.V277001.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 23rd July 2005 Brief Description of the Service: 122 Aldenham Road is a large, two-storey, detached house located in a residential area of Bushey. It offers accommodation to six adults who have learning difficulties. On the ground floor, accommodation comprises of a large entrance hall, a bedroom, a bathroom, a 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 out door area where service users may smoke if they choose, a small recreation room and a further building, which is used as a laundry room. The food freezers are also stored here. There is a garden area to the rear of the property and a parking area at the front of the building. The house is situated on a main Road and has easy access to Watford town centre. There are also local shops within walking distance. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection of the inspection year. Two inspectors spent the afternoon at the home. One inspector spent time talking to service users and staff about the home and available activities. The other inspector discussed the outstanding requirements with the manager. This included looking at records and care plans. Requirements have been repeated on the concern regarding recruitment and retention of staff. What the service does well: What has improved since the last inspection? The kitchen and ground floor bathroom has been refrubuished. The kitchen area is a now a nice environment for service users to relax, and eat together. Risk assessments are now detailed. Risks are clearly identified. There also good examples of behaviour management guidelines. These are easy to follow, and agency staff can read them to provide greater information. The service users appear to go out regularly and access the local community with support from staff. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 6 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.V277001.R01.S.doc Version 5.1 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 Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 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): 4 The registered manager is aware of the complex needs of service users who live in the home, and clearly takes great care prior to agreeing an admission. EVIDENCE: Perspective service users are assessed prior to admission, and given every opportunity to try the service. This is not only to see if they like the home environment, but also the other service users who live in it. This is a dual process, with service users who already live there having opportunity to be consulted about the prospective new person. There was a recent good example of this where a prospective admission, did not happen as a current service user raised concerns about the persons behaviour directed towards them. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 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 and 7 All service users have a plan of care on file. Further detail is required in a userfriendly format to enable service users to be more involved. EVIDENCE: There are risk assessments and behaviour management guidelines on file. These are easy to understand and follow. These are obviously integral in supporting people who have complex needs. Work has begun on developing a more person centred approach to working, but the plans are not as yet working documents. The present format requires greater simplicity, and few were signed or dated by the service user or representative. There appears to be very limited advocacy input, and limited information of other people being actively involved in service users lives. Some service users did have structured activity programmes, but others appeared to undertake activities on an adhoc basis. Whilst staff stated that he /she has possible different options and this may be evidence of choice, concern remains that as there are a high number of different agency staff working with service users and activities may not occur or will be very limited. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 10 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 and 16 The staff spoken to appear committed and supportive in assisting service users to access the community and the facilities within it. It is important that people who find difficulty in expressing themselves have every opportunity for advocates and external sources to support them in the day-to-day running of the home. Documentation must clearly state how this is happening. EVIDENCE: Records viewed made evidencing activities difficult. It was obvious from inspector’s observation that service users were out participating in activities. A person also waited for a worker to take him out to the pub. He appeared keen to do this and the member of staff who arrived gave several options of where they could go, and indeed lots of chat about food they could eat. One service user did have an activity planner, and the staff advised that the person forgets what they are doing which can be confusing and is why this has been developed. Overall greater detail relating to recording and how this relates to the goals set in the care plan is needed. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 11 Observation at the inspection showed that staff members are familiar with service users needs and how they can best be met. There is a key worker system in place which promotes close relationships between staff and service users. However, due to the limited number of permanent staff, some are key working more then one person. Work since the last inspection has been carried on the menus. They were on display and provided a balanced varied selection of meals. The dietitian is involved in supporting service users with choices as many are on weight monitoring programmes. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 12 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): Please refer to inspection report of 23rd July 2005. Above standards not assessed on this occasion. EVIDENCE: Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 13 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 The registered manager evidenced that permanent staff had completed training on the protection of vulnerable adults; and are able to act to protect service users from possible abuse. There is a company policy relating to the managing and handling complaints, but no service users guide was available on the day. EVIDENCE: The registered manager clearly places priority on all staff having knowledge relating to the protection of service users. A recent example recorded showed a prompt and well coordinated response to a case of concern. On the day of inspection a service users complaints guide was not available to inspectors, this was later forwarded to CSCI. The leaflet should be on display and accessible to users of the service. The format received is limited, and format for recording complaints is vital to people who find difficulty in expressing their needs. The registered manager must also be able to clearly demonstrate how complaints have been investigated, and the service user advised of the outcome. Again advocacy services maybe considerably helpful in regard to situations where two service users are living in the same house are in despute. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 14 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): 24,25 The home has a refrishbuished kitchen, which is a large space in which service users can relax and enjoy meals together. Work has also been carried out in the downstairs toilets/bathroom area. The home appears to be well used and requires continued checking, to ensure that it remains in good decorative order. EVIDENCE: The home is spacious and provides ample space for service users to be involved in different activities. The manager has began to address some of the maintance issues raised in the previous inspection, but there was no available maintance and redecoration plan on the day of inspection. This was forwarded later to the CSCI but is very limited. Regular house checks are required to ensure the environment remains safe, comfortable, and well maintained. An issue relating to the window restrictors in a service users bedroom was discussed and the registered manager must show evidence of having consulted with the Environmental Health Department. Pull chords in bathrooms should be replaced to allow easy access to the light when service users are using these facilities. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 15 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): 33 and 35 The permanent staff appear skilled and committed to working with service users which can be both demanding and challenging. The constant use of agency staff requires more experienced staff not only to work along staff that need to be inducted, but also be the person who takes the lead responsibility on shift, as they know the service user. EVIDENCE: The registered manager appears to have made an effort since the last inspection to recruit permanent staff within the home. Recruitment of staff is an on going concern, with new staff having been appointed, but there are still vacancies. The current provider policy dictates that agency staff are not provided with regular hours. This is due to concern relating to agency staff being seen as employed. This appeared to allow very limited consistency for service users or indeed agency staff. The consequences being that experienced agency staff that know the service users are not always available at peak times. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 16 On the day of inspection the staffing rota was illegible. Significant changes had been made. It was difficult to ascertain who was on shift, and how many were agency staff. A copy of the rota was forwarded to CSCI after the inspection. The inspector spoke to staff, and it became apparent that there has been concern about the lack of permanent staff for a lengthily period of time. Permanent staff appear skilled, committed and caring. It is very important for them to continue to be available to provide consistency to the people living in the home. Recruitment must be given a priority by Walsingham, with immediate action being pursued. The home has robust policies and procedures for recruitment of staff, employees do not start work until POVA First and CRB checks have been received, and two supporting references. Permanent staff are regularly supervised, and this has started to be linked to the annual appraisal system. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 17 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): 41,42 and 43 The home would benefit from a review of the storage of documentation. Although space is limited many significant document s were not available on the day of inspection. The risk assessments had been updated and reviewed since the last inspection, and appear satisfactory. EVIDENCE: The manager has started to work on the requirements made at the last inspection. A risk assessment regarding disposable gloves being left in the bathroom room was actioned, and forwarded to the Commission within a few days of the inspection. The manager had discussed this with his staff team. Checks had been introduced for Leginella. The certificate and relevant paperwork was made available. The safe management of COSHH products continues to be of concern. On both inspections products were found left in the kitchen and the bathroom. This Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 18 could impact on the safety of service users. An immediate requirement was made, and as been acted on with regard to COSHH products being kept in a locked cupboard. The registered manager must demonstrate that significant effort has been made to recruit new staff. Without a permanent staff team the service users cannot receive the high level of consistency, and diversity of skills required to effectively meet their needs. Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 19 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 x 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 2 34 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x x x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 x 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x x x x x 2 2 2 Aldenham Road (122) DS0000019263.V277001.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered manager must ensure that all service users have a current and up to date person centred plan The registered manager must involve advocacy services within the home for those with limited networks. The registered manager must liaise with the Health and Safety Executive with regard to the window, restrictors being sufficiently safe in a service users bedroom. The registered manager must ensure that there is an up to date maintance and redecoration plan. Records to be kept on work carried out. The registered manager must ensure that at all times there are suitably qualified, competent and experienced staff working at the home. The registered manager must ensure that the use of temporary/agency staff does not prevent service users from receiving continuity of care(Carried forward from the DS0000019263.V277001.R01.S.doc Timescale for action 01/04/06 2. YA7 13(4)(c) 31/05/06 3. YA24 13(4)(c) 31/03/05 4. YA24 23 31/03/06 5. YA33 18(1)(a) 31/05/06 6. YA33 18(1)(b) 31/05/06 Aldenham Road (122) Version 5.1 Page 21 previous inspection) 7. YA42 13(4) All COSHH products must be stored in a locked cupboard, and be put away once used. 13/01/06 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.V277001.R01.S.doc Version 5.1 Page 22 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.V277001.R01.S.doc Version 5.1 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!