Inspection on 29/01/07 for Money Lane, 1

This inspection was carried out on 29th January 2007.

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

Other inspections for this house

Money Lane, 1 13/07/07

Money Lane, 1 22/02/06

Money Lane, 1 14/07/05

Money Lane, 1 07/10/04

Money Lane, 1 25/06/04

Money Lane, 1 18/06/03

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Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

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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 Money Lane, 1 West Drayton Middlesex UB7 7NU Lead Inspector Jean Stuart Key Unannounced Inspection 29th January 2007 12:00 Money Lane, 1 DS0000027066.V324533.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 Money Lane, 1 DS0000027066.V324533.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. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Money Lane, 1 Address West Drayton Middlesex UB7 7NU 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 430 687 01895 430 687 hmo29varley@mencap.org.uk www.mencap.org.uk Royal Mencap Society Gail Andrea Varley Care Home 5 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user can continue to be accommodated over the age of 65 years old, as agreed by the Commission For Social Care Inspection on 23rd November 2004, whilst the home can meet the needs of all service users. The home must advise the CSCI when the service user no longer resides at the home. 22nd February 2006 Date of last inspection Brief Description of the Service: Money Lane is a care home registered to provide care for five adults with learning disabilities and mental health needs. The property is owned by New Era Housing Association and managed by MENCAP. The home is located in a quiet residential area of West Drayton close to local shops and transport links. The service users bedrooms are located on the ground and first floor and there are bathroom facilities on both floors. There is a lounge, kitchen and separate dining room on the ground floor and a small office/sleeping in room for staff on the first floor. There is a well maintained garden to the rear of the house. The range fees are £249 to £377. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out on 29 January 07. The inspection involved examination of care documentation, a tour of the premises, and discussions with the area manager, service users and staff. The inspection took five hours. The home continues to work on improving the service but is lacking the direction of a registered manager. Five services users forms, four relatives forms, and seven health care professional survey forms were sent out. Five service user (100 ), four relatives (100 ) and two health care professional (14 ) survey forms were returned. People were most positive about the service offered. The overall standard of the home is perceived by the CSCI as adequate. This is primarily a reflection on the section looking at the conduct of the home And the health and safety of service users. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that the quality of a person’s life is not dramatically reduced by the presence of another service user. The home needs to ensure that a person is registered as manager. A variation of registration must be completed for the resident whose needs are outside of the homes remit. Outstanding health and safety issues and environmental issues must be dealt with. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 6 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. Money Lane, 1 DS0000027066.V324533.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 Money Lane, 1 DS0000027066.V324533.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment focuses on ensuring that the facilities and care services provided meets peoples needs. 2 EVIDENCE: All the service users have lived at the home for some time. No service users have been admitted to the home since the last inspection. It was seen that Mencap carries out their own assessment procedure for any prospective service user. From this assessment a decision is made as to whether or not the home can meet the service users needs. A satisfactory assessment is completed. When needs dramatically change service users are reassessed, and for one service user this has shown that the home no longer meets their needs, an alternative placement is being sought. Money Lane, 1 DS0000027066.V324533.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are firmly committed to supporting all service users, to do this effectively all areas of risk must be identified. 6,7,9. EVIDENCE: Service users reported that they liked living in the house. The survey forms supported this. Two service users disliked the shouting/screaming noise made by another service user. When one service user expressed reluctance to go downstairs for lunch because of the noise, a member of staff suggested they could have lunch in the kitchen with the door shut. The service user agreed to go downstairs. Service users support needs and preferences are outlined in their care plan. This promotes the values of choice and independence documenting how people Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 10 make their own decisions concerning their lifestyle. This was also reflected on the returns from service users. Three care plans were seen, a good record of their daily life is maintained. With the exception of one service user appropriate care is delivered. The care plan for one service user whose needs are changing, had been updated. Old information remained on file for one aspect of their care, however the information does not give a clear message to carers. Overall the home is not meeting this person’s holistic needs and is not able to provide suitable care for the person. Risk assessments are available for all residents. For one individual their changing needs are not reflected in a risk assessment. This was organised prior to the inspector leaving the house, but to ensure the service users safety this should have already been in place. A recent event at the home demonstrated that the risk assessment for ensuring service users do not have access to kitchen knives has not been adhered to. There has been no repeat of this incident and staff reported that the incident reminded them of the need to be careful. Service users reported that they were given choices about what to do with their time, and enabled to make decisions. Money Lane, 1 DS0000027066.V324533.