Inspection on 02/06/05 for Tewin Road (1)

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Tewin Road (1) 19/01/09

Tewin Road (1) 24/01/07

Tewin Road (1) 25/01/06

Tewin Road (1) 14/03/05

Tewin Road (1) 18/11/04

Tewin Road (1) 11/03/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Tewin Road 1 Tewin Road Leverstock Green Hemel Hempstead Herts HP2 4NU Lead Inspector Julia Bradshaw Unannounced 02 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tewin Road Address 1 Tewin Road Leverstock Green Hemel Hempstead Herts HP2 4NU 01442 214796 01442 244250 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) Caretech Community Services Limited Natalie Gordelier Care Home 6 Category(ies) of LD 6 registration, with number PD 6 of places Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 6 people with learning disability or physical disability (when associated with learning disability) Date of last inspection 14 March 2005 Brief Description of the Service: Tewin Road is a respite care unit for up to six people with a learning disability and associated physical disabilities. In addition, up to two further clients may receive day care at any one time. Service users have an allotted numbers of nights per year (specified by Adult Care Services) and therefore come for repeated short stays, becoming familiar with the home and the staff. There are approximately sixty-five clients that currently use the service. There are two ‘shared care’ beds for service users with a physical disability. The building is an ordinary detached two-storey house in a residential neighbourhood, adjacent to parkland. Accommodation comprises of a lounge, dining room, small office, laundry room and kitchen. There are two bedrooms on the ground floor for use the use of’ shared care’ clients with physical disabilities and an assisted shower room. There are four bedrooms on the first floor and two bathrooms. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced of this year. It took place in morning to mid afternoon. The inspector-spent time talking to both staff who were on duty. The registered manager was not on duty as she was attending a training course. Time was spent looking through records, care plans, risk assessments, policies and procedures. A tour of the building was also carried out. This was a generally a positive inspection in terms of the needs of the service user being met. What the service does well: What has improved since the last inspection? The manager and staff have worked tirelessly to improve and develop the environment and communal areas of the home, especially the lounge and dining rooms which now provides a stylish and comfortable area in which all service users have access to and can enjoy. The dining room has had a new table and chairs and new flooring fitted since the last inspection took place. The lounge has a new plasma television and has been re-furbished and reTewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 6 decorated. The general administration within the home has improved within the office area and now presents as well organised and efficiently maintained. All documentation was being stored appropriately and confidential information was secured within a metal filing cabinet. The home has also purchased a new washing machine since the last inspection was carried out. 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. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3. Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service user and the home to continuously review the individuals care package provided. Information provided to the service user about the home and its terms is suitable to meet their needs and therefore enables the service user to make an informed choice about where to live. EVIDENCE: A detailed Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The Statement contains information for the service user to make an informed choice about where to live. The content is suitable to meet individual needs. The Statement of Purpose requires minor and in some areas and could benefit from being presented in a more user friendly format Full assessments of each service users needs and aspiration are made before the service user moves into the home. The assessments carried out within the home are continuously occurring supporting and monitoring individual progress and needs identified. Qualified and competent people complete the assessments. The home also receives and seeks external specialist support to meet the individual service users needs. Whole life reviews occur through the placing authority care manager and the key worker from the home is invited to Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 9 contribute to these meetings. However the manager must ensure that these assessments are kept under regular review and updated at least once a year or sooner if the needs of the individual service user change. Several of the assessments checked on the day of the inspection were dated 2003 and risk assessments for the two service users who are at risk of choking did not have an up to date risk assessment on their files. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.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) 6,7,9 Individual needs and choices within the home are being promoted to encourage and empower user self-determination. The absence of current individual risk assessments presents a risk to the health and safety of the service user. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them in the home. Individual daily notes and guidelines for the service users where observed within the home. All service users are supported within an annual review framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the individual owns the care plan. Within the home each service user is encouraged to partake in daily living tasks, for example being supported with some meal preparation, washing up, laying the table, shopping. The service users are consulted about the type of meals they would like to eat on a daily basis and are able to choose from a stock of food within the freezers as well as fresh food/vegetables. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 11 All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Risk assessments are identified and completed on an individual and generic basis. However, some of these risk assessments require updating and reviewing, with particular attention to the risk assessments for the two service users who have difficulty in swallowing. Also the manager must ensure there is a current risk assessment for all the service users who self-medicate. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.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 Personal development opportunities are encouraged for all service users ensuring interactions with the outside community are encouraged, although this can prove problematic due to the rural location of the home. Individual rights and opportunities are recognised and supported, where possible. Service users are provided with a varied and wholesome diet. EVIDENCE: All service users at Tewin Road maintain their day care placements as part of their agreed package of care. These include attending Butterwick and Jarmans Day centre or attending courses at local Colleges. If service users are attending work experience whilst staying at the home, this is also supported and maintained. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 13 All service users are encouraged and supported to maintain links with the local community, although this can be difficult for service users who are only at the home on a tempory, repite basis. The staff team endeavour to promote routines within the home in order to maintain service user’s independence. Service uses are unrestricted in movement around the home, with the exception of the kitchen area and laundry room, where staff support is required for health and safety reasons. Menus are devised on a daily basis and created from service users individual choices and preferences. A record is then maintained and alternative meals recorded, when necessary. There were adequate stocks of food seen on the day of the inspection, including some fresh fruit and vegetables. The home also caters for a variety of special diets, including halal meats diets, soft/palatable meals and healthy eating diets are encouraged for everyone during their respite stay. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.