Inspection on 27/09/05 for Nine Elms Lane

This inspection was carried out on 27th September 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nine Elms Lane 16/06/09

Nine Elms Lane 08/08/07

Nine Elms Lane 23/08/06

Nine Elms Lane 26/01/06

Nine Elms Lane 08/10/04

Nine Elms Lane 30/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Nine Elms Lane 87-89 Nine Elms Lane Park Village Wolverhampton West Midlands WV Lead Inspector Joy Hoelzel Unannounced Inspection 27th September 2005 12:30 Nine Elms Lane DS0000017190.V256292.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 Nine Elms Lane DS0000017190.V256292.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. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nine Elms Lane Address 87-89 Nine Elms Lane Park Village Wolverhampton West Midlands WV 01902 833730 01902 833731 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) Lonsdale (Midlands) Limited Miss Kay Michelle Andrews Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Learning Disability who may also have phyiscal disability Learning disability with Guardianship or supervision orders under the Mental Health Act 1983 8th October 2004 Date of last inspection Brief Description of the Service: 87-89 Nine Elms Lane is a care home providing accommodation, personal and nursing care for seven adults with learning disabilities. It is privately owned by Lonsdale (Midlands) Limited. The home is located in a residential area of Wolverhampton overlooking park lands. Local shops and amentities are a short walk away. The property is a two storey building providing single private accomodation, communal lounge and dining areas. The home has a passenger lift for access to the first floor. There is adequate parking to the front of the building with enclosed gardens to the rear. Nine Elms Lane DS0000017190.V256292.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 over four hours on Tuesday 27th September 2005 and is the first of the two statutory inspections for 2005/06. Three care staff, the manager and a registered nurse were on the premises at the time of the inspection. Seven people are currently residing at the home. Three clients were out as various day centres and four people and were at the home engaged in various activities. One care plan was inspected in depth, together with supporting documents, discussions were held with residents and staff, and a tour of the building was conducted. What the service does well: What has improved since the last inspection? The recruitment and selection procedure has been reviewed and now includes all the necessary checks being carried out prior to a person starting working at the home. A registered manager has been recruited to have overall responsibility of the day-to day management of the home. She is fully supported by a knowledgeable deputy, first level nurses and support workers. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 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. Nine Elms Lane DS0000017190.V256292.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 Nine Elms Lane DS0000017190.V256292.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): 1,2 The home does not have a current statement of purpose or service user guide, without these documents prospective service users or other interested parties do not have the information needed to make an informed choice as to the suitability of the home. However, appropriate procedures are in place that would enable the successful admission of new clients to the home. EVIDENCE: The statement of purpose and service user guide have not been produced and are still unavailable to clients, and other interested parties. The manager stated that there has been no new admissions since the last inspection, the home and other professionals, prior to any prospective clients moving into the home, carry out pre-admission assessments. Nine Elms Lane DS0000017190.V256292.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): 6,7,9 Staff evidently highly respect clients rights and there is a constant monitoring and review process to ensure that their identified needs are being met and very individualised care given EVIDENCE: The care plan is initially generated from the pre admission assessments and is then reviewed and updated at regular intervals. Regular interdisciplinary reviews are carried out with the clients involvement and/or representative when ever possible. The care plan inspected included a behavioural record chart based on the antecedent, behaviour, and consequence model to record incidences of challenging behaviours enabling a clear picture of any possible likely triggers to the behaviours. The plan inspected included risk assessments for the identified hazards or potential hazards with the plan of care including clear instructions ensuring the aim of the plan is achieved. However, this client was assessed as being at very high risk of developing pressure areas but a care plan had not been instigated for the action needed to reduce the risk. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 10 The manager stated that whenever possible clients are fully involved in the care planning process but due to some cognitive problems it is not always appropriate and in such cases advocates would be accessed. Nine Elms Lane DS0000017190.V256292.