Inspection on 02/08/07 for Coombe Road (82)

This inspection was carried out on 2nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coombe Road (82) 12/05/06

Coombe Road (82) 24/11/05

Coombe Road (82) 26/07/05

Coombe Road (82) 01/09/04

Coombe Road (82) 20/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Coombe Road (82) 82 Coombe Road Croydon Surrey CR0 5RA Lead Inspector Lee Willis Key Unannounced Inspection 2nd August 2007 10:15 Coombe Road (82) DS0000028482.V347258.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 Coombe Road (82) DS0000028482.V347258.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. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coombe Road (82) Address 82 Coombe Road Croydon Surrey CR0 5RA 020 8681 8078 020 8681 8078 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Michael Luganda Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2006 Brief Description of the Service: 82 Coombe Road is owned by Milbury Care Services and is registered with the Commission to provide personal care and support for up to eight generally middle aged (i.e. aged 40 to 65) adults with learning disabilities. Michael Luganda, who has been the registered manager of the service since November 2003, remains in operational day-to-day control. This detached Victorian property is set back from a main road in a residential suburb to the South east of Croydon and is opposite a large park. Local trams and buses stop right outside the home and central Croydon with its wide variety of shops, banks, restaurants, and other leisure facilities is no more than a ten minute ride away. The property is built over three stories and comprises of eight single occupancy bedrooms; a main lounge; separate dinning area with a conservatory attached, new sensory room, large kitchen, laundry room, top floor office, and staff sleep-in room. The garden at the rear of the property is mainly laid to lawn and is well maintained. The providers ensure people who live at the home are given a guide and a contract, which contains information about what services, and facilities are offered, and what people can expect to pay for them. Fees charged currently range from £48,000 - £56,000 per annum. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having significantly more strengths than areas of weakness. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. Key standards are generally met, and where weaknesses have been identified the Commission is confident the home will manage them well. This unannounced site visit was carried out on a Thursday between 10.15am and 3.15pm. During the course of this five-hour inspection three people who use the service, the registered manager, and two newly appointed members of staff, were all met and spoken with at length. Two people using the service who were both involved in a significant incident that recently occurred in the home were selected to have the care they receive ‘case tracked’. The remainder of this site visit was spent examining the homes records and touring the premises. An expert by experience was also invited to take part in the inspection process and accompanied the inspector on the site visit. An expert by experience is a person who has a shared experience of using services who can help an inspector get a better picture of what it is like to live in a care home. The expert by experience came with their support worker and they both spent over two hours engaging with a number of people who live at the home. Key parts of the report compiled by the expert by experience with the help of their support worker will be used as evidence to support the judgments I have made about the homes performance. What the service does well: All the verbal feedback received from the people met who use the service was very positive. One person spoken with at length told us they liked the staff at Coombe Road ‘who were very nice’. The home is good at ensuring information about the services and facilities on offer are available in easy to read formats that the people using the service can understand. For example, the homes Statement of purpose, service users Guide, relatively new Care plan and health care records, activity schedules, weekly menus, and complaints procedures, are all written in plain language and illustrated with ‘easy’ to understand pictures, symbols and photographs. This ensures information about how the home operates is made more meaningful and interesting for the people using the service. The home is pleasantly decorated and reasonably well maintained ensuring the people who use the service live in a very homely, comfortable and safe Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 6 environment. The atmosphere in the home during the course of this unannounced site visit remained very relaxed and congenial throughout. It was positively noted that in line with National Minimum Standards the entire staff team have either already achieved a National Vocational Qualification in care or are currently working towards this objective. Evidence was found to show that staff have a good understanding of the unique and often complex needs of the people who use the service and can deliver highly effective person centred care. What has improved since the last inspection? What they could do better: Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 7 All the positive comments made above notwithstanding there are a few areas of practice the service could improve: The manager acknowledges that although the homes new sensory room is now in use its still not fully operational and will require further work to ensure the room is suitably resourced and daylight can be blocked out when required. The manager told us this facility will be fit for purpose by September 2007 and the Commission is confident this aim will be achieved. To enable the people who use the service to feel more confident that their views about the standard of care they receive are taken seriously and underpin the continuous development of the home it is recommended the service should the results of service user satisfaction surveys in the homes Guide. 