Inspection on 13/12/06 for High Road 73

This inspection was carried out on 13th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Road 73 04/10/07

High Road 73 02/12/05

High Road 73 29/04/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 High Road 73 73 High Road Gorefield, Wisbech Cambridgeshire PE13 4PG Lead Inspector Don Traylen Key Unannounced Inspection 13th December 2006 13:00 High Road 73 DS0000063111.V298424.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 High Road 73 DS0000063111.V298424.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. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Road 73 Address 73 High Road Gorefield, Wisbech Cambridgeshire PE13 4PG 01543 442500 01543 442511 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) Milbury Care Services Anita Dawn Blackburn Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2nd December 2005 Brief Description of the Service: 73 High Road, Gorefield, is a detached house with seven bedrooms situated in the small village of Gorefield, close to Wisbech in north Cambridgeshire. The service is provided by Milbury Care Services. On their website, Milbury aspire to, “provide high quality specialist care for adults with learning disabilities, physical disabilities and other specialist needs in family sized houses to give people a sense of belonging and ownership. We regard every house as a home and our staff provide a warm, welcoming environment which enables everyone in our care to live as ordinary a life as possible regardless of their disability.” Their homes are typically for three to eight people. The home has been completely refurbished for the service that was first registered in December 2004. The home is decorated to a high standard and is well furnished. The comfortable and spacious rooms and corridors make the home a relaxing and secure environment for service users. There is a large garden area to the front and left side of the property and a large patio area with adequate seating and table arrangement for all service users to use. The driveway provides ample parking space for the homes’ vehicles and for staff to park their cars. Fees are £1432.00 per week High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At different times during the inspection the seven service users were at home. Each service users was spoken to either individually or in groups. One service user escorted the inspector around the home. Frequently the service users were very eager to communicate with staff, including the manager. The atmosphere in the home was one where service users were afforded a balance of freedom and assistance. This key inspection took place over 4 hours in the afternoon of the 13th December 2006. A pre-inspection questionnaire was used to gain basic service information and Regulation 26 reports and Regulation 37 notifications made under the Care Homes Regulations 2001 were assessed, as were Care Plans, the records of service users finances, staff training records, protection arrangements and the management of the home. The health and safety of service users including the fire equipment testing, frequency of fire drills electrical testing and the services policies and procedures were assessed. What the service does well: The same remarks made in the last report apply as the home has continued to provide a person centred approach to care and support. Service users have progressed and developed and are given freedom to express themselves and to follow their expressed interests. Overall, the service is careful to attend to complex and very different individual needs for people with learning disabilities. The home manages to do this with respect and through a thoughtful and sensitive understanding of each service user’s circumstances and of their potential development and happiness. Staff have helped to create a relaxed and respectful atmosphere in which to live. The home has provided for seven service users with a high level of need since first becoming registered in December 2004. The home arranged for lengthy and careful pre-admission assessments for each of the service users, five of whom moved from one establishment on the 1st December 2004 and two service users who moved to the home in February 2005. Service users are stimulated by a variety of interests and activities they follow. New social and leisure interests are continuously being suggested and introduced whenever possible. The built environment of the home is conducive to providing a calm and homely environment where service users have established themselves as the owners of their environment. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 6 The home employ care staff who communicate easily with service users and work well together. The home is part of Milbury Care Services who provide support through management, recruitment and training for care staff. 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. High Road 73 DS0000063111.V298424.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 High Road 73 DS0000063111.V298424.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): 1,2,3,4,5, The quality outcome for the group of Standards assessed is good. This judgement has been made using available evidence and a visit to the service. Service users who move into the home are afforded a thorough admission process and afforded opportunities to express their feelings. EVIDENCE: The admission process has been commented on as a good process in previous inspections. It is thorough, well planned and an open process. A comprehensive assessment by the Learning Disability Partnership (Cambridgeshire) has been provided for all existing service users. No new service user has moved to the home since last inspection. A prospective service user would be supported through a phased move into the service. The majority of the financial documentation and detail regarding contractual and funding arrangements were not available in the home and must be provided to the Commission for inspection by the timescale set for requirement number 1, made in this report. There was an individual Service Agreement for some of the service users, but not for all of them. This document was essentially a Service User Guide but did not include a statement about the complaints process or about the availability of inspection reports. It did include the terms and conditions and a copy of the Terms of Business that included the annual fee and the name of the service user. The management of service users’ finances and their individual arrangements were discussed at length with the manager, who stated she would request the full details to be made available from the financial department of the organisation that deals with service users’ contracts. High Road 73 DS0000063111.V298424.