Inspection on 16/07/07 for Twyford Lane (9)

This inspection was carried out on 16th July 2007.

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 (9) 24/11/06

Twyford Lane (9) 16/12/05

Twyford Lane (9) 17/08/05

Twyford Lane (9) 10/12/04

Twyford Lane (9) 02/09/04

Twyford Lane (9) 18/02/04

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 (9) 9 Twyford Lane Browns Wood Milton Keynes Bucks MK7 8DE Lead Inspector Mike Murphy Unannounced Inspection 16th July 2007 1:45 Twyford Lane (9) DS0000015075.V338863.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 (9) DS0000015075.V338863.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 (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twyford Lane (9) Address 9 Twyford Lane Browns Wood Milton Keynes Bucks MK7 8DE 01908 639087 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) tem@birt.co.uk The Disabilities Trust Mrs Sandra Jane Stevens Care Home 3 Category(ies) of Physical disability (3) registration, with number of places Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 3 people with a physical disability. Date of last inspection 24th November 2006 Brief Description of the Service: 9 Twyford Lane is a care home providing rehabilitative support for up to three residents (known as ‘clients’ in this service) with an acquired brain injury. At the time of this unannounced inspection three male residents lived in the home. The home, which is part of the Brain Injuries Rehabilitation Trust (BIRT), is situated in Browns Wood, Milton Keynes. The home is one of three properties situated on the site. The home is conveniently located for the amenities of Bletchley and Milton Keynes. Transport to both towns is regular and service users are supported in accessing public transport as part of their rehabilitation plans. All properties share a communal garden, which is centrally situated and there is also a communal car park with parking facilities for up to eight vehicles at the front. All bedrooms provide single room accommodation and are fitted with adjacent en-suite facilities. Bedrooms are situated on both floors of the property. There are communal living areas situated on the ground floor. Fees for the service range from £1,140 to £2,720 per week. The average fee is £1200 per week. Residents need to pay for personal items such as toiletries and sundries, plus outings in addition to the fee. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was carried out by one inspector over the course of an afternoon and early evening in July 2007. The inspection included discussion with residents, managers and staff, examination of records, observation of practice, a tour of the home and garden, examination of care plans and consideration of feedback communicated through questionnaires from residents, families, and health and social care professionals. Overall, the inspection finds that this well run home provides a safe and supportive home for the three people (known as ‘clients’ by the service and as ‘residents’ in this report) who live there. Although the home has not had a vacancy for seven years or so, the organisation, the Brain Injury Rehabilitation Trust (BIRT), a division of the Disabilities Trust, has good systems for assessing the needs of a prospective resident and for ensuring that the home can meet the needs of a person who is offered, and accepts, a place there. A care plan is in place for each resident. Support workers co-ordinate care and support the residents. Care is reviewed monthly and a more comprehensive review is carried out annually. The home is situated in the quiet but accessible Browns Wood area of Milton Keynes. It is well located for the amenities of Bletchley and Milton Keynes and a bus to both towns conveniently stops right out side the service. The home is a detached house which is part of a larger complex on the site. All three bedrooms have en-suite facilities. Residents are supported in accessing a range of social, leisure and training facilities. There is one support worker on duty throughout the day and one sleep-in support worker at night. These are supplemented by a support worker who works flexible hours. Staff turnover is low. BIRT provides an ongoing staff training programme. Staff supervision and appraisal systems are well established. Residents and relatives express satisfaction with the service. The organisation carries out an annual survey and has recently acquired CARF accreditation. This development should support a mix of activities aimed at ensuring that the home is continuing to meets the needs of its residents. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Repair the problems with the front door so that residents in the lounge are not disrupted by visitors entering and leaving the home. Ensure that evidence of conformance to Schedule 2 information is retained on staff files in the home to confirm that staff recruitment procedures protect residents. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are thoroughly assessed by experienced staff before admission to ensure the home can meet the person’s needs and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: The home has not had a vacancy for over seven years. Admissions are routed through the organisation’s assessment centre at Thomas Edward Milton (T.E.M) House in Milton Keynes. The process for assessing a new referral was described by the registered manager. Referrals normally originate from an NHS PCT (Primary Care Trust). The person referred would be visited at their current place of residence (most often a hospital or in their own home) by a consultant neuropsychologist. The assessment is structured by a ‘pre-admission’ screening tool. The outcome of the referral is discussed at a multi-disciplinary meeting. Where it is felt the referral is appropriate an admission date is arranged. The initial admission is for a twelve week period of assessment. At the end of the assessment a decision is made on further arrangements for care. Where this involves the offer of a place at Twyford Lane (9) arrangements are made Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 10 for the prospective resident to visit the home, view its facilities, meet residents and staff, and consider whether he or she would wish to live there. Further visits are arranged and admission agreed. The process is flexible and organised according to the needs of the person. At approximately twelve weeks after admission a review takes place. If it is decided that the home can meet the person’s needs and that the person and his or her family share that view and are happy with the home, then admission for as long as the person needs it is agreed. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each resident. The views of residents are sought through regular meetings. Together, these activities aim to ensure that peoples’ needs are met, that their independence is supported, and that residents can influence life in the home. EVIDENCE: There is a care plan for each resident. Care plans are comprehensive, well structured and detailed. They include a photograph of the person, an assessment of needs, a range of risk assessments relevant to the person, and correspondence. Notes are made twice a day, these consist of a description of how the resident was over the relevant time period and a summary of how he spent his time. Care plans are reviewed monthly by a psychologist and a more comprehensive review is carried out annually. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 12 The role of staff is to enable residents to regain and maintain their independence. Residents are supported in making decisions as far as possible. Care plans include a copy of the resident’s weekly planner. This is drawn up by the resident with help from staff as needed. The CARF accreditation requires the home to hold monthly meetings with residents. Residents make their own choices for meals. Residents complete an annual satisfaction questionnaire. The format of this was under review with a view towards improving its presentation to residents. Each resident has a folder, a ‘Client File’, the contents of which include: a copy of the service user’s guide; a copy of their contract; the annual questionnaire; the person’s rehabilitation plan; risk assessments; a statement of the ‘house rules’ and ‘rights and responsibilities’; copies of some policies; the statement of purpose; a copy of the most recent inspection report; and, reports of review meetings. This is a comprehensive set of information which reflects the open philosophy of the service. It could be improved by presenting some of the information in a more ‘user friendly’ format (this recommendation would also, of course, apply to the inspection report, which is not the responsibility of the service) Given the aims of the service, risk assessment processes are well established. Generic risk assessment cover a range of potential hazards in the environment. Individual risk assessments address risks which are specific to individual residents and inform the degree of support and supervision to be provided by staff to the resident. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home lead a varied lifestyle according to their individual interests, abilities and needs. This ensures that people have experience of a range of social, leisure and other activities and are involved with the local community. EVIDENCE: The home is part of a specialist rehabilitation service and all three residents have pursued education courses – often at Milton Keynes College. Courses have included food hygiene, numeracy and literacy, computing, and a course connected with the profession of a resident. Residents have had work placements at T.E.M house, a stables, the shop at the local hospital, and participation in a work skills programme, ‘Special Needs Advancement Programme’ (SNAP). One resident who was currently on a work placement at a nursery said that he was enjoying it very much. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 14 The home is well served by public transport – buses stop immediately outside. This facilitates access to the amenities of Bletchley, Kingston, Willen Lake and Central Milton Keynes. Residents who have a bus pass may also use that as a contribution towards the cost of a taxi. Residents participate in badminton and bowling at Bletchley, local walks, swimming, meals out, and on occasions have gone to the cinema and theatre in Milton Keynes. The home itself is equipped with TVs, music centres and DVDs. Trips out have also included the London Eye and Woburn Park. Some residents have recently started going to an evening club in Milton Keynes. Residents did not have a holiday in 2006 but in 2005 went to the Eden Project in Cornwall. Day trips have included Cadbury World and Dancing on Ice. The manager said that they are hoping to go to Blackpool later in 2007. Holidays and trips out are paid for by the residents. One resident goes on holiday with his parents. With regard to holidays a respondent to the CSCI survey stated ‘The only way it seems possible to provide a holiday for clients seems to cost the clients a lot of money for a couple of days in a hotel out of season’. The registered manager may wish to consider this comment in the context of standard 14.4 which relates to an annual holiday for residents on ‘long-term’ placements. Residents are supported in maintaining contacts with family and friends. The home is well established in the area and residents are on good relations with many people in the locality. A policy on personal relationships is in place. The home routine is flexible. However, most residents tend to get up early, have breakfast, and, after a few light domestic tasks, attend to whatever is on their programme for the morning. Lunch may be taken in the home or wherever the resident happens to be at the time. The afternoon is usually home based, baking, gardening or just taking it easy around the house. The evening meal is around 6:00 pm and is cooked on an individual basis by each resident. The evenings are free time. Meals are chosen by the residents. According to menus supplied for this inspection breakfast consists of cereals and hot drinks. Lunch is either a snack if at home (such as cheese on toast, a sandwich or salad), a packed lunch, or is taken at TEM house. The evening meal is the main meal of the day. There is a bias towards meat based meals but that is a matter of individual choice. Meals chosen by residents during the month preceding this inspection included chicken curry and rice, tuna pasta bake, pork chops with vegetables, fish & chips with mushy peas, and, sausage casserole. Residents are weighed monthly. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 15 The pace of life in the home seemed to suit the residents. All three residents expressed satisfaction with the service and said that it met their needs at present. One relative respondent to the CSCI survey wrote ‘[Relationship] are very pleased with the way they structure everyday activities with clients, to meet their every day needs. It has helped our [relationship & name] to meet his potential and he has done extremely well since he was admitted to Twyford Lane in [month & year]. He is very happy and has made many friends. The care staff are all very caring and understand the needs of clients’. Although the current residents are all of ‘White UK’ ethnicity the Brain Injury Rehabilitation Trust has a policy governing its approach to values of privacy, dignity, choice, fulfilment, rights and independence, which aim to ensure that the home not discriminate against any group and that equality and diversity needs are met. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide support to residents as required. Arrangements for liaising with health and social care services in the community and for the control of medicines are satisfactory. These aim to ensure that people’s healthcare needs are met. EVIDENCE: Each resident has a personal support worker who is responsible for coordinating the care required by the resident. The worker provides support where required, whether it involves activities in the home or in liaison with other services in the community. The resident and support worker meet weekly to review progress. One resident employs a support worker to provide additional one-to-one support for some activities. Residents choose their own clothes, daily routines, diet and activities. The home employs one male support worker. All residents are registered with a GP. The organisation employs a psychologist who reviews care monthly. Occupational therapists and physiotherapists are Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 17 accessed through the local NHS PCT. An NHS podiatrist visits quarterly but that service is soon to be discontinued. Staff are to be trained in the correct techniques of basic foot care. Routine NHS dentistry is available in Milton Keynes. NHS opticians are accessed through two of the larger national chains in Milton Keynes. A local GP practice offers a ‘Well Man’ clinic. Residents are offered annual influenza vaccination via their GP. Residents on anticonvulsant therapy have their medication prescribed by their GP and their generally monitored by specialist epilepsy nurses based at Milton Keynes hospital. A ‘seizure plan’ is drawn up for such residents where required. Medicines are prescribed by the resident’s GP and are dispensed by Boots Chemists in Bletchley. The organisation has a policy governing the administration of medicines. Medicines are administered by designated staff i.e. staff who have had training in the procedure. Initial training is provided in the home but some staff have completed an extended distance learning course which is run by Milton Keynes College. One resident was administering his own medication. The home’s arrangements for the storage of medicines are satisfactory for current needs. The arrangements are periodically audited by a Boots pharmacist. No errors were noted during a brief examination of medicines administration records (‘MAR’ charts) during the course of this inspection. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 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. 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 this service. The home has a policy and procedure for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to the protection of vulnerable adults (POVA). Together, these aim to protect people from abuse and ensure that complaints are properly investigated EVIDENCE: The home is required to conform to the policy of The Disabilities Trust with regard to the management of complaints. The policy includes the statement that ‘Complainants will not suffer discrimination or any other negative treatment because they have made a complaint’. All but one respondent to the CSCI survey said that they knew how to make a complaint. The one exception to this wrote ‘It’s never arisen. I don’t suppose I’d have much trouble finding out’. The complaints procedure is straightforward and includes details of the Oxford office of the CSCI. It conforms to this standard. The procedure (which was updated in May 2007) could be further improved by including the telephone numbers of the various points of contact mentioned, and the policy improved by ensuring that references to the ‘National Care Standards Commission’ are amended to read ‘Commission for Social Care Inspection’. Systems are in place for recording complaints and compliments. CSCI have received no complaints about this service since the last inspection. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 19 All residents are registered to vote and have exercised this right on election days. The home has a copy of the organisation’s policy on the protection of vulnerable adults (POVA) and of the Milton Keynes policy and procedures on this subject. It would be advisable for the home to check with the relevant department at Milton Keynes social services that it has a copy of the current version of the policy. The organisation also has a Whistle blowing policy. The subject of POVA is included in the organisation’s training programme and four of five staff have attended training to date. Staff receive training and guidance on dealing with aggression. This is essentially focussed on de-escalation of a situation, since physical contact without adequate support would place both the member of staff and resident at risk. Staff have access to psychology advice and support in managing such situations. Contracts are drawn up with residents who may be liable to display aggression and threaten violence on occasions. The home manages some monies for residents and has a policy and procedure governing this aspect of its work. There are facilities for secure storage in the home. Individual boxes are in place for each resident and the balance is checked at each handover. Records are maintained of all transactions. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a homely, clean and comfortable environment for residents in a quiet and accessible area of Milton Keynes. However, some problems related to earlier local subsidence have not been fully corrected and this may have an indirect adverse effect on residents on occasions. EVIDENCE: The home is located in the Browns Wood area of Milton Keynes. Central Milton Keynes is approximately 4 miles away and the centre of Bletchley is approximately 3 miles. There are rail stations in Milton Keynes and Bletchley. There is a very good bus service to both Milton Keynes and Bletchley and buses stop right outside the home – something which is extremely convenient for residents. There is adequate parking and collection/drop off spaces to the front of the site. The home is part of a small complex of three services run by BIRT on the site. The service was opened in 1998 and is well established in the locality. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 21 The home is a detached house which accommodates three residents. The ground floor consists of an entrance hall, living room, staff office (and sleep-in room), staff WC and shower, kitchen/dining room, utility room, and one bedroom. The first floor has two further bedrooms and storage space. All three bedrooms have en-suite accommodation. The shared communal space consists of the lounge, kitchen/diner and garden (which is also shared with the other two BIRT services on the site). The home does not have a lift, therefore only the ground floor bedroom would be accessible to a resident who requires use of a wheelchair. While negotiating the ground floor in a wheelchair might be possible, it would not be straightforward. None of the residents living there at the time of this inspection had a mobility problem. The home suffered from local subsidence in recent years which caused some cracks to appear in some areas. The building has been deemed to be sound. Some problems have not been fully resolved – for example the front door is said to cause problems on occasions and people tend to use the back door instead. This entails walking through the residents’ lounge and is not acceptable on a long term basis. The problem with the door is said not to have affected the time it takes to evacuate the building during fire drills. The home is pleasantly decorated and comfortably furnished. The living room has a large TV, DVD player and music centre. Bedrooms vary in size. The residents choose their own decoration for their rooms and each reflected the distinctive tastes of the occupant. Overall the home provides a pleasant and appropriate domestic environment for residents. The utility room has a domestic style washing machine, tumble dryer and sink. All areas were tidy and clean on the day of this inspection. The organisation’s health and safety policies is reported to include reference to the control of infection. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are considered adequate, procedures for the recruitment of new staff are satisfactory and staff have access to a range of training and development opportunities. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet people needs. EVIDENCE: The current staffing for the home provides for one member of care staff in the morning, one in the afternoon, and one sleep-in care staff member at night. This is supplemented by one member of staff who works flexible hours according to the needs of the service. The home does not employ volunteers. Staff turnover is reported to be low and most of the present group of staff are experienced in supporting residents. Two of four staff have acquired NVQ2. All staff have a copy of the General Social Care Council (GSCC) codes of practice. Where required the home is supported in providing care to residents by healthcare professional staff based at T.E.M House in Milton Keynes. Staff meetings are held monthly. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 23 One new member of staff has been recruited since the last inspection. The person had previously worked in the capacity as a bank worker, therefore was familiar with the home, the residents and the systems of the organisation. The registered manager said that vacancies are first advertised to bank staff. If suitable applicants do not apply then the vacancy is advertised in the job centre. There are job descriptions and person specifications for all posts. Selection is through application, interview, meeting residents, and a written exercise. The views of residents on candidates interviewed are taken account of by the interview panel. New staff are required to complete a probationary period of three months. In some circumstances this can be extended to six months. Staff files should contain (among other documents) a recent photograph of the staff member, a copy of the application form, a copy of the contract of employment, two references, health questionnaire, exemption to the European Working Time Directive where applicable, a copy of the job description and person specification, and an equal opportunities monitoring form. The file examined contained this information with the exception of a photograph of the staff member or any reference to CRB status. It was explained that in this case the documents were at T.E.M House. The information was subsequently forwarded to the inspector and confirmed that appropriate pre-employment checks are carried out by the home. Where Schedule 2 information is retained elsewhere (such as T.E.M House) then, subject to agreement with CSCI (which must include the arrangements for inspectors to examine the original documents if necessary), a summary of key information, which confirms conformance to the Regulations, may be held with the staff file in the home. It was noted that the organisation’s application form does not require applicants to state why they left previous employment, although there is a column for the applicant to state their salary in all previous jobs. Since the introduction of the POVA list, where practicable, employers are required to ask why a person left a previous position in a care service. A copy of the staff training programme for June 2007 to May 2008 was