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Inspection on 25/05/05 for Dartford Road (16-18)

Also see our care home review for Dartford Road (16-18) for more information

This inspection was carried out on 25th May 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

An excellent statement of purpose and service users` guide gave service users, relatives and others, full information about the home and the services provided. Individual plans had been made with service users twice a year and service users were encouraged to choose for themselves and to develop their independence. Service users were supported by staff in attending day centres, participating in leisure time activities and in having contact with family and friends. Service users liked the food and had received good health care. The home was comfortable, with ample communal space and service users` bedrooms were full of their personal possessions. Service users were well supported and cared for by a competent staff team. The home had been well run by the senior support worker, while the manager had been off work due to sickness.

What has improved since the last inspection?

The home was providing good care when the last inspection took place in December 2004 and only two requirements were made. Since then, the window above the stairs had been permanently secured. Also, on one occasion, when a mistake had been made with medication, the right action had been taken.

What the care home could do better:

Service users still did not have proper contracts for their residence in the home. Theses should set out exactly what services would be provided. More staffing hours should be provided so that service users can go on more outingsand participate in more leisure time activities. Staff should not smoke near service users and some parts of the building and garden needed attention.

CARE HOME ADULTS 18-65 Dartford Road (16-18) 16-18 Dartford Road Dartford Kent DA5 2AZ Lead Inspector Elizabeth Brunton Announced 25 May 2005 10:30 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 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 Stationary 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. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dartford Road (16-18) Address 16 - 18 Dartford Road, Bexley, Kent, DA5 2AZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01322 524 610 MCCH Society Limited Mrs Pauline Brooks Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13 December 2004 Brief Description of the Service: 16-18 Dardford Road is a care home which provides care for up to five adults with learning disabilities. The home has been open since September 1999 and is operated by the Maidstone Community Care Housing Ltd (MCCH). The home is two semi-detached houses, which have been converted into one house. There is a large lounge/dining room, a kitchen and a smaller lounge. Therer is also a conservatory , which is used as an activities room. Therer are five single bedrooms, one on the ground floor and four on the first floor. There are three bathrooms, a laundry room, office and a small additional room on the first floor, which is used by one of the service users for activities. There is an enclosed garden to the rear of the property, which is wheelchair accessible. The home is situated on a busy road, close to shops and buses. Access to the home is via a sloping path or driveway. On the day of inspection, there were five service users living in the home and no vacancies. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and started at 10.30am. The inspector was in the home for seven and a half hours. Two service users and a visiting relative were spoken to separately. It was not possible to find out the views of other service users, because of communication issues. Pre-inspection questionnaires were completed by two relatives. The senior support worker and other care staff on duty during the day were spoken to. The manager was not seen as she was off work due to sickness. The communal rooms, garden and service users’ bedrooms were seen. Records were looked at, together with three service users’ individual case files. What the service does well: What has improved since the last inspection? What they could do better: Service users still did not have proper contracts for their residence in the home. Theses should set out exactly what services would be provided. More staffing hours should be provided so that service users can go on more outings Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 6 and participate in more leisure time activities. Staff should not smoke near service users and some parts of the building and garden needed attention. 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. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 standard(s) 1, 2 & 5 The statement of purpose and service users guide were excellent. Assessment information was on file but contracts for service users were still needed, in order to give service users full information about the services provided in the home. EVIDENCE: The home had a statement of purpose and a version which incorporated symbols was displayed on the notice board in the small lounge. There was an excellent service user’s guide. It was comprehensive, written in appropriate language and including symbols. There was much information about resident service users on their files and staff spoken to clearly knew them well. No new service users had come to live in the home for several years. Any new service user would be admitted on the basis of a full assessment undertaken by professionals from the Bexley Social Services Learning Disability Team. Comprehensive contracts for service users were still needed. Service users and their relatives or representatives needed clear information about the terms and conditions of residence in the home. (see requirement 1) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 standard(s) 6, 7 & 9 Service users had taken part in regular planning meetings, where goals had been set. Service users had made decisions and choices about their lives and were supported by staff in developing their communication, skills, activities and independence. EVIDENCE: Individual planning meetings had been held with service users and their relatives twice a year. Staff had helped one service user think about changes he would like in his life at a recent person centred planning meeting. Staff