Inspection on 15/05/07 for Middle West

This inspection was carried out on 15th May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Middle West 10/01/06

Middle West 15/06/05

Middle West 20/12/04

Middle West 07/07/04

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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 Middle West Middle West Carlton Road South Godstone Surrey RH9 8LE Lead Inspector Mary Williamson Unannounced Inspection 15th May 2007 13:00 Middle West DS0000013719.V340785.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 Middle West DS0000013719.V340785.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. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middle West Address Middle West Carlton Road South Godstone Surrey RH9 8LE 01342 893804 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) Mr Jonathan Georges Esparon Mrs Winifred May Esparon Mrs Winifred May Esparon Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 18-64 YEARS of whom one person may be over 65 years of age of female gender catergory LD(E) Of the 10 service users accommodated in the home up to 4 service users of either gender may have a Physical Disability within catergory PD as a secondary condition to their primary condition of Learning Disability Conditions attached to maximum height of service users accommodated in first floor bedrooms. 10th January 2006 2. 3. Date of last inspection Brief Description of the Service: Middle West is a care home registered for provision of personal care and support for ten adults with learning disabilities. Up to four service users may have a physical disability, excluding sensory impairment, as a secondary condition. The building is a detached chalet bungalow, with two bedrooms and a bathroom on the first floor. The location of the home is semi-rural within a private residential estate. Transport is provided to facilitate access to nearby South Godstone village and all community facilities. Communal areas are spacious affording a comfortable lounge, separate dining room, kitchen and large conservatory. A separate utility room is available and office facilities. A wheelchair accessible shower room is available on the ground floor additional to other bathing facilities. Bedroom accommodation is a combination of single and shared occupancy rooms. One of the shared bedrooms on the ground floor has an en-suite bathroom. The first floor shared bedroom, single bedroom and bathroom are accessible by a steep, narrow staircase. Accommodation on this floor is subject to specific conditions. The home has a pleasant garden and car parking facilities. The fees charged range from £790 to £1500 per week. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. The inspection took place over three hours. Mary Williamson, Regulation Inspector, carried out the inspection. The registered manager, Mrs Winnie Esparon, represented the establishment. A tour of the premises was undertaken and records relating to the care of the residents and the management of the home were examined. It was possible to meet most of the residents and talk with them, some in more detail than others. They are all very satisfied with the support provided in the home and the staff working there. Some residents were attending various activities and returned to the home during the inspection. It was also possible to have discussions with two staff individually. They confirmed the training they had undertaken and both felt totally supported by the staffing and management structure within the home. The manager completed a pre-inspection questionnaire. Two relative surveys, two GP surveys, one resident survey, one advocate survey and a consultant psychiatrist survey were returned to the inspector, all with positive comments regarding the service. The Commission for Social Care Inspection would like to thank the residents and staff for their hospitality during this inspection. What the service does well: The home offers a good standard of accommodation in single and double bedrooms for the residents living there. The atmosphere is relaxed, homely and welcoming. The standard of care is good and all the residents appeared well cared for. Each resident has an activities programme in place and some attend external day care centres. Family links are maintained and relatives are always welcome in the home. The arrangements in place to meet residents’ health care needs are good. The standard of care planning is satisfactory and care is reviewed regularly. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 6 The home is managed well by the manager, who is also the provider. Health, safety and welfare of residents is promoted and risk assessments are in place for all identified risks and for safe working practice. 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. The summary of this inspection report can be made available in other formats on request. Middle West DS0000013719.V340785.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 Middle West DS0000013719.V340785.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): 1, 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have sufficient information available to them to in order to help them make an informed choice about living in the home. Contracts of occupancy and pre-admission needs assessments are in place. EVIDENCE: The home has a statement of purpose and service user guide in place, a copy of which is kept in individual resident’s rooms. The manager stated that she reads and explains the content of these documents to individual residents on admission to the home. There is a clear admission policy in place and an assessment of needs is undertaken on all residents prior to admission to the home. The home manager undertakes this. Three assessments were randomly sampled and found to be informative, detailed and reviewed on a regular basis. Currently two residents’ needs are changing more rapidly than others, and the manager stated that these needs are constantly under review. Contracts of occupancy are in place and outline the care provided, the type of room offered and the fees and frequency of payment. Contracts are signed by residents whenever possible, or by a representative on their behalf. Middle West DS0000013719.V340785.