Inspection on 25/06/05 for Twyford Lane (7)

This inspection was carried out on 25th June 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 (7) 17/12/09

Twyford Lane (7) 31/10/07

Twyford Lane (7) 13/11/06

Twyford Lane (7) 16/12/05

Twyford Lane (7) 29/09/04

Twyford Lane (7) 23/05/04

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 (7) Browns Wood Milton Keynes Bucks MK7 8DE Lead Inspector Moira Jones Unannounced 25th June 2005 9:30am 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. Twyford Lane (7) Version 1.10 Page 3 SERVICE INFORMATION Name of service Twyford Lane (7) Address 7 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 639086 The Disabilities Trust Mrs Sandra Jane Stevens Care Home 3 Category(ies) of Physical disability (3) registration, with number of places Twyford Lane (7) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 29th September 2004 Brief Description of the Service: 7 Twyford Lane is a care home registered to provide rehabilitative care and accommodation for three younger people with an acquired brain injury. At the time of this announced inspection two service users resided at the home. The home is administrated by The Brain Injuries Rehabilitation Trust, which is part of The Disabilities Trust. 7 Twyford Lane is situated on the Brownswood development, which is to the south of the new town of Milton Keynes. The home is close to the local shopping districts of Old Farm Park and Walnut Tree and the more accessible and diverse Milton Keynes shopping centre. The home is close to a direct bus route that enables service users to have easy access to the towns of Bletchley and Milton Keynes as well as to main line train stations. The home is one of three properties built in a complex of three homes, all of which are administrated by The Brain Injuries Rehabilitation Trust. 7 Twyford Lane is a bungalow, which has been carefully adapted to provide for the needs of the service users who live there. Service users accommodation consists of single bedrooms with adjacent en-suite facilities. Communal areas consist of a lounge and kitchen/diner. The home shares a communal car park and garden with the other two properties on the complex. Twyford Lane (7) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the inspection that was conducted on two days during June 2005. The first visit to the home consisted of a tour of the building, discussions with the staff member representing the home on that occasion as well as the assessment of a variety of documentation and a brief discussion with the service user who was present in the home. The second visit gave the opportunity for protracted discussion with the second service user, who was on a weekend visit with family during the first day of the inspection and a general conversation with the staff member who was on duty on the second day of the inspection. The home was visited on the first day of inspection during the morning and on the second day, during the afternoon. As a result of the last announced inspection of the home, which was conducted in September 2004, one recommendation was issued in relation to the maintenance of records. It was ascertained during this inspection that the recommendation was being met on an ongoing basis. As a result of this announced inspection one requirement that relates to the environment has been issued. Within the body of this report is evidenced the fact that 7 Twyford Lane continues to be well managed with the rehabilitation needs of service users paramount, facilitated by staff who are well informed and committed to their roles. What the service does well: Service users needs are assessed prior to admission, ensuring that individual requirements are known to staff and enabling them to ensure that requirements are efficiently and effectively met from the outset. The support required by service users to achieve their rehabilitation goals are outlined within individual plans. Service users are enabled to proactively make decisions about their rehabilitation via the development of weekly plans that outline opportunities to be independent and autonomous. Risk assessments underpin service users activities of rehabilitation and everyday living. Service users have good opportunities to access the community. Visiting at the home is flexible within individual rehabilitation programmes, enabling service users to maintain family contact and develop personal and platonic relationships. The routines of the home are flexible. Healthy eating is promoted at the home. Independence and individuality are promoted, ensuring that rehabilitation is effective and progress made at a pace that is appropriate to the individual. Service users healthcare needs are robustly met and access to NHS entitlements are ensured. The home has robust systems in place to ensure that prescribed medications are effectively managed. Twyford Lane (7) Version 1.10 Page 6 There is a complaints policy and procedure, which is known to service users and enables them to make their comments known and listened to. Vulnerable service users are protected from abuse through policies, procedures and staff training. The environmental standards of the home are good. Standards of cleanliness and hygiene within the home are good. Staff are inducted to their posts and trained to mandatory standards. Personal and professional development opportunities are available to staff. Quality standards of the service available to service users are ensured via various methods in place to measure effectiveness, efficiency and continuity. Health and safety within the home is well managed. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Twyford Lane (7) Version 1.10 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 Twyford Lane (7) Version 1.10 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 All service users who are admitted into the home have their needs assessed prior to admission, ensuring that individual requirements are known to staff and enabling them to ensure that requirements are efficiently and effectively met from the outset. EVIDENCE: Younger service users with an acquired brain injury are admitted into 7 Twyford Lane for rehabilitation. Some are admitted via Thomas Edward Mitton House, which is the assessment unit based in Emerson Valley in Milton Keynes and other service users are admitted via direct referral. All service users admitted into 7 Twyford Lane undergo a period of assessment, usually undertaken by representatives of the clinical team, prior to transition into the home. This enables staff to ascertain whether they are going to be able to meet service users’ specific rehabilitative and general needs. During the time under review three service users have been discharged from the home. One service user has emigrated and another service user has been rehabilitated into the community. The third service user was discharged back to Thomas Edward Mitton House. Three service users, including the person discharged back to Thomas Edward Mitton House have been admitted into the home. Two of the service users were admitted via Thomas Edward Mitton House and one via direct referral. Twyford Lane (7) Version 1.10 Page 9 Copies of the completed pre-admission screening forms were seen, the originals are held at Thomas Edward Mitton House. Recording on these were appropriate and gave a good basis for the development of rehabilitation plans. Service users general and rehabilitation needs are regularly reviewed with a meeting on a fortnightly basis to discuss individual challenges and progress and a formal meeting that is held at Thomas Edward Mitton House every three months. A variety of therapists who are accessible to the home’s staff are available to guide and support individual needs are based at Thomas Edward Mitton House. No changes were ascertained as having been made to the admission policy and procedure that is in place to guide staff in admissions although it was noted that the admission and discharge checklists that prompt qualitative transitions have been updated since the time of the last announced inspection. Any prohibitions on service users access to services are outlined on the service users guide. Twyford Lane (7) Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 The support required by service users to achieve their rehabilitation goals are outlined within individual plans, ensuring that staff have a good understanding of individual requirements. Service users are enabled to proactively make decisions about their rehabilitation via the development of individual weekly plans that outline opportunities to be independent and autonomous. Risk assessments underpin service users’ activities of rehabilitation and everyday living, ensuring that their ability to be independent is supported within an agreed framework of considered control. EVIDENCE: Each service user has a plan of rehabilitation that is developed in line with their assessed needs and is thereafter updated and extended in line with individual progress. Rehabilitation plans are made up of functional goals, competent sub goals and planned actions/interventions. Rehabilitation plans outline the levels of support required by service users however, the aim of the home is to encourage service users to become skilled, re-skilled and as independent as possible. Rehabilitation plans also outline any restrictions on choice and Twyford Lane (7) Version 1.10 Page 11 freedom and these are identified within a risk assessment framework and agreed with service users. The information held within rehabilitation plans seen was, as far as can be ascertained, current and all information was substantiated by the staff member assisting the service user to plan and achieve their goals via signature and dates. The rehabilitation plans were evident, via review notes and assessed updating of information, of the progress made by service users. For one service user, the rehabilitation plan included clear ‘behaviour and communication guidelines, which was supported by a considered rationale to underpin the guidance. The guideline was acknowledged by the service user and staff via signatures. There are core risk assessments in place, which were evidential of the regular updates that take place as service users rehabilitation progresses. The assessments focus on the vulnerabilities of service users whilst undertaking their rehabilitation and the activities of everyday living. Assessments were found to be current and included control measures that reduce but do not completely remove reasonable risks. Activities of daily living and rehabilitation are recorded by staff on daily records. All entries made are signed and dated by the staff member making the entry. Staff’s recording practices were found to be good. As part of their rehabilitation service users are encouraged and supported to make day-to-day decisions. Service users plan their weekly rehabilitation plans. These include tasks that promote independent living skills as well as a varied social programme. All initiatives, which include some cleaning, laundering, menu planning and shopping tasks, are recorded on the daily records to evidence progress and participation. Service users meetings are held on a monthly basis and these are recorded. As part of their rehabilitation service users are encouraged to manage their own finances although staff are available to support them in this task. Staff support with this aspect of service users rehabilitation is outlined within an organisational generated policy and procedure. In addition to the risk assessment initiative as noted above, there is also a missing person’s policy and procedure in place. No changes have been made to this policy and