Inspection on 17/12/06 for Richmond Close

This inspection was carried out on 17th December 2006.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond Close 10/12/05

Richmond Close 20/07/05

Richmond Close 16/12/04

Richmond Close 12/07/04

Richmond Close 23/03/04

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 Thaddeus House 18/20 Richmond Close The Leys Tamworth Staffordshire B79 7QS Lead Inspector Mrs Kathryn Marks Key Unannounced Inspection 17 December 2006 09:30 Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thaddeus House Address 18/20 Richmond Close The Leys Tamworth Staffordshire B79 7QS 01827 311991 01827 66988 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Walsingham Proposed Manager In Place Michelle Runcorn Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12 December 2005 Brief Description of the Service: Thaddeus House is registered to provide care for eight young people with a learning disability who need twenty-four hour support and guidance. The home is located in two semi-detached properties, owned by Focus Housing Association and operated by Walsingham. Each property provides accommodation for four young people and has its own kitchen/ dining and lounge facilities. The two houses have a connecting door and some shared communal areas like activities room and gardens. The home was operated as two family style environments and the service users were encouraged to live an independent lifestyle with support from staff. The home presents as clean, tidy and is pleasantly decorated, bedrooms reflect the individual service users personality and interests. Bathrooms and toilets are located throughout the home and are in close proximity of all bedrooms and communal areas. Access to all necessary health care services is available when required. There is a varied skill mix of staff providing support and care. Information gained from the Care Manager identified that the current fees charged are £605 to £729.65 per week. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out on Sunday 17 December 2006 between 2.30pm to 7pm. Examination of records systems and procedures along with discussions with staff and service users assisted with the completion of this report. As at the previous visit during the course of the inspection positive interaction was observed to be taking place between staff on duty and residents in the home. Service Users themselves were observed to be relaxed and comfortable in the presence of staff and each other. The proposed Care Manager provided written information regarding staffing, staff training, menu and dietary provision that was observed by the inspector to be in place at the home. On arrival at Thaddeus House service users were following their chosen pastime and visitors were in the building. Resident’s accommodation is located on the ground and first floor during a walk around the home the inspector’s observations were that the home was generally clean and well maintained to a high standard. Resident’s bedrooms were personalised and reflected the personality of the individual occupying the room. The home had in place a Statement of Purpose and Service Users Guide that provide information to prospective service users and their relatives about the service the home is able to offer. All new residents would have a full assessment of their needs carried out prior to admission to ensure their needs can be met at Thaddeus House. The current resident group have been at the home for some years since it opened and know one another very well. Good arrangements are in place for meeting the health and personal care needs of service users and details are recorded in care records. As at previous inspection a variety of social opportunities are available for individuals who wish to be involved at day services, at home and in the community. Observations of the menu identified that there is a choice of well-balanced and nutritious food available to residents that they choose, shop for and cook. The home has in place a complaints procedure this is also in pictorial form to promote the understanding of the resident group. The complaints procedure was discussed with some residents who were able to demonstrate an understanding of who to speak to. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 6 Seven comments cards were received from residents who had been assisted by key workers to complete them. Feedback on these cards was positive. One feedback card was received from General Practitioner who felt that the home should be recognised for promoting good practice in taking service users to health care practice. Two feedback cards were received from relatives. What the service does well: What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has in place a Statement of Purpose and Service User Guide providing service users and prospective service users/carers/relatives with details of the services the home provides enabling an informed decision about admission to be made. Assessments and preadmission visits would be carried out for all new residents. Standards 2, 4 were reviewed at this visit. EVIDENCE: Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 9 The Proposed Care Manager confirmed that all new prospective residents would be subject to a pre admission assessment to establish whether the home would be suitable to meet the individuals identified care needs. There is a static group of residents in the home and there have been no recent admissions. The current resident group have been at the home for some years. There was a formal pre admission assessment tool in place; information derived from this assessment provided the basis for the development of a care plan and a risk assessment. The Care Manager was aware of providing written confirmation to prospective residents with regards to the homes suitability to meet their needs, in compliance to regulation 14, of the Care Homes Regulations. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are made aware that their assessed and changing needs and personal goals are included within their individual plan of care. The philosophy of care, as laid out in the Statement of Purpose, promotes a home environment that will afford service users greater security, choice, independence and a good quality of life. Standards 6, 7, and 9 were reviewed at this visit. EVIDENCE: Following discussions with the proposed Care Manager records inspected showed that service users freely make decisions about their life in the home and what they are going to do with their time, based on a detailed risk assessed basis. As at previous inspection assessments, care plans and risk assessments were examined and found to offer an excellent record of daily living, which were comprehensive, and included a provider assessment; a person centred plan, a Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 11 health and safety assessment, and a planned intervention, rehabilitation and therapeutic programme. It was noted that each day had a different schedule of events encouraging therapeutic and social activities geared to meeting service users sense of belonging. Three service users were case tracked with an examination of care records, health records including risk assessments, records of reviews and action plans. All five-service users at home today were spoken with and accommodation visited. During the inspection service users spoken to in both houses were observed to be happy and interacting well with each other. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. As at the previous visit the home has successfully integrated with the local community, with evidence that neighbours play an active part in the social life of residents, and individuals being involved in various social and educational opportunities. Service users are encouraged to choose healthy options when shopping to ensure dietary needs are met. Standards 12, 13, 15, 16, 17 were reviewed at this visit. EVIDENCE: As at previous inspection service users’ life-styles and interests are recorded in their care plans, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. The recording of social opportunities was seen to be a valuable part of care reporting and planning and individuals used local community facilities on a daily basis with many varied activities being available. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 13 Individuals are encouraged to see family and friends and make them welcome in their home. Where service users develop personal intimate relationships advocates are sought and specialist guidance is given. The management demonstrated the strength of protecting service user’s rights, which was secured through the robustness of the procedures in place. This was confirmed on examination of records. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. A varied menu is available for service users, on a resident centred cycle, and represented a wholesome, appealing and varied balanced diet. The shopping and preparation is a joint undertaking involving residents and staff. Both houses had enjoyed a roast dinner today. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Observations of staff indicated that they had a very good understanding of the residents personal, emotional and physical support needs. The medication at this home was well-managed clear and comprehensive arrangements being in place to ensure service users medication needs are met. Standards 18, 19, 20 were reviewed at this visit. EVIDENCE: Observations today were that staff provided support as required to individuals in a sensitive way with principals of care being promoted. Flexible routines were observed to be in place and service users decided how they presented their own personal image. Individuals accessing health care practices of their choice supported by staff if necessary meet healthcare needs. Access by referral to specialist services is via general practitioner. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 15 Observations were that policies and procedures are in place for the administration of medication. Senior staffs are trained in the management of medication with medication being well managed, securely stored and medication administration sheets signed and up to date. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with some evidence that service users feel their views are listened to. In house and external training takes place to protect residents from abuse. Standards 22,23 were reviewed at this visit. EVIDENCE: As at the previous visit the complaints policy was seen and records examined. On discussions with the proposed Care Manager it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Service users spoken with said they would tell staff if they were unhappy about something and said staff listened to them. Observations of care records confirmed the effectiveness of a proposed care manager and staff sensitive to service users needs and readiness to test the robustness of their information and report structures. Residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially in protecting service users from abuse, of all types. All staff has received training on abuse, Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 17 Vulnerable Adults and social role Valorisation this is carried out on an annual basis. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to offer a high standard of accommodation that was suitable to meet the needs of residents, with adequate communal space, sufficient bathing and single occupancy bedrooms in both houses. Standards 24, 26, 30 were reviewed at this visit. EVIDENCE: As at the previous visit the complaints policy was seen and records examined. On discussions with the proposed Care Manager it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Service users spoken with said they would tell staff if they were unhappy about something and said staff listened to them. Observations of care records confirmed the effectiveness of a proposed care manager and staff sensitive to service users needs and readiness to test the robustness of their information and report structures. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 19 Residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially in protecting service users from abuse, of all types. All staff has received training on abuse, Vulnerable Adults and social role Valorisation this is carried out on an annual basis. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Observations at the time of this inspection were that staffing levels were adequately maintained with staff that had been trained to ensure that service user needs were appropriately addressed. Standards 34, 35 were reviewed at this visit. EVIDENCE: The management have established a satisfactory procedure for interview, selection and appointment of staff. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of service users. All staff received training in care issues within the home and from external trainers. Criminal Records Bureau checks and POVA checks are obtained prior to employment being offered. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 21 As at previous visits the home has in place a staff-training programme there is a staff-training plan with records being maintained. All staff receives appropriate induction and all staff receive training specific to their post. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Observations at the time of this inspection were that staffing levels were adequately maintained staff on duty demonstrated an awareness of their roles and responsibilities and were familiar with the needs of service users. Standards 37,39,42 were reviewed at this visit. EVIDENCE: The proposed Care Manager is competent and experienced to manage the home. She has twelve years experience working with service users with learning disabilities and deputy at the home for two years. Proposed manager is registered to start NVQ in care and management and has completed all mandatory training and any other training available to update her knowledge. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 23 Thaddeus House is a well run home and there are clear lines of accountability within the home and with external managers from Walsingham. Policies and procedures are in place ensuring that resident’s rights and best interests are safeguarded and opinions are listened to. As at the previous inspection the proposed manager ensures so far as is reasonably practicable the health safety and welfare of service users and staff. Safe working practices are in place and staff had received all mandatory training. Training records are maintained and updates are arranged as required. Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X Thaddeus House DS0000005010.V320542.R01.S.doc Version 5.2 Page 25 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 YA30 Regulation 23 (2) (d) 13 (3) Requirement Maintain cleaning procedures in laundry to ensure all parts of the home are kept clean. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the home. Timescale for action 29/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA26 Good Practice Recommendations Complete discussions with the fire officer with regard to locks on bedroom doors to ensure compliance with regulations. 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