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Inspection on 23/10/08 for Ethel Road (7)

Also see our care home review for Ethel Road (7) for more information

This inspection was carried out on 23rd October 2008.

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

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

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

On the day of the inspection the person using the service was out for the day at college. The manager had offered to keep him at home for the day but consideration was given to his routines and following a discussion it was felt that he should continue his day as normal. The manager instead told us all about the person who uses her service and it was clear that this individual is considered a much loved family member. Photographs around the home demonstrated he is involved fully in family life. The manager also showed us the family holiday pictures they all had in Spain in the summer. Part of the family are two young brothers who is referred to as the person who uses the service foster brother. The manager said they play games together on the computer and all have an interest in the families pets. The home was comfortable and inviting with plenty of communal space but also the person using the service has his own personalised bedroom where he can relax on his own if he wishes. The manager enables the individual to attend college four days a week and attend his clubs two evenings a week. He also has an advocate who he visits and his birth mother where he visits every other weekend.

What has improved since the last inspection?

Three requirements were made following the inspection in November 2007 and these have now been met. Risk assessments relating to falls, choking and nutrition are all in place. There is also a community risk assessment to help achieve an independent lifestyle. The home has an up to date insurance certificate.

What the care home could do better:

No requirements or recommendations were made as a result of this key inspection.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ethel Road (7) 7 Ethel Road Ashford Middlesex TW15 3RB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 23 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: Ethel Road (7) 7 Ethel Road Ashford Middlesex TW15 3RB 01784240646 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Victoria Charlton Type of registration: Number of places registered: Mr Vaughan Charlton,Mrs Victoria Charlton care home 1 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The age/age range of the persons to be accommodated will be 18 - 35 years The age/age range of the persons to be accommodated will be 18 - 35 years The gender of those accommodated will be Male The gender of those accommodated will be Male Date of last inspection Brief description of the care home The home is registered as a care home within the service user category: Learning Disability. The home is registered to provide personal care for one male resident. The accommodation within the home is a communal lounge, dining room, conservatory and domestic style kitchen. The person using the service has a single bedroom with an ensuite bathroom and toilet. The service is privately owned providing a caring and supportive environment and is run as an ordinary domestic household. 1 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an announced Key Inspection and the home was given forty-eight hours notice. Mrs L Garrett, Regulation Inspector, carried out the inspection and the registered manager represented the service. The inspector arrived at the service at 10:15 and was in the home for two hours. It was a look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last inspection in November 2007. The inspection was announced as the service only provides care and accommodation for one person. The person using the service was fostered by the family until the age of seventeen. We looked at how well the service was meeting the key national minimum Care Homes for Adults (18-65 years) Page 5 of 23 standards and complying with the regulations and has in this report made judgments about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments and the Annual Quality Assurance Assessment (AQAA) that the manager supplied to us. From the evidence seen by the inspector we consider that the home would be able to provide a service to meet the need of the individual should they have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person using the service has lived at the home for a number of years and his assessed needs are being met and kept under review. Evidence: The manager and her husband had been foster carers to the the person using the service. When the individual reached the age of eighteen years they made arrangements to register the home as a care home to enable the individual to continue living with them. The manager said that the person using the service has always been treated as a family member. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person using the service is is involved in decisions about his life and appropriate risk assessments are in place and keep under review. Evidence: The care plan in place was observed to be person centered and outlined how the individuals needs and daily routine were being met. The plan was written in plain English and easy to follow. The manager, with the person using the services permission, makes this plan available to those people who have responsibility for him during the day. For example the college, clubs and his advocate. It was noted that daily occurrence sheets were in place. Entries were not recorded on a daily basis. The manager said that changes to the individuals daily routine were minimal and as a result entries were recorded when some changes occurred. There was evidence seen confirming that regular reviews of the individuals care needs Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: were taking place, which involved the care manager, person using the service, manager and the advocate. The manager said that the review for this year was overdue but that she had contacted social service to remind them. During the last inspection in November 2007 it was noted that no risk assessments were in place relating to choking, nutrition and falls. These have now been completed and again these are made available to other carers that may have responsibility for the person using the service during the day. The manager stated that the person using the service was still not able to manage his own finances. However, the individual was in receipt of a weekly allowance from the placing authority and was able to spend it on personal items such as DVDs, stationery, outings and eating out in his favorite fast food restaurant. There was a transaction sheet in place recording all incoming and outgoing payments. These transactions are kept on the computer and both the manager and the individual sit down together regularly to up date the information.The individuals advocate also continues to check the transactions sheet which promotes transparency. The manager stated that the person using the service still does not use any public transport alone. The manager drives him to all of his activities and college. A community risk assessment has been developed for when he leaves the home to go on outings with the college or club when he visits his family or goes out with his advocate. These are also available to these people. Care Homes for Adults (18-65 years) Page 11 of 23 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person using the service is seen as part of the family and local community and is assisted to take part in activities that are appropriate to his age and ability Evidence: The person using the service continues to attend college four times a week and was undertaking training in literacy, computers, health eating and transport. The individual has a love of animals and spends two hours a week as a volunteer in the RSPCA