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. Coombe Road (82) DS0000028482.V347258.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 Coombe Road (82) DS0000028482.V347258.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 People who use the 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 have good information about the home in order to make an informed decision about whether the service is right for them. People’s needs are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate. EVIDENCE: A copy of the homes latest Statement of Purpose and Guide was produced on request. The manager told us that the document had been reviewed in the past twelve months and up dated accordingly to reflect any changes in provision. The document clearly sets out the objectives and philosophy of the home and what people using the service can expect with regard the quality of their accommodation, qualifications of staff, and how to make a complaint if they are satisfied with any aspect of its operation. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 10 The manager told us systems are in place for people using the service to express their views about the quality of care they receive at Coombe Road. The Commission is aware that these comments are published in a quality assurance report that Milbury Care produces on an annual basis. To make the results of any satisfaction surveys undertaken by the home more accessible the manager may wish to consider incorporating them into the homes Guide. The Guide is available in an ‘easy’ to understand format, which is written in relatively plain language and contains all manner of coloured pictures, symbols, and photographs to illustrate the text. One person who uses the service told us they had been given a copy of the Guide, which they keep in their room, but had never read. The expert by experience looked at the Guide and reported that it ‘was hard to read and had small writing. It was also many pages long. Could have been made easier to read with larger writing so the people using the service could read it as well as carers’. The manager told us he was in the process of undertaking a full assessment of the needs of the homes latest referral. The manager confirmed that in line with the providers own admissions procedures an initial assessment of this prospective service users needs, wishes and personal aspirations would be carried out at their current address before they and their representative would be invited to visit Coombe Road to meet the other residents and staff. The manager demonstrated a good understanding of his role and responsibilities regarding the admission process and was very clear that he would have no hesitation to refuse a place to someone he felt would not ‘fit in’ with the existing service user group. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 11 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): 6, 7 & 9 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect what is important to the individual, their capabilities, and what support they need to achieve their personal aspirations. The homes arrangements for assessing and managing risk are suitably robust to ensure service users are able to take ‘responsible’ risks and develop their independent living skills. EVIDENCE: The care plans for the two people selected for case tracking were both examined in some depth. The manager told us that since the homes last inspection a new care plan format had been introduced and the process of converting the old plans was now complete. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 12 The new plans included a particularly good section entitled ‘communication passport’ which sets out in detail people’s specialist communication needs and their preferred method of communication. It was evident from the comments made by one person who uses the service that staff actively encourage and support people they key work to develop their own care plans. Furthermore to enable people who use the service to have a better understanding of their new care plans the documents are written in plain language and the text is illustrated with all manner of photos, pictures, and symbols. This more person centred approach places a greater emphasis on peoples unique strengths and personal preferences. The plans celebrate an individuals life experiences and sets out clearly how all their current requirements and aspirations are to be met through positive interventions. One member of staff met told us the new care plan format was a better working tool that helped them deliver the support required by the people who used the service. This individual was also able to describe how they had helped develop the new care plans and accurately described the plans for the two service users whose care was being case tracked. This knowledge means that service users can be confident that they will get support from people who understand their care needs. As part of the more person centred approach to planning care documentary evidence was produced to show that keyworkers are now expected to review care plans on a monthly basis and up date them accordingly to reflect any changes in provision. The service is commended for introducing this practice, which exceeds National Minimum Standards. Assessments taken from the two care plans being case tracked set out in detail management strategies that had been put in place to help staff minimise and/or deal with identified risks. In particular one care plan contained very specific guidance to help staff deal with incidents of aggression involving one individual. The Commission was recently notified in a timely fashion about an incident that challenged the service. Information received revealed that staff on duty at the time had managed the incident well in a prompt and professional manner. A relatively new member of staff met during the site visit also demonstrated a good understanding of the provider’s policies and procedures for dealing with incidents of aggression. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 13 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): 11, 12, 14, 15, 16 & 17 People who use the 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 good range of activities within the home and the local community means the people who use the service are able to enjoy a full and stimulating lifestyles with a variety of social, leisure, and recreational options to choose from. Dietary needs and preferences are in the main well catered providing daily variation, choice, and interest for the people who use the service. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 14 EVIDENCE: During the course of this site visit one individual who lived at the home was observed helping staff to dry up dishes after lunch. The individual appeared to enjoy participating in this household chore. Other people who use the service who also told us staff actively encourage them to keep their own bedrooms clean. Care plans being case tracked contained information about specific household tasks these particular individuals had agreed to be responsible for. The manager told us he believed this helped people who used the service to develop their independent living skills and take pride in their home. The expert by experience wrote in their report: ‘According to one service user they are allowed to go out shopping with support and buy what they wanted. ‘A few service users said they had their own keys to their rooms where as some others didn’t. Staff said that people who didn’t have keys to their rooms were unable to look after them properly but if they wanted another try with their keys they could.’ The atmosphere in the home felt very relaxed on arrival. A service user who was reading in the lounge told us they had already been out with a member of staff that morning to buy a magazine and withdraw some money from their bank. Another person seemed to be content drawing pictures in the conservatory. The manager told us that one service user would be out attending sessions at a local day centre all morning that matched the information recorded on their weekly activity schedule. The expert by experience reported: ‘A service user said that they had a large selection of things to do during the day’. The manager has introduced an excellent record of all the activities people who use the service engage in each day, both at home and in the wider community. The activity logs for the two people being case tracked, which staff had appropriately maintained and kept up to date, revealed that last month these two individuals had participated in a wide variety of social, leisure and recreational activities, both at home and in the local community, including; music sessions, arts and crafts, shopping trips, walks in the local park, and day trips to various destinations. The manager told us all the people who use the service are currently involved in a competition being run by Milbury care to find out who can grow the tallest sunflower. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 15 The manager told us two people who live at the home have specific spiritual needs. Records showed this need is specific in their individual care plans and staff support them to attend services at a local church as and when they feel like going. One person who uses the service told us they had recently been on holiday with their family. The manager told us that everyone had been on a group holiday this year to a popular coastal resort in southern England. The expert by experience reported: Service user said that they were taken on holiday for a week. They said that they enjoyed doing this and have been a few times before. The manager told us the service continues to operate an open visitors policy and that there are no restrictions on visiting times. A visitor’s book is conspicuously displayed in the entrance hall, which anyone entering or living the home must sign, and date. Record showed that one service user whose care was being case tracked is actively encouraged to maintain close ties with their family and boyfriend, who regular visit the home. A menu advertising the choice of meals on offer for the week is conspicuously displayed on a notice board in the dinning room. Photographs with Velcro attached to the back are used to ensure the people who use the service know what choice of meals are available each day. The three people who had a meal in the dinning room during the course of this visit had a choice between macaroni cheese and spaghetti in tomato sauce for lunch. The manager told us staff encourage people to help them plan the menus every week. The expert by experience reported: ‘Easy read menu was good with pictures for each individual meal. Service users are given a choice of what to eat for the day as it is listed on an easy to read menu, but the selection is limited. ‘If you didn’t like the meal that was cooked you could ask for something else. Sometimes they were able to get a different meal and sometimes they had to eat what they were given. Staff told us that at the start of every week the residents decide what they want to eat each evening for the rest of the week. This was then written down into the menu and another copy of the menu was put into easy to read format and placed on the notice board for the residents to read’. Staff maintain detailed records of the food actually eaten by the people who use the service that indicated meals were on the whole reasonably varied and nutritionally balanced. The manager told us people who live at the home do not have to stick to the choices advertised on the weekly menus, but can choose an alternative meal from the food stocks available on the day. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 16 The manager told us that advice had recently been sought from a dietician about one individual’s specialist nutritional needs. As a consequence new guidelines for staff to follow had been established to ensure this individual specific dietary needs were being catered for. These guidelines were conspicuously displayed in the kitchen and staff met were fully aware of their responsibilities regarding this individuals assessed dietary needs. The expert by experience reported: We saw a specialist menu for one service user, which was designed to go along with her health, needs. This menu had separate meals at different times of day to the rest of the residents so they could go along with her dietary requirements. Care plans for the two people whose care was being case tracked contained detailed information about these individuals’ food and drink preferences, as well as their dislikes. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 17 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): 18, 19 & 20 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. The home has good arrangements in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are always recognised and met. The homes policies and procedures for handling medication need to be improved to ensure they are sufficiently robust to minimise the risk of service users being harmed and/or abused. EVIDENCE: All the people who use the service met during this site visit were suitably dressed in well-maintained summer clothing that one person told us they had recently bought. This individual told us they had chosen to wash their hair that morning before going out and could have a bath whenever they liked. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 18 The service has developed excellent health care records that set out in detail each person who lives at the homes full medical history and the outcome of all the appointments they have with various health care professionals, including GP’s, community based nurses, dentists and opticians. Care plans also contain weight charts. All the staff spoken with demonstrated a good understanding of each of people’s unique personal and health care needs, which included emotional and physical requirements. Staff continue to maintain detailed records of all the accidents and incidents involving service users. These records showed that staff on duty had appropriately dealt with the two accidents and the one incident that had occurred since the homes last inspection at the time. None of the people who use the service have sustained any major injuries in the past twelve months or been admitted to hospital. No recording errors were noted on medication administration (MAR) sheets sampled at random where staff had failed to enter the appropriate codes for medicines received, administered, and/or returned. All the medication held by the home on service users behalves is securely stored in a locked metal cabinet. It was positively noted that all the good practice recommendations made in the homes last external pharmacy inspection carried out in April 2007 have been implemented. A photograph of each of the people who use the service is now included on their Medication Administration sheets. Some people who use the service are prescribed as required PRN medication and clear instructions regarding their use were made available on request. Staff asked about PRN medication were very clear when and how to give this type of medication. In keeping with good practice staff always state the reason why any PRN meds are used on the back of the relevant MAR sheet. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes arrangements for dealing with complaints and allegations of abuse are sufficiently robust and understood by staff to ensure people who use the service feel listened and safe. EVIDENCE: A copy of the homes complaints procedure is conspicuously displayed on a notice board. The document was written in plain language and illustrated with colourful pictures to enable it to be read and understood by the people who use the service. The manager told us to date he has not received any formal complaints about the homes operation. The expert by experience reported: The service has an easy to read complaints policy. The manager told us that none of the people who use the service had been subject to a safeguarding vulnerable adults referral in 2007. The manager demonstrated a good understanding of the Local Authorities and Milbury Cares abuse reporting protocols. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 20 The balances recorded on the financial sheets kept for the two people being case tracked matched the amounts being held by the home on their behalves. The manager told us that it was custom and practice for purchases over £100 to be authorised by senior managers representing Milbury Care. Receipts are kept for all goods and services purchased by staff on service users behalves. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 21 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): 24, 26, 27, 28 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The décor, and condition of the fixtures and fittings in the home ensures the people who use the service live in a homely, comfortable, and safe environment. The homes new sensory room needs to be made fit for purpose to ensure the people who use the service can live more fulfilling and stimulating lives. The homes arrangements for keeping the premises hygienically clean and for the desposal of clinical waste are sufficiently robust to promote the health and welfare of the people who use the service, their guests, and staff. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 22 EVIDENCE: On arrival it was noted that all the communal areas were spotlessly clean, bright, and free from any offensive odours. During a tour of the premises it was noted that carpet in the lounge and entrance hall had started to show signs of wear. It is recommended that the providers establish a time specific rolling programmes to replace it over time. It was noted that one person in particular appeared to enjoy sitting on the new sofa in the lobby, which seemed to provide an alternative place for people using the service to get some ‘quiet’ time outside the confines of their bedrooms. The main lounge remains the most popular place for the vast majority of people who live at the home to sit and relax. The expert by experience reported: Whole building looked nice and clean and looked well presented. The rear garden contains a wide variety of flowers, shrubs, and plants and the lawn is well maintained. It was therefore supervising to the expert by experience, their support worker, and the inspector that there was no furniture in the garden for people to sit on and enjoy it. The manager told us that plastic garden furniture had been purchased, but the people who use the service had chosen to keep it in the conservatory and use it for arts and craft projects. It is therefore recommended the providers consider purchasing some additional items of furniture that could be permanently left in the garden. The expert by experience reported: Garden was large and appeared to be well kept. There were garden chairs available but they were kept indoors. Considering how warm it was outside there could be a permanent set of furniture outdoors. Rather then having to carry it inside and back out. One person who lived at the home invited us to view their bedroom. The room looked very personalised, contained all the furniture and fittings required by the standards, and was decorated to a satisfactory level. The expert by experience reported: Rooms looked nice and tidy. Rooms were allowed to be decorated, as they wanted them to be. Most people’s rooms that we saw had pictures of friends or family. Nearly all rooms had a TV or radio in them. The manager told us that people who live at the home had begun to use the new sensory room. However, during a tour of the premises it was noted that the room was not sufficiently resourced with sensory equipment and lacked curtains/blinds to block out sunlight. This facility is still a work in progress. The expert by experience and their support worker also told us that they did not think the room was currently ‘fit for purpose’. The manager told us delays in releasing the necessary funds to pay for the completion of the sensory room Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 23 had been the major stumbling block, but was confident this financial matter had now been resolved. The timescale for this outstanding requirement to be met has therefore been extended. The temperature of hot water emanating from the ground floor bathroom was found to be a safe 42 degrees Celsius when tested at 12.10. The manager told is all the homes shower facilities had been fitted with thermostatic mixer valves that prevented water temperatures exceeding a safe 43 degrees. The homes washing machine is capable of cleaning laundry at appropriate temperatures and has a sluice programme for dealing with foul laundry. The walls and floor of the laundry room are readily cleanable. Gloves and aprons were available in the laundry room for staff use and the manager told us the home has a contract for dealing with clinical waste, which is collected on a weekly basis. A new member of staff demonstrated a good understanding of the homes arrangements for disposing of this type of waste and infection control procedures in general. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 24 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, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of suitably competent and experienced staff are employed on a daily basis to ensure the needs and wishes of the people who use the service are being met. Procedures for recruiting new members of staff are sufficiently robust to enable the manager to make an informed judgment about a candidate’s suitability to work with vulnerable adults. EVIDENCE: On arrival three support workers and the registered manager were all on duty, which matched the staff rota for that days early shift. The manager told us that four out of eight members of his permanent staff team had now achieved an National Vocational Qualification level 2 or above in care, in line with National Minimum Standards for staff training. Furthermore, all those members of staff who were not NVQ trained are enrolled on suitable courses and the manager is confident these staff will be suitably qualified by 2008. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 25 The service has experienced relatively high rates of staff turnover in the past year, which included the relatively new deputy manager, who transferred to another Milbury Care Home. Consequently, the manager has needed to recruit three new members of staff in 2007. The manager told us that in line with an agreement reached between the providers and senior representatives of the CSCI all records pertaining to staff are now kept at Milbury Cares central office in Henley. The manager told us he had seen all the recruitment checks carried on his new members of staff. Two of the homes most recent recruits informally interviewed during the course of this site visit confirmed that they had been required by their new employers to supply them with up to date Criminal Record Bureau and Protection of Vulnerable Adults checks, proof their identities, and Home Office approved work permits. Copies of recruitment checks and two written references