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): 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 make choices and develop their life skills. 12,13,15,16,17. EVIDENCE: Service users are able to enjoy a full and stimulating life. The one exception to this is a service user whose needs are not being fulfilled. Efforts are being made to find more suitable accommodation.The majority of service users have regular daily activities. One service user reported that they go to day care, another individual reported that they go to college. Outside of the working day routines are flexible and can be changed to meet individual needs. Service users confirmed that activities are arranged around their preferences. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 12 Service users go out to clubs where they meet with their peers. One person attends a local church where “there are plenty of people to talk with”, another individual uses the local community centre to attend a diet club (although no longer, on a regular basis). Service users expressed interest in activities at home. One person said they really enjoys music and was happy to show their wide collection of compact discs. Another person has an interest in recycling. One individual is planning to go on holiday and has bought board games tol spend more time indoors and save money for the holiday. A list is maintained in the kitchen of peoples’ daily routines. For one person this reflected an activity which is no longer a regular occurrence. For two others their programme appeared to be empty. However these two individuals spend time with one to one workers with them. This must be recorded. Contact with family is encouraged by the home. One resident chooses to go home most weekends. For another resident a family member visits the home. One resident is planning a holiday away with their family. This shows good links with family members. The home keeps the required record of food served, this covers every meal. A relative reported there is “very good food”. Service users reported “staff are good” and it was observed that staff converse in an appropriate manner showing service users respect. Service users demonstrated that they are take part in the running of the home, helping a member of staff to unload the shopping from the car, debating the menu, and helping to prepare the evening meal. Money Lane, 1 DS0000027066.V324533.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. 18,19,20. EVIDENCE: The staff team give service users the opportunity and support to remain independent. Support given is responsive, flexible and reliable. Staff were observed maintaining the privacy and dignity of service users, and personal care needs are appropriately met. Personal support is as far as possible provided by a person of the same gender if stated in the care plan. To prevent inequality due to physical needs technical aids are available to maximise residents’ independence. Service users health care needs are noted in a record of physical and health needs. The record demonstrates when they have received medical treatment. Service users receive medication from the staff. Liquid medication is now Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 14 dated. The area manager reported that “Boots” have recently completed their own checks on medication. A member of staff reported that they had completed medication training. The training files showed medication training for staff had taken place, the area manager confirmed this. Good medication practice protects the well being of service users. The one area of medication practice that needs improving is that of consent. A person who has dementia has rapidly changing medication needs for which they cannot give consent. Consent to give medication must be gained from an appropriate person. Money Lane, 1 DS0000027066.V324533.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel safe and supported by staff at Money Lane. 22,23. EVIDENCE: Service users indicated that they would “talk to staff “if they were unhappy and they have “no need to complain”. Five survey forms were returned from service users, all had been completed with the support of another person. Relatives returned four forms. One relative indicated that they had complained in the past, but “staff are now efficient and professional”. All staff are trained in the protection of vulnerable adults. There is a clear procedure for the reporting of any suspicion or allegation of abuse. The home has a system for the recording and handling of service users money or valuables. This was checked for two service users and found to be correct. The area manager reported that the home has not received any complaints in the last year. The CSCI had not received any complaints. The low level of complaint is a measure of the level of satisfaction felt by the service users, their families and the professional involved with service users care. Money Lane, 1 DS0000027066.V324533.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and clean environment, which encourages their independence. 24,25,26,29,30. EVIDENCE: One service user reported that they “like this room” (their bedroom). Individual bedrooms provide homely accommodation for service users. Rooms were observed to be clean and free from offensive odour. For one resident their independence is promoted through the use of a tripod walking aid and a handrail to help them get into bed. There are two communal areas offering service users a choice of where to sit. The lounge and dining area are comfortable. The area manager reported that Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 17 the house is due for redecoration this year, this is well timed as the walls of the dining room are scuffed and starting to look tired. On previous inspections a requirement was made for the kitchen flooring to be replaced. This was due to be completed two weeks ago but is still awaited. The flooring in the hall way is also damaged by a recent water leak. The leak has now been resolved, the area manager reported that the flooring is to be replaced. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The regular team has the skills, knowledge and expertise to meet the needs of the service users. The same level of expertise is required from agency staff. 32,34,35. EVIDENCE: A service user reported that they “feel cared for”. Regular staff members who ensure the needs of the individuals are known and are met care for Service users. A relative reported that “staff are friendly”. The service has a group of staff all who have or are completing National Vocational Qualifications (NVQ) level three. The area manager feels it is possible to commence with this level of NVQ as all staff have received skills for care induction and foundation training. Training improves the quality of care staff deliver. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 19 The needs of one service user have changed. Additional one to one time is available for this individual. The time for the service user is not structured, nor is it provided by an individual with a familiarity with dementia. The home provides a service for people who have learning disabilities, the staff lack training in the dementia field. For appropriate care to be given it is necessary for this person to move to another care facility. One to one time is also available for another resident. Neither of the staff members are listed on the rota. Anyone paid to contribute to service user’s care must be on the homes documents. Care plans are maintained, daily recording is being consistently completed by staff. It was not possible to see staff files as the neither the manager or deputy manager were present. The area manager reported that she has recently on a monitoring visit seen staff files and records of supervision, and satisfactory recruitment records are maintained. Staff reported on the good level of training provided by the organisation and confirmed that they received supervision. The general training file was seen this shows that staff had completed NVQ training, food hygiene, first aid and other courses. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home lacks the direction provided by a registered manager, resulting in reactive care rather that proactive planning. 37,39,42. EVIDENCE: The home has not had a registered manager for some months. The person who has applied for registration is currently absent from work. On two of the four forms returned by relatives anxieties were reported concerning “the continuity of management”. The deputy manager has the experience to run the home and is to apply for the post. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 21 The home currently has one service user who is outside of the registration. The needs of this person are not being met by the home. Indeed the quality of life for others is reduced by the presence of this service user. The home must apply for a variation of registration, and find a more suitable placement. It was noted that fire doors are still propped open. One service user reported that they “like the door to be open, I do not want the door to be closed”. It was suggested to the area manager that they should speak with the fire officer to see if open doors can be accommodated at any time. If this is not possible a way of maintaining services users safety must be found. The home has risk assessments in other areas of client care but these are not current or always actively followed. Notifications to the CSCI of events in the home involving service users showed a pattern of behaviour that challenged the system. This is an indication that needs were not being met. This pattern has not been repeated since this date and the home is meting people’s needs. A service users meeting was held on the 18 January 07. The record shows that service users dislike the screaming by one resident. This was also reflected in the survey forms. On the inspection three people reported their dislike of the noise made by one resident. An individual reported that a “ person will be joining the home when another person who makes a noise moves on” demonstrating an awareness of planning by senior staff. Service users receive care that is regularly reviewed. Records are routinely completed. The deputy manager has recently taken steps to ensure that efficient systems are in place to monitor staff adherence to policies and procedures. An example was seen of this as carers checked the homes monies as a part of their shift. The home now has a new quality drive, this looks at risks around financial, internal and external risks, and compliance with standards. Mencap conducts a annual survey of service users views. A service user stated that they had recently had a form asking him about the house and if they liked living there. The area manager reported that this was a audit by head office and all results are centralised. Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 22 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 x 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 2 25 3 26 3 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 3 32 x 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 2 x 2 x 3 x x 2 x Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 23 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 YA9 Regulation 13(4)(c ) Requirement The registered person must ensure that action is taken to minimise identified risks in the home. The registered person must ensure that a service users consent, or that of an appropriate person is obtained and recorded. The registered person must ensure that premises are well maintained and floor covering is replaced in the kitchen and hall. The registered person must ensure that a manager for the home is proposed and appointed. The registered person must ensure the health, safety and wellbeing of service users is maintained. The registered person must ensure that fire safety is maintained in the home. Previous timescale 14/07/05 and 30/4/06 were not achieved. Timescale for action 31/03/07 2. YA20 13(1)(b) 31/03/07 3 YA24 23(2)(b) 31/03/07 4 5 YA37 YA42 18(1)(a) 12(10)(a) 31/05/07 31/03/07 6 Ya42 23(4)(a) 31/03/07 Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 24 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 Money Lane, 1 DS0000027066.V324533.R01.S.doc Version 5.2 Page 25 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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