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. Individual care plans are in place and these include risk assessments. Residents are encouraged to make decisions, and can participate in all aspects of life in the home. EVIDENCE: Individual care plans are in place and three of these were randomly sampled. These are well written on the basis of the initial needs assessment, input from the residents whenever possible, information available from relatives and friends, and any other information from care managers and medical reports. Care plans are kept in individual bedrooms and records of care entered on a daily basis. Detailed risk assessments are included in the care plans, for example activities within the home and community, use of transport, receiving personal care and management of personal finances. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 10 Residents are encouraged to participate in decision making regarding daily living and make choices about what they wear, how to spend their leisure time, what activities they wish to participate in, the choice of menu and who they wish to help them with personal care. The manager stated that residents are also supported to take part in household activities, for example cleaning their bedrooms, doing personal washing, assisting in cleaning communal areas of the home and kitchen activities. Middle West DS0000013719.V340785.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. Residents are given the opportunity for personal development and appropriate leisure activity. Family links are maintained and nutritional needs are met. EVIDENCE: Each resident has an individual programme of leisure and activity in place. One resident attends Colebrook Day Centre and stated that he really enjoyed going there in the bus. Two residents had recently started attending a drama group at The Croft and explained what they had been doing there when they returned home. One resident attends the East Surrey College and his timetable includes literacy, numeracy, pottery, art therapy and art and craft. Community participation includes shopping trips, visits to the local pub, meals out, clothes shopping, cinema and leisure centre. Holidays are arranged every year and the manager stated that residents are going on holiday in July. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 12 Family links are maintained and relatives are welcome in the home at any reasonable time. They are also encouraged to take part in the care planning process and attend reviews of care. One resident goes home for occasional weekends with her family. Friendship groups are supported and residents can see their friends outside the home on arrangement. Spiritual needs of residents are supported and the manager stated that a member of the local clergy visits monthly for worship. Some residents will attend church on special occasions. The menu is planned on each Friday for the coming week with input from residents. The manager stated that residents support each other in choice, likes and dislikes. The menu seen was appropriate to the residents’ needs and requirements. The manager stated that residents are reminded the day before of their choice of food and are offered an alternative choice if required. The residents stated that the food was good. Meals are served in two dining areas in a relaxed and unhurried atmosphere. The manager informed the inspector that residents have free access to the kitchen and can make drinks and snacks throughout the day. All staff who handle food hold a current food hygiene certificate. Middle West DS0000013719.V340785.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. Residents receive personal care in a way they prefer. Appropriate arrangements are in place to meet the health, emotional and medication needs of the residents in a respectful manner. EVIDENCE: Residents are supported in their personal care needs as outlined in individual care plans. All residents are registered with local GPs and are well supported by them. They can either visit the surgery or the GP will visit residents in the home. Dental care is accessed in a local practice and residents see the dental hygienist every three months. Chiropody treatment is available in the local resource centre, and the manager stated that she has a certificate of competency in chiropody and can cut residents’ toenails. There is a medication administration policy in place and all staff who administer medication have undertaken training in this procedure. Two staff administer medication and check and sign the medication balance daily. The medication recording charts were seen and are well maintained. There are clear audit trails of medication and a book of returned medication is kept. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 14 Currently there is one resident who self medicates and there are clear risk assessments in place for this procedure. There is a list of homely remedies in place and all medication is stored safely. Middle West DS0000013719.V340785.