obtained in respect of these individuals were faxed over to Coombe Road within an hour of the request being made to the providers Human Resources Department. Both the homes latest recruits told us they had both received thorough inductions, which had included safe working practices, their roles and responsibilities as support workers, and the specific needs of the people who used the service. One new member of staff was very clear about what they needed to do in the event of a fire, and the preferred methods of communication of all the people who lived at the home. The other new member of staff demonstrated a good understanding of peoples rights and mentioned the importance of promoting service users choice and independence whenever practicable. Documentary evidence was produced on request to show that all three new members of staff had received at least two formal supervision sessions with a senior member of staff during their probationary periods of employment. The manager has carried out a training needs and strengths assessment of his entire staff team. The document revealed that sufficient numbers of staff were either already qualified or enrolled on training courses in fire safety, first aid, food hygiene, Non Violent Crisis Intervention techniques, adult protection, medication, infection control, and supporting people with epilepsy. During the course of this site visit one member of staff was observed taking a formal examination electronically to test their knowledge of infection control. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 26 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 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit from living in a reasonably well run home which a highly competent and experienced person manages. In the main sufficiently robust health and safety arrangements are in place to ensure the welfare of the people who use the service, their guests, and staff are promoted and protected. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 27 EVIDENCE: The homes registered manager is suitably qualified and experienced to run a residential care home for adults with learning disabilities. The manager was able to describe a clear vision of the home and able to evidence a sound understanding and application of ‘best practice’, particularly in relation to improving their quality of life. The manager was able to evidence his commitment to meeting service users unique needs. The manager told us he had refreshed his training in food hygiene, health and safety, fire, moving and handling, adult protection, and infection control, in 2007. The providers relatively new quality assurance system was judged to be good at the time of the homes last random inspection carried out in January 2007. This standard was therefore not reassessed on this occasion, but will be revisited at the homes next inspection. Fire records revealed that the homes fire alarm system continues to be tested on a weekly basis. Three fire drills, which included one at night, as recommended at the homes last inspection, have been carried in 2007. During a tour of the premises it was noted that none of the homes fire resistant doors were being inappropriately wedged open to prevent there automatic closure in the event of a fire. Two fire doors tested at random both closed flush into their frames when released. Staff spoke with about the homes emergency evacuation protocols demonstrated a good understanding of their responsibilities in the event of the fire alarm being activated. Up to date Certificates of worthiness were in place to show that suitably qualified engineers had checked all the homes gas (Landlords) installations, portable electrical appliances, and fire alarms system/extinguishers, in the past twelve months. The manager is aware the homes electrical installations and wiring is nearly five years old and will need to be retested sometime in the next twelve months. An inspection was carried out by the local environmental health agency in 2006 and no recommendations were made. All items of food found in the kitchen were correctly stored and any food taken out of its original packaging was also labelled and dated in line with basic food hygiene standards. Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 28 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 3 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 3 25 X 26 3 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X X X X 3 X Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 29 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. Standard YA14 Regulation 12(1), 16(2)(n) & 23(2)(h) Requirement People who use the service must have access to a fully operational sensory room, which is ‘fit for purpose’. This will ensure all the people using the service have their social needs met. Previous timescale for action of 1st June 2007 not met. Timescale for action 01/09/07 Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations To ensure people using the service and their representatives are part of the homes quality assurance systems their views about the standard of service they receive should be included in the Guide. A larger font and audio versions of the Guide should also be developed to enable people with sensory impairments to access information about the service. A time specific programme to replace the carpets in the hallway and lounge should be established. Furniture that can be permanently left in the garden should be purchased. This will ensure people who use the service, and their guests will have the option of being able to sit in the garden as and when they choose. 2. 3. YA24 YA28 Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Coombe Road (82) DS0000028482.V347258.R01.S.doc Version 5.2 Page 32 - 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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