Inspection on 29/11/06 for Cumberland Road, 84

This inspection was carried out on 29th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cumberland Road, 84 18/10/07

Cumberland Road, 84 26/01/06

Cumberland Road, 84 13/07/05

Cumberland Road, 84 18/01/05

Cumberland Road, 84 25/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Cumberland Road, 84 Hanwell London W7 2EB Lead Inspector Ms Jean Bovell Key Unannounced Inspection 29th November 11:30 Cumberland Road, 84 DS0000027728.V312450.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 Cumberland Road, 84 DS0000027728.V312450.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. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Road, 84 Address Hanwell London W7 2EB 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) 0208 566 2404 0208 566 2404 Ealing Consortium Limited Mrs Mariam Abiodun Gbaja Care Home 3 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: 84 Cumberland Road was originally registered as a small home, under the Registered Homes Act 1984 and 1991 Amendment Act, for three service users. The Registered Providers are Ealing Consortium. The staff team comprises of a House Manager and five support workers. One of these posts has been divided into two in order to have a male worker in the team to work with the male service user. There is at least one member of staff working on each shift, with a person working a middle shift, to offer the opportunity for service users to receive one to one support during part of the day. The home provides a service for adults with a learning disability and or mental health needs. The home is a terraced property, which is situated in Hanwell. There are shops nearby in West Ealing or Ealing Broadway, both accessible by public transport, which is nearby. The accommodation consists of three single bedrooms. Service users are required to manage stairs to access the bedrooms, bathroom and toilet that are located on the first floor. There is a lounge, a kitchen/dining room and office/sleeping in room on the ground floor. A small garden is to the rear of the property, which is mainly paved, with some shrubs. Service users access day centres and community resources as appropriate. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 11:30 am and 3:30 pm on 29th November 2006. The Registered Manager, two care support workers and two service users were present. The Inspector was informed that one service user was attending the day centre. During the course of the inspection the home’s policies, procedures, records and documents were viewed, observations were made and a tour of the building was undertaken. The Inspector spoke to two service users and two care support workers. One requirement that was made at the last inspection and all key Standards were examined. The Inspector received co-operation and assistance from the Registered Manager and a care support worker throughout the inspection. What the service does well: The service users were appropriately dressed and appeared comfortable and content. Those who spoke to the Inspector indicated that they were happy with the care and support they received. All records viewed were accurate, up to date and reflective of the health and welfare of the service users being safeguarded at the home. Care support workers were appropriately trained and were observed being competent and attentive in meeting the needs of the service users. Overall, the home was found to clean and hygienic. The atmosphere was calm and homely. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cumberland Road, 84 DS0000027728.V312450.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 Cumberland Road, 84 DS0000027728.V312450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. The needs and aspirations of prospective service users are appropriately assessed prior to admission. EVIDENCE: It was evidenced on service users’ files that copies of assessments that had been carried out by placing authorities, in relation to perspective service users, had been submitted to the home at the point of referral. Copies of subsequent initial needs led assessments that had been undertaken by the home were also within service users files. There were indicators that social workers, relatives, medical professionals – where appropriate, and previous carers were involved in determining the capacity of the home to meet specific identified needs and aspirations. Cumberland Road, 84 DS0000027728.V312450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Care plans and appropriate risk assessments are being satisfactorily undertaken at the home. A requirement under Standard 9 in relation to risk assessments had been complied with. EVIDENCE: The participation of service users and their relatives were reflected within care plans that were examined at the time of the inspection. It was indicated that separate personal, social and health care needs had been assessed and that appropriate action plans and goals were put into place. Risk assessments in relation to activities identified within care plans such as bathing and behavioural patterns had been undertaken. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 10 All care plans and risk assessments were reviewed on a six monthly basis. It was evidenced on records viewed that decisions regarding weekly menus were made during service users meetings that were held on each week. A care support worker confirmed that service users were also encouraged to make decisions in relation to activities, what they wore, hairstyles, make up and personal purchases. Service users were observed being offered lunch options at the time of the inspection. An accident and incident book was in place and appropriately documented. Records were reflective of risk assessments being undertaken following the occurrence of accidents that had been sustained by service users at the home or within the community. Cumberland Road, 84 DS0000027728.V312450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Service users receive appropriate support during separate activities at the home and within the community. Contact with relatives and friends are being encouraged and maintained. The rights of service users are respected and varied and nutritional meal choices are being provided. EVIDENCE: The Inspector was informed by the Registered Manager that service users had in the past attended college but that this was not currently the case. It was reflected on care plans that service users attended the day centre. Annual holidays were arranged and service users were supported in participating in activities within the community such as train spotting, the Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 12 cinema, meals out, shopping and walks. They were also accompanied to Church Services. One service user was taken on a shopping trip at the time of the inspection. An open visiting policy is in operation at the home and face-to-face and/or telephone contact with relatives, friends and advocates was encouraged and facilitated. None of the service users were in personal relationships at the time of the inspection. The Registered Manager confirmed that service users regularly assisted with clearing the table, loading/unloading the dishwasher and/or washing machine, gardening, vacuuming and sweeping. Care support workers were observed relating to service users in a respectful manner and knocked on bedroom doors prior to entering. The Registered Manager reported that service users were able to receive confidential mail and make personal telephone calls. Service users were observed resting in their bedrooms, watching television in the lounge and making tea in the kitchen. Varied and wholesome cooked meals were listed on the menus and service users were offered healthy lunch options at the time of the inspection. Snacks and drinks were seen to be readily available. Cumberland Road, 84 DS0000027728.V312450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Service users receive personal support as required and their physical, emotional and health care needs are being met. The home’s policy and procedures on medication were appropriately detailed but one MAR sheet had not been satisfactorily completed. EVIDENCE: It was reflected on care plans that the service users required prompting or assistance with their personal care routines but the Registered Manager confirmed that all personal care tasks were undertaken in privacy within bedrooms or bathrooms. Service users were however able to choose what they wore, hairstyles and makeup. The health care needs of the service users were identified within care plans and it was indicated that they received appropriate access to GPs, Chiropodists and Psychiatrists and were accompanied to medical appointments. There were regular dental and optical checks and visits from a community nurse. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 14 Service users also received weekly massages and aroma and drama therapies. A service user was accompanied to a GP appointment at the time of the inspection. The home’s policy and procedures on medication were in place and storage and disposal of medicines were satisfactory. However, there were no signatures in relation to medicines that had been administered on the morning of the inspection. The Registered Manager reported that the service users were unable to selfadminister their medication. Cumberland Road, 84 DS0000027728.V312450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. The complaints procedure is not readily accessible to the service users and their relatives and has not been up dated. The service users are being protected from abuse. EVIDENCE: The complaints procedure was clear, concise and written and illustrated in a format suitable to meeting the needs of the service users. However, it was held within a policies folder and as a consequence not accessible to the service users and their relatives. The complaints procedure had also not been updated to reflect changes to CSCI contact details. The complaints book was viewed and it was indicated that no complaints were received at the home following the last inspection. The home’s policy and procedures on the protection of vulnerable adults were satisfactorily detailed and a copy of the Department of Health practical guide on the protection of vulnerable adults was in place. The records indicated that training on the protection of vulnerable adults had been delivered to all members of the care support staff team. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 16 State benefits are paid directly into service users banks accounts and weekly allowances are safeguarded at the home. The service users’ financial records were examined and no discrepancies were identified. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30. Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The home was essentially clean and hygienic and the environment was safe and homely. A number of chairs in the dining room and various areas within the bathroom were in an unsatisfactory condition. Soap and towels for hand washing were not in place at the time of the inspection. EVIDENCE: The communal areas within the home are adequately spacious and suitable for shared or individual activity. The lounge was comfortably furnished but several chairs in the kitchen/diner were worn or broken and were replaced with garden furniture. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 18 The bathroom and toilet facilities are sufficient for meeting the personal needs of the service users. However, a toilet seat was missing, various parts of the bathtub was chipped and the washbasin and bath taps were loose. Soap and towels for hand washing were not in place at the time of the inspection. The garden was well maintained and accessible to the service users. There were no issues regarding the laundry. Overall the home was found to be essentially clean and hygienic and adequately maintained. The atmosphere was calm and homely. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Care support workers are appropriately trained and qualified for meeting the needs of the service users. The recruitment policy and procedures are satisfactory. EVIDENCE: The Registered Manager, two permanent care workers and two permanent part-time workers are employed at the home. It was reflected on the staff rota that two care support workers were on duty during waking hours and one care support worker covered sleeping duty at night. A training programme was in place and indicated that staff training during 2006 included protection of vulnerable adults, health and safety, moving and handling, food hygiene, fire safety, first aid and medication. One care support worker had achieved level 2 national vocational qualification in care. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 20 Care support workers were observed being competent and attentive in meeting the needs of the service users. The Inspector was informed by the Registered Manager that personnel files were kept at Head Office. However, personal folders were held at the home. These were viewed at random and found to contain required documents such as photo-identity, references and CRB disclosure certificate numbers. The home’s policy and procedures on recruitment were in place. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. The Registered Manager is suitably qualified. Quality assurance exercises are being appropriately undertaken. The health and safety of the service users are being safeguarded. EVIDENCE: The Registered Manager has held her current position for two years and has obtained the Registered Managers and Assessors Award. Care support workers who spoke to the Inspector reported that the Registered Manager was open, approachable and supportive. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 22 It was evidenced on documents viewed that questionnaires in relation to selfmonitoring were provided to service users, relatives, advocates and stakeholders and that appropriate summaries had been completed. Quality assurance exercises were being carried out annually. The records indicated that checks in relation to fire safety, portable appliances, water temperature, gas safety and legionella were up to date. Day and night fire drills were regularly undertaken. Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 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 2 X 3 X 3 X X 3 X Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 24 No 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 YA20 YA22 Regulation 17(3)(a) 22(5) Requirement The Registered Person must MAR sheets are kept up to date. Timescale for action 20/12/06 31/01/07 3 YA22 4 5 YA24 YA27 6 YA27 The Registered Person must ensure that the complaints procedure is accessible to the service users and their relatives/advocates. 22(7)(6)(a) The Registered Person must ensure that the complaints procedure is updated to reflect current CSCI contact details. 16(2)(c) The Registered Person must ensure that all broken or worn chairs are repaired or replaced. 23(2)(b)(c) The Registered Person must ensure that a toilet seat in the bathroom is replaced and that the chipped bathtub and faulty taps receive appropriate attention. 13(4)(c) The Registered Person must ensure that soap and towels for hand washing are at all times available next to the washbasin in the bathroom. 31/01/07 01/04/07 01/04/07 20/12/06 Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 25 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 Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cumberland Road, 84 DS0000027728.V312450.R01.S.doc Version 5.2 Page 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. 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