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. Residents’ views are listened to and they are protected from abuse. EVIDENCE: The home has a complaints procedure in place, which is part of the service user guide. All residents have access to a copy of this, which is kept in their bedrooms. The manager stated that she has explained this procedure to the residents and there have been no complaints since the last inspection. Relatives also have access to a copy of this procedure. There is an abuse awareness procedure in place and staff confirmed during discussion that they are aware of this procedure and had undertaken training in this. There is also a copy of Surrey’s Multi-Agency Policies and Procedures on Safeguarding Vulnerable Adults in place and the manager stated that she had attended training in these procedures. Middle West DS0000013719.V340785.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and homely environment. The standard of cleanliness is excellent. EVIDENCE: The residents live in a homely, well maintained and comfortable home, which meets their individual and communal needs. Bedrooms are both single and shared and are decorated and furnished to a good standard. These are personalised to reflect individual personalities. Communal space includes a spacious lounge, large dining room and a large conservatory overlooking a well-maintained garden. The kitchen is domestic in appearance and is well equipped. The laundry is situated at the back of the house. The standard of hygiene and cleanliness is excellent and there is an infection control policy in place. Middle West DS0000013719.V340785.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. JUDGEMENT – we looked at outcomes for the following standard(s): 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. A competent staff team supports residents. The home follows safe recruitment practice. EVIDENCE: The staffing arrangements were discussed with the manager and are satisfactory to meet the current needs of the residents. It was recognised that these arrangements need regular reviewing to meet the changing needs of three residents. Two staff members were spoken to in detail and confirmed that they had undertaken induction training and attend regular update training. They both confirmed that they had a contract of employment and job description. They also stated that they attend regular staff meetings and feel supported by the staff team. Two staff have NVQ Level 3 and one staff member stated that she was attending the local college to help with her English and that she intends to undertake NVQ Level 2. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 18 Regular supervision is undertaken and recorded in individual supervision records. The recruitment procedures in place are safe and protect the residents living in the home. Four staff employment files were seen and contained all the required employment documentation including an application form, two written references, an employment history and a CRB (Criminal Records Bureau) disclosure number. Middle West DS0000013719.V340785.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well managed home, that promotes their health, welfare and safety. EVIDENCE: The home is well run by the registered manager who is also the provider. She has over twenty-five years experience in the provision of care to residents with a learning disability. Her husband and co-owner is mainly responsible for the administration of the home. Staff confirmed that they felt supported by the management structure within the home. Quality assurance systems are in place. The manager demonstrated that she sends resident and relative surveys with positive feedback. These are retained on file in the office. Resident and staff meetings also take place and records are also kept of these. Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 20 The standard of record keeping is satisfactory and records sampled included needs assessments, care plans, medication recording charts, menus, duty rotas, employment records and supervision records. However, on examination of the procedure relating to the management of residents’ personal finances, there were no bank records available in the home. The manager stated that these records were currently being kept in the provider’s own home for updating. A requirement has been made that all records relating to residents’ care and welfare are to be kept in the home at all times for inspection. The home promotes health and safety and a wide range of policies and procedures were seen during the inspection. All staff undertake induction training relating to these procedures in line with TOPSS. This includes food hygiene, first aid, medication administration, manual handling, fire safety, challenging behaviour and COSHH. The fire safety practices were sampled. The fire alarms are tested and recorded weekly. Fire drills are undertaken every three months. There is a contract in place for the maintenance of the fire fighting equipment and emergency lighting. The reporting of accidents and incidents is satisfactory. Middle West DS0000013719.V340785.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 3 2 3 3 X 4 X 5 3 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 4 25 4 26 X 27 X 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 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 X 3 X 2 3 X Middle West DS0000013719.V340785.R01.S.doc Version 5.2 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 YA41 Regulation 17(a) and (b) Requirement The registered person must ensure that records, including documents and information relating to residents are maintained, and kept securely in the home at all times available for inspection. This includes individual financial records of residents’ accounts. Timescale for action 15/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI Middle West DS0000013719.V340785.R01.S.doc Version 5.2 Page 24 - 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. 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