Inspection on 28/06/05 for Reddown Road (37)

This inspection was carried out on 28th June 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

Reddown Road (37) 18/03/09

Reddown Road (37) 15/04/08

Reddown Road (37) 02/07/07

Reddown Road (37) 23/06/06

Reddown Road (37) 25/10/05

Reddown Road (37) 02/11/04

Reddown Road (37) 15/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Reddown Road (37) 37 Reddown Road Coulsdon Surrey CR5 1AN Lead Inspector Lee Willis Announced 28 June 2005 10:15 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. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Reddown road (37) Address 37 Reddown Road, Coulsdon, Surrey, CR5 1AN 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) 01737 559 309 01737 559 309 Milbury Care Services Limited Mr Gavin Ainslie Care Home 8 Category(ies) of Learning Disability (8) registration, with number of places Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: A variation has been granted to allow one specified resident over the age of 65 with a learning disability to be admitted. Date of last inspection 2nd November 2004 Brief Description of the Service: 37 Reddown Road is a residential care home that is owned, managed and staffed by Milbury Care Services a public limited company that specialises in providing accommodation and personal care for adults with learning disabilities. The home is registered with the CSCI to take up to eight service users. There are seven male service users all aged between 50 and 70 years of age currently residing at the home. Gavin Ainslie continues to be the registered manager of the service, a post he has held since June 2003. The home itself is a large detached property situated in a quiet residential street in Coulsdon, a suburb to the South of Croydon. The home is within walking distance of a variety of community based resources, including some local shops, resturants and pubs. The home also has its own transportation and is within 200 metres of a small local train station and several bus stops. There have been no significant changes made to the homes physical environment since the last inspection and the property still comprises of eight single occupancy bedrooms, a large L shaped lounge/dinning area, a games room, sensory facilities, kitchen, laundry room, and first floor office. There are sufficient numbers of toilets and bathrooms located near service users bedrooms and communal areas. The garden at the rear of the property has a raised lawn which can only be accessed by steps, and a small patio area with a bench. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 10.00am. It took place over one six hours on Tuesday 28th June 2005. People living at the home, their families and staff at the home had all been made aware that this announced inspection was due. All seven of the service users currently residing at the home were met at various times throughout the course of the day and appeared to be well cared for and relaxed. The majority of the service users use distinct modes of non-verbal communication to express their wishes and feelings. During the course of this inspection several of the service users and members of staff were observed to be interacting with one another in a very respectful and friendly manner. A total of eight comment cards were returned to the Commission, the majority of which were completed by service users relatives. Care Managers representing placing authorities completed two of the cards and another was returned by a service users’ General Practitioner. All the comments made were extremely positive about the quality of the service being provided and in particular the professionalism shown by the manager and his staff team. To quote a card completed by one of the service users relatives, “I am extremely satisfied with the care my relative is receiving at Reddown. The staff seem enthusiastic, friendly and patient”. None of the service users relatives or their other representatives, including Care managers, were met in person at the inspection, although one of the homes immediate neighbours was spoken to at length about concerns she had about the service. These issues are addressed in the main body of this report. The rest of the inspection was largely speaking to the homes registered manager, although a couple of members of staff who were on duty at the time were also met. A large proportion was also dedicated to examining records and touring the premises. In the past twelve months the home has been inspected twice, in accordance with the Care Homes Act 2000. No additional visits or complaints investigations have been carried out by the CSCI in this time, although Croydon Council’s Vulnerable Adult Protection Team has convened several strategy meetings to investigate alleged abuse at the home since the turn of the year. The allegation of abuse was subsequently upheld and a disciplinary hearing is to be held agree action to be taken. What the service does well: In each of the homes three previous inspections reports the number of new as well as outstanding areas of concern the Commission has had about the service has been steadily falling. There are no outstanding requirements that need to be carried over into this report, and the total number of new Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 6 requirements stands at just three. Since the appointment of Gavin Ainslie as the homes manager nearly two years ago the service users and staff have all benefited from his leadership approach, which is both open and inclusive. . What has improved since the last inspection? What they could do better: The positive comments made overleaf notwithstanding, there are still some areas that the service could improve upon. This includes staff recording of medication administered in the home. An unacceptable number of errors were noted were staff had failed to sign for medicines given. Staff will need to be reminded to be more vigilant in this area of practice. The rolling programme to redecorate all the service users bedrooms needs to be completed. Finally, the homes new management team believe that the home would benefit from some team building exercises in order to boost staff morale and improve their communication with one another and other social/health professionals. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 7 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. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 8 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 Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 9 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 & 4 The homes admission procedures are very robust ensuring that there is a thorough assessment of prospective service users needs prior to them moving in. This information will guide staff on the action to be taken to ensure all prospective new service users needs are planned for and met. EVIDENCE: The home has accepted two new referrals since April 2005. Records indicate that the needs of these service users were assessed by the manager and covered every aspect of their personal, social and health care needs. The homes latest admission is privately funded and was referred as an emergency placement. The service providers have established an excellent emergency admissions policy, which clearly sets the service providers procedures. The manager stated that in accordance with these rules the homes latest admission was assessed within five working days. A copy of the needs assessment carried out by a Care manager representing the homes other new referral was made available on request. The manager stated that all prospective new service users are initially placed on a three months trial period of residency before any decision about whether or not to make the move more permanent is ever taken. This process enables all the stakeholders, including the prospective and existing service users, their relatives, Care managers and staff working at the home to be consulted about the ‘suitability’ of a particular placement. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 10 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, 8, 9 & 10 Care plans and assessments of risk accurately reflect service users current needs and set out in sufficient detail what support each service user requires They provide guidance for staff to follow, which enables them to support service users take responsible risks and achieve their personal goals. EVIDENCE: Care plans sampled at random were all clearly based on service users individuals needs assessments and covered every aspect of their personal, social and health care needs. In the past twelve months the service providers have introduced a new care plan format that is evidently person centred and focuses not only on each service users individual needs, but their own unique goals, and more specifically, what support they will each require to achieve these identified goals. The new format is extremely well set out and easy to access. Having asked to see what guidelines the home had in place to enable staff to communicate more effectively with the service users, the manager was able to produce this information within seconds of requesting it. Furthermore, staff questioned about particular service users communication needs were evidently familiar with each service users preferred method of communication. Plans sampled at random also referred to service users food/drink preferences and social interests. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 11 Records indicated that the care plan for the homes most recent admission had been reviewed within the first three months of the individual’s arrival, in accordance with Milbury Cares own admission procedures. In attendance at the review was the prospective new service user, five members of his family, a solicitor, his recently assigned keyworker, and the homes manager. It was clear from care plans and comments made by staff that service users would gain little from having their own meetings. However, the manager has established other arrangements to ensure the service users are able to participate in decision making within the home. Records indicate that in the last three months all seven of the service users designated keyworkers have raised issues at staff meetings on their key service users behalves. The minutes of these meetings also revealed that one service user in particular likes to participate in staff meetings on a regular basis. Staff spoken with on the day of the inspection seemed to be very familiar with their key service users preferred modes of communication, food preferences and leisure interests. This sentiment was echoed by the relative of one service user who wrote on a comment card, “ my son’s appointed carer has been very kind to him and understanding of his needs”. A comprehensive collection of risk assessments are included in each service users care plan, and set out in detail what action needs to be taken by staff to ensure identified risks and/or hazards are, so far as ‘reasonably’ practicable, minimised. One of the homes most recent admissions had risk assessments covering every aspect of their life’s, including personal care, kitchen safety, accessing the wider community, unplanned absences, epileptic seizures and how staff should support him with behaviours that challenge the service. Several members of staff said it was customary for them to actively encourage and support the service users to get involved with domestic chores around the house, (e.g. clearing up after meals ect), as part of a structured programme of promoting independent living skills. Information held about service users is still being stored on ‘open’ shelving in the first floor office. As required in the homes previous report the manager has developed a locked door policy, which has been incorporated into the visitor’s guide. This policy clearly states that when the office is not in use the room must be locked, a practice observed during the course of this inspection. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 12 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) 13, 15 & 17 Social, leisure and employment opportunities for service users to engage in, both inside the home and in the wider community are well managed, ‘age’ appropriate, and provide the service users with daily variety and stimulation. Dietary needs are well catered for and well balanced; nutritional meals, based on personal preferences are also being prepared and eaten by the service users. EVIDENCE: Each service user has a structured activities schedule for the week included in their care plan, which is clearly based on their unique social and leisure interests. From entries contained in a service users daily diary notes it was evidence that he had recently been bowling and on outings to the local park, Kingston and the cinema. In the afternoon a member of staff was observed actively encouraging three service users to join in a building game in the activities room. Another member of staff was seen supporting a service user to out. The member of staff said they planned to go and see a film at the local cinema with a service user who liked going to the cinema. The relative of one service user wrote on a comment card “ staff regularly take my son out shopping and do other interesting activities”. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 13 Since the manager’s appointment in June 2003 the number and variety of opportunities the service users have to participate in activities, both inside and outside the home, has improved beyond all recognition. The manager’s major achievement since his arrival has been to ensure sufficient space, by way of games and sensory rooms, as well as resources, are available in the home to prevent the service users becoming bored. Since the last inspection two members of staff have volunteered to become the homes activity cocoordinators. Records show that service users families are always invited to their love ones care plan reviews. The manager stated that there are no restrictions on ‘reasonable’ visiting times, a sentiment echoed in the homes new visitors policy. The menus displayed in the kitchen seemed to be nutritionally well balanced and varied. A member of staff said the menus are planned a week in advance and take into account the service users food and drink preferences. A member of staff who was cooking lunch at the time of our conversation seemed to be extremely well informed about different service users individual food likes and dislikes. At breakfast several service users were observed eating a variety of food and drink, which included cereal, toast, tea and orange juice. This meal was ‘unhurried’ and staff were observed appropriately assisting service users to eat their breakfasts, with verbal prompts and specialist eating aids. Appropriate eating aids are based on individual service users needs and includes anti-slip mats, plate guards and specially adapted utensils. It was positively noted that as recommended the homes previous report the manager had replaced the homes large dining room table with several smaller ones, which seems to make dinning in this room a far more relaxed and congenial experience for everyone concerned. The former dinning room table has been put to good use in the activities/games room. The manager stated that all the service users have been referred to a dietician for a nutritional needs assessment. As a result one service user is now on an approved low cholesterol diet and a list of foods they must avoid is included in their care plan. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 14 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, 19, & 20 Suitable arrangements are in place to ensure that service users physical and emotional health care needs are identified and met. Although the homes medications records were generally well maintained, an unacceptable number of recording errors were identified and more diligence in this area is required in order to protect the service users from avoidable harm. EVIDENCE: One service user has a specific mobility need and as required in the homes previous report an assessment was carried out by a qualified occupational therapist in June 2005. The recommendations made in the subsequent report have been implemented by the home. A number of the service users have incontinence needs and it was evident from care plans sampled at random that advice has been sought from the relevant community based healthcare professionals. It was positively noted that continence promotion and management strategies are include in individual service users care plans. It is hoped these measures will eventually reduce the need for incontinence pads in the home. The homes accident book revealed that two significant incidents had occurred in the home since the last inspection, both of which had resulted in service users being admitted to Accident and Emergency. Both incidents had been dealt with promptly at the time of their occurrence, reported to the Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 15 Commission in accordance with the Care Homes Regulations (2001), and appropriate action taken to, so far as ‘reasonably’ practicable, minimise the likelihood of similar incidents reoccurring in the future. An unacceptable number of recording errors where staff had failed to sign for medication administered in the home were found on several of the service users medication administration sheets. The manager has agreed to remind staff of their medication reporting responsibilities. All six members of staff ‘authorised’ to handle medication in the home have successfully completed an in-house medication competency assessment, a record of which is held on each of their staff files. Protocols for the use of ‘as required’ (PRN) medication, which includes clear instructions for staff about when and how to administer this type of medication, was made available on request. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 16 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 Service users relatives are on the whole confident that their concerns will be listened to, taken seriously and acted upon, in accordance with the homes written procedures. The homes vulnerable adult protection and abuse prevention measures that are in place are ‘suitably’ robust to ensure the service users are, so far as ‘reasonably’ practicable, protected from abuse, neglect and/or harm. EVIDENCE: An immediate neighbour met during the course of this inspection expressed concerns about the homes operation. The manager confirmed that issues had been brought to the homes attention in the past twelve months by this neighbour, which pertained largely to matters of privacy and in particular the size of the chicken wire fence that currently separates the rear gardens of both these neighbouring properties. Records show that the concerns raised were noted by staff and the manager informed the immediate neighbour at the time of this inspection that a plan of action was in the process of being drawn up by the service