Inspection on 05/12/06 for Heather Lane, 74

This inspection was carried out on 5th December 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heather Lane, 74 18/09/07

Heather Lane, 74 24/01/06

Heather Lane, 74 28/10/04

Heather Lane, 74 01/07/04

Heather Lane, 74 05/11/03

Heather Lane, 74 23/05/03

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Heather Lane, 74 Yiewsley Middlesex UB7 7AU Lead Inspector Ms Jean Bovell Key Unannounced Inspection 5th December 2006 11:00 Heather Lane, 74 DS0000027090.V321729.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 Heather Lane, 74 DS0000027090.V321729.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. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heather Lane, 74 Address Yiewsley Middlesex UB7 7AU 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) 01895 421947 tanners@lifeopportunitiestrust.co.uk www.lifeopportunitiestr Life Opportunities Trust Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th May 2006 Brief Description of the Service: 74 Heather Lane is a registered home that offers support for three service users who have a learning disability. Two female service users are currently placed at the home and have lived there since it opened in 1990. The home is managed by LOT (Life Opportunities Trust) and the building is owned and maintained by Shepherds Bush Housing Association. The house is in a residential area of Yiewlsey with the shopping centres of Uxbridge and West Drayton accessible by public transport. The ground floor has a large lounge, kitchen, one bedroom and a shower room. On the first floor are two bedrooms, a bathroom and a sleeping-in room/ office. There is an attractive garden to the rear. The staff team at the time of the inspection consisted of four Residential Workers. There was no Registered Manager in place. The staff on duty provide single staff cover. Heather Lane, 74 DS0000027090.V321729.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 11:00am and 3:00pm on the 5th December 2006. One senior support worker, one support worker and one service user were present. It was confirmed by a support worker that the Registered Manager was on a training day and that one care support worker was attending the day centre. During the course of the inspection, the home’s policies, procedures, records and documents were viewed. A tour of the building was undertaken and observations were made. One service user was spoken with. The requirements that were made at the last inspection and all key Standards were inspected. A senior care support worker and a support worker were co-operative and provided appropriate assistance throughout the inspection. What the service does well: What has improved since the last inspection? Of sixteen requirements made at the last inspection, twelve had been complied with. These related to assessments, admissions, continence issues, the complaints procedure, magnetic door closures, staffing, training, management, updating of policies and procedures, the health and safety policy, fire safety issues and supervision. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Heather Lane, 74 DS0000027090.V321729.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 Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are appropriately assessed prior to admission. Requirements under Standards 2 and 3 relating assessments and admissions have been met. EVIDENCE: A personal file relating to a prospective service user who is being currently assessed was examined and evidenced that a copy of the placing Authority’s assessment had been submitted at the point of referral. It was indicated that a representative from the home visited the prospective service user in his/her place of residence and at day and evening resources. Relatives, carers, social workers and medical professionals were involved in a process of assessing and determining the home’s capacity to meet specific personal, health care and social needs and aspirations. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are drawn up appropriately. Service users are able to make decisions in relation to their daily living routines. EVIDENCE: Care plans relating to two service users were inspected and were satisfactory. It was reflected that individual personal, social and health care needs were identified and that appropriate action plans and set goals had been into place. Care plans were reviewed on a monthly basis. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 10 A senior support worker confirmed that service users were offered choice in relation to home decorating/colour schemes, furniture and carpets, personal purchases, clothing, make-up and hairstyles. The records indicated that monthly service users’ meetings were held and that service users were encouraged to make decisions regarding the menu, shopping and shared activities. It was evidenced that risk assessments had been undertaken in relation to specific activities identified within care plans. These included accidents, illness, confusion and mobility. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in appropriate activities within the community and contact with relatives and/or friends are being maintained. The rights of the service users are respected at the home. Varied and wholesome meal choices are being provided to the service users. EVIDENCE: It was indicated on separate care plans that service users were able to attend Religious services, college courses, day centres and evening clubs. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 12 Service users were also supported during activities in the community such as shopping, meals out, the cinema or theatre, day trips and annual holidays. One service user attended the day centre and another watched television or listened to music in the home’s lounge during the inspection. There is an open visiting policy in place and contact with relatives and/or friends are encouraged and facilitated. The Inspector was informed by a care support worker that service users assisted with various housekeeping tasks including clearing the dining table, emptying the dishwater and hovering. Service users were also able to make and/or receive personal telephone calls and letters were handed to them unopened. Care support workers were observed interacting with a service user in a sensitive and respectful manner and knocked on bedroom doors prior to entering. Varied and nutritional meals were listed on the menus and a service user was offered healthy lunch options at the time of the inspection. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users receive assistance with personal care as required and their health care needs are being met appropriately. The policy and procedures relating to medication are satisfactory. A requirement under Standard 19 relating to continence issues has been met. EVIDENCE: It was confirmed by a senior support worker that any assistance or prompting that were required in relation to personal care routines, were undertaken in privacy within bathrooms or separate bedrooms. However, service users independently chose what they wore, makeup and hairstyles. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 14 The Inspector was informed by a care support worker that there were no incontinent issues in relation to the service users that were currently placed at the home. The health care needs of the service users were identified within their individual care plans. It was evidenced that service users received access to General Practitioners, Physiotherapists and Chiropodists as required. Regular dental and optical checks were arranged and service users were accompanied during medical appointments. The home’s policy on medication was in place and the records indicated that medication training had been delivered to the care support workers. The storage, disposal and administration of medicines were satisfactory. None of the service users were able to self-administer their medication. A service user did not attend the day centre at the time of the inspection as he/she was feeling unwell and was observed receiving appropriate attention from care support workers. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is satisfactorily detailed and the service users are protected from abuse. A requirement under Standard 22 relating to the complaints procedure has been complied with. A requirement under Standard 23 relating to financial issues has not been met. EVIDENCE: The complaints procedure was clearly written, appropriately illustrated and accessible to the service users and their relatives. The records indicated that no complaints had been made to the home following the last inspection. The home’s policy and procedures on the protection of vulnerable adults were in place and had been updated. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 16 It was reflected on records viewed that all members of the care support staff team had received training on the protection of vulnerable adults. The personal allowances of the service users are safeguarded at the home. The financial records relating to two service users were inspected and though no discrepancies were identified, it was indicated that care workers’ Bank Cards were often used for small purchases. This matter was discussed with a senior support worker who gave assurances that appropriate action would be taken. Heather Lane, 74 DS0000027090.V321729.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable, safe and well maintained. A requirement under Standard 24 relating to magnetic door closures has been met. EVIDENCE: The communal areas at the home are adequately spacious, comfortably furnished and appropriate for shared and/or individual activity. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 18 Magnetic door closures were in place. The garden was well maintained and accessible the service users. There were no issues in relation to the laundry. Overall, the home was found to be clean, hygienic and well maintained. The atmosphere was calm, pleasant and homely. Heather Lane, 74 DS0000027090.V321729.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care support workers are appropriately trained and qualified for meeting the needs of the service users. The home’s recruitment and selection policy is satisfactory. Requirements under Standards 31 and 36 in relation to staff training and supervision have been met. A requirement under Standard 34 relating to recruitment files was not assessed. Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 20 EVIDENCE: It was reflected on the staff rota that two care support workers were on duty during the morning shift. One care support worker covered the afternoon, evening and sleep over shifts. A training programme was in place and the records indicated that new staff members received induction training and that recent staff training delivered included health and safety, dementia, epilepsy, first aid and fire safety. Two care support workers had obtained national vocational qualification in levels 2 and 3. The Registered Manager was on a training day at the time of the inspection and as a consequence personnel files were not accessible. The home’s recruitment and selection policy was in place. The records confirmed that staff supervision was delivered on a monthly basis. Heather Lane, 74 DS0000027090.V321729.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. JUDGEMENT – we looked at outcomes for the following standard(s): Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 22 37, 38, 39, 40 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A Registered Manager is in post and the home is well run. Appropriate quality assurance has been undertaken. The home’s policies and procedures are satisfactory. The health and safety of the service users are being adequately safeguarded. Requirements under Standards 38 and 40 relating to management and policies and procedures have been met. Requirement under Standards 39 and 42 in relation to quality assurance and legionella testing remains outstanding. EVIDENCE: A Registered Manager is in post at the home but was not present during the inspection. A senior care support worker and a care support worker reported that the Registered Manager was open, supportive and approachable. Documented evidence that self-monitoring had been undertaken by the home was not available for viewing at the time of the inspection. The home’s policies and procedures were in place and had been updated. Health and safety checks including those for fire safety, portable appliances and gas maintenance were up to date. Morning and evening fire drills had been undertaken and accurately recorded. The records indicated that environmental risk assessments had been carried out and reviewed annually. Up to date testing for legionella was not evidenced at the time of the inspection. Heather Lane, 74 DS0000027090.V321729.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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 3 3 2 X Heather Lane, 74 DS0000027090.V321729.R01.S.doc Version 5.2 Page 24 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 YA34 Regulation 17 (2) 19 (1) Requirement All of the recruitment records required under Schedules 2 and 4 of the Care Homes Regulations 2001 must be available for inspection. (Previous timescale 31/10/05 and 31/07/06) Not assessed at this inspection. The results of service user surveys must be made available to the service users and their relatives. (previous timescale 31/07/06) Evidence must be provided that current Legionella testing has been carried out. (Previous timescale of 28/02/06 and 31/07/06 not met) Timescale for action 31/01/07 2 YA39 24 (1) (2) & (3) 30/04/07 3 YA42 13 (4)(a) 30/04/07 Heather Lane, 74 DS0000027090.V321729.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 Heather Lane, 74 DS0000027090.V321729.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: 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. 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