Inspection on 03/07/06 for Monica Close (8 and 9)

This inspection was carried out on 3rd July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Monica Close (8 and 9) 16/11/05

Monica Close (8 and 9) 07/07/05

Monica Close (8 and 9) 24/01/05

Monica Close (8 and 9) 21/06/04

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 Monica Close (8 and 9) 8 and 9 Monica Close Radlett Road Estate Watford Hertfordshire WD24 4GZ Lead Inspector Angela Dalton Unannounced Inspection 3rd July 2006 11:00 Monica Close (8 and 9) DS0000019471.V301717.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 Monica Close (8 and 9) DS0000019471.V301717.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. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Monica Close (8 and 9) Address 8 and 9 Monica Close Radlett Road Estate Watford Hertfordshire WD24 4GZ 01923 250561 01923 250561 FP 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) Walsingham Awaiting Application Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16th November 2005 Brief Description of the Service: 8 and 9 Monica Close is registered to provide care and accommodation for up to 6 adults, under the age of 65, with a learning disability. The home is managed by Walsingham and comprises two semi-detached houses, each of which can provide accommodation for three adults with learning disabilities. The home is situated in a quiet residential neighbourhood in Watford close to the many amenities of the town centre and within easy reach of public transport. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection consisted of a site visit by one Inspector on 3rd July 2006. Number 8 Monica Close is under going a major refurbishment and both service users have temporarily moved out. Two vacancies exist across both houses. One service user has recently moved to an environment better able to meet his needs. Staff have coped well with a number of staffing vacancies and regular agency staff have provided support. Two service users are currently living at Number 9 Monica Close and the Inspector met with both. One service user spent a proportion of time with the Inspector providing a good insight into the care and support they receive. The manager was present for the start of the inspection but left to take personal belongings to the service user who has recently moved. Some requirements have been made to evidence information that could not be gathered during the visit. What the service does well: What has improved since the last inspection? Number 8 Monica Close is being refurbished with maintenance issues identified at the previous inspection being addressed. The source of the leak causing the damp ceiling has been identified and the bathroom is being refurbished. Most of the house is being recarpeted and redecorated. A service user with complex needs has moved to a more suitable home where the environment is more suitable and staff are equipped to meet his needs. This occurred last week and service users and staff are adapting to this change. Staff vacancies are due to be filled in the near future to achieve a full staff team and ensure a consistent approach. The garden has been maintained and summer containers were displayed. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Monica Close (8 and 9) DS0000019471.V301717.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 Monica Close (8 and 9) DS0000019471.V301717.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 The Statement of Purpose could better reflect the suitability of the premises and current service users. Individual needs are assessed and form the basis for the care plan. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is aware that the assessment process will focus upon Monica Close being equipped to meet any new service users’ needs. This will avoid any repeat of the difficulties the home has previously experienced regarding challenging behaviour. No new service users have yet been identified for the home but an assessment is available for use during this process. A recommendation has been made for the Statement of Purpose to reflect that Monica Close is unsuitable for service users with complex needs. Monica Close (8 and 9) DS0000019471.V301717.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 Care plans are informative but valuable information is missing. Service users make informed choices enabling them to live full and varied lives. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were inspected and contained a wealth of information. Staff recognised that care plans would benefit from an overhaul due to the amount of historical information available. A good standard of care is delivered and staff (both permanent and agency) know service users’ needs well. Care plans could better reflect how staff successfully manage mental health needs and what individual triggers are and how they are managed. This was in place for one service user but not another. A requirement has been made. Individual requests are met and where a risk may be involved a risk assessment is completed. Service users have very full lives: one service user acts as a self-advocate for POWHER (an advocacy provision), attends the local church and plays badminton. They also attend a work placement three days a week. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 10 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 Service users fully participate within the community. Mealtimes are service user led. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated above service users have a presence in the local community. They have a good relationship with their neighbours and one service user who attends church takes part in the social aspect of her religion. The night before the inspection service users had been to the local pub. Low staff cover occasionally affects service users’ opportunities but it is hoped that this will be addressed in the near future. Service users are dependent upon public transport or staff vehicles if they wish to go out. One service user has a boyfriend and they stated that they were able to meet at home if they wished. The size of 8 and 9 Monica Close does impede upon service users’ privacy, as the lounge is also the dining room. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 11 Meal times are dictated by service users and they confirmed that they plan the menus and are supported to do this. A delivery from a supermarket took place during the inspection. Up until a week ago there were 3 service users but only 2 dining chairs. Staff are unable to eat with service users – a requirement will be made in the premises section of the report to rectify this. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 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): 18,19,20 Service users’ individual wishes are respected. Health needs could be better reflected in care plans to reflect good care delivery. A safe medication system is not in place. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users confirmed that they were encouraged to be independent and the care plans supported this. As stated earlier care plans contain a wealth of information but guidance was lacking regarding one service user’s mental health. Staff evidently support this individual extremely well but there was no reflection of how this is achieved. Another care plan contained guidelines but they had not been reviewed for some time. A requirement has been made. As there are only currently two service users it may be an opportune time to streamline care plans and review them to ensure all necessary information is contained. The Inspector recognises that staff have been under pressure regarding staff shortages and worked with challenging situations for an ongoing period of time. Medication was reviewed and a number of issues were identified: tablets that were not in a blister pack did not reconcile and amounts were not recorded on the MAR sheet; Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 13 discontinued medication had been scribbled out on the Medication Administration Record Sheets (MAR) rendering them illegible; opening dates had not been recorded on containers. As there were only 2 service users these issues must be addressed before they escalate. Medication storage temperatures were at the maximum level and this must be monitored especially in the current hot weather. A more suitable cooling system could prove beneficial as this room is also the sleep in room and ventilation is limited. Monica Close (8 and 9) DS0000019471.V301717.