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): 6,7,9, The quality outcome for the group of Standards assessed is good. This judgement has been made using available evidence and a visit to the service. Despite the comment made below, the judgement is that service users’ care is well planned and effectively delivered and service users have safe and independent lifestyles. EVIDENCE: Care Plans were neat and carefully maintained. They covered a range of identified aspects of individual care. One person’s risk assessment identified a risk that had not been translated into an element in his care plan. It was an important element of a behaviour pattern that was not clearly, or sufficiently addressed by an action plan. The care plans were generally repetitive and would benefit from being reformatted. Both of these issues were spoken about with the manager and were given as feedback during the inspection. Service users are encouraged to participate in their chosen interests. This was evident during the inspection when service user were returning form a day out and some were preparing to go out again that evening. Risks were measured through risk assessments and balanced with a quality of life that had been expressed by each service user. Staff demonstrated they knew service users’ High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 10 wishes as well as their limitations. Observations of staff interaction showed they were able to sensitively negotiate service users’ requests. For instance, one service user was keen to go and play or watch football and was supported by being offered alternative pursuits, as well as being allowed to follow his clearly expressed interest. High Road 73 DS0000063111.V298424.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): 12,13,15,16,17, The quality outcome for this group of Standards assessed is good. This judgement has been made using available evidence and a visit to the service. Service users are enabled and encouraged to live active lifestyles and to pursue their chosen interests. EVIDENCE: Service users were recorded as attending Bingo, exercise and recreation sessions at a gym; cottage crafts and attending regularly at local church services. Several service users spoke about their interests and going out and enjoying themselves. Music and dancing and going to discos was very evident as an interest that service users have. It was observed that there are quiet areas of the home for service users to be in should they choose. The activities that service users wish to be involved in when they are at home was observed to be an intense and varied experience and one that requires constant staff attention and involvement. Staff were observed to be respectful and directly engaging with service users. There were sufficient staff working to ensure that enough attention and supervision was provided, as well as meaningful interaction with service users. Family connections are encouraged High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 12 and facilitated by the home. Service users who have relatives who are willing to keep in touch do keep in regular contact with them. The home has acquired a vehicle able to take wheelchairs when service users need this transport High Road 73 DS0000063111.V298424.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): 18,19,20, The quality outcome for this group of Standards assessed is good. This judgement has been made using available evidence and a visit to the service. Service users continue to be supported in their emotional, physical and health related needs. EVIDENCE: No service user manages their medication. At the last inspection it was recorded “It was discussed how the home must complete the comments section when service users are away from the home on “social leave” and medication has been given to relatives to administer. It was agreed with the senior carer that relatives must sign for any medications given to them to be responsible for and the MAR sheets must record this.” This had been put into action by the manager and was verified during the assessment of medication records. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 14 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): 22,23, The quality outcome for this group of Standards assessed is adequate. This judgement has been made using available evidence and a visit to the service. Service users and staff are not consistently protected. EVIDENCE: One recent incident in the home was reported to the adult protection coordinator. There was a delay in reporting this as a concern and the home must be clearer and more decisive about dealing with any similar incident. Contacts for the lead Social Worker Key Practitioner and the Police were not immediately available or visible in the office. These contacts should be easily accessible for all staff. An incident record book had been maintained that revealed not all incidents of harm had been reported to CSCI and some had not been referred to appropriate key practitioners. Although some of the records for these concerns and incidents had been maintained not all of the responses had been recorded. For instance, the manager stated that a referral to the Learning Disability Partnership had been made although it was not recorded. A referral to Milbury’s own behavioural therapist had been made, but not responded to. A full catalogue of responses is required to be made in such incidents and must be maintained in the future. There is an additional concern that staff were vulnerable in the instances and this must be addressed by appropriate reporting and suitable responses by the registered manager to protect and prevent harm to service users and staff. As the manager has attended the Key Practitioner training provided by Cambridgeshire County Council adult Protection Trainer, it is expected these issue will be addressed and improve in the immediate future. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 15 It was uncertain if service users felt their views were listened to. Observations made during the inspection visit concluded that their feelings are listened to. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 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 the following standard(s): 24,25,26,27,28,29,30, The quality outcome for this group of Standards assessed is good. This judgement has been made using available evidence and a visit to the service. The environment is appropriate for all service users’ needs. EVIDENCE: A tour of the building showed the environment is suitably clean and warm. It is a homely environment well equipped with some specialist mobility equipment for one service user who needs these adaptations. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 17 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): 32,34,35, The quality outcome for this group of Standards assessed is adequate. This judgement has been made using available evidence and a visit to the service. Some improvements in the training programme and a more rigorous recruitment process would be in service users’ best interests. EVIDENCE: NVQ level 2 awards have been achieved by a low number of care staff. Some staff have left and recently recruited staff have yet to embark on NVQ level 2 awards. Induction training is well organised and is provided through the organisation. The manager has attended the Cambridgeshire County Council Key Practitioners training in Adult Protection and is a key practitioner for the service where she is employed. This allows her to provide an acceptable level of training to recently recruited staff for their induction training. However, there was some evidence about a lack of effective training concerning adult protection in the failure to immediately report known incidents as abuse. Staff records showed only one reference was suitable for a recently employed care assistant. The manager had recently rejected a human resources reference addressed to “whom it may concern”. It is surprising that the human resources recruitment officer in the regional office did not deal with this matter. Documentation showed that the manager did not have enough detail provided by her regional office/human resources to accurately cross-reference POVA first checks with CRB disclosures for new employees. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 18 High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 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 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): 37,38,39,42, The quality outcome for this group of Standards assessed is good. This judgement has been made using available evidence and a visit to the service. The example of management style and openness towards service users and staff is highly appropriate in this home. EVIDENCE: The manger demonstrated she sets a good example and an ethos based on equality and respecting diversity in her communication and interaction with staff and service users. The care staff and the manager listened to service users views and feelings during the inspection. There are adequate safety checks for fire alarms fire equipment testing and fire drills. Portable electrical appliances had been checked and a service contract for the heating system and boiler were in place. Reporting accidents was maintained in a logbook. Although Standard 43 was not fully assessed it was found that the home did not have a method to audit service users’ finances. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 20 High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 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 Standard No Score 1 2 2 3 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 3 X X 3 X High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 22 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 Standard YA1 Regulation 5(1),(2),(3) & 6(a) Requirement Timescale for action 31/03/07 2 YA5 3 YA6 The Service User Guide must be reviewed to include all details expected under the Standard and Regulation and must be given to each service user. 31/03/07 5(1)(b)(ba)(bb) The registered person must (bc)(bd)(c), make available for inspection the detailed information and 5(3) & (4),& document for each service Schedule 4(8)(9) users’ financial arrangements & and these must include the Section 31, details regarding the benefits Care Standards they receive, their financial Act 2000. status and capacity to manage their own money; the arrangements that have been made for others to act on their behalf; the commissioning and funding arrangements and the agreement for the payment of each service user’s fees, plus the copies of their contract and terms and conditions. 15 (2)(b) Care Plans must include and 31/03/07 describe, the actions to be taken to manage the risks around harmful behaviour DS0000063111.V298424.R01.S.doc Version 5.2 Page 23 High Road 73 4 YA23 13(6) 5 YA23 37 6 YA34 19(1)(b) 7 YA34 19(1)(b)(c) that has been identified in the risk assessments that have been carried out. The registered manager must ensure that service users and staff are protected by procedures for reporting all incidents of suspected harm All incidents of suspected harm must be recorded notification must be sent to the Commission without delay. The registered provider must ensure the registered manager is able to verify whether a satisfactory CRB and POVA first check have been obtained for any member of staff. Two satisfactory references from appropriate sources must be obtained for any new employee 31/01/07 31/01/07 31/03/07 31/03/07 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 Refer to Standard YA6 YA23 YA32 Good Practice Recommendations Care Plans should include what arrangements are made for service users to access money they need on a daily basis. Contact details for reporting an allegations or suspicion of abuse must be easily accessible for all staff and should be visible in the manager’s office. At least 50 of care staff should achieve NVQ level 2 awards in care and arrangement should be made to ensure this will occur. High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 High Road 73 DS0000063111.V298424.R01.S.doc Version 5.2 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!