are to be commended for the pictorial plan produced at this meeting and displayed in the service user’s bedroom. Service users chose what they wanted for lunch on the day of inspection and helped to prepare it. The weekly menu was decided by staff and service users, with each service user choosing an evening meal. Staff said that service users decided whether they wanted to attend day centres, join in outings and other activities. Two service users had recently chosen to ‘retire’ from attending day centre. Service users were encouraged to take part in the running of the home, as much as they were able. Staff had continued to work with service users on developing communication in the home and were pleased that service Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 10 users had become more assertive and able to say ‘no’ to things they did not want. Staff wanted service users to live full lives and to develop their interests, activities and independence. Service users used public transport and took part in activities outside the home. The necessary risk assessments had been completed. One service user said she enjoyed going to the local shops on her own. A member of staff is to be commended for a plan she had drawn up with a service user for developing his skills, social network and activities, in preparation for more independent living. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, 15, 16 & 17 Service users had contact with the local community and participated in activities but these areas of life could be further developed. Staff supported service users in maintaining contact with relatives and friends. Varied and nutritious meals were served but staff should not smoke near service users at mealtimes. EVIDENCE: Most service users attended day centres and one young man went to college. Service users did drawing, puzzles, jigsaws, watched videos and other activities at home. They went bowling, shopping, out for meals and on occasional day trips. The inspector agreed with staff that some additional service users would benefit from dedicated social pursuits staff hours, so that they could be supported in pursuing new interests and activities of their choice. Service users visited local shops, attended disabled fellowship services and used public transport. Their contact with local people was limited. Information about voting in the recent general election was displayed on the notice board. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 12 Staff said that service users had been given the opportunity to vote but no-one had chosen to do so. Most service users had contact with relatives and some people visited their families regularly at weekends. A visiting relative said that she was always made welcome at the home and was kept informed about important matters affecting her brother. This was confirmed by the two relatives who completed pre-inspection questionnaires. One service user had recently been supported in inviting a friend to tea and another service user was being encouraged to widen his circle of friends and acquaintances, in preparation for supported living. Service users said they liked the food. Those menus seen showed that varied and nutritious meals had been served. As previously mentioned, service users helped to plan the menu. Cooked breakfasts were available every day and service users chose what to eat at lunchtime. One service user was supported in making her packed lunch. Other service users helped to prepare a snack lunch to eat at home. There was an instruction in the staff message book that staff should sit with service users at meal times and offer encouragement and sensitive assistance. However, this was not the case at lunchtime on the day of inspection. The residential social worker on duty sat on the patio smoking. He was close to the open patio doors and to the table where service users were eating their lunch. A requirement has been made concerning this incident under standard 42, though the senior support worker took immediate action, when it was reported to her. (see recommendation 1) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 standard(s) 18, 19 & 20 Healthcare and personal needs were well met. Medication was safely stored and properly administered. A medication incident had been properly dealt with. EVIDENCE: Staff were seen to provide personal care discreetly and with respect for service users’ privacy and dignity. Service users were well dressed and staff and a visiting relative said that service users chose their own clothes. Information about service user’s health care needs was seen on file. Records showed that service users attended the doctor, hospital, dentist and optician when necessary and that staff supported them in this. The senior support worker is to be commended for her research into one service user’s medical condition and its effects and for the resulting guidance for staff. Health care needs had been discussed at service users’ individual planning meetings. Medication was safely stored. A sample check of medication and administration records was made and this was satisfactory. An incident had occurred in March 2005 where a service user was given an additional dose of medicine by a member of staff, who was relatively new to the home and was not yet supposed to be administering medication. The incident was dealt with Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 14 satisfactorily. The administration of homely remedies had been recorded. However, the homely remedies in use had been approved by the GP in August 2003 and this needed to be updated. (see requirement 2 and recommendation 2) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 standard(s) 22 & 23 Service users and relatives had been told how to complain and service users were protected from harm and abuse. EVIDENCE: There had been no complaints since the last inspection. Relatives confirmed that they were aware of the home’s complaints procedure. The complaints procedure was included in the service users’ guide. Staff spoken to were aware of safe practice and seemed committed to the protection of service users. Staff had continued to respond sensitively and carefully to one service user’s expression of preference for a particular member of staff. This was originally reported as an adult protection concern. The senior support worker was in close touch with service users, staff and with day-to-day events in the home. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home was sufficiently spacious, comfortable and generally well maintained. However, some work was needed on the house and garden. EVIDENCE: The home was generally well decorated and furnished. Staff said that some service users liked to use the recently converted activity room and second lounge for activities or for quiet time. The home had acquired a pair of lovebirds, which service users enjoyed watching and talking to. Four of the bedrooms were spacious and the occupant of the smaller fifth bedroom had an additional small room for activities. Bedrooms were highly personalised. The hall and landing on one side of the property, one bedroom and both first floor bathrooms needed redecoration/refurbishment. However, an asbestos check was required before any further work could be undertaken on the building. This had been outstanding for some time. The front of the house needed painting and a new dining table and chairs would improve the appearance of the lounge/dining room and the comfort of service users. Work was needed on the spacious rear garden, to make it more attractive for service users. Extension of the existing patio would make it more accessible. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 17 Staff removed a piece of broken glass and cleared the small patio of cigarette ash and a large container of cigarette ends, at the inspector’s request. Patio furniture needed cleaning and old garden furniture and other rubbish needed to be removed. Tree stumps with jagged tops required attention, as these could be a hazard to service users. The home was generally clean, apart from the first floor bathrooms and radiators. Radiator covers needed to be regularly removed so that radiators could be cleaned. The home’s washing machine had broken and washing was being done by hand or at the laundrette. A new, industrial machine was on order. (see requirements 3, 4 & 5 and recommendations 3, 4 and 5) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 & 35 The home was adequately staffed by a generally able staff group. Not all the required staff recruitment records were retained in the home and NVQ training needed to be arranged. EVIDENCE: Services users and relatives thought that there were enough staff on duty at any time. Additional staffing hours to support service users in undertaking activities was recommended under a previous standard. Service users and relatives said that staff were kind and helpful. Most staff on duty worked hard at communicating effectively with service users and seemed committed to meeting their needs. There was one vacancy, which was to be recruited to. (see requirement 6 and recommendation 6) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 42 The home was well managed. The health service users had been protected, though some additional measures were required. EVIDENCE: The manager had been on sick leave for six weeks. The home had been well run by the senior support worker during this time, with support from the staff group and the service manager. Regular monthly visits to the home had been carried out on behalf of the provider. The building appeared to be safe and no hazards or risks to the safety of service users were identified, apart from two electric sockets in one of the hallways. These were said to be unsafe to use and were taped over but a more permanent solution was needed. Gas and electrical installations and equipment had been serviced and checked and some work had been required. The senior support worker had been trying to find out from MCCH when the outstanding work was to be done. Records showed that fire equipment had Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 20 been regularly tested and checked and fire drills had been regularly held. The need for service user to be protected from exposure to cigarette smoke and attention needed to jagged tree stumps has already been mentioned. (see requirements 7, 8 & 9) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 4 3 x x 1 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score x x 2 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Dartford Road (16-18) Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 22 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 5 Regulation 5(3) Requirement Each service user must be provided with a copy of their contract/statement of terms and conditions of residence in the home, which includes all the matters listed under this standard. (This has been outstanding since April 2002) Staff must only administer medication when it has been agreed that they are sufficiently competent and experienced to do so. The building must be checked for asbestos, so that outstanding redecoration work can be carried out. The garden must be maintained in a safe condition for service users. Jagged tree stumps must be attended to. All parts of the home must be kept clean. The required staff recruitment records must be kept in the home, in line with schedule 4. Service users must not be exposed to the risks of passive smoking by staff. The faulty electrical socket in one of the hallways must be Timescale for action 1 October 2005 2. 20 13(2) 26 May 2005 3. 24 23(2) 1 October 2005 1 August 2005 1 July 2005 1 August 2005 26 May 2005 1 August 2005 Page 23 4. 24 13(4) 5. 6. 7. 8. 30 34 42 42 23(2) 17(2) 13(4) 13(4) Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 attended to. 9. 42 13(4) The outstanding work on the gas installation(s) must be completed. 1 August 2005 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. 2. 3. 4. 5. 6. Refer to Standard 13 & 14 20 24 24 24 32 Good Practice Recommendations Service users should be supported by additional staffing hours to develop additional leisure time activities and local community contact. The homely remedies in use in the home should be reviewed annually by the GP. Uncultivated parts of the rear garden should be attended to and the patio area extended. The front of house should be painted. The dining table and chairs should be replaced. NVQ training should be provided for those staff who wish to undertake it. Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent, DA14 5RH 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 Dartford Road (16-18) G51-G01 S38185 Dartford Road V216963 250505 Stage 4.doc Version 1.30 Page 25 - 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!