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 Service users views are encouraged and incorporated into the running of the home. The financial system does not safeguard service users or promote financial involvement. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints policy is in place and the manager is developing this to ensure it is user friendly for residents. Staff are aware of the Adult Protection policy and a copy is available in the home. Regular service user meetings are held and one resident is a self-advocate for an advocacy organisation which they promote at home. One service user stressed that they would always bring any problems or concerns to staff. The financial system that is in place is open to abuse. Records are stored on the computer and all staff have access to this. Records could be changed without trace. It appear a complicated system: staff record money taken out in an individual book but no balance is noted (that is kept on the computer); receipts are filled out but in order for the Inspector to check the balance a staff member had to collate all the invoice vouchers. This system does not foster service users’ independence and they are not involved in financial matters as they are not computer literate. Staff do not record their signature anywhere to reflect financial balances have been checked. This system must be reviewed to protect service users form potential financial abuse and encourage involvement in financial matters. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 15 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): 24,28,30 Furniture and furnishings are in poor condition and inadequate. Communal space is limited. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Number 8 Monica Close was not inspected as major refurbishment work is taking place and service users have moved out temporarily. Number 9 Monica Close was generally clean and tidy. The home was odour free and infection control measures are well observed. Soap and hand towels are available throughout the home. The exception to this was the extremely stained lounge carpet. All the lounge furniture is faded and the arms of both settees are broken. As stated earlier there are only two dining chairs which do not enable service users to invite friends for meals or to invite staff to eat with them. Mealtimes are valuable social occasions which cannot be enjoyed due to the lack of furniture. The doorbell is broken at Number 9. Communal space is limited as there is only a lounge diner available for use. A recommendation has been made to explore ways to address this issue. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 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): 32,34,35 Staff know service users well and work together as a team. They are competent to meet current service users’ needs. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team has coped with challenging situations of late: reduced permanent staff, refurbishment and relocation of service users, managing challenging behaviour and a service user moving to a new home. Staff did not receive training to assist them to manage challenging behaviour and senior management must be mindful of this as it placed staff and service users at risk. A recruitment programme has commenced and it is hoped that a permanent staff team will be achieved in the near future. There are currently only four members of permanent staff. The manager endeavours to use regular members of Agency staff. No new staff had been recruited since the previous inspection. The manager agreed to notify CSCI when permanent staff are employed. Mandatory training occurs but staff would benefit from specialist training to assist in caring for service users. The manager is currently exploring options available. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 17 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): 37,39,42 The manager is not registered with the Commission. The health and safety of service users and staff is not assured. A Quality Assurance report has been requested to evidence Walsingham’s monitoring system. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has yet to register with the Commission and a requirement has been made to do so. Staff spoke highly of the manager’s support and their positive approach to dealing with current difficulties. A requirement has been made to submit evidence of how Walsingham ensure quality assurance. Some health and safety issues were identified as part of the Inspection: door wedges were being used and a safe alterative must be employed; one staff member has been in post for a year but has had no fire training; one service user chooses to remain in their room during fire drills and refuses to leave but there is no protocol in place; Service users at Number 8 have no night staff but no protocol is in place as to how they receive staff assistance or summon help if needed. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 18 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 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 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 2 2 X 2 X 2 X X 2 x Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 19 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 YA19 Regulation 12,15 Requirement Care plans must explain how individual health needs are monitored, managed and met. Regular reviews of information must occur to ensure up to date information is in place. A safe medication system must be in place. The financial system must ensure service users are protected from financial abuse and promote financial involvement. Furniture must be in good condition and suitable for service user and staff use. A maintenance programme must be submitted to the Commission to reflect when identified issues will be resolved. Confirmation of when work is completed at Number 8 Monica Close is required. The manager must register with the Commission for Social Care Inspection. A report evidencing how Quality Assurance is monitored must be submitted to CSCI Door wedges must not be used DS0000019471.V301717.R01.S.doc Timescale for action 31/07/06 2. 3. YA20 YA23 13(2) 13(6) 31/07/06 31/07/06 4. YA24 23 31/07/06 5. 6. 7. YA37 YA39 YA42 8 24 13(4) 31/07/06 30/09/06 04/07/06 Page 20 Monica Close (8 and 9) Version 5.2 8. YA42 13(4) and a safe and suitable alternative be employed. The health and safety of service users and staff must be assured. 31/07/06 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 Refer to Standard YA1 YA28 Good Practice Recommendations It is recommended that the Statement of Purpose better reflect that Monica Close is unsuitable for service users with complex needs. Communal space in the home is extremely limited. Options should be explored as to how this could be improved. Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Monica Close (8 and 9) DS0000019471.V301717.R01.S.doc Version 5.2 Page 22 - 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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