procedure since the last time it was assessed. The procedure is clear and there is a ‘thumbnail’ file in place that includes a photograph and a description of the service user so that any absences may be quickly responded to from prepared information. Although it is not a regular occurrence, the home recently had cause to initiate the missing persons procedure and it appears to have been effectively and efficiently applied with a positive outcome. Twyford Lane (7) Version 1.10 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 Although service users are not in remunerated employment, their self-esteem and individuality is promoted via the achieving of rehabilitation goals. Service users have good opportunities to access the community, enabling them to develop community links and ensuring that their social needs are met. Visiting at the home is flexible within individual rehabilitation programmes, which means that service users are able to maintain family contact and develop personal and platonic relationships. The routines of the home are flexible within agreed rehabilitation plans, enabling service users to work towards independence or part independence while at the same time living fulfilling lifestyles. Service users are supported to plan and shop for groceries and prepare meals, ensuring that the ethos of healthy eating is promoted and that their nutritional needs are met. EVIDENCE: Twyford Lane (7) Version 1.10 Page 13 Due to the short-term nature of stays at the home, service users are not in remunerated employment although the organisation does support service users to fulfil educational/work placements, as individual rehabilitation plans allow. As part of their rehabilitation and in line with their goals to achieve independent or partly independent living, service users are taught new skills or are introduced to forgotten skills that range from using public transport to running their own homes and preparing meals. Staff are available to support service users to manage their finances and there are organisation guidelines in place that promote good practices as well as for the protection of both service users and staff. As part of their rehabilitation and the promotion of independent living skills service users participate in the general maintenance of the home, specifically in the cleaning of their bedrooms and the communal areas and also launder their own clothing. 7 Twyford Lane is situated within the community in Brownswood, which is on the periphery of Bletchley and Milton Keynes. The home is situated on a bus route, giving service users good opportunities to access local communities. Historically, the home is well supported by its neighbours and this situation remains unchanged. Service users are supported either by their key worker or another member of staff to use local public transport and as their rehabilitation progresses may be considered ‘off escort’ when they are enabled to use transport independently. This is subject to ongoing assessments and is evidenced within a risk assessment framework that is underpinned by considered and agreed control measures. Service users are registered on the electoral roll and are encouraged to participate in the civic process. The diversity of the staff team and the local community reflects the cultural needs of service users. Male staff are employed at the home and at the time of this unannounced inspection both service users residing at the home were male. Within the boundaries of individual rehabilitation plans visiting at the home is flexible. Visitors to the home are invited to sign the visitor’s book when entering and leaving the home. An audible alarm has recently been fitted to the front door of the home and restraints have recently been fitted to all windows facing the car park to prohibit intruders from accessing the home. Service users are able to meet with their visitors within the privacy of their individual bedrooms or in the less private communal lounge. Service users are encouraged to maintain relationships with their families and are able to go home at weekends. One service user in particular makes the most of this and visits his family at home every weekend. Further, service users are encouraged to develop relationships with peers and there is a guideline in place to inform staff of what is acceptable and how to appropriately guide service users with this aspect of their personal decision-making. Outside of individual rehabilitation plans daily routines are reasonably flexible. The appointments that have been arranged by service users by themselves or on their behalf only dictate times of rising and retiring. Twyford Lane (7) Version 1.10 Page 14 Service users’ post is directly given to them and support is available from staff to enable them to manage its contents. With the exception of other service users bedrooms there is unrestricted access to all areas of the home and the garden is shared between all three properties on the development. Preferred forms of address are indicated on individual rehabilitation plans. Individual hobbies, interests and religious observance, which service users are encouraged and supported to continue to participate in are evidenced on individual plans, although participation is entirely the prerogative of service users. Service users are provided with keys to their bedrooms and to the front door of the home when admitted and the risks and agreed control measures that underpin this activity are identified on individual assessments. The rules on smoking, the use of alcohol and illicit substances are outlined within the service users guides and also form an integral part of the contract/statement of terms and conditions of occupancy, which are acknowledged by service users at the point of admission. Service users confirmed that there were few restrictions in relation to their liberty