shop. The manager supports the individual to be part of the local community. She stated he has lots of friends and makes use of the facilities and activities in the local community. He goes out regularly on shopping trips to purchase personal items. He has regular outings to the cinema and theatre and is enabled to visit the local pub for a drink and his favourite fast food restaurant. The manager also said that he attends a club two Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: evenings a week and this sometimes includes outings at weekends. The person using the service is a loved family memeber who will always go with the family to visit their friends and family. He also goes on the yearly family holiday and the manager said they all enjoyed a villa holiday in Spain last summer. Photographs of the individual are displayed around the home with the two children of the manager and her husband. The manager continues to support him to maintain links with his family members and friends. He visits his mother every other weekend and is able to choose whom he wishes to see. He has an advocate who also takes him out regularly. The resident has his own bedroom and bathroom, which are situated on the ground floor and he is expected to help keep these areas clean and tidy. He is able to put away his laundry and change his bed linen. He has been living in this unique residential setting for a number of years and feels very much part of the family and has unrestricted access to all areas of the family home. Mealtime was not observed, as the main meal is prepared in the evening and the individual was at college on the day of the visit. The manager said that the resident has three meals daily and is provided with drinks and snacks throughout the day. He was able to help himself to snacks if he wished to at anytime. It was reflected in the care plan that the resident had difficulty with swallowing and soft foods should be provided. The manager stated that she provides soft foods like mashed potatoes, mince, fish and lasagne and pastas. Following each meal the person using the service has to sit upright for forty-five minutes to avoid the risk of choking. The manager said that often her children would sit at the dining room table with him doing an activity they can all join in for example drawing or colouring. Care Homes for Adults (18-65 years) Page 13 of 23 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service ensures that the health and personal care provided is based on the individual needs of the person using the service. Evidence: The care plan seen reflected that the person using the service was able to wash and dress himself without assistance. The manager assists the individual with washing his hair, shaving and running the bath. The manager said that to give the individual his dignity she stands at the door rather that in the bathroom to remind him to wash when bathing or clean his teeth. There has been a gradual deterioration in his health and the manager said that if she left him in the morning he would not get out of bed and could remiain asleep for most of the day. The manger confirmed that there was a certain amount of flexability with when he gets up in the morning and goes to bed although in the week he has college so can be too tired in the morning if he is not reminded to go to bed. The person using the service is registered with a general practitioner and has access to Care Homes for Adults (18-65 years) Page 14 of 23 Evidence: health care and other specialist treatment via the general practitioner. There was evidence seen in the care documentation reflecting that the resident was supported by the manager to attend hospital appointments. The manager informed the inspector that she escorts the resident monthly to the hospital to have blood tests. Six monthly dental and yearly optical appointments were maintained. The manager told us that they had attended the hospital the day before the inspection and that she had taken him to that appointment. The manager stated that the person using the service does not take any medication at the moment. Care Homes for Adults (18-65 years) Page 15 of 23 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person using the service can be confident that his complaint would be listened to and that they are protected from abuse. Evidence: The manager said that the individual is aware of how to make a complaint. She said that if he was not happy he would speak to her.His advocate is also available to speak to and the college he attends has a welfare officer who is available if problems occur. The manager said that the person using the service is aware of all the people he can talk to. He also has contact with his mother and can speak to her. The Commission has not received any complaints about the service. The home has an up to date copy of Surrey Multi Agency Safeguarding Procedures and an easy read summary of the keeping people safe document issued by the Department of Health. There has not been any safeguarding of vulnerable adult concerns reported to the Commission about the service. Care Homes for Adults (18-65 years) Page 16 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a safe, well-maintained, comfortable family home for the person who uses the service to enjoy and relax in. Evidence: The home is a family home. The person who uses the service has a bedroom situated on the ground floor and there is a separate toilet and bathroom. The room was personalised with family photographs and posters reflecting the individuals personality. The room was clean and tidy. The manager said that the floor covering has been replaced which has made it much easier to keep clean and odour free. The home was clean, hygienic and smelt fresh on the day of the inspection. There are family pets at the home which include cats, tortoise and snakes. Care Homes for Adults (18-65 years) Page 17 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person using the service is supported by the manager who has the appropriate qualifications to enable to carry out her job. Evidence: There are no staff employed in the home, the registered manager is the sole person who cares for the individual with support from her husband who is the responsible individual for the service. The person who uses the service has contact with an advocate who both also supports him. The manager said that the advocate have been subject to enhanced criminal record bureau checks. The individuals employers carried out these checks. The manager has now completed a management course at a local college and showed us the certificate. She remains updated on the local safeguarding procedures. Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is a competent well-trained individual who treats and cares for the person using the service as a family member. Evidence: The manager has been caring for the resident for more than ten years. She has had experience working with people with a physical disability and learning disability in a residential and day care setting. She has a B-Tec certificate in social care and completed her certificate in management studies. There was evidence seen to indicate that the manager was being pro-active and undertaking periodic training to update her knowledge and skills to support her to care for the individauls diverse needs. The home does not have a quality assurance system in place but the individual has an advocate whom he sees regularly and is able to speak on his behalf if required. Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: The service maintains a record for checking smoke detectors. The manager said that checks are carried out weekly. The AQAA indicated that all the necessary health and safety checks were in place and the home has current insurance. Care Homes for Adults (18-65 years) Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 22 of 23 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 23 of 23 - 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!