Inspection on 28/07/05 for Twyford Lane (11)

This inspection was carried out on 28th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Twyford Lane (11) 27/11/08

Twyford Lane (11) 20/03/07

Twyford Lane (11) 07/08/06

Twyford Lane (11) 16/12/05

Twyford Lane (11) 17/12/04

Twyford Lane (11) 02/09/04

Twyford Lane (11) 18/12/03

Similar services:

Flint House

The Cotswold Home

Fairways

Treloar College

Rush Court

The Maypole Nursing Centre

Fir Tree Lodge

Chilmington House

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

CARE HOME ADULTS 18-65 11 Twyford Lane 11 Twyford Lane Browns Wood Milton Keynes Bucks, MK7 8DE Lead Inspector Moira Jones Unannounced 28 July 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. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Twyford Lane (11) Address 11, Twyford Lane, Browns Wood, Milton Keynes, Bucks MK7 8DE 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) 01908 639089 The Disabilities Trust Rosalind Ann Tyson Care Home 3 Category(ies) of Physical Disability registration, with number of places 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 17th December 2004 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. At the time of this unannounced inspection, the home was carrying one vacancy. The home is situated on the Brownswood development in the south of the new town 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. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of 11 Twyford Lane was conducted over the course of one day, commencing at 8.55am and concluding at approximately 3.00pm. The opportunity to meet with both service users, the manager and a member of the support team was taken as well as the chance to assess a variety of policies, procedures and completed pro forma to substantiate the exchange of information. The opportunity was also taken to measure the progress made in relation to the two requirements and one recommendation that were issued as a result of the last announced inspection of the home, which took place during December 2004. This was a positive inspection for the home and it was pleasing to note the palpable progress made by one service user and the efforts made to meet the changing needs of the second service user. The home is to be commended for its efforts to meet service users rehabilitation needs, which have been successfully complied with even though the dynamics of the staff team have diversified due to staff changes. Discussions with both service users confirmed their satisfaction with the support they receive from staff. One service user described the staff as ‘doing a good job’ and there was very clear evidence of the mutually respectful relationships that exist. The staff spoken with confirmed the levels of support provided to them by the manager in all aspects of the work they undertake and their personal development. This inspection resulted in no requirements or recommendations being issued and the home is urged to continue to maintain the standards achieved, in line with the Care Homes Regulations 2001 and the Care Standards Act 2000. What the service does well: Service users benefit from having their needs assessed prior to admission into the home. Each service user has a supported living plan, which are updated regularly. Service users are enabled by staff to make decisions about their lives Assessments that describe the hazards that face service users when undertaking tasks of rehabilitation and independent living are in place. Risk assessments are underpinned by considered control measures. The home enables service users to participate in activities that promote personal development. Service users are encouraged to participate in the local community. Flexible visiting is encouraged at the home. Staff provide unobtrusive support to service users when undertaking the tasks of rehabilitation. Service users take responsibility for the decisions they make. Service users are supported to plan menus, shop for groceries and prepare meals. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 6 Service users are supported in their personal needs through prompting and encouragement. Service users are supported to access routine healthcare support from community-based practices. Medications held within the home are robustly managed. The home has a complaints policy and procedure, which enables service users to make their comments known and have them, listened to in a nonjudgemental manner. Vulnerable service users are protected via policies, procedures and staff training. Service users live in an environment, which has been sympathetically refurbished to meet their needs. Standards of cleanliness at the home are good. Staff are inducted to their posts. Staff’s ongoing development enables them to provide service users with robust support. There are systems in place to assure that the standards of support and rehabilitation within the home are not compromised. The health, safety and welfare of service users are safeguarded. 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. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 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 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 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) 2 Service users benefit from having their needs assessed prior to admission into 11 Twyford Lane, which means that staff have a good understanding of individual rehabilitation needs. EVIDENCE: One service user has been discharged from the home to Thomas Edward Mitton House, which is the main Brain Injury Rehabilitation Trust assessment unit in Milton Keynes where his changing needs can be more appropriately met. No admissions have been made into the home during the time under review. All new admissions into the home would be made in line with the organisational admission policy and procedure, which remains unchanged since it was last positively assessed as being compliant with the requirements of the standard. Service users are generally admitted via Thomas Edward Mitton House and their needs are assessed there prior to transfer into the home. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Each service user has a supported living plan, which advises staff about the individual rehabilitation goals of service users, ensuring that their needs are known and therefore met. Service users are encouraged and enabled by staff to make decisions about their lives, ensuring that they are able to exercise some control over their individual rehabilitation programmes. The risks that are applied to the everyday activities of rehabilitation and independent living are described within risk assessments and are underpinned with considered control measures, ensuring that service user’s safety and welfare is promoted and protected. EVIDENCE: Each service user has a supported living plan. One plan, which had been updated in January 2005, was seen and a further update identified as being required in January 2006. Supported living plans outline the factors affecting progress towards independence such as the physical, emotional and behavioural, cognitive and dysexecutive and functional occurrences. The supported living plans also identify the medications prescribed for service users, the functional goals that outline personal goals, short-term goals and 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 10 the action/intervention identified as required towards meeting the goals. All supported living plans were signed and dated by the service user, clinical psychologist, key worker and manager. Daily reports of the activities of rehabilitation, the support given and the tasks of independent living are maintained and held on service users files. All entries were noted to be supported by the date and the signature of the staff member making the entry. Narratives were well recorded and gave a concise record of service users activities. Staff had clearly benefited from the report writing skills guidance facilitated by the manager. From records assessed, it was clear that ABC charts were being used at the time of this unannounced inspection to note the factors that affect the behaviours of one service user. By virtue of the fact that service users are working towards some degree of independent living they are encouraged to make decisions about their daily living as part of their rehabilitation. Service users plan their individual rehabilitation programme each week. Some core activities such as work and college placements that take place at the same time each week are instinctively scheduled into individual programmes and other more flexible activities are fitted in as wished, by service users. Weekly plans are signed and dated by the person it pertains to. Service users also develop their own menus, with support from staff. Service users acknowledge their choices via signatures placed on the menus. Service users shop for groceries and prepare their own meals, again with support from staff. Service users also undertake some domestic and laundry tasks as part of their ongoing rehabilitation programmes. As part of the initiative towards rehabilitation service users access the community. This is achieved on a gradated basis with service users orientated to the area and to the public transport system with staff’s support. Until service users are deemed able to access the community independently they are considered to be ‘on escort’ after which they are then to be considered ‘off escort’. No independent advocate visits the home but guidance on how to access this type of service is made available to service users via posters and leaflets. No volunteers were being retained by the home at the time of this unannounced inspection. Service users personal allowances are held by the home on their behalf. There are individual financial plans in place that are linked to rehabilitative activities. Staff support service users to manage their money. The risks that are applied to the everyday activities of rehabilitation and independent living are described within risk assessments and are underpinned with considered control measures that reduce but do not completely eliminate the hazards that present to service users. The risk assessments developed in line with individual vulnerabilities identify the risks as low, medium or high and were noted to have been completed on a core basis and thereafter updated on at least an annual basis but more often, as required. Risk assessments are signed by the assessor, service user and manager. The home works in line with the organisational Missing Persons policy and procedure, which includes an integral ‘client summary’ that outlines a 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 11 description of the service user, focusing on distinguishing features such as height, eye colour, birth marks etc. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 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) 12, 13, 15, 16 and 17 The home enables service users to participate in activities that promote personal development. Service users are encouraged to participate in the local community, ensuring that in addition to meeting their rehabilitative needs service users also have the opportunity to exercise their civic rights. Flexible visiting is encouraged, which means that service users have the opportunity to maintain contact with relatives and long standing friends as well as more recently formed friendships. Staff provide unobtrusive support to service users when undertaking the tasks of rehabilitation ensuring that they are able to assume responsibility for the decisions they make and take reasonable risks in achieving their individual goals. Service users are supported to plan menus on a weekly basis, ensuring that their planning skills are promoted and maintained and their nutritional needs met. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 13 EVIDENCE: Until recently both service users have actively undertaken some personal development either through college placements or work placements. One service user continues to be employed on a non-remunerated therapeutic basis at a local day nursery for one day per week. It was clearly evident that the service user enjoyed the time spent with the children at the nursery and it would appear from ‘feedback’ given to the manager that the nursery considers the service user a valuable member of the volunteer staff team. The manager also stated the benefits she perceived as having enhanced the service users approach and attitude towards all aspects of rehabilitation – an opinion that is concurred with, based on observations made throughout the course of the inspection. The work placement attended by this service user forms a small part of the rehabilitation programme. The second service user, who was attending a college placement at the time of the last inspection of the home has now officially taken ‘early retirement’ and is now concentrating on rehabilitation to ensure that changing needs are more effectively and appropriately met. Spiritual needs are individually met, as indicated via service users personal beliefs. As part of their rehabilitation towards independent or semi-independent living, service users utilise the public transport system that serves Bletchley and Milton Keynes: the home is situated on a direct bus route to both towns. Service users also use the local shops in Walnut Tree and are therefore well known within the local community. The work placement attended by one service user is within a short distance as is the general practice both service users are registered with. All service users are registered on the electoral roll, are politically active and exercised their civic right to vote during the recent general elections. The home promotes flexible visiting within programme times. There is a visitor’s book in the entrance hall of the home, which all visitors are invited to sign. Visitors to the home are advised to notify the home prior to making their journeys as service users are generally very active and do not necessarily undertake the activities of rehabilitation within the home’s environment. Service users are supported by staff in their decision about whom to see and not see. The organisation has developed policies to guide staff on acceptable professional and personal boundaries and there is also a policy in place relating to sexual expression. Service users are encouraged to make their own friends and would be supported by the home to develop personal and platonic relationships, so far as both parties are able to make informed decisions. Service users are supported to visit their families and are also enabled to invite their friends into the home. Through necessity, the routines of the home tend to be repetitive. However, flexibility is also promoted and there are less stringently planned activities in place than the core tasks of rehabilitation. Times of rising and retiring are generally flexible but clearly linked to programme times. Service users are given the option of holding the key to their bedroom door and to the front door 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 14 of the home and this is managed within a framework of controlled risk. Service users have use of the home’s telephone but generally receive more calls than they make. Supported living plans outline the preferences of the individual service users such as preferred form of address, likes, dislikes, hobbies, interests, religion and beliefs etc. Participation is recorded on service users files. Service users are given their post unopened and are supported, as required, to deal with its contents. Service users prepare their own meals, with support and also make their own drinks and snacks. Bedrooms are fitted with lockable facilities so that service users may keep some money and any valuable items securely. Access to all areas of the home, with the exception of other bedrooms including the staff’s sleeping in accommodation is available to service users. The home has a communal garden that it shares with the other two homes on the development. Service users undertake some laundry and domestic tasks as part of the initiative towards rehabilitation and independent living. The use of alcohol is prohibited, in line with medication regimes and smoking is only permitted in the garden. All activities of rehabilitation and independent living are contained within a framework of risk assessment, which are inclusive of considered control measures. Healthy eating is promoted within the home. With staff’s support and advice service users plan, shop for and prepare the menus on a weekly basis. Service users menus were imaginative, balanced and reflective of seasonal availability and preferences. Advice can be sourced from the dietician who is based at Thomas Edward Mitton House however, at the time of this inspection no service user required a special diet per se and needs were being adequately met by the home. The kitchen, which is further discussed within the section marked ‘Environment’ is now in need of refurbishment and it is believed that this is imminent. The kitchen however, is well equipped and was clean and tidy at the time of this inspection. Service users generally eat in the kitchen/diner, which looks out on to the communal garden. Mealtimes are flexible within agreed time frames and programme and activity times. One service user was unobtrusively observed preparing lunch. The support given was discreet and considerate of the service user’s abilities. All advice was given in a positive manner. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 15 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 and 20 Service users are supported in their personal needs through prompting and encouragement, which enables their rehabilitation to be achieved as selfreliantly as possible and therefore promoting the development of skills while maintaining individuality and independence. Service users are supported to access routine healthcare support from community-based practices, ensuring that their NHS entitlements are ensured and their right to independence and privacy are exercised. Medications held within the home are robustly managed, ensuring that service users property is protected and promoting safe practices. EVIDENCE: Service users are not provided with direct care but rather, in order to meet their rehabilitation and independent living needs, are supported through prompting and encouragement to ensure their goals are met. Service users are supported to access the community, initially with staff support and, in the long term, with little or no supervision. During the time under review one service user’s needs have changed considerably and the manager has ensured that the person’s needs have been re-assessed on an ongoing basis. The home has clearly worked closely with the community based health care professionals as well as the range of therapists who are based at Thomas 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 16 Edward Mitton House to ensure the service user is appropriately and effectively supported. All initiatives regarding the person’s changing needs were recorded and specific action appropriately and clearly outlined on the supported living plan. Each service user is allocated a key worker who provides support to a specific service user as well as general support to the residual service user group, as their supported living plans dictate. Although service users are prompted in their hygiene needs, the appropriateness of clothing and hairstyles the ethos of the home is that, as adults, service users take ownership and responsibility for their actions. At the time of this inspection the ratio of ethnicity, gender and the cultural backgrounds of staff to service users did not balance however, the home promotes diversity and observations and discussions with service users and staff confirmed that there was an open and transparent atmosphere within the home with an easy and mutually respectful dialogue between all parties. To aid service users rehabilitation, where required aids and adaptations have been fitted further to occupational therapist assessment. The occupational and physiotherapist are based at Thomas Edward Mitton House, providing the home with immediate access to advice in order to meet service users needs. The routines of the home are flexible within programme commitments. Times of rising and retiring are dependent on service user’s planned activities. All service users are registered with a local general practice and consultations generally take place at the surgery however, should service users be very unwell home visits by the doctor can be arranged when consultations take place within the privacy of individual bedrooms. There was clear evidence on service users files of the routine healthcare appointment attended by service users both at Thomas Edward Mitton House and within the local community. Since the time of the last inspection of the home an alternate NHS dentist has been sourced for service users as the dentist they were registered with at that time became a private practice. All other healthcare arrangements with the optician and podiatrist remain unchanged. The home has no direct access to a community psychiatric nurse but should service users require this level of support there is access to a psychiatrist who holds a regular clinic at Thomas Edward Mitton House. Service users receive annual healthcare checks and their medications are reviewed regularly. There was evidence of the home’s robust endeavours to ensure that service users have access to their NHS entitlement. Medications are delivered to the home from a local pharmacy using the ‘Medications Manager’ as opposed to the Nomad system of administration, which was in place during the time of the last inspection of the service. The system adopted by the home to store medications remains unchanged and they were found to be securely stored within an appropriate environment. No controlled drugs were noted to be prescribed for any service user at the time of this unannounced inspection. No service user was self-administering their medications at the time of this inspection. Medications prescribed to service users are reviewed regularly by the person’s doctor and in partnership with other healthcare professionals who are involved in the care and support of 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 17 service users. Medication administration recording (MAR) sheets are used to record medications received into the home and are also used to record the medications administered to service users, in line with the doctor’s advice. Any medications returned to the pharmacy are recorded on a designated book and their return is acknowledged by the pharmacist by means of a pharmacy stamp and signature. The medication policy and procedure, which has been developed by the organisation and has previously been positively assessed against the criteria of Standard 20 remains unchanged since the time of the last inspection of the home. The activity of storing and administrating medications is contained within a risk assessment framework, which is inclusive of control measures. Overall, the storage and administration of medications prescribed for service users was found to be robustly managed. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 18 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 and 23 The home has a complaints policy and procedure, which enables service users to make their comments known and have them listened to in a non-judgmental manner. Vulnerable service users are protected via policies, procedures and training that ensures staff understand their duty to report any instances of actual or alleged abuse. EVIDENCE: The annual review of the organisational generated complaints policy and procedure has taken place and has resulted in no changes being required. A copy of the complaints policy and procedure, which has been assessed as being compliant with the requirements of Regulation 22 of the Care Homes Regulations 2001, forms an integral part of the service users guide. During the time under review the Aylesbury office of the Commission has received no complaints relating to 11 Twyford Lane for Social Care Inspection or by the home itself. There is however, a designated file in place to record any complaints made known to the home and there is also a comments book, posted in the entrance hall of the home for visitors, service users and staff to use. There are policies and procedures, such as the whistle blowing, finance and challenging behaviour policies that guide staff in the protection of vulnerable service users and the home also refers to the Milton Keynes inter-agency policy and procedure that promotes the protection of vulnerable service users. There is also a personal relationships policy that guide staff in how to support service users to develop appropriate personal and platonic relationships and inform staff of appropriate professional boundaries. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 19 The assistant manager of Thomas Edward Mitton House facilitates adult protection training. All four staff employed at 11 Twyford Lane have attended adult protection training since December 2004. Training that is in line with the challenging behaviour policy and procedure is included on the Brain Injury Rehabilitation Trust’s annual development plan and de-escalation training is provided on request. The non-violent crisis intervention training is a two-day course and has been attended by the manager. The next scheduled non-violent intervention training course was due on the day following this unannounced inspection, although the three staff members who require this training were not due to attend. This course however, has been factored into the training plan and the staff will be trained within a reasonable timescale. Induction training is inclusive of challenging behaviour training. At the time of this unannounced inspection ‘ABC’ charts were in place for one service user. Recording on the charts was appropriately completed to record the person’s behaviours that present as challenging. There are no adult protection issues at the home and service users did not indicate that they were unhappy with any aspect of the home’s management. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 20 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 and 30 Service users live in an environment, which has been sympathetically refurbished to meet their needs and is decorated and furnished to a good standard, ensuring that their comfort is secured. Standards of cleanliness at the home are good, ensuring that service users’ health and welfare is protected. EVIDENCE: 11 Twyford Lane is one of three small homes administrated by the Brain Injury Rehabilitation Trust and is situated on a development in the Brownswood area of Milton Keynes. 11 Twyford Lane is a bungalow, which has been sympathetically designed to meet the rehabilitative needs of three younger service users with an acquired brain injury. At the time of this inspection the home was carrying one vacancy, one service user having been discharged to Thomas Edward Mitton House where his needs could be more appropriately met. Access into the home is directly from the car park, which is situated at the front of the home. The entrance hall of the home provides access to all areas. Bedrooms provide single room accommodation and are fitted with an adjacent en-suite facility that consists of a walk-in shower, toilet and washbasin. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 21 Bedrooms were noted to have been individualised with personal possessions and were clearly reflective of hobbies, interests and family links. There is a communal lounge, laundry, kitchen/diner and garden, which is accessible through the lounge and kitchen by means of French doors. Décor throughout the home is bright. Furniture is of a good specification although it would seem that the sofa and chair in the communal lounge might be replaced within the next year. The kitchen also requires refurbishment and the manager advised that this had been factored into the capital budget of the home and its upgrade is imminent. Lighting is domestic in character and emergency lighting is fitted throughout the home. The garden is centrally situated on the development and the three properties are situated on its periphery, effectively enclosing the garden. Service users undertake the maintenance of the garden as part of their rehabilitation and they are supported in this task by staff. Maintenance at the home is undertaken by a handyman who is based at Thomas Edward Mitton House and whom visits the three properties on the Brownswood development