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): 12,13,15,16,17 The home provides a good quality and unique lifestyle for the people in residence. Clients are potentially being placed at risk by not being offered a well-balanced or nutritious diet. EVIDENCE: At the time of the inspection two clients were out at the day centres, two other clients access regular placements at the day centres. The manager stated that the local college has been contacted for possible placement of another client. During the afternoon two clients and staff went to the local shops and park. Social and leisure activities are arranged on an individual basis by the staff for each client. Contacts with families and friends is actively encouraged, one client has regular overnight stays at the family house. Daily routines are fairly structured, the care plan included a day care activities plan with activities and likes and dislikes recorded in the dairy sheet. One client was watching a Charlie Chaplin DVD and was thoroughly enjoying it. Food shopping, meal planning, preparation and preparing are the responsibility of the staff. The evening meal was being prepared, by a care staff member Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 12 during the inspection, and consisted of Cornish pasty, chips and beans. The staff member stated that for dessert ice cream would be offered. There was no ice cream available in the freezer. On observation of the weekly menu it did not appear to be nutritious or well balanced. Most meals on the menu were of a snack type and did not include fresh vegetables. A bag of potatoes and some onions were the only fresh produce on the premises. No fresh fruit or fruit juices were available. The manager had earlier stated that clients were gaining weight rapidly and on inspection of the menus it was clear to see why. The manager stated that the menu is to the preferences of clients, nevertheless, the menu must be reviewed and revised, be well balanced nutritionally and offer true choices. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 The personal and health needs of clients are very well met with evidence of regular review and of good multi disciplinary working taking place on a regular basis. EVIDENCE: The care plan indicated that referrals to other healthcare professionals are carried out when a problem has been identified and include visits from the district nurse, G.P., chiropodist etc. The home operates a twenty eight day regime of medication administration. Staff administer the medications to all the residents for whom medication is prescribed. Printed dispensing labels are attached to the Medication Administration Record (MAR) sheet, the labels are prone to coming unstuck therefore handwritten instructions are required. Tubs and tubes of creams were observed to be in use, the date of opening had not been placed on the containers. The dispensing instructions on a packet of tablets were different from the instructions on the Medication Administration Record chart. One client had been prescribed risperadal and had been signed on the Medication Administration Record chart as having been given earlier in the day, the tablets were not in the medication cupboard and the empty packet could not be found. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 14 The manager stated that they were out of stock and had not been reordered in the usual way. The surgery was contacted during the inspection and a repeat prescription was obtained. The fridge for storing medications that require a low temperature for safe storage was open when the instructions on the front of the fridge stated ‘to be kept locked’. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Staff are sensitive to, and have developed systems to identify, what clients like, dislike or object to in a commendable manner, complaint procedures and practices are in place. EVIDENCE: The home has a satisfactory complaint procedure, a copy of which is readily available. The registered manager stated that alternative formats could be available if required. The Commission for Social Care Inspection have not received any complaints since the last inspection. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 The standard of the environment is good, providing clients with a homely and comfortable place to live, some minor attention to detail would further enhance the quality of the home. EVIDENCE: Furniture and fittings provided at the home is domestic in character, some redecoration of bedrooms and communal areas has been completed. The curtains have not been replaced since the dining room has been redecorated. The settee in the lounge must be repaired or replaced as the inner foam is exposed. The manager explained that there have been problems with the central heating boiler needing repair and being out of use whilst waiting for the repair. Portable electric heaters were used to maintain the temperature of the building and were still in the lounge and dining room. To prevent accidents when these are in use they must be secured or a guard placed around them. When not in use they should be safely stored away. Some hand and bath towels were seen to be very worn and frayed. One bedroom had a malodour; the manager explained that the carpet was cleaned on a regular basis to attempt to control the odour. It is recommended that the carpet be replaced with easily cleanable flooring. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 17 The first floor bathroom and laundry did not have any suitable hand washing facilities. In all communal areas and private areas where staff assist with personal care, and to reduce the risk of cross infection, adequate hand wash facilities must be provided and include liquid soap, paper towels and a lidded disposal bin. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Clients are supported by a well trained and committed staff group who are meeting the needs of each individual in a sensitive and professional manner. However, regular staff supervision is needed to ensure that this continues. EVIDENCE: The home is led by registered nurses and supported by a team of care workers. Staff were observed to be sensitive to the needs of the client group and they demonstrated good knowledge of personal preferences. The staff training matrix indicates that National Vocational Qualification training, core topics and specialist subjects continue to be arranged for and attended by the staff. Two staff personnel files evidenced that the necessary checks are carried out prior to starting work. Formal staff supervision continues to be arranged at irregular intervals and not taking place every two months. The staffing complement remains at the agreed levels with the manager, 1 registered nurse and three support workers during the day and at night one registered nurse and one support worker. The manager currently has twenty five hours a week allocated supernumery time. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,42,43 There are clear lines of accountability within the home’s management structure and within the organisation. EVIDENCE: The manager is a first level nurse with the skills and knowledge to successfully manage the home on a day-to-day basis. She has yet to complete the Registered Managers Award due to difficulties at the college and having recently had maternity leave. A date for completion has been agreed for March 2006. It is highly recommended that completion of the course occurs as soon as is practicably possible The mop and bucket stored in the laundry were observed to be dirty and in need of a good wash or replacement. The annual, monthly and weekly safety checks continue to be carried out at the specified times and records kept. The business and financial plan for the home and service was not available. The manager was requested to obtain a copy and forward it to the local office of the Commission for Social Care Inspection. Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 20 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 1 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 1 CONDUCT AND MANAGEMENT OF THE HOME 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Nine Elms Lane Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 2 DS0000017190.V256292.R01.S.doc Version 5.0 Page 21 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 1 Regulation 5 Requirement The Registered Provider needs to ensure that there is a service users guide; this must be available to all service users and their advocates. Previous timescale of 30/11/04 not met A care plan must be developed for service users at risk of developing pressure areas; to include the action needed to reduce the risk. The registered person must ensure that meals are provided are wholesome, nutritious and varied. The dispensing instructions of medications must be accurately handwritten on the Medication Administration Record charts and checked for accuracy by another member of staff. The registered person must ensure that prescribed medications are ordered at the correct time to ensure continuity of the treatment. The registered person must ensure that the dispensing DS0000017190.V256292.R01.S.doc Timescale for action 30/11/05 2 6 12(1)(a) 31/10/05 3 17 16(2)(i) 31/10/05 4 20 13(2) 31/10/05 5 20 13(2) 31/10/05 6 20 13(3) 31/10/05 Nine Elms Lane Version 5.0 Page 22 7 20 8 9 10 11 12 20 24 24 24 30 13 36 14 15 42 43 instructions are correct and return any discrepancies to the pharmacy. 13(3) The registered person must ensure that the date of opening tubes and pots of creams is placed on the container. Tubs and pots of creams must be discarded 28days after opening with tubes discarded after three months. This being for possible contamination and cross infection purposes. 13(2) The fridge for storing medications must be kept locked when not in use. 23(2)(c) The settee in the lounge must be repaired and /or replaced. 13(4)(a)(c) Portable electric heaters must be securely guarded when in use. 16(2)(c) The registered manager must ensure there is a good supply of bath and hand towels. 13(3) The registered manager must ensure that suitable hand washing facilities are available in the communal and private areas of the home 18(2) The Manager must ensure that there are procedures in place to ensure that all staff have supervision at least 6 times a year and an appraisal annually. Previous timescale of 30/11/04 not met 13(4)(a) The mop and bucket must be thoroughly washed after each use and/or replaced. 25(3)(c) The registered person must forward a copy of the business and financial plan to the local Commission for Social Care Inspection office. 31/10/05 31/10/05 31/10/05 31/10/05 30/11/05 31/10/05 31/10/05 31/10/05 31/10/05 Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 23 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 30 37 Good Practice Recommendations It is recommended that the carpet in the bedroom be replaced with easily cleanable flooring. It is highly recommended that the registered manager completes the Registered Managers Award course as soon as is practicably possible, but no later than 31/03/06 Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE 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 Nine Elms Lane DS0000017190.V256292.R01.S.doc Version 5.0 Page 25 - 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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