Inspection on 07/07/05 for Monica Close (8 and 9)

This inspection was carried out on 7th July 2005.

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 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) 03/07/06

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

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 Monica Close Radlett Road Estate Watford Herts WD24 4GZ Lead Inspector Jeffrey Orange Unnnounced 07 July 2005 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 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 Stationary 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 I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Monica Close Address 8 and 9 Monica Close Radlett Road Estate Watford Herts WD24 4GZ 01923 250561 01923 250561 Telephone number Fax number Email 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 Vacant Care Home only 6 Category(ies) of LD 6 registration, with number of places Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 24 January 2005 Brief Description of the Service: 8 & 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 I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 8.40 a.m. which provided an opportunity to observe the morning routine in the home as the residents prepared to leave for day centres and college. It was possible to speak to four of the five residents and also to members of staff both permanent, newly appointed and agency. The new acting manager had only started three days previous to the inspection visit, following a period that had included several key staff changes. It was evident both from records and talking to the acting manager and members of staff, that the service had been under some pressure, both because of those staff changes and also because of additional demands put on the service by one resident. What the service does well: What has improved since the last inspection? What they could do better: The standard of record keeping and in particular the administration of medication has deteriorated since the previous inspection in January 2005. The general tidiness of the home and its gardens has also deteriorated. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 standard(s) 2,5 This is a very stable resident group with no recent admissions to the home. The policies and procedures for assessment that are in place, together with a close working relationship between the home and the placement authorities should ensure that only someone whose needs can be met appropriately and satisfactorily at Monica Close would be considered for admission. EVIDENCE: Existing resident’s files include evidence of a robust and thorough assessment process. In the past, advice has been sought from the Commission for Social Care Inspection (CSCI) on the suitability of prospective residents, which demonstrates an open, partnership approach on the part of Walsingham. This is also borne out by evidence on files of close working relationships with social workers and other health and social care professionals, all of whom would be involved in decisions about admissions to the home, as appropriate. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 standard(s) 6,7,9,10 The care planning process of the home provides, when fully and regularly completed, for a comprehensive system of assessment and review, with the full participation of residents as part of a genuinely person centred approach to meeting their needs and maintaining independence within a risk assessment context. EVIDENCE: Care plan documentation was tracked for one resident and found to be comprehensive in scope although the recent level of completion was not at the standard previously found in the home. The CSCI have been kept very fully informed where events occur which adversely affect the well-being of residents. It was possible to track and progress both from records and in conversation with staff specific action taken by the home in response to recent examples of this. Residents were seen to be preparing drinks, “packed lunches” and cleaning their rooms, under appropriate, discreet supervision and again the staff’s relationship with residents was seen to be very supportive and not directive. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 10 As one care plan seen had the resident’s PIN number prominently and clearly displayed towards the front of the file, it is imperative that at all times unauthorised or inappropriate access to this information is prevented. It may be advisable to consider keeping such very sensitive information where it is not likely to be easily accessed in error. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 standard(s) 12,13,15,16 Residents are encouraged and enabled to develop their interests and participate in a range of social, leisure and learning activities based on their own goals and preferences. EVIDENCE: “I go to college and play darts”…. “We are going to the pub tonight” These were some of the comments made. One resident was having a day off, but was considering what she could do with staff, another was attending a multi agency review outside of the home, and three were going or had already left for college or day centre. Care plans included evidence of a range of different activities being undertaken by residents, together with a variety of contacts with families and friends in the community. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 standard(s) 18,20 Recent changes in staff and the home’s management have put additional pressure on the home, which has led to some deterioration in the standard of medication practice and recording and has tested the ability of the management to provide consistent support to residents by a stable team of permanent staff. EVIDENCE: The use of agency staff has increased, although the home does attempt to use agency staff who already have some experience of the home and its residents. There have been a number of errors in the recording and administration of medication and whilst these have in most cases been noted and action taken in line with the home’s policy on medication errors, the frequency of these has given rise to some concern. A further example of the non- recording of medication was found during this inspection and a medication error had been discovered on the previous day. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 standard(s) 22,23 Residents are well protected from abuse, neglect and self-harm by a thorough and robust system of policies, procedures and staff training. EVIDENCE: The home’s complaints policy has been seen, together with details of policies and staff training in the recognition of abuse and what to do if it is suspected. Throughout the inspection staff were seen to be first seeking the views of residents and then to be providing care in a way that reflected those views and preferences. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 standard(s) 24,30 The overall feel of the home is comfortable and homely and it provides a pleasant and safe environment for its residents. The home and gardens are currently rather untidier than they could be if some simple clearing of clutter inside and out was undertaken. EVIDENCE: The bathroom in one house has been fully refurbished and is now very pleasant for residents to use. Both lounges are very well furnished and by the end of the inspection the standard of cleanliness in the home’s communal areas was much improved. The grounds are rather untidy with, for example, mops and old curtain rails left in the garden. The grass and borders also now need attention. Internally there are boxes of pictures, and poles leaning up in the lounge and there was a definite odour in one kitchen area, which was drawn to the attention of staff. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,36 Recent staff changes in conjunction with additional demands placed on staff by one resident have provided a period of some challenge for the home, the results of which are reflected in this report. EVIDENCE: The commitment of the existing staff team has enabled the home to maintain a good standard of care for residents despite the challenges they have faced. Staff shortages and increased demands in respect of one resident have led to some deterioration in record keeping and particularly in medication practice. The recent appointment of a temporary manager will, it is hoped, enable the home to effectively maintain the frequency and standard of key working and supervision in the home. Where agency staff are employed by the home, it remains the homes’ manager’s responsibility to ensure that they have the necessary skills, training and experience for them to carry out the role assigned to them. (See requirements) Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,40,41,42 In a period when the home is experiencing a loss of manager and some senior members of the staff team, the focus of the home has remained firmly on the health, safety and welfare of the residents. EVIDENCE: Where lapses in medication administration have occurred, they have usually been identified, if not entirely eliminated. Local care plan reviews and national policies demonstrate that Walsingham involves its service users in its national and local policy making and planning. The standard of some records has not been maintained at the previous high level. This has however been recognised and there appears to be a genuine commitment to address this. The acting manager and her staff were very open and helpful throughout this inspection and demonstrated a high degree of commitment to the welfare of Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 17 the residents. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score 3 x 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Monica Close Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 3 2 3 x I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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 20 Regulation 13 Requirement Timescale for action From 7.7.05 and thereafter. By 31.7.05 2. 20.10 3. 33 & 35 The registered person must make arrangements for the recording, handling and safe administration of medication. 18(1)(c)(ii In the light of recent failures the ) manager must review the training of all staff, permanent or agency, who are involved in the administration of medication in the home. 18(1)(b)& The registered person must (c) ensure that the employment of any person on a temporary basis, does not prevent service users receiving reasonable continuity of care and that all staff, permanent, temporary or agency are suitably qualified, competent and experienced in order to appropraitely meet the needs of service users. From 7.7.05 and thereafter. 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 I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 20 Monica Close 1. 2. 6.1 & 6.3 10 3. 30 Care plan documentation should be reviewed and brought up to date where required to fully reflect any recent changes in goals, progress and activity. The manager should review how residents PIN numbers and any other very sensitive financial access information can be best protected from unauthorised or accidental access. The home and grounds should be inspected to see where routine cleaning, clearing or garden maintnance could improve the experience of living in the home for residents. Monica Close I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts 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 I52_s19471_Monica Close_v237005_070705_stage 2.doc Version 1.40 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. 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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