on a regular basis, although it was clear that his attendance at the home was not enough to ensure that all maintenance was immediately completed. It was recommended further to the last announced inspection of the home that the organisation recruit a part-time handyman to support the current handyman. This has not been complied with but it was ascertained that a system has been developed where the manager of 11 Twyford Lane co-ordinates all the maintenance tasks required and liaises with the handyman. The manager reported that the revised system has been effective and ensures that all remedial work is immediately dealt with. The tour of the building indicated that there were no outstanding maintenance tasks. Standards of cleanliness, as noted during the tour of the building, were good. Service users clean their own bedrooms and other parts of the home as part of their rehabilitation programmes and are supported by staff in this task. The home has a small laundry, which is fitted with domestic appliances. The laundry has a hand washing sink and adequate storage facilities to keep detergents and cleaning materials. The flooring in the laundry is non-slip and washable and the walls are partly tiled. The home has an infection control and laundry procedure in place to guide staff in acceptable practices. Although no clinical waste is produced at 11 Twyford Lane there is a collection service, which is retained by the organisation and accessible to the home. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 22 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) 35 Staff receive induction and training that enables them to provide service users with robust support when undertaking the tasks of independent living and service users therefore benefit from a holistic approach towards their rehabilitation. EVIDENCE: All staff are inducted to their posts and all appointments to the staff team are subject to a probationary period with progress meetings conducted at three and five months. The induction undertaken by staff is specific to brain injury and outlines all the potential issues that may be presented to staff in the course of their duties and to service users whilst becoming accustomed to having a brain injury and the subsequent tasks of rehabilitation. The process of induction adopted by the organisation is conducted over the course of three months, is described as flexible and cross-references to NVQ. Mandatory training includes: • Moving and handling • First aid • Fire awareness • COSHH • Food hygiene • Infection control, 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 23 and is included on the organisation’s annual development plan, which is generated from information gathered further to staff’s annual appraisals where their performance in the year, to date, is discussed and the training they require to successfully undertake their roles during the year ahead is discussed and agreed. Two of the four staff members, including the manager, who are employed to work at the home, have attended all mandatory training courses and their qualification is to within current timescales. The other tow staff members, who have more recently joined the staff team, have a few courses to attend but this is in hand to imminently take place. All training attended by staff is noted on individual training records. A threemonth training matrix has been developed by the community support manager, which is thereafter replicated and is based on local and legislative needs. This is in addition to the organisation’s annual development plan, as reported on as above. Thomas Edward Mitton House’s assistant manager and the community support manager, who is also based at Thomas Edward Mitton House, undertake the management of staff’s training and development. Ros Tysom, the manager of 11 Twyford Lane is currently undertaking the Registered Manager’s Award via the Aylesbury Training Group. The manager has also undergone the NVQ assessor award but due to circumstances beyond her control had not concluded the award. It would appear that the organisation is in the process of developing it own NVQ Assessment Centre. One staff member has qualified to NVQ Level 2 and another has completed the NVQ Level 3 award. Of the residual two staff members, one has been identified as a candidate to commence NVQ Level 3 and, as the fourth member of the team is newly appointed no decisions have yet been made in relation to the award. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 There are systems in place to assure that the standards of support and rehabilitation within the home are not compromised therefore providing service users with continuity, quality and a transparent approach and attitude to the provision of their individual needs. The health, safety and welfare of service users are safeguarded through the systems that are in place to ensure that these aspects of their care is not compromised and that are conscientiously applied by staff who have a good awareness of safe working practices. EVIDENCE: There are several local and organisational methods to measure the quality standards and to meet legislative requirements. Monthly visits to the home by a senior representative of the organisation are conducted in line with Regulation 26 of the Care Homes Regulations 2001 and a report is subsequently submitted to the Aylesbury office of the Commission for Social Care Inspection. The visits are recorded on a pre printed pro forma, 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 25 as far as can be ascertained are thoroughly undertaken with any remedial action required by the home outlined within the report. Audits of the medications held within the home are conducted every three months; the last once took place in