providers to erect a far larger and more ‘suitable’ wood panelling fence in the back garden. The immediate neighbour said she was satisfied with this response and now felt the concerns of her family were being taken much more seriously by Milbury Care. It is recommended that along with all formal complaints, less formal concerns, such as the one raised by the homes immediate neighbour, are included in the homes complaints book. The record should also include details regarding the outcome of any action taken in response to concerns raised, including ones received verbally. Since the last inspection there has been one allegation of abuse made within the home. The manager’s response to the situation was both appropriate and swift. The accused member of staff was immediately suspended from duty, in Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 17 accordance with good practice protocols, and all the relevant professional bodies were notified without delay, including the Croydon Councils vulnerable adult protection team, all the service users Placing/Funding Authorities, and the CSCI. Following several complex strategy meetings convened by the Local Authority it was agreed that the service providers must undertake an internal investigation into the alleged incident. The investigation concluded that in ‘all probability’ the incident took place. Consequently, the staff member involved was immediately dismissed and referred for possible inclusion on the Protection Of Vulnerable Adults (POVA) register by the service providers, in accordance with the Care Homes Act (2000). Documentary evidence was available on request to show that sufficient numbers of the current staff team had either received or were about to attend training in recognising, preventing and reporting abuse. Furthermore, it is compulsory for all Milbury care staff to attend an accredited two-day training course in the use of non-violent crisis intervention. Staff must also attend an annual refresher course in the use of these non-physical intervention techniques. The manager stated that staff are not permitted to use physical interventions techniques in the home and that specific guidance for them to follow when dealing with aggression/challenging behaviour is included in individual service users care plans, as and when applicable. The home supports all the service users to look after their money. Records of all incoming and outgoing payments are appropriately maintained and receipts are kept for all items purchased by staff on service users behalves. Service users money is individually stored in lockable cash tins, which are kept in a secure place in the office. The running balances recorded on two service users financial balance sheets sampled at random matched the amounts held by the home on their behalves. In accordance with each service users terms and conditions of occupancy they are expected to contribute £5 a week to transport costs and the running of the homes vehicle. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 18 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, 26, 27, 28 & 30 Overall, the size and layout of the home, which is furnished and decorated to a reasonable standard, ensures the service users have a homely, safe and clean environment in which to live. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 19 EVIDENCE: Over the past year and a half most of the service users bedrooms and communal areas have been redecorated. There are also new soft furnishings, by way of carpets and curtains, throughout most of the home. Furthermore, the ramp in the lounge previously identified as a hazard in the homes last report, has now been made flush against the patio step to minimise the risk of service users tripping over it. Overall, the service users now live in a much safer, more comfortable and generally far ‘homelier’ environment. The manager stated that in the past year he has noted a marked improvement in the amount of time it is now taking Milbury Cares Maintenance team to respond to both routine, as well as more urgent, repair jobs in and around the home. As part of a plan to improve the homes physical layout for the benefit of the service users the manager is proposing to make further environmental changes by swapping the existing art/games room and kitchen over, and convert bedroom No#9 on the ground floor into a much larger sensory room. The former sensory room will then be converted into extra storage space. The service users will ultimately benefit from these proposed changes and the Commission agrees to them in principle. The manager is aware that before any alterations to the interior layout of the home can begin, building plans must submitted to the Commission for approval. Several bedrooms were viewed at random and were found to be very personalised and decorated to a good standard. Lots of electrical home entertainment equipment and personal effects, such as photographs and pictures, were noted in all the rooms seen. One service user has a new television set that is securely stored in a protective case to prevent it being damaged. The individual has access to a remote control and is able to choose which channel to watch. All the bedrooms are painted different colours, which were individually chosen by the service users. A member of staff stated that they recently visited a well-known DIY store with a service user to help them choose a colour scheme for their bedroom. Having viewed bedroom No#2 with the manager it was agreed that the room needed to be redecorated. As bedroom No#6 on the first floor looks out onto the street and several of the neighbours gardens it was agreed that some net curtains would need to be hung across the bay window in order to protect, not only the service users dignity, but also the immediate neighbours privacy. The damaged wall in the same bedroom will also need to be repaired and a doorstopper device fitted to prevent further damage reoccurring. Having tested the temperature of water running from the hot tap attached to the ground floor ‘Parker’ bath it was found to be a safe 40 degrees Celsius at 2.20pm. The manager stated that all the wash hand basins in service users bedrooms had been fitted with preset, fail-safe and tamper proof thermostatic mixer valves. The manager stated that an order for some ‘push down’ style Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 