and acknowledged that what ‘rules’ were in place were there for reasons of health and safety. Service users confirmed that staff were relatively flexible in their approach although clear when supporting service users to achieve their rehabilitation goals. From observations made, staff and service users interacted appropriately and any agreements made were as a result of mutual discussions where no pressure was placed on any one party to relent to the demands of the other party. The home promotes healthy eating. Menus are planned by service users who are supported by staff to make appropriate decisions about variety, seasonal availability and expenditure. Service users are also supported by staff to prepare meals in the kitchen, which is well equipped for this purpose and has recently been refurbished. Cultural, clinical and religious needs are considered when planning and preparing meals and service users are able to access the support of the dietician via a doctor’s referral. At the time of this unannounced inspection no specialist considerations were required when planning meals. Service users generally dine together in the kitchen/diner. No service user currently residing at the home required assistance to eat. Service users confirmed that they were well supported in this aspect of their rehabilitation and daily living. Twyford Lane (7) Version 1.10 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 Although direct care is not provided to service users, individuality and independence is promoted, ensuring that rehabilitation is effective and progress is made at a pace that is appropriate to the individual. Service users healthcare needs are well met by means of good access to the therapists based at Thomas Edward Mitton House and the healthcare professionals based in the community and the general practice they are registered at. The home has robust systems in place to ensure that medications are effectively stored, ensuring that service users’ property is secure and that their welfare and safety is protected. EVIDENCE: Direct care is not provided at the home and service users are encouraged to be as independent as their abilities enable them to be while in the process of becoming skilled and/or re-skilled through their individual rehabilitation programmes. Service users are provided with single room accommodation that promotes privacy and dignity and bedrooms are fitted with en-suite facilities that consist of a shower, toilet and washbasin. Both service users currently residing at the home are male and there are male staff members on the team. The cultural mix of staff and service users is balanced. Service Twyford Lane (7) Version 1.10 Page 16 users rise and retire as their individual rehabilitation plans dictate. The home operates a key worker system and all staff are available to guide service users in the appropriateness of their clothing etc. Service users are autonomous in the choice of hairstyles. Staff were clear regarding their roles and responsibilities and service users confirmed that the support given was appropriately pitched, enabling independence and individuality to be maintained and skills to develop effectively. Staff and service users stated that established staffing hours gave ample opportunity to undertake the tasks of everyday living as well as more individual rehabilitation programmes. The home is fitted with aids and adaptations that have been assessed as meeting the general needs of service users. Should service users require specialist aids and adaptations their needs would be assessed by an occupational therapist based at Thomas Edward Mitton House. Other therapists that may be able to offer advice on individual rehabilitation plans are based at Thomas Edward Mitton House and are accessible to staff. No advocate or volunteer currently visit the home although information that relates to independent advocates is available to service users. Service users are able to register with a medical practice of their choice although most people who are admitted into the home opt to be registered with the Walnut Tree practice, which is within walking distance of the home and historically has been reported as providing an excellent level of support to individuals. Consultations generally take place at the surgery as and when required, but should a service user be so unwell as to warrant a home visit, this would be arranged and the consultation would take place within the privacy of the service users’ own bedroom. Service users and staff confirmed that the approach and attitude towards ensuring that healthcare needs are robustly met. Routine healthcare appointments attended to dentists, opticians and podiatrists were noted on individual plans. From records seen and from discussions with service users it was clearly apparent that their NHS entitlements are ensured. Medications are delivered to the home on a weekly basis using the Nomad system of administration. The home notes all medications delivered to the home on the medication administration record (MAR) sheets and any returned to the pharmacy are recorded in a separate book, evidence of which indicated that the home’s practices were good. MAR sheets evidenced good recording practices in lieu of administration. No controlled drugs are currently prescribed for any service user and no service user who resides at the home selfadministers their medications. The organisation generated medication policy effectively outlines the use of controlled drugs within the home and provides staff with a guide regarding the self-administration of medication. The policy has previously been positively assessed and no changes were ascertained as having been made to the document during the time under review. Medications are held within the home and are securely stored within an appropriate environment. Access to the medications