Inspection on 15/12/08 for Apton Road

This inspection was carried out on 15th December 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Apton Road 09/01/08

Apton Road 19/01/07

Apton Road 28/02/06

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Paradise Lodge

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Newton Court (1-2)

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Apton Road 34 Apton Road Bishops Stortford Hertfordshire CM23 3SN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 1 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Apton Road 34 Apton Road Bishops Stortford Hertfordshire CM23 3SN 01279755656 01279505939 lizoreilly@hertscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Elizabeth Jane O`Reilly Type of registration: Number of places registered: Hertfordshire County Council care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 34 Apton Road is a four-bedroom two storey house standing within the 32-40 Apton Road supported living complex of buildings operated by Hertfordshire County Council. Number 34 has been separately registered as a care home providing respite care to a maximum of four adults with learning disabilities at any one time. The house is fully equipped with lounge, dining room, kitchen, utility room, bathroom with large walk in shower and toilets. On the first floor there are four single bedrooms a bathroom and an office. There is a large garden to the rear with a patio and terraced lawn area accessed by some steps. The house is only able to accommodate fully ambulant residents as it is not wheelchair accessible as it has no lift. The Apton Road complex is effectively in a cul-de-sac, located very close to the centre of Bishops Stortford with its shops, amenities and mainline railway station. The site offers easy access to all public transport and community facilities and there is a day centre in the same road. The fees are variable and are assessed by Hertfordshire Social Services according to individual Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 4 Brief description of the care home incomes. Information about the service is available in the statement of purpose and service user guide. These and the most recent inspection report are available from the service. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit that took place over 4 hours. At this visit we considered how well the respite service meets the needs of the people who use it and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to staff and management with telephone calls subsequent to the visit with other professionals involved with the service. Prior to the site visit the manager had completed and sent into the Commission for Care Homes for Adults (18-65 years) Page 6 of 27 Social Care Inspection the homes Annual Quality Assurance Assessment. This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people using the service and how they can evidence this. Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to people using the service, relatives and staff. Views expressed in survey responses have been incorporated into this report. Feedback on findings was provided to the manager at the end of the site visit and the opportunity for discussion and clarification was given. The previous key inspection of this service took place on 9th January 2008. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A robust admission process ensures that people wishing to use the service are sure their needs can be met. Evidence: The service offered at 34 Apton Road was purely a respite service and as such had a core group of returning residents who stayed for varying periods throughout the course of a year dependent on their needs and circumstances. It was reported that some people used the service for regular overnight stays on a weekly basis whilst others only had need for the service a couple of times a year. The manager told us there had been no changes to the admissions procedures since the previous inspection of this service. All referrals came from social services and all applicants received a full assessment of their personal care and individual needs. This assessment formed the basis of the care plan developed at the home with the person using the service and their full time carers. This ensured that each persons assessed personal and social care needs were met according to individual preferences. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: The managers AQAA told us that admissions are not agreed until a full needs assessment is received in order to assess whether their needs can be met. Professionals we spoke with confirmed that the service ensure they were thoroughly aware of each persons needs before they were admitted to the home. Family members told us they were involved in the admission process by providing the finer detail of how people liked to be supported. Since the previous inspection of this service a welcome pack had been developed with the involvement of people using the service. This involved a user friendly Service User Guide that included an entertainment and leisure guide to the local town and its amenities. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this respite service are encouraged and supported to maintain control in their daily lives. Evidence: Care plans for 5 people that use the service were looked at to determine if peoples changing needs and personal goals were accurately reflected. We noted that care plans were developed from the initial assessments made by the referring social service team. Once the person had moved into 34 Apton Road the detail within the care plan increased with input from their full time carers to ensure that the transition from home to respite unit was as smooth and trouble free as possible for both the person using the service and their carer. The care plans were detailed providing clear information about individuals choices, preferences and strategies that staff may need to employ to manage any challenging behaviours. Care plans were updated each time people returned to the service to ensure the staff had the current information necessary to support people as they Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: wished. Each persons file included a checklist of potential risks to individual health, safety or well being. Where a potential risk was identified a care plan was developed detailing the level of risk and actions to be taken by staff members to reduce or if possible remove the risk factor. Examples seen included accessing the community alone, managing prescribed medications and managing challenging outbursts. Care plans included detail of where independent advocates were working with people to assist with personal choices, preferences and decision making. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will be offered appropriate leisure activities, encouraged to access the local community and be treated as individuals. Evidence: Staff told us that some people liked to come into the service and do absolutely nothing and have a restful break, others used the service whilst their families were on holiday so they liked their stay to be a special experience and go on trips out, go to the cinema and have meals out and some liked their routines of every day living to be maintained. Each persons stay at 34 Apton Road was very different and daily recording in the care plans reflected this. We noted that every day activities such as shopping trips and meal preparation took place as well as trips to Southend and an instance of a limousine trip into London to see a show and have a meal. One health and social care professional told us what people really like about Apton Road is that Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: the staff make big efforts to ensure people go out and about and Apton Road works with people on their independence skills. Staff told us how some people use the service as a family base where they can drop in and out for a coffee, a chat and support at will. On the day of this visit people were due to come for afternoon tea and one person came for a coffee during the morning. Meals were provided in accordance with peoples individual preferences and needs with dietary needs strictly adhered to. People were encouraged and supported to shop for food and became involved with staff in preparing meals. Staff told us that the tradition of a weekly Saturday night takeaway continued to be enjoyed by all residents. We noted that food in the fridge that had been opened had been suitably covered and labelled with the date to show when it had been opened. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service may be confident that personal care will be provided in accordance with their wishes maintaining their dignity and privacy. Evidence: The managers AQAA told us that people were encouraged to maintain their independence and do as much as they were able to do for themselves without intervention. Daily recording confirmed that each person received their care according to their individual needs and preferences. Staff told us that no two weeks were the same at the unit as the dynamics changed so much depending on the group of people that were residing at the unit at the time. Care records gave good detail of where a potential health issue had been recognised by staff and how this was being investigated with health professionals. During this visit we noted that staff interacted with residents with sensitivity and respect. The previous report identified that the lack of assisted bathing facilities had a negative impact on the privacy and dignity afforded to people using the service. Since then a large walk in shower had replaced the existing bath. The shower unit was simple to Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: use and a robust shower chair was available for those who needed it. Staff reported that many more residents were now able to attend to their own personal hygiene needs independently therefore promoting dignity and privacy. There was a secure medication storage system, cupboard and fridge, a secure facility for controlled drugs has been installed since the previous visit. The Medication Administration Records were accurate and subject to management monitoring. A formal re-assessment of each persons medication was made at every period of respite care. One professional involved with the service told us We have never had any issues with the service and There is always good 2 way communication that ensures the right people would be alerted if there were any issues. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this respite service may be confident that any concerns would be listened to, taken seriously and acted upon. Evidence: The service has a clear and easily understood complaints policy that is available in a user friendly format to explain to residents how they can raise any concerns. Two complaints had been received by the home since the previous inspection visit and these were documented to show they had been responded to appropriately and within agreed timescales. We noted a friendly and relaxed relationship between staff and a person using the service on the day of this visit, this would encourage people to be able to raise concerns. Hertfordshire County Council adult safeguarding guidance was available at the home. The managers AQAA stated that staff had training in safeguarding adults from abuse, staff members confirmed this to us by demonstrating good awareness of procedures to be followed. There have been no incidents requiring a safeguarding referral since the previous inspection. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service will find that it is homely and comfortable with a family atmosphere. Evidence: The service provides a relaxed family, homely atmosphere. The furnishings were robust to withstand considerable wear and tear but were attractive and homely. A physical tour of the building showed us that the home was clean fresh and tidy however some communal areas were in need of some routine decorating to make it appear less tired. Families of people using the service reported in surveys X has never known it to be anything other than clean and fresh. Since the last inspection visit a large walk in shower has replaced the domestic bath. Staff told us that most people using the service prefer the shower to the bath because they can use it on their own without the assistance of staff. This helps to promote their privacy, dignity and independence. Risk assessments were in place for those people who choose to shower alone. The Service User Guide had been amended to reflect the change in the facilities provided. The previous two reports had identified that the kitchen required refurbishment. This had still not taken place at the time of this visit however the manager was able to Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: demonstrate that the housing association responsible for the maintenance and upkeep of the building was obtaining quotes for the work to be done. This included the Kitchen, the laundry and downstairs toilet. No date had been set for these works to commence. Since the last inspection visit some major works had taken place in the garden at 34 Apton Road. Previous reports told us that because most of the garden was very sloped it was mainly unusable for many people using the service. The slope has been excavated to create a large patio area directly to the rear of the house with steps leading up to a terrace which is planned to be lawned in time for next summer. This work gives all people using the service access to the gardens. There were four bedrooms on the first floor, we looked in two that were not allocated to residents at the time of this visit. Both were of a good size and had the appropriate furnishings necessary to meet peoples needs. Staff told us that people were encouraged to personalise their space even for a short period of respite stay. For example one person brought many posters in with them to put on the wall so barely any space was showing. There was a plasma television positioned on the lounge wall. Staff were aware that the trailing power lead could potentially be dangerous and were managing this risk effectively. The maintenance work had been booked to make this safe. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will receive support from well recruited, fully trained staff in suitable numbers to meet their individual needs. Evidence: Staff rotas showed us that the staffing levels maintained at the home were flexible to meet the needs of the people using the service. The home does not always have all rooms occupied and the needs of people using the service vary greatly from needing 1:1 support to needing very little support. The staff group is an established and stable team with a very low turnover. Evidence was available to confirm that regular staff meetings took place, these involved staff from the whole site of which the respite unit is one part. Evidence was available to confirm that all staff receive 1:1 supervision with their line manager at least 6 times per year. We looked at recruitment documentation of most recent employed support worker and this confirmed that all necessary checks were undertaken before people started to work at the unit. One professional involved with the service told us They are brilliant, I cant fault them, they are totally committed and do their best for every person that uses the service. Excellent communication with social working team that goes 2 ways. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Completed surveys returned to us from family members included the comment The staff have always treated X extremely well and X is very happy there and The care received from the staff is excellent. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident the home the service they use is managed in an open and inclusive way that supports peoples independence, safety and well being. Evidence: 34, Apton Road forms part of a complex of care services operated by Hertfordshire County Council however is the only one registered with us. The registered manager is experienced and qualified is responsible for all the services operating on this site. The registered manager reported attending various training courses relevant to her role since the last visit including budgeting, performance management, Mental Capacity Act training and a course about Legionnaires disease. The service has started to develop a quality assurance monitoring system however this needs further development to include the views of outside stakeholders such as healthcare professionals, social workers and external advocates. The deputy manager reported that surveys had been sent to approximately 30 families of people using the service. There had been a very high return rate with the majority being very positive. All maintenance was undertaken by the housing association. Routine temperature Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: checks such as fridges and water were recorded. Training necessary to protect the health, safety and well being of the people using the service was provided for the staff team. Routine servicing, such as fire extinguishers, was noted to have taken place. Risk assessments were in place for any activity involving people using the service or staff members. The assessments identified areas of risk and included the actions to be taken to minimise or remove the risk. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 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!