CARE HOME ADULTS 18-65
Twyford Lane (11) 11 Twyford Lane Browns Wood Milton Keynes Bucks MK7 8DE Lead Inspector
Nancy Gates Unannounced Inspection 20th March 2007 11:30 Twyford Lane (11) DS0000015076.V328764.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 Twyford Lane (11) DS0000015076.V328764.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. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Twyford Lane (11) Address 11 Twyford Lane Browns Wood Milton Keynes Bucks MK7 8DE 01908 639089 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) The Disabilities Trust Ms Rosalind Ann Tysom Care Home 3 Category(ies) of Physical disability (3) registration, with number of places Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: 11 Twyford Lane is a small home, registered to provide long-term rehabilitative support and accommodation for up to three service users. The home is situated on the Brownswood development in the south of Milton Keynes. The home is one of three properties on the Twyford Lane development, all of which are administrated by the Brain Injury Rehabilitation Trust. The home is a single storey construction. Service users benefit from single room accommodation and there are also communal spaces situated centrally within the home. At the front of the home there are communal car parking facilities for appropriately eight vehicles. There is a shared garden centrally situated on the development. Twyford Lane is well appointed to access all bus routes, enabling service users to be able to travel to local amenities relatively easily. Fees range from £1241.17 to £1840.37 per week. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of the service was an unannounced ‘key inspection’. The inspector arrived at the service at 11.30 p.m. on the 20th March 2007. The total number of hours spent at the home was 6 hours. The time spent at the home allowed for a thorough look at how well the service is doing. The inspection took into account detailed information provided by the service manager inclusive of information that CSCI has received about the service since the last inspection. The inspector asked for the views of the people who use the service. All household members were in the home at the time of inspection. The inspector also asked the views of others who support the needs of the people who use the service via a questionnaire that the CSCI sent out. Staff and residents were very welcoming. The inspector looked around the home including the bedrooms of the residents at their invitation. A number of records were viewed including a resident’s care plans, staff recruitment records, staffing rotas and maintenance records. The inspector looked at how well the service was meeting the standards set by the government. The report includes judgements about the standard of the service. What the service does well:
A clear and detailed assessment of need is completed before a person is admitted, giving assurance that care needs will be met. The assessments completed for individuals provide good quality information for admission. Assessments highlight the importance of clear risk management strategies prior to admission and how the strategies can ensure that a person is supported to take risks whilst remaining within the remit of their care plan. Care plans are in place, outlining needs in order that these can be met. The plans also show how people are enabled and supported to take risks to promote independence. Support plans also detail decisions made by people, again highlighting the promotion of independence. Care plans focused on achieving goals towards independence. People were observed preparing lunch and doing household chores. Menus are planned with individuals, staff monitor nutritional intake. The people who live at Twyford Road are part of the community and have appropriate activities, providing them with community presence and stimulation. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 6 Individuals are enabled to have appropriate relationships, maintaining important social contacts. Rights and responsibilities are respected, ensuring appropriate recognition. Personal support is provided according to needs, ensuring that people receive the assistance they require. Support needs are clearly described within care plan files. Health care needs are met, ensuring that people keep well. Medication is appropriately managed, ensuring that people receive the medicines they require. Needs arsing from equality and diversity are well met. From the evidence seen, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Effective complaints procedures are in place to listen to the views of the people who live at Twyford Road and their representatives. Appropriate Protection of Vulnerable Adults/Safeguarding Adults and whistle blowing procedures are in place, to safeguard against the risk of harm. A clean, safe and well maintained environment has been created, providing a comfortable and homely place to live. Competent and qualified staff work at Twyford Road, ensuring that needs are met. Staff have undertaken necessary training to meet needs. The home benefits for consistent management ensuring the service is run effectively and meets care needs. There is regular monitoring by the provider, ensuring that the service operates effectively. Due regard continues to be shown toward health and safety, to reduce the risk of accidental injury to household members, staff and visitors. What has improved since the last inspection? What they could do better:
