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Inspection on 15/03/07 for Strangers Way, 72 to 74

Also see our care home review for Strangers Way, 72 to 74 for more information

This inspection was carried out on 15th March 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Those living at the home who were spoken to made it clear that they liked the home and the staff. Other people living at the home who were seen at various times of the day were happy and enjoying their interaction with staff. In one case where a person was clearly distressed the staff did their best to understand what was upsetting them and to put things right. There are good arrangements for involving those living at the home in the process of finding out how they would wish their needs to be met. Those living at the home have a wide range of activities and are supported to be as independent as possible. The staff are very good at encouraging and supporting those living at the home to achieve their goals. The staff helped those living at the home to remain as healthy and as safe as possible. The manager and staff support those living at the home when they had concerns to make complaints if they cannot bring about the required change. The manager makes sure that Mencap`s constant improvement policy is working well and that those living at the home are involved in the process.

What has improved since the last inspection?

A walk-in shower had been installed and one of the front rooms had been redecorated. There was a period since the last inspection when the home was without a manager. At the beginning of October 2006, however, a new manager was appointed.

What the care home could do better:

There were no requirements arising from this inspection. The new manager noted, however, a number of areas where she was looking to makeimprovements. These included taking the person centred planning forward. This had already been set in motion with a new staff facilitator feeding back ideas to the staff team and a digital camera having been purchased for the home. The manager was also looking at how to improve the way the service users` plans are regularly monitored, reviewed and updated.

