Inspection on 25/10/05 for Milbury 46 Flambard Road

This inspection was carried out on 25th October 2005.

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milbury 46 Flambard Road 07/07/08

Milbury 46 Flambard Road 15/08/07

Milbury 46 Flambard Road 20/03/07

Milbury 46 Flambard Road 20/04/06

Milbury 46 Flambard Road 01/06/05

Milbury 46 Flambard Road 11/01/05

Milbury 46 Flambard Road 26/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 46 Flambard Road 46 Flambard Road Harrow Middlesex HA1 2NA Lead Inspector Ms Sue Barker Unannounced Inspection 25th October 2005 08:45 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 46 Flambard Road Address 46 Flambard Road Harrow Middlesex HA1 2NA 020 8907 5896 020 8907 5896 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 Community Services Nigel McCann Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2005 Brief Description of the Service: 46 Flambard Road is registered to provide care and accommodation to a maximum of 8 adults (aged 18-65) who have learning disabilities. The Registered Provider is Milbury Community Services and the Registered Manager is Mr Nigel McCann. The care home is on located on a suburban road fairly close to central Harrow and Kenton. It is close to a variety of shops, health and social care facilities and services, public transport and other community leisure facilities. The building is on two floors. All bedrooms are single and are located on both floors. The home has a lounge, dining room and conservatory/smoking room. There is a small laundry room and kitchen. There is a large garden to the rear of the property. The home has some parking spaces on the front driveway. are some metered street parking places available. Otherwise there The home usually has its own vehicle that can be used by residents to access the community, providing there is a member of staff on duty who can drive. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on mild Tuesday morning in late October. It began at 8.45am and ended at 13.55pm. The Inspector was pleased to spend time talking with some residents, staff on duty and Mr McCann. In addition time was spent with Ms Angela Duce (the Line Manager for 46 Flambard Road) on what was her final visit to the care home before leaving the post. One resident kindly confirmed that they were currently satisfied with the service available in 46 Flambard Road. It was also acknowledged that there were things in the house that needed sorting out. The Inspector spent much time viewing the communal areas of the care home and a large number of items requiring attention were noted. Whilst the Commission for Social Care Inspection has been informed of Milbury’s plans for updating the building, it must be maintained in an adequate state of repair for residents whilst also maintaining adequate levels of health and safety. Items noted included state of repair of the building, broken light fitments and trip hazards. An Immediate Requirement Notice was issued regarding the state of the building and non-compliance will result in enforcement action being considered. What the service does well: What has improved since the last inspection? The Inspector noted a calm atmosphere in 46 Flambard Road during the unannounced inspection. There was documentary evidence to confirm that residents’ needs have been reassessed since the last unannounced inspection as was required. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 6 Staff have access to policies and there are strategies in place that aim to protect residents from abuse and neglect in 46 Flambard Road. Observations during the unannounced inspection indicated that residents are becoming staff’s primary focus. There was clear evidence to confirm that the management focus of the care home is very much on resident’s development and inclusion in the house routines. Residents are now supported by a fairly stable team of care staff in 46 Flambard Road, with all vacant posts filled, pending receipt of satisfactory checks. There was evidence of the training that staff undertake in order to provide an effective level of care and support to residents. 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. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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): 2 Residents’ care and support have been reviewed in order to ensure that their needs and aspirations are identified and (where possible) met by the care home. EVIDENCE: Mr McCann indicated that no new residents were being assessed for the vacancy in the care home. No new residents had been admitted to 46 Flambard Road since the last unannounced inspection. In addition it was noted that representatives from their respective funding authorities were reviewing all the current residents’ care and support needs. There were care plans in place for all the residents living in 46 Flambard Road. One resident kindly mentioned that they had recently had a review meeting. Staff spoke about residents’ varying contact with their families. The care home is registered to provide personal care and support to adults aged 18-65 years who have learning disability. Throughout the unannounced inspection it was apparent that some residents also have significant other needs that fall within other categories of care. The Registered Provider must consider the registration of the care home and submit an ‘Application for Variation of Conditions of Registration’ in respect of those residents for whom their need for care and accommodation in 46 Flambard Road falls outside the current registration of the care home. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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 Residents have care plans in order to ensure a consistency of their care and support. Residents’ care plans have been reviewed in order to ensure that their care and support goals/aspirations are up to date. EVIDENCE: Two residents’ care plans were briefly viewed during the unannounced inspection and their current needs and aspirations were discussed with staff on duty and one resident. Care plans included information about the resident’s personal preferences and choices. It was gathered that staff meet with residents on a monthly basis to review the progress in meeting their care plan goals. Reviews had identified a resident’s aspirations. Staff spoke about individual resident’s preferences. Individual care plans included evidence of reviews having been carried out. The Inspector acknowledged that staff had worked on the care plans. All residents have named key workers from within the staff team. One resident stated that their key worker had changed a lot. Mr McCann spoke about different strategies that had been introduced for staff in order to work more effectively with residents. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 10 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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): EVIDENCE: The key standards were assessed at the previous unannounced inspection. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 12 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): 20 The storage and administration of medication in 46 Flambard Road presents as mostly a safe service for residents. EVIDENCE: The medication cupboard was viewed during the unannounced inspection. It was well ordered. The contracted pharmacist supplies a blister pack system of medication administration to the care home. Mr McCann indicated those issued that had been highlighted during his review of the care home’s medication systems. One of the consequences of this review is that two members of staff sign to record that prescribed items of medication have been administered to the resident. No evidence of medication training having been made available to staff was viewed. This therefore remains an outstanding requirement. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 13 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): 23 Strategies are in place that aim to protect residents from abuse and neglect in 46 Flambard Road. EVIDENCE: Mr McCann indicated that all staff have undertaken training in Protection of Vulnerable Adults. This training was discussed during the unannounced inspection. This training was not recorded in individual staff files. The care home has a copy of the London Borough of Harrow Protection of Vulnerable Adults from Abuse policy that is located in the office. Within the sample of staff files viewed one member had undertaken training in ‘Non Violent Crisis Intervention’. Mr McCann spoke about his strategy in terms of the ethos of the care home, namely to focus on residents at all levels and the achievement of their care/support goals and aspirations. This has included the implementation of new strategies and ways of working with those residents who challenge the service in 46 Flambard Road. Examples of these new strategies were viewed during the unannounced inspection. A number of incidents occurring in the care home have been reported to the Commission for Social Care Inspection as required. This reporting includes what subsequent actions have been taken and outcomes. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 14 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 Residents do not live in a homely, comfortable and safe environment within 46 Flambard Road. EVIDENCE: The Inspector viewed the communal areas of the home and the garden. Staff had recently painted the dining room and were planning to paint other areas of the care home. Many requirements were noted in order to maintain basic levels of health and safety for residents and staff. They are: • • • • • • • Repair or replace dishwasher as its handle is broken exposing the wiring. The laundry flooring is lifting by the back door therefore creating a trip hazard. The kitchen cupboards and plinths are in a very poor state of repair with areas of exposed chipboard and broken cupboards and doors. Many door handles in the building were broken. Communal areas of the building are in a poor state of decorative repair other than the lounge. The ceiling lights in the kitchen were mostly not working making this area dark and potentially unsafe to work in. The kitchen cupboards need cleaning. DS0000017532.V257027.R01.S.doc Version 5.0 Page 15 46 Flambard Road • • • • • • • • • • • • • • • • Ventaxias in the building must be repaired where not working. In addition some were very dirty and must be included in the cleaning schedules for the care home. The laundry walls and flooring are not impervious. The laundry needs cleaning particularly areas behind the machines. There was evidence of a leak in the laundry adjacent to the sink. The toilet seat in the ground floor toilet is loose, worn and in need of replacement. There is a hole in the ground floor toilet door. Soap and paper towels must be provided with wash hand basins in order to maintain adequate levels of hygiene in the care home. Some of the fence panels in the garden were broken and in need of repair. Lounge carpet requires deep cleaning or replacement if the stains are indelible. Items such as cardboard boxes and the vacuum cleaner are stored in the boiler room. This must be addressed in terms of the Fire Risk Assessment for the care home. The boiler room door did not self-close positively. The lobby area outside the ground floor bathroom is extensively cracked. All fire doors in the building must be self-close positively. Carpet on the stairs is coming away and could potentially present a trip hazard. The first floor bathroom requires extensive work. The light fitment cover was missing, flooring is extensively marked, cracks in ceiling, tiles around the bath are broken and areas of grouting missing. Furniture in the communal areas presented as in a poor state of repair. An ‘Immediate Requirement Notice’ was issued. The Registered Provider must ensure that: 1. An audit of the building is carried out identifying those areas that require immediate attention, with Action Plan to the Commission for Social Care Inspection for agreement by 14/11/05. 