Inspection on 07/08/06 for Twyford Lane (11)

This inspection was carried out on 7th August 2006.

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

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

Other inspections for this house

Twyford Lane (11) 27/11/08

Twyford Lane (11) 20/03/07

Twyford Lane (11) 16/12/05

Twyford Lane (11) 28/07/05

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 Twyford Lane (11) 11 Twyford Lane Browns Wood Milton Keynes Bucks MK7 8DE Lead Inspector Ms Chris Schwarz Unannounced Inspection 7th August 2006 09:30 Twyford Lane (11) DS0000015076.V300349.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.V300349.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.V300349.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.V300349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th December 2005 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 full, with one service user in hospital. 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. Fees range from £1241.17 to £1840.37 per week. Information supplied by the manager in the pre-inspection questionnaire. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course a day and covered all of the key standards for younger adults. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. There were no returned comment cards. The inspection consisted of discussion with the manager and other members of the staff team. There were opportunities to observe care practice and to meet with service users to gain their views. A tour of the premises and examination of some of the required records was also undertaken. At the end of the inspection, feedback was given to the manager. Staff and service users are thanked for their co-operation and hospitality during this inspection visit. What the service does well: 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 are enabled to take risks, to promote independence. Service users are part of the community and have appropriate activities, providing them with community presence and stimulation. Service users are enabled to have appropriate relationships, maintaining important social contacts. Rights and responsibilities are respected, ensuring that service users’ have appropriate recognition. Meals and menu planning are appropriately managed, ensuring that nutritional needs are met. Personal support is provided according to needs, ensuring that service users receive the assistance they require. Health care needs are met, ensuring that service users keep well. Medication is appropriately managed, ensuring that service users receive the medicines they require. Needs arsing from equality and diversity are well met. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 6 Effective complaints procedures are in place to listen to the views of service users and their representatives. Appropriate Protection of Vulnerable 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 for service users, providing them with a comfortable and homely place to live. 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. 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 is shown toward health and safety, to reduce the risk of accidental injury to service users, staff and visitors. 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. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: A service user had transferred from one of the other two properties on the site since the last inspection. This person was already familiar with the service and staff and detailed needs assessments were already in place and a series of visits prior to admission to the home were not necessary. In these circumstances, it is not possible to fully assess the standard. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the 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 are enabled to take risks, to promote independence. EVIDENCE: Care plans are in place for each of the three service users, with a photograph to identify them. There was evidence of needs being reviewed and risk assessments were in place for daily living tasks such as using public transport, cooking and using the kettle, as well as for self harming, potential for violence and substance abuse. There were clear goals 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 service users and there was evidence of multi-disciplinary input to ensure that needs are identified and met. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 10 The home manages service users’ money and there are individual tins and record books in place. Service users have cash point cards to withdraw money and need support from staff to remember the personal identification numbers that go with these. The home did not have any risk assessments in place to ensure that sufficient safeguards are in place to prevent fraudulent use of the cards and the organisational policy was not being followed. It is recommended that a risk assessment be written to ensure that adequate safeguards are in place, and that any actions to minimise fraudulent use are then monitored by the manager. There were notes of four service user meetings for this year. Observation of practice provided evidence of service users being encouraged to complete daily living tasks with staff support or supervision as necessary. A missing persons procedure is in place. The organisation’s version refers to notifying the Commission of anyone who goes missing, as required. This is absent from the local procedure which staff are more likely to use. It is recommended that the local version be revised to ensure that notifications are made. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are part of the community and have appropriate activities, providing them with community presence and stimulation. Service users are enabled to have appropriate relationships, maintaining important social contacts. Rights and responsibilities are respected, ensuring that service users’ have appropriate recognition. Meals and menu planning are appropriately managed, ensuring that nutritional needs are met. EVIDENCE: From speaking with service users and reading daily reports, it was clear that the people living at Twyford Lane have access to the local community and make use of the facilities in the city centre. Files contained risk assessments Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 12 for using transport, including making use of the bus services in the area and road safety. One person had a placement in a local nursery. Care plans focused on achieving goals towards independence. Service users were observed doing their laundry and preparing lunch and each person had produced a menu of the week’s meals. Service users are able to see friends and family. There was freedom for them to be alone or in company and staff interacted with them. No one currently has a key to their room although these are available if needed. Staff respected the privacy of the person in hospital by not entering his bedroom. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Personal support is provided according to needs, ensuring that service users receive the assistance they require. Health care needs are met, ensuring that service users keep well. Medication is appropriately managed, ensuring that service users receive the medicines they require. EVIDENCE: Support needed by service users is noted within their care plan files. Records are maintained of attendance at medical appointments and there was evidence of multi-disciplinary input from review notes and other documents on files. Weights were also recorded. The home has changed over to a different monitored dose system of medication administration and this was reported to be working well. The medication cabinet was secure and locked when not in use, with appropriate arrangements for the storage, administration and recording of controlled Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 14 drugs. Medication administration records were in good order and there was a photograph of each service user in the records folder. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Effective complaints procedures are in place to listen to the views of service users and their representatives. Appropriate Protection of Vulnerable Adults and whistle blowing procedures are in place, to safeguard against the risk of harm. EVIDENCE: A copy of the complaints procedure was submitted with the pre-inspection questionnaire and contained all required information for anyone wishing to express views about the service. The Commission has not received any complaints about this service and none were indicated as being received by the home on the pre-inspection questionnaire. The home’s log book did not contain any recent entries. The Commission is not aware of any adult protection concerns about the service. There are adult protection and whistle blowing policies to refer to and staff have undertaken Protection of Vulnerable Adults training last year. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A clean, safe and well maintained environment has been created for service users, providing them with a comfortable and homely place to live. EVIDENCE: The home is well maintained and is not identifiable in the road as a care home. Accommodation is on ground floor level with level access throughout and widened doorways. Each person has a single en-suite bedroom and these had been decorated and arranged to different tastes. The lounge was modern and seating comfortable and there was access to the garden from here. The kitchen and dining area are small but in keeping with the size of the home. 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. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 17 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. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the 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: The manager and one other member of staff were on duty at the start of this visit with a further carer arriving early afternoon to relieve the manager. There were no staff vacancies and the manager indicated that the staff team were reliable. Those spoken with had a 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 manager is doing level 4. The induction used at the home follows a comprehensive format and includes issuing staff with a copy of the General Social Care Council code of practice. There was a copy of this also available in the office. One of the three induction records was examined and found to be signed and dated to show which areas had been completed. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 19 There was evidence of two staff meetings taking place this year from records of minutes. Minutes of a third meeting could not be located. Training was in good order with recent updates undertaken to refresh knowledge. Recruitment files were examined during a visit to the service earlier in the year and found to be satisfactory, with evidence of all required checks in place. No new staff have started since then therefore it was not possible to assess the standard on this occasion. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the 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 is shown toward health and safety, to reduce the risk of accidental injury to service users, staff and visitors. EVIDENCE: The home has a registered manager, who is in charge of day to day running of the service. She 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 Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 21 receive the support and assistance they require. Until managers have achieved the Award, the standard cannot be scored as fully met. Reports of monthly monitoring visits by the provider are forwarded to the Commission on a regular basis and provide good evidence of detailed monitoring. The home’s certificate of registration was displayed in the hallway and there was evidence of sufficient employer’s liability insurance as well. The Commission had not been notified of the planned hospital admission of one service user and clarification was given that any hospital admission should be notified. A requirement is made to ensure that future notifiable incidents are reported within 24 hours of occurrence. The home had a current gas safety certificate and electrical appliances had been tested this year. 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, due for review this month. Generic risk assessments had been revised in March this year and there were 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 was said to be good. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 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 x 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.V300349.R01.S.doc Version 5.2 Page 23 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. 1 Standard YA37 Regulation 37 Requirement All notifiable occurrences are to be reported to the Commission within 24 hours of occurrence. Timescale for action 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA7 YA7 Good Practice Recommendations A risk assessment is to be written on supporting service users to withdraw money using cash point cards. The local version of the missing persons procedure is to state that the Commission should be notified of any missing person. Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury 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 Twyford Lane (11) DS0000015076.V300349.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!