May 2005 and resulted in no requirements or recommendations being issued. Support plans are summarised every month and there are formal annual reviews of service users needs, which can be arranged with more frequency, as needs dictate. The organisation has developed a formal quality assurance programme. Questionnaires are sent out to service users and stakeholders annually and a report is generated from the information submitted on the returned pro forma. Any required actions are discussed with the home. All policies and procedures are reviewed and revised, as required, by the organisation each year. There are formal forums in place to support staff in their roles. Supervision takes place every four to six weeks and performance is formally discussed on an annual basis with development plans being resultant. Staff and house meetings take place, with service users participating in the meeting for the non-confidential agenda items. The last recorded staff and house meeting was noted as being 21 June 2005 and the aim is to arrange for them to take place every four to six weeks. All initiatives are recorded. As previously reported two of the four staff members employed at the home have yet to undertake a couple of mandatory courses each. Two of the staff members have attended all mandatory training courses to within reasonable timescales. Three of the four staff members are qualified to First Aid standards. There is a health and safety policy in place to guide staff in safe working practices. The home has an infection control policy and, although no clinical waste is produced at the home there is an arrangement in place that facilitates the regular collection of any clinical waste that my be produced. Risk assessments have been developed at the home that focuses on the potential risks to service users that may present during the course of their rehabilitation, COSHH and fire. There are also risk assessments in place that focus on safe working practices and the general environment. The generic risk assessments were updated during March 2005 and identify the following factors and control measures: • activity • hazard • risk • those at risk • precautions • rating (low, medium or high) • action required • revised rating (further to action) • training • the date of the core assessment and review date/s • the identity of the assessor and date of assessment 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 26 Risk assessments that pertain to food safety were updated during September 2004. COSHH risk assessments were developed in line with the information held on the data sheets that pertain to all chemicals in use at the home. Staff have also received training in the management of COSSH substances. With the exception of the fire risk assessments, risk assessments were found to be thorough, well recorded and in date. Although the manager had updated the fire risk assessments, she had omitted to date the assessments and was therefore asked to ensure that this deficit was remedied. All accidents and incidents that take place within the home are recorded on a pre printed pro forma, which were well recorded and prompted appropriate action. During the time under review eleven accidents and/or incidents have occurred at the home. Many were incidents that involved behaviours that presented as challenging. The home is aware of its duty to report all adverse accidents and incidents in line with Regulation 37 of the Care Homes Regulations 2001. Thermostatic valves are fitted to all hot water outlets. A gas safety certificate that validates the effectiveness of the home’s boiler and central heating system was issued on 31 March 2005. Heat, smoke and carbon monoxide detectors are fitted throughout the home, as appropriate. They are visually checked every week and the initiative is recorded. Records indicated that the smoke alarm fitted in the staff room had not been working for a short period of time but that had been remedied by the time of this unannounced inspection. A fire action guideline and a floor plan of the home with exit routes highlighted is posted in the entrance hall of 11 Twyford Lane and copies given to service users, for their reference. There is an annual service contract that applies to all the fire fighting equipment placed at the home and the emergency lighting system is discharged every month. The fire alarm is sounded every month from a different call point. Fire drills are conducted on a monthly basis, the last one taking place on 21 July 2005. Fire fighting equipment is visually checked every month and all initiatives are recorded. The records indicated that the fire drills and visual checks of the fire fighting equipment coincided. All but one staff are trained in fire awareness, the fourth staff member was due to attend a fire awareness course on August 8th, 2005. The home is well maintained and there is a revised arrangement in place to ensure that required remedial work is attended to with as little delay as possible. Overall, the approach and attitude of the home towards health and safety is conscientious and all initiatives appear to be well undertaken. 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 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 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 11 Twyford Lane Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 1. Refer to Standard Good Practice Recommendations 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 29 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, BuckS HP19 8JR 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 11 Twyford Lane H53_S1507H53_ S15076 -Twyford Lane 11_V242150_Stage 2 28 July 05 - MJ-PS.doc Version 1.40 Page 30 - 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!