Inspection on 11/05/07 for Belmont Road (9 & 10)

This inspection was carried out on 11th May 2007.

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

Belmont Road (9 & 10) 17/05/06

Belmont Road (9 & 10) 10/02/06

Belmont Road (9 & 10) 29/07/05

Belmont Road (9 & 10) 07/03/05

Belmont Road (9 & 10) 07/09/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Belmont Road (9 & 10) March Cambridgeshire PE15 8RQ Lead Inspector Alan Buttery Key Unannounced Inspection 11th May 2007 10:00 Belmont Road (9 & 10) DS0000015298.V342193.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 Belmont Road (9 & 10) DS0000015298.V342193.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. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belmont Road (9 & 10) Address March Cambridgeshire PE15 8RQ 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) 01354 660623 01354 653851 Conquest Care Homes (Peterborough) Limited Linda Jane Day Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD only in association with LD Date of last inspection 17th May 2006 Brief Description of the Service: 9/10 Belmont Road provides accommodation for 13 adults with a learning disability, many of whom have an associated physical disability. The home is purpose built and operated by Craegmoor Healthcare. The accommodation consists of two bungalows linked together at the end of a small cul-de sac in the Cambridgeshire town of March. The bedrooms are all single, and each has its own washbasin. Each bungalow has its own lounge and dining room and separate kitchens and bathrooms, and the two bungalows share a sensory room There is a shared garden, which can be accessed directly from a number of the bedrooms, and which is used extensively in the better weather Fees charged range between £675 and £1309 per week, depending on assessed need, and copies of previous reports are available either in the reception area or from the office. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, and looked at the key inspection standards for younger adults. The inspection lasted three hours, during which time the service’s manager and acting deputy manager were available to assist with information required. The individuals living in the home all have complex difficulties, but were able to indicate their thoughts on the service provided. What the service does well: What has improved since the last inspection? What they could do better: Further improvements to the environment are needed, especially the replacement of dining room furniture, and the service must adhere to the fire officers recommendations Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Belmont Road (9 & 10) DS0000015298.V342193.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 Belmont Road (9 & 10) DS0000015298.V342193.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Detailed information would be obtained prior to anyone new moving to the home to ensure needs identified could be met. EVIDENCE: As in previous years, there have no changes in the group of people living in the home, and again, no changes are expected in the next twelve months as the service is intended to provide a long-term home for the people living there. The service is run by a large provider, and policies and procedures are in place to ensure that any new admission to the home would follow an accepted pattern, with full assessment of need, trial visits and compatibility issues all explored. Belmont Road (9 & 10) DS0000015298.V342193.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Detailed information is provided in individual plans to show clearly how the people living in the home choose to receive support. EVIDENCE: Since the last inspection, the providers have introduced a new care plan format, and this is being introduced for everyone living in the home. Around half of the care plans have been rewritten so far, and a sample of these was seen and discussed with the manager and deputy. In addition, two of the care plans yet to be re written were also examined. The new format demonstrated a very person centred approach to the care plans, and clear involvement of the individuals themselves in the process. They were more concise than the previous care plans, but provide detailed information for any staff new to the service and clearly show how people living in the home wish their identified needs to be met. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 10 The individual plans also detail how people living in the home have made choices, and how these choices are achieved, for example where people have chosen to go on holiday. The individual plans also include risk assessments which ensure that people living in the home can lead a safe life but still undertake activities of their choice. Belmont Road (9 & 10) DS0000015298.V342193.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. A variety of activities are available enabling people living in the home choice in all areas of their lives. EVIDENCE: The service continues to maintain its excellent links with the local community, and people living in the home enjoy a variety of local facilities and pursuits including local pubs and restaurants, shopping, sports and leisure facilities, the local theatre together with a variety of structured daytime activities, although more of these are now managed from the home rather than with outside agencies. One of the care staff has become a full time day services worker, and was seen during the inspection arranging a variety of activities for the people living there. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 12 Evidence was seen of the involvement of people living in the home in deciding what they wanted to do, and where to go, including a variety of holiday options. The service ensures people living there have a varied and appetising diet, although some of the furniture in the dining room must be replaced. Belmont Road (9 & 10) DS0000015298.V342193.