CARE HOME ADULTS 18-65 Strangers Way, 72/74 Luton LU4 9ND Lead Inspector Mr Paul Worthy Unannounced Inspection 15th March 2007 11:00 Strangers Way, 72/74 DS0000014974.V331133.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 Strangers Way, 72/74 DS0000014974.V331133.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. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Strangers Way, 72/74 Address Luton LU4 9ND 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) 01582 505013 01582 572397 www.aldwyck.co.uk Mencap Vacancy Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: 72-74 Strangers Way provides accommodation to six people with learning or physical disabilities. It is situated on the corner of a main road in the Leagrave area of Luton. The home was created from two semi-detached three-bedroom houses. These were converted to provide two separate units (no 72 and 74): one with four bedrooms plus normal communal facilities and the other with two bedrooms, walk-in shower, kitchen and lounge. The units can only be accessed from the outside. The smaller unit (no 74) is intended for two service users who are able to live more independently and require a smaller staff input. The staff on duty work across both units. Night staff are based in no 72. There is off-road parking for three vehicles and the garden at the back of the house provides an attractive leisure space for all six service users. There is a good bus service along the main road and the railway station is about a mile from the home. The charges are £556 - £834. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 11.30 a.m. The inspector joined people living at the home and staff while they had their lunch time and evening meal and talked to two people living at the home separately. He talked to three staff and the manager, looked over some of the public parts of the building and saw some records. He also saw the staff and those living at the home interacting during the visit. Account was taken of the pre-inspection information that the manager had returned and some documents provided during the inspection. The inspector is very grateful to everyone at the home for their help during this inspection. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements arising from this inspection. The new manager noted, however, a number of areas where she was looking to make Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 6 improvements. These included taking the person centred planning forward. This had already been set in motion with a new staff facilitator feeding back ideas to the staff team and a digital camera having been purchased for the home. The manager was also looking at how to improve the way the service users plans are regularly monitored, reviewed and updated. 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. Strangers Way, 72/74 DS0000014974.V331133.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 Strangers Way, 72/74 DS0000014974.V331133.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good arrangements for assessing the needs of service users to ensure that they could be met. EVIDENCE: There had been no recent moves to the home. There were seen, however, to be good arrangements for ensuring that the changing needs of those living at the home were observed by staff and incorporated into the service users plans. This included, where necessary, involving other professionals in the assessment process. Staff were seen to produce excellent reports following contact with other professionals. The manager and the staff spoken to were well aware of the wide range of needs of the service users, including those that were changing. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good service users plans which ensured that the needs of those living at the home would be met in ways that took account of their wishes and encouraged as much independence as possible. EVIDENCE: There were files for each service user that contained the assessment and planning information that constituted the service users plan. These files also contain risk assessments and the homes recent reports submitted to annual reviews as well as, in some cases, a copy from the placing authority of the report of the annual review. The plans were very comprehensive and covered all the required areas. They provided some referencing to the risk assessments and other documents that would need to be reviewed at the same time as the plans. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 10 Key workers were responsible for the plans and produced monthly reports on the person they worked with. They also produced the annual report for the annual reviews with the placing authority. It was seen that the plans had been or were in the process of being reviewed and updated. These included reviewing the risk assessments and removing those that were no longer appropriate. The manager was introducing new arrangements for monitoring, reviewing and updating the plans. This included ensuring that the specific goals spelt out at the end of the plans were comprehensive and sufficiently specific to allow them to be monitored. The cross-referencing was to be made more systematic and the monthly reports produced by key workers were to reflect the structure of the plans so that they showed the progress in meeting goals and highlighted where changes were required. Where changes were required the procedures for making alterations were to be clarified. The procedures relating to the way plans would be reviewed and the way this related to the reviews held by placing authorities were also to be clarified. There was ongoing work in connection with person centred planning (PCP) to ensure there were appropriate approaches reflecting the different needs of the service users. A member of staff had recently taken on the role of facilitator and was feeding back to the staff team ways of taking PCP forward. A digital camera had recently been acquired by the home and this was now being used. It was being used to help people build up their own personal diaries and also to provide a picture bank that could be used in helping those living at the home to make decisions. There were weekly meetings at number 74 to help arrange with the two people their plans for the following week and the type of staff support that this would require. The manager was considering a service users monthly meeting with them to specifically look at longer term planning and issues of possible concern. Service users meetings were not held for those living at no 72 because of the problems they would have in communicating and understanding. Instead there is a reliance on staff and key workers picking up on concerns and wishes they might have. The two of the service users plans noted how developing PCP would take this forward. The most important aspect of supporting those living at no 72 to live as far as possible as they wish was seen to be the close and understanding relationships that staff had with the service users and their ability to understand their wishes and to support them in achieving them. The risk assessments provided a context for ensuring that this was done in ways that ensured they remained safe while being as independent as possible. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at the home were provided with the support that they needed to be able to lead fulfilling and enjoyable lives both at home and in the community. EVIDENCE: Arrangements were seen to be in place, including assessment and planning information, to ensure that those living at the home were able to enjoy a full range of normal activities in and out of the home. These appropriately reflected the level of independence of the service users and staffing support was tailored to the different levels of support that was needed. Staff confirmed that the home had its own vehicle and when there were no drivers on duty taxies were used. The range of activities included those aimed at helping service users to have the opportunity for personal and spiritual Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 12 development. The importance of music in the life of the home was observed. Some of the older service users were enjoying attending college courses. There was support for service users to attend day centres or to be employed. The latter was linked to programmes to support, where appropriate, those living at the home to move on to homes where they would have even greater independence. The emphasis in these cases was seen to be to build up selfconfidence. Those living at no 74 were able to access the community on their own and did so. The activities of those living at no 72 took them into the community supported by staff. The planning of activities was seen to be closely linked with the drawing up of rotas to ensure that there were enough staff to ensure that there was the required amount of support. Staff confirmed that there were normally enough staff to allow planned activities to go ahead. The home provided a group living situation with an expectation that all the service users, to the extent that they were able, would be supported to participate in helping with the daily household activities to the extent that they were able. This was seen to provide at no 72 an opportunity for staff and those living at the home to interact and enjoy each others company. The meals were seen to be a very pleasant social occasion for staff and those living at the home. The service users plans contained information relating to the meals they liked or disliked and any dietary considerations. There was a book of pictures of foods and meals that could be used by the staff member responsible for planning meals with those living at the home to help them choose their meals. The records provided evidence of those living at the home were being supported to maintain their contacts with their relatives and friends. The manager was planning to update some of this information on the plans so that the levels of support needed and how arrangements were made would be clearly stated. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good arrangements for determining the care and health needs of those living at the home so as to ensure that they received appropriate care and medical support. EVIDENCE: There were sections in the service users plans appropriately covering personal care. They gave guidance to staff, who when spoken to were aware of the needs of those living at the home for support through prompting and some personal care. For all those living at the home good arrangements were seen to be in place to ensure that emergency, ongoing and routine medical needs were addressed. This included very good medical information in the service users plans. Excellent notes were seen to be written up by the support staff attending a medical appointment with a service user. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 14 Appropriate arrangements for managing medication were seen to be in place. The service users plans contained good medicine profiles that made clear why medication was being taken and other details such as possible side effects. There was an appropriate medicine cabinet. A measured dosage system was being used. There were appropriate MAR sheets to cover medication that was not covered under these arrangements. These helped the process of auditing this medication. There were excellent arrangements for immediate checking and ongoing auditing to ensure that mistakes did not occur. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were effective arrangements for identifying and addressing the concerns that those living at the home might have so that they would feel in control and for ensuring they were protected so that they would feel safe. EVIDENCE: The needs of the service users differed considerably in the type of support they would need to make their concerns known, including drawing attention to any abuse that they might have experienced. In the case of those with good communication skills there were examples where they had been able to complain about situations where they felt that the service they were entitled to was not being provided as it should. There had been two recent incidents of this. In the one case it had related to the need to have an appropriate shower for two service users. In the other it related to the placing authority supporting a move to greater independence. In both cases the manager and staff had and were supporting the service users, including providing support to obtain an external advocate in the latter case. Staff confirmed that there had been recent training relating to the local protocols relating to the protection of vulnerable adults that had been given by Luton Borough Council. The manager was planning to review the risk assessments to ensure that levels of vulnerability to abuse either because of Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 16 levels of independence or of problems of communication or of a history of attention seeking accusations. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 17 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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation was well maintained and furnished so that it provided those living there with a homely and comfortable environment. EVIDENCE: The public areas of the accommodation were seen to have a homely and comfortable feel and to be well maintained. It continued to meet the needs of the service users, although there was an awareness that the age of some of the service users meant that this needed to be kept under review. A shower had been installed by the Aldwyck Housing Association, who own the property. There had been problems following the work and temporary measures had been taken to make it usable. The intention was to return to complete this work. The home was observed to be being kept clean and fresh. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff were appropriately trained and organised to ensure that all the needs of those living at the home would be met. EVIDENCE: Good arrangements were seen to be in place for ensuring that enough staff were always on duty. The manager confirmed that only briefly had there been a full team over the last two years because of frequent staff moves. The good relief staff arrangements ensured, however, that this had been covered by staff who were known to those living at the home. Recruiting had just been completed and there was now a full staff team. Staff spoke very highly of their colleagues and the support that was to be found within the team. They also confirmed that there were always enough staff on duty to provide the support that those living at the home required. There was a waking night-staff, which reflected the needs of service users. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 19 The relationship that the staff had with those living at the home was seen to be excellent and sensitive to their very different needs. Staff confirmed that there were arrangements for induction and foundation training. There were also arrangements for ensuring that all mandatory training was covered. The manager confirmed that she kept records on each member of staff so that she is aware when they need to update mandatory training. This was monitored through the supervision sessions that are at least six times a year. The manager was undertaking all the supervision but the intention was that this would be split with her deputy. Staff confirmed that there were monthly staff meetings. Two staff were spoken to who had recently been recruited. They confirmed that the correct procedures had been followed to ensure that no one worked in the home who could pose a threat to the service users. . Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 20 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): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at the home benefited from it being well managed so that they could live as independently and fully as possible. EVIDENCE: The manager had been in post since 1st October 2006. She confirmed that an application would be made to CSCI for her to be registered. Staff confirmed that she was supportive, accessible and provided positive leadership. The ethos of the home was friendly and relaxed. The manager commented very positively on the staff team and the way it was functioning, despite the amount of change over the past two years. Observing the running of the home Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 21 provided evidence of good systems, including administrative ones, being in place to ensure that the needs of the service users were met. Mencaps arrangements for ensuring contiuous improvement were seen to be in place. These included the required monthly visits on behalf of the provider (regulation 26 visits), when very detailed forms were completed, and the managers monthly compliance check. A quarterly report for stakeholders meetings. The latter meetings provided an opportunity for service users and their representatives to have an input. There was also a Continuous Improvement Plan that identified all the areas where improvement to the services could be made. The manager had produced an annual development/business plan for 2006/2007 and a copy was provided at the inspection. The managers monthly compliance and regulation 26 checks were seen to ensure that all the monitoring relating to health and safety was being undertaken. Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 22 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 x 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 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Strangers Way, 72/74 DS0000014974.V331133.R01.S.doc Version 5.2 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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