20 taps had been placed and would be attached to the wash hand basin in bedroom No#9 to minimise the identified risk of the bedroom being flooded. The first floor bathroom window, which was recently smashed by a service user, has been repaired using reinforced glass to minimise the risk of a similar incident reoccurring. The manager stated that the service providers own maintenance team repaired the window in a timely fashion. As previously mentioned, plans are being drawn up to relocate the kitchen and to replace all the existing units and old appliances with new ones. The manager also stated that Milbury Care has employed a new gardener, who has already visited the home to measure the fence, which is to be replaced, and generally look into ways of improving the overall layout and design of the back garden. Progress on these environmental matters will be assessed at the homes next inspection. The home has a comprehensive set of new infection control procedures which cover good working practices for the safe handling and disposal of clinical waste; dealing with spillages, including bodily fluids; the wearing of protective clothing; and hand washing. The manager stated that the home has a contract with the Local Authority to collect clinical waste on weekly basis. A member of staff met during the inspection was aware of the homes procedures for dealing with clinical waste and said he would always wear gloves when disposing of soiled incontinence pads. Used pads are kept in a bin in the ‘Parker’ bath, which is lined with a yellow and black clinical waste bag. Clinical waste bags, which become full, are then placed outside for collection. It was noted at the time of this inspection that the bin in the Parker bathroom had recently been emptied and that the full bag of soiled pads was left in this room. The manager stated that this practice was customary as the Local Authority were not willing to provide the home with a lockable bin for storing clinical waste outside, because of the small amounts of waste the home produced each week. It is acknowledged that the ‘Parker’ bathroom was free of any offensive odours at the time of this inspection, but nevertheless it is recommended that in accordance with good infection control guidelines, the manager should seriously consider purchasing a separate bin for storing full clinical waste bags outside prior to their collection. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 21 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, 32, 33, 34, 35 & 36 Progress has been made to ensure the home has a relatively stable staff team, which is in the main ‘suitably’ trained to meet the health and welfare needs of the service users. However, sufficient numbers of staff still need training to ensure they are suitably qualified and competent to meet all the service users specific autistic and epilepsy needs. The homes procedures for the recruitment of staff are sufficiently robust and provide the necessary safeguards to ensure that so far as reasonably practicable service users are not placed at risk of harm or abuse from individuals who are clearly not ‘fit’ to work with vulnerable adults. EVIDENCE: It was positively noted that the manager has introduced a quiz style questionnaire to facilitate the staff’s understanding of their various roles and responsibilities within the home. The manager and staff members on duty at the time of this visit were observed interacting with the service users in a very caring and respectful manner throughout the course of the day. The manager stated that all the service users currently residing at the home have designated keyworkers who are familiar with their key service users needs and routines. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 22 Records indicate that four members of the current staff team have been awarded a National Vocational Qualification in Care Level 2 or above and that another two are on course to have achieved this award by the end of 2005. With twelve members of staff currently employed by the home the service is just about on course to achieve the aim of having 50 of the staff team suitably trained to NVQ level by the end of the year (2005). The manager stated that Milbury Care have recently reassessed their training provision and are now fully committed to meeting the aforementioned objective. It is statutory for all the homes staff to register with the Learning Disability Award Framework as part of their induction training. It was positively noted that staffing levels have recently been reviewed and as a result numbers have been increased to four during the day to meet the changing needs of the service users, whose numbers have also increased in recent months following the admission of two new service users. Staffing levels appear adequate to meet the assessed needs of the service users at this time. The homes duty rosters revealed that no agency staff had been employed by the home in the past eight weeks. The home has experienced relatively low levels of staff turnover in the past six months ensuring a degree of continuity for the service users. The manager believes he has assembled a competent staff team, who generally work well together, although he concedes there is stillroom for improvement in this area, particularly with regard staff communication. The manager acknowledges that the largely black African and Afro-Caribbean ethnic mix of the current staff team does not accurately reflect that of the service users who are all white Caucasian males. The manager is aware of this cultural imbalance and said he will be mindful of it when he next recruits. Since the homes last inspection three new members of staff have been employed. All the new member of staffs files were examined in some depth and found to contain all the relevant information required by the Care Homes Regulations (2001), including a completed job application, two written references, the terms and conditions of their employment, a reference number to show that an Enhanced criminal records and police checks (CRB) had been carried out before these individuals were allowed to commence their employment, and proof of their identify. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 23 Staff records revealed that all new members of staff receive a structured induction as part of their initial training package, which starts on the day they commenced their employment, which is on going for up to six months, as part of their probationary period of employment. Sufficient numbers of the existing staff team have either received or are booked to attend a suitable training course in a number of core areas of practice, including fire safety, moving and handling, first aid and basic food hygiene. As previously mentioned, Milbury care have employed a new training officer who is in the process of arranging dates to ensure the current staff teams training needs are met. Having discussed training shortfalls with the manager it was agreed that insufficient numbers of the current staff team were ‘suitably’ trained to meet all the service users complex autistic and epilepsy needs. Staff records sampled at random revealed that the home has an annual appraisal system in place, which is being carried out by the manager for his entire staff team. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 24 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) 37, 38, 39, 40 & 42 The leadership style of the manager is a very open and inclusive one. Overall the homes periodic health and safety checks, including those associated with fire safety and prevention, are sufficiently robust to ensure the welfare of service users, their visitors and staff are promoted and that they are protected from avoidable harm. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 25 EVIDENCE: The registered manager has been in operational day-to-day control of the home for the past two years and has achieved a National Vocational Qualification Level 4 in Management and Care. Since the homes last inspection Julie Goodyear has been appointed the its new Operations Manager. There are clear lines of accountability within Milbury Care and the manager stated that his new line manager is always on hand to offer advice and support as and when required. Unannounced visits to the home continue to be undertaken by the new Regional manager in accordance with the Care Homes Regulations (2001). The manager stated that he continues to receive supervisions with his line manager at regular intervals. Records indicate that staff meetings continue to be carried out on a monthly basis and cover a variety of topics, including staff communication, activities, and menu planning. The home has a professionally recognised quality assurance system in place, which is used to seek the views of service users and their representatives, using questionnaires and surveys. Since the homes last inspection the service providers have completed the lengthy task of up dating and reviewing all the homes existing policies and procedures, as well as introducing new ones, to ensure they comply with current legislation and the National Minimum Standards for Younger Adults. The manager stated that there is an on going programme to ensure his entire staff read and understand the contents of all the homes new and updated policies and procedures. The home is well maintained and ‘suitable’ arrangements are in place to promote and protect the health and safety of the service users and staff. Inspection of the homes fire records indicate that the fire alarm system continues to be tested on a weekly basis and staff participate in fire drills at regular intervals (i.e. One every quarter). It was also positively noted that having sought advice from the Local Fire Authority all the homes fire extinguishers are now much more secure stored in wall mounted containers, which staff can still access quickly, in the event of an emergency. Up to date Certificates of worthiness were in place in respect of the homes passenger lift; fire alarms and extinguishers; and emergency lighting, as evidence that they had all been tested by a suitably qualified professional at least once in the past twelve months. Furthermore, the homes water heating had been checked in the past year for compliance with Legionella. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 26 Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 27 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 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 3 3 x 3 Standard No 11 12 13 14 15 16 17 x x 4 x 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Reddown Road (37) Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x 3 x G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 28 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(2) Requirement Timescale for action 1st September 2005 1st September 2005 1st January 2006 2. 26 3. 35 Staff must ensure records of all medicines administered in the home are appropriately maintained. 12(4)(a) Nets curtains need to be hung in & 16(2)(c) bedroom No#6 to ensure the privacy of the occupant is respected. 12(1) & Sufficient numbers of the current 18(1) staff team must be suitably trained to meet the autistic and epilepsy needs of the service users. 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. Refer to Standard 22 Good Practice Recommendations It is recommended that in addition to recording all formal complaints made about the homes operation the manager should also consider recording all the concerns raised, including any action taken in response. Bedroom No#2 should be redecorated within the next three months in accodance with the service users wishes. A suitable doorstopper device should be fitted in bedroom No#6 to prevent the wall being damaged further. G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 29 2. 3. 26 26 Reddown Road (37) 4. 5. 6. 30 32 33 The manager should seriously consider purchasing a seperate bin for storing clinical waste bags outside the home prior to their collection by the Local Authority. 50 of care staff to have achieved an NVQ level 2 or above in Care by the end of 2005. The manager should be mindful of the cultural imbalance that exists between the current staff team and the service users when recruiting new members of staff. Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 30 Commission for Social Care Inspection Croydon, Kingston & Sutton Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP 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 Reddown Road (37) G53-G53 S25829 Reddown Road V217273 280605.doc Version 1.30 Page 31 - 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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