2. Required works must be completed by 25/12/05. The Registered Provider has responded to the Commission for Social Care Inspection on this matter. There remain outstanding requirements from the previous unannounced inspection in respect of standards 24, 25, 27, 29 & 30. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 16 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): 35 Residents are supported by a fairly stable team of care staff in 46 Flambard Road. There was evidence of the training that staff undertake in order to provide an effective level of care and support to residents. EVIDENCE: The Inspector viewed a sample of 2 individual staff files during the unannounced inspection. A record is maintained of staff induction and training. This included training in Fire awareness, Protection of Vulnerable Adults from Abuse, Client Handling, key Working, First Aid and Health & Safety. The Deputy Manager indicated that 2 staff are shortly undertaking training in Food Hygiene. In addition 2 staff are doing training in supervision and appraisal. A record is maintained of the Induction that new staff undertake. In one of the examples viewed the induction record had not been completed so it was unclear. It must be ensured that staff complete a structured induction programme within 6 weeks of appointment that is recorded. There were 4 support staff on duty during the unannounced inspection in addition the Care Manager and Deputy Care Manager. One resident receives 1:1 staff support. This was incorporated into the shift plan for the morning of the unannounced inspection. Mr McCann stated that there were 3 support worker staff vacancies in 46 Flambard Road that had been recruited to. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 17 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 18 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 & 42 Residents benefit from living in a care home where they are is clear management focus on their development and inclusion. EVIDENCE: The key standards were inspected at the previous unannounced inspection. Mr McCann spoke about his management aims for the care home. This includes the staff focus becoming residents and their inclusion in the daily routines of the care home wherever possible. In addition Mr McCann is working to establish an effective and informed staff team in 46 Flambard Road. Mr McCann stated that the health and safety arrangement for the care home have been under review. This includes the development and review of risk assessments. There remains an outstanding requirement regarding the required tests and inspection of equipment at the home that must be carried out, with Certificates of Worthiness available at the home for inspection. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x x x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 2 x 2 x 2 2 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 46 Flambard Road Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x DS0000017532.V257027.R01.S.doc Version 5.0 Page 20 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 YA2 Regulation 12 Requirement The Registered Provider must consider the registration of the care home and submit an ‘Application for Variation of Conditions of Registration’ in respect of those residents for whom their need for care and accommodation in 46 Flambard Road falls outside the current registration of the care home. The Registered Provider must ensure all staff are appropriately trained in the administration of medication. (Previous timescale of 30/07/05 not met) Comply with the ‘Immediate Requirement Notice’ within the stated timescales. The Registered Provider must ensure that: An audit of the building is carried out identifying those areas that require immediate attention, with Action Plan to the Commission for Social Care Inspection for agreement by 14/11/05. 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 21 Timescale for action 25/01/06 2 YA20 18 25/12/06 3 YA24 23 14/11/05 3 4 YA24 YA24 23 23 5 YA24 23 6 YA24 23 7 YA25 23 8 YA27 23 9 YA29 23 10 YA30 16 Required works must be completed by 25/12/05. The Registered Provider must ensure that the home is fit for the purpose for which it was intended and that the safety of residents is assured. (Previous timescale of 30/07/05 not met) The Registered Provider must ensure outstanding renovation repairs and upgrading work at the home is carried out without further delay. (Previous timescale of 30/07/05 not met) The Registered Provider must provide a plan of action to the Commission for Social Care Inspection detailing the work to be done and the start date. (Previous timescale of 30/07/05 not met) The Registered Provider must ensure the residents’ bedrooms are equipped to meet their individual needs and maintained in an acceptable condition. (Previous timescale of 30/07/05 not met) The Registered Provider must ensure there are an adequate number of bathrooms and toilets that are appropriately equipped to meet the needs of residents at home. (Previous timescale of 30/07/05 not met) The Registered Provider must ensure that the home has the appropriate equipment and mobility aids to meet the needs of residents individually and collectively. (Previous timescale of 30/07/05 not met) The Registered Provider must ensure the home is adequately DS0000017532.V257027.R01.S.doc 25/12/05 25/12/05 25/12/05 25/01/06 25/01/06 25/01/06 25/01/06 25/12/05 46 Flambard Road Version 5.0 Page 22 11 YA35 17 12 YA42 23 cleaned, including individual rooms and communal areas. (Previous timescale of 30/07/05 not met) It must be ensured that staff 25/01/06 complete a structured induction programme within 6 weeks of appointment that is recorded. The Registered Provider must 25/12/05 ensure that all required tests and inspection of equipment at the home are carried out. Certificates must be available at the home for inspection. (Previous timescale of 30/07/05 not met) 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 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 46 Flambard Road DS0000017532.V257027.R01.S.doc Version 5.0 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. 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. 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