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 The current medication practices and maintenance of medication are sufficient and adequate. Service users emotional and physical needs are being met adequately. EVIDENCE: All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Assessments and reviews are completed ensuring that the approach adopted is person centred and holistic to each service users needs. These assessments are not all maintained and updated regularly in order to ensure the changing needs of the service users are identified and assessments were out of date. Service users needs and are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. The medical needs of the service users are generally supported through the main carers or the families and therefore the home only intervenes in situations of emergency. Information and advice is provided to all services users regarding general health issues. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 15 The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receive training prior to being deemed competent to administer medication. The home uses the preferred methods of administering medication of the individual service users. These include both the nomad/dosette system and administering straight from the boxes/packages. This method is not ideal but the usual methods of administration are difficult to implement due to the nature of the respite service provided. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.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 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: The home has a comprehensive complaints procedure in place, which details that all complaints are responded to within 28 days. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. The home should be congratulated for producing this procedure in a “user-friendly” format. Robust procedures are in place to ensure that service users are protected from abuse and harm. Staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Staff personnel files were unable to be inspected due to the manager not being on duty and care staff do not and should not have access to this information. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 The home is in need of some redecoration and works throughout, to ensure it functions as a homely, comfortable, safe environment for the service users. Individual bedrooms were personalised which promoted independence and choices and preferences for the service users. The organisation is not providing adequate appliances to assist and protect service users. EVIDENCE: The manager and staff have worked hard to improve and develop the environment for service users to enjoy. These improvements include the refurbishment of the dining room and lounge and several new carpets and flooring have been fitted. The home has also purchased a new plasma screen television. A new washing machine has also been purchased. However, the staff on duty stated that the current dishwasher has been broken for several months and staff are currently hand washing all cooking equipment and utensils. It is Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 18 unacceptable that the home should have been without a dishwasher for the past five months and therefore this requires an urgent response by the organisation. A “housekeeping” audit of all bedding and bedroom furniture is needed as some of the beds are either very worn or broken and require replacement. Some bedrooms have had new carpets/flooring fitted since the last inspection took place. The staff are currently in the process of re-decorating some of the bedrooms to co-ordinate the colour schemes of the new flooring. The home provides sufficient lighting, heating and ventilation. A maintenance and renewal and redecoration plan is required. Each service user has a single bedroom. The kitchen and laundry areas of the home are sufficient to meet the needs of the current service user group. The home provides two bedrooms on the ground floor of the home for disabled access. There are several aids provided to assist these service users with mobility during their stay and these include, hoists, assisted rails in the bathroom and toilets and assisted beds. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 19 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) 31,32,35 The home is suitably staffed with well-trained individuals ensuring that at all times service users complex and changing needs can be met. Policies and procedures are in place to ensure the protection of service users. Staff supervision and appraisals are being carried out by the manager and senior staff effectively. EVIDENCE: Staff spoken with during the inspection appeared very clear of their individual roles and responsibilities. The home has a loyal staff team that appear to have a good understanding of the current service users needs and abilities. Staff were seen to support the main aims and values of the home. All staff should receive a copy of the General Social Care Council Code of Conduct before the next inspection takes place. The home has clearly defined job descriptions and person specifications in place. Staff training records and personnel records could not be assessed on this occasion as the manager was off duty. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 20 The manager provides regular staff meetings and individual supervisions are carried out on a monthly/six weekly basis. The rota checked on the day of the inspection confirmed that adequate staffing levels were being maintained even though the home currently has staff vacancies, including a deputy post. These vacant posts are currently being covered by permanent staff doing additional hours or by regular bank staff. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. In-house quality assurance systems are in the process of being implemented to ensure that service users views underpin all self-monitoring, review and development of the home and the home is subject to an annual audit by an external organisation. Accurate records in relation to health and safety are being maintained although some attention is required to risk assessments to ensure the safety of service users at all times. EVIDENCE: The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The management Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 22 approach of the home endeavours to create an open and positive atmosphere, staff and service users spoken to commented that they feel supported and feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The home is in the process of carrying out annual appraisals but supervision sessions appear inconsistent and need to be held more regularly. In House quality assurance systems are in the process of being developed within the home in order to assure that the service users views underpin all self-monitoring, review and development of the home. The deputy manager has recently completed a kitchen and medication audit and will have completed a care-planning audit before the next inspection takes place. Service user meetings are held. All records are secure within the home and were up to date and held in accordance with the Data Protection Act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures Records regarding staff recruitment and training were not inspected, as the manager was not on duty at the time of the inspection. There was one issue identified during this inspection, which could compromise the service users health and safety, which relates to individual risk assessments on service users who have difficulty in swallowing. A current and up to date risk assessment must be maintained for the service users. Generally the manager maintains accurate and up to date information on all issues relating to the health and safety of both service users and staff. COSHH assessments are completed on an annual basis and updated accordingly. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 23 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 2 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 1 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tewin Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 1 x I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 24 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 9 42 Regulation 13(4)(c) Requirement The manager must complete a risk asessment on each individual person who is at risk of choking. The manager must also maintain accurate and up to date assessments on all service users receiving respite care service at Tewin Road. The proprietor must arrange for the current dishwasher to be repaired or for a new dishwasher to be purchased. All bedding/bedroom furniture provided must be in good repair and appropriate to meet the nees of the service users. Timescale for action Immediate from 2/6/05 2. 30 42 25 26 16(2)(g) 13(4)(c) 16(2)(c) 15/6/05 3. 30/6/05 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 1 Good Practice Recommendations The Statement of Purpose should be made available in a more friendly format. Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tewin Road I52_Tewin Road_s19564_v229958_020605 stage 4.doc Version 1.30 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!