is the prerogative of staff only and there is a system in place to substantiate service users’ identity prior to medications being administered. The supplying pharmacist audits medications held within the home; the last audit took place during May 2005 and resulted Twyford Lane (7) Version 1.10 Page 17 in no requirements or recommendations being issued. A minimum number of medications were held in stock and all were well within their ‘use by’ dates. Staff training in the administration of medications is delivered via distance learning. Twyford Lane (7) Version 1.10 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 is known to service users and enables them to make their comments known and listened to. Vulnerable service users are protected from abuse through policies, procedures and staff training. EVIDENCE: No changes have been made to the organisation-generated complaints policy and procedure, which is used at the home as a guideline for service users, staff and visitors and which is included on the service users guide. A copy of the policy and procedure is posted in the entrance of the home and there are systems in place to record all comments and compliments made. No complaints have been received by the home or at the Aylesbury office of the Commission for Social Care Inspection during the time under review. Individual training records indicated that all staff are trained in the protection of vulnerable adults to within current timescales and, with the exception of one staff member who is due to attend training during July 2005, staff’s training in non-violent crisis intervention was also current. Staff’s training in the protection of vulnerable adults and in the management of behaviour that challenges is in line with the guidance outlined within the policies and procedures developed by the organisation. Supplementary to the organisation’s adult protection policy and procedure, the home also refers to the Milton Keynes inter-agency policy and procedure for the protection of vulnerable adults. Twyford Lane (7) Version 1.10 Page 19 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 Environmental standards at the home are good, ensuring that service users benefit from a comfortable home that is fitted with aids to assist their rehabilitations. Standards of cleanliness and hygiene within the home are good, ensuring that service users health and welfare is not at risk. EVIDENCE: 7 Twyford Lane is a bungalow, which has been refurbished to provide rehabilitative care and accommodation for up to three service users. It is situated in the Brownswood area of Milton Keynes, close to all local amenities and the more cosmopolitan environment of the new town. The home is one of three properties administrated by The Brain Injuries Rehabilitation trust, which operates under the auspices of The Disability Trust. The home shares a communal car park with adequate parking for eight or nine vehicles, and gardens with the other two properties. The home provides single room accommodation to the service users and all bedrooms are fitted with adjacent en-suite facilities that consist of a walk-in shower, toilet and washbasin. There is a spacious lounge and a kitchen/diner. The kitchen has recently been refurbished with replacement cupboard, drawer Twyford Lane (7) Version 1.10 Page 20 fronts and worktops. Both rooms have immediate access on to a patio area via two sets of French doors. The home is brightly decorated throughout, although it was noted that the architraves require redecoration as they have been damaged through use of wheelchairs. Since the time of the last announced inspection of the home the staff bathroom and one bedroom have been redecorated. Also, during the course of the last few weeks an audible alarm has been fitted to the front door of the home. The furniture is modern and domestic in style. The home, with the exception of en-suite facilities, laundry and kitchen, is carpeted throughout. Staff advised that carpets are due for replacement and quotes have been obtained to this end and blinds have been purchased for all windows and were awaiting fitting at the time of this visit. Lighting is domestic in character. The communal gardens situated centrally between all properties are generally well maintained by staff and service users as part of their rehabilitation. A contracted gardener maintains the grounds on the periphery of the property. Although 7 Twyford Lane is constructed on one level, window restraints have recently been fitted to all the windows that face the car park on the advice of the local crime prevention officer to protect service users and staff from intruders. Service users stated that the home’s amenities were of a good standard and promoted privacy, individuality and independence. Service users are responsible for undertaking household cleaning, with support from staff. The laundry is situated adjacent to the front door and is fitted with a domestic style washing machine and tumble dryer. The laundry is fitted with a non-slip, washable flooring and the walls are partly tiled. The laundry was found to be generally well ordered. On the first day of the inspection an unpleasant odour permeated from the laundry, although it and the rest of the home were obviously clean. This was quickly dealt with and no further odours were detected. Staff work in line with infection control and clinical waste policies that promote good practices. No changes were noted to have been made to the contents of either policy during the time under review. Twyford Lane (7) Version 1.10 Page 21 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 are inducted to their posts and are trained to mandatory standards, which are regularly updated ensuring tat service users benefit from staff who are well informed and educated to current legislative standards. EVIDENCE: Newly employed