No requirements or recommendations were made at this inspection. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 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. 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. A clear and detailed assessment of need is completed before a person is admitted, giving assurance that care needs will be met. EVIDENCE: No admissions have been made to the home since the previous inspection. Information for prospective service users accurately describes what the home has to offer. The assessments completed for current household members provide good quality information for admission. Assessments highlight the importance of clear risk management strategies prior to admission and how the strategies can ensure that a person is supported to take risks whilst remaining within the remit of their care plan. The current scale of fees for this service is £1241.17 to £1840.37 per week. Twyford Lane (11) DS0000015076.V328764.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. Care plans are in place, outlining needs in order that these can be met. Service users make decisions in everyday life, giving them choice. Service users continue to be enabled to take risks, to promote independence. EVIDENCE: Care plans are in place for each of the three people living at the home, and included a photograph. Care plan files contained a number of clear assessments and plans relating to support needs. The plans are based upon assessments completed by psychologists and provide clear guidance and boundaries of support. Needs are clearly reviewed on a regular basis and related to risk assessments which were in place for daily living tasks such as using public transport, Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 11 cooking and using the kettle, as well as for self harming, potential for violence and substance misuse. There are clear goals identified for each person as part of their plans and daily notes reflected compliance with agreements to achieve these goals. Care plans had been drawn up in consultation with the people who live at the home and there was evidence of multi-disciplinary input to ensure that needs are identified and met. Observation of practice provided evidence of individuals being encouraged to complete daily living tasks with staff support or supervision as necessary. Daily records demonstrated that staff are aware of the need to be nonjudgemental, positive and respectful, and to highlight strengths. The home continues to manage individual’s money and there are individual tins and record books in place. People continue to have cash point cards to withdraw money and need support from staff to remember the personal identification numbers that go with these. Risk assessments and appropriate monitoring are now in place to ensure that there are sufficient safeguards to prevent fraudulent use of the cards. Twyford Lane (11) DS0000015076.V328764.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): 12, 13, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at the home are part of the community and have appropriate activities, providing them with community presence and stimulation. People are also enabled to have appropriate relationships, maintaining important social contacts. Rights and responsibilities continue to be respected Meals and menu planning are appropriately managed, ensuring that nutritional needs are met. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 13 EVIDENCE: From speaking with the people who live at the home and reading daily reports, it was clear that there is good access to the local community and make people make use of the facilities in the city centre. Files contained risk assessments for using transport, including making use of the bus services in the local area and road safety. One person continues to attend a placement in a local nursery. Care plans focused on achieving goals towards independence. People were observed preparing lunch and doing household chores. Menus are planned with individuals, staff monitor nutritional intake. People who live at Twyford Road are able to see friends and family. No one currently has a key to his or her room although these are available if needed. Twyford Lane (11) DS0000015076.V328764.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): 18, 19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Personal support continues to be provided according to needs, ensuring that people receive the assistance they require. Access to additional support from health care professionals is consistent and meets health needs. Medication is stored securely and administration is accurate, ensuring safety. EVIDENCE: Support needs are clearly described within care plan files. Care plans hold clear guidance of how people wish their personal and healthcare needs to be supported. Records are maintained of attendance at medical appointments and there was evidence of multi-disciplinary input from review notes and other documents on files. Weight is also recorded.
Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 15 A local pharmacist supplies the home with medication stored within blister pack dispensing systems. Medication administration records are supplied by the pharmacist to support accurate administration and recording. Recording is accurate, no omissions were noted and there is a photograph of each person who receives medication in the records folder. The medication cabinet was secure and locked when not in use, with appropriate arrangements for the storage, administration and recording of controlled drugs. Medication administration records were in good order Twyford Lane (11) DS0000015076.V328764.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): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Effective complaints procedures are in place to listen to the views of the people who live at the home and their representatives. Appropriate Safeguarding Adults and whistle blowing procedures are in place, EVIDENCE: No formal complaints have been received at the home or at the CSCI since the last inspection. The complaint procedure contains all the required information for anyone wishing to express views about the service. The Commission is not aware of any adult protection concerns about the service. There are Safeguarding Adults/adult protection and whistle blowing policies to refer to and staff have undertaken Protection of Vulnerable Adults training. Twyford Lane (11) DS0000015076.V328764.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 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A clean, safe and well maintained environment has been created, providing people with a comfortable and homely place to live. EVIDENCE: Accommodation is on ground floor level with level access throughout and widened doorways. Each person has a single en-suite bedroom and each room has been decorated and arranged to individual tastes. The lounge remains modern and seating is comfortable. There is access to the garden from both the lounge and kitchen/dining area. The kitchen and dining area are small but in keeping with the size of the home and are usable by all household members. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 18 The office is compact and doubles up as the sleeping in room, with a toilet and shower en-suite. A laundry room completes the accommodation and this is of a decent size. Outside, there is sufficient parking and the home shares the garden with the two other homes on the site. All areas of the home appeared clean and there were no unpleasant odours. It is part of the philosophy of the home that service users undertake domestic chores and gentle encouragement was overheard. The home is well maintained. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff, ensuring that needs are met. Staff have undertaken the necessary training in order to meet service users’ needs. EVIDENCE: Two members of staff were on duty at the start of this inspection visit with Operations Manager arriving soon after. There were no staff vacancies and the Operations Manager indicated that the staff team were reliable and committed to working for The Disabilities Trust. Those spoken with had a very good understanding of care needs and were friendly and hospitable. Two of the three staff have attained at least National Vocational Qualification level 2 and the Registered Manager is continuing with level 4.
Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 20 The induction used at the home continues to follow a comprehensive format. Staff confirmed that they are given a copy of the General Social Care Council code of practice. T here was a copy of this also available in the office. Records indicated that staff had completed the comprehensive induction. Records demonstrated that regular staff meetings are held with minutes taken and shared responsibility for actions to be taken. Training was in good order with recent updates undertaken to refresh knowledge. Staff recruitment records are held at the home and contain the relevant information for the protection of all house members. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home benefits from consistent management ensuring the service is run effectively and meets care needs. There is regular monitoring by the provider, ensuring that the service operates effectively. Due regard continues to be shown toward health and safety, to reduce the risk of accidental injury to service users, staff and visitors. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has a registered manager, who is in charge of day-to-day running of the service. The manager is undertaking National Vocational Qualification level 4/Registered Manager’s Award and has the necessary experience and skills to ensure that the service operates to a high quality and that service users receive the support and assistance they require. Until managers have achieved the Award, the standard cannot be scored as fully met. The registered manager is currently on long-term sick leave. The Operations Manager has undertaken management responsibility for the home and is currently pursuing long-term management options with the CSCI. Reports of monthly monitoring visits by the provider are held and provide good evidence of detailed monitoring. Formal and informal review of residents’ opinions is sought on a regular basis, house meetings providing a forum for the people who live at Twyford Road to express opinions. The home’s certificate of registration was displayed in the hallway and there was evidence of sufficient employer’s liability insurance as well. The home had a current gas safety certificate and electrical appliances had been tested. A certificate verified that the electrical supply installation at the home meets safety standards. Fire safety checks were in good order and the home had a fire based risk assessment. Generic risk assessments remain in place and there continue to be records of regular testing of fridge and freezer temperatures, shower head descaling, carbon monoxide alarms and smoke alarms. Staff undertake training in control of substances hazardous to health and health and safety, as well as manual handling, food handling and first aid. Data sheets were in place for cleaning products used at the home, in case of accidental spillage or ingestion. No obvious hazards were seen during the tour of the building; response to maintenance issues by the provider continues to be good. Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 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 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 X 32 3 33 X 34 3 35 3 36 X 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 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 3 X X 3 X Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 Twyford Lane (11) DS0000015076.V328764.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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
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