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Personal and emotional support is provided in accordance with the individual’s wishes. EVIDENCE: As discussed earlier in the report, a new format of individual care plan has been introduced, and this includes health care needs. As mentioined earlier, a sample of care plans was examined both old and new, and clearly evidenced that people living in the home have been included in the discussions, and the manner in which support is provided is in line with their own wishes. During the inspection, a member of staff was seen discussing the new care plans with one of the people in the home, and in spite of communication issues able to clearly show that the individual’s preferences were being taken into account. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 14 None of the people living in the home are able to manage their own medication, and the services policy was discussed with the manager, and records of medication examined. Both the policy and the records were in order, and staff receive training in administering medication. Belmont Road (9 & 10) DS0000015298.V342193.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure people living in the home can make concerns known, and are protected from abuse. EVIDENCE: The service has appropriate policies and procedures in place to ensure that complaints or concerns raised by people living in the home, families or other involved parties are listened to and acted upon where necessary. A log of complaints is kept, and since the last inspection, there have been no significant concerns raised. All staff currently working in the home have received updated training in adult protection issues and are aware of the procedures to be followed in the event of suspected abuse, although no incidents have occurred. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Further work is needed on the environment to ensure the comfort of people in the home. EVIDENCE: It was pleasing to note that after a lengthy delay, the required work on the bathrooms in the home has now been completed, and the bathrooms are now suitable equipped to meet the needs of the people living in the home. On the day of the inspection, the home was clean and tidy, and there were no offensive odours. Both the rooms of individual service users, and communal areas are generally homely and provide safe accommodation. A redecoration programme is in place, and a number of parts of the home had been redecorated since the last visit. However, the furniture in the dining rooms is now of poor standard, and some of the chairs have been repaired by the services maintenance person, which may bring into question the safety of this furniture. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 17 This furniture now needs to be replaced, and consideration must be given to the needs of the people in the home in order that suitable furniture is in place both for people able to sit at tables, and those using a wheelchair. In addition, further work is required to the outside of the home to ensure that there is safe method of exit from the garden in the event of a fire, as required by the fire officers as at present, the path in place does not extend to the gate. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A well trained team of staff are available to care for the people in the home. EVIDENCE: Staff records were examined as part of the inspection process, and clearly demonstrated that the recruitment processes are robust and offer protection to service users. The providers deal with recruitment centrally, but local interviews are held, and all required records were available in the home. Staff working on the day of the inspection were clear in their roles, and the staff team appear to work extremely well as a team. The staff team have remained relatively unchanged, although the homes deputy manager has transferred to another service operated by the provider. Since the last inspection, one of the care staff has transferred from a caring role to a full time day care post. The training provided to staff is very comprehensive, and a record of the training received was seen on the three staff files examined, which included all mandatory training as well as other more service users specific courses. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well managed for the benefit of the people living there, but professional advice must be followed. EVIDENCE: The service continues to be well managed, and since the last visit, a new regional manager has been appointed, who was visiting the home on the day of the inspection. The service’s manager confirmed that she receives a high level of support from him and regular supervision. People living in the home are involved in all day to day decisions affecting the service, for example they were supported in choosing a new colour scheme in some of the communal parts of the home. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 20 As mentioned earlier in the report, requirements made by the fire officer at his last visit remain outstanding, and must be addressed urgently. Policies and procedures are in place to protect the health and safety of service users and staff, and during the course of the inspection a number of records were examined including fire and lighting checks, maintenance records and equipment records. These were all satisfactory. Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 21 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 22 Yes 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 2 Standard YA24 YA42 Regulation 23(2)(g) 23(4)(b) Requirement Appropriate furniture must be provided for the people living in the home Professional guidance and requirements must be followed to maintain the safety of people living in the home. Timescale for action 30/09/07 30/09/07 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 Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 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 © 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 Belmont Road (9 & 10) DS0000015298.V342193.R01.S.doc Version 5.2 Page 24 - 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!