staff are inducted to have knowledge of the ethos and philosophies of the organisation and are also inducted and orientated to their posts. Mandatory training and equal opportunities training are integral to staff’s induction and underpin good practice approaches towards health, safety, good practice based practices and personal development opportunities. Staff’s individual training records indicated that staff training was current to within acceptable timescales. A training co-ordinator who manages a central budget has responsibility for developing an organisational training plan that takes into consideration the personal development requirements of staff, as ascertained during their annual performance and development appraisals. Training schedules are presented to staff every six months and they apply, as their development needs dictate for inclusion on courses. Staff, one of whom was relatively new to the team, spoken with confirmed that training opportunities were good and promoted personal and professional development. Twyford Lane (7) Version 1.10 Page 22 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 The quality standards of the services available to service users are ensured via the various methods in place to measure effectiveness, efficiency and continuity. Health and safety within the home is well managed, ensuring that service users, welfare, health and safety are not compromised. EVIDENCE: The organisation conscientiously undertakes monthly Regulation 26 visits of the home and submits a detailed report of the activity to the Aylesbury office of the Commission for Social Care inspection. The Regulation 26 visits are thoroughly undertaken and recording is concise with action plans in place to address any perceived deficits. Staff’s performance is evaluated each year during their ‘annual appraisals’, which measure their performance for the previous twelve months and to agree their personal development plans for the year ahead. From information Twyford Lane (7) Version 1.10 Page 23 gathered during the process of staff appraisal, the organisation develops an annual development plan for the home. Other methods for measuring quality assurance within the home are in place and there are regular updates of all rehabilitation plans and risk assessments as well as reviews of needs, the measuring of progress and the agreement of goals in line with service users’ achievements. The Brain Injuries Rehabilitation Trust also canvasses all stakeholders to elicit their opinion of the service. The findings are published and an action plan developed to address any issued that present. Policies and procedures are reviewed and revised by the organisation. Service users are made aware of how to contact independent advocates as, due to the short-term nature of the home no volunteer or advocate is currently retained at 7 Twyford Lane. This needs to be a future consideration for the home. As previously reported all staff are trained in mandatory topics to within reasonable timescales. Fire awareness training is arranged to take place every six months and supplementary to this are routine checks of the fire safety systems in place. Smoke and heat detectors are fitted throughout the home, as appropriate and are tested each month. Fire drills take place every month and the emergency lighting system is discharged on a monthly basis. Fire blankets and extinguishers are subject to monthly visual checks. All fire fighting equipment are subject to annual efficiency checks and were serviced during March 2005. As a result of the announced inspection of the home that took place during September 2004 it was recommended that the daily ‘means of escape’ checks be recorded. At the time of this unannounced inspection it was ascertained that this was now the case. No gas appliances are fitted within the home therefore no gas safety certificate is required at Twyford Lane. Testing of all the portable appliances in the home was undertaken by the maintenance person during December 2004 and is conducted on an annual basis. The hardwiring of the home is conducted every five years and was last undertaken in November 2004. All accidents and incidents are recorded on a pre printed pro forma that encourages good recording practices. Accidents and incidents were noted to be minimal. Safety checks that ensure the hygiene standards of the home are undertaken on a weekly basis and the initiative recorded. Showerheads are de-scaled and disinfected on a weekly basis. Fridge and freezer temperatures are taken twice daily and water temperatures from all hot water outlets, which are fitted with thermostatic valves, are recorded each week. There are risk assessments in place that relate to the vulnerabilities of service users, the environment, all safe working practices and COSHH. Data sheets that relate to all chemicals used within the home are in place to underpin the use of those particular chemicals. Overall, health and safety within the home was found to be well managed. Twyford Lane (7) Version 1.10 Page 24 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x x x x 3 Standard No 11 12 13 14 15 Twyford Lane (7) x 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x Version 1.10 Page 25 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x Twyford Lane (7) Version 1.10 Page 26 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 30 Regulation 23(2)(b) Requirement The architraves that have been damaged by wheelchair use require redecoration. Timescale for action 1 October 2005 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 Twyford Lane (7) Version 1.10 Page 27 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire 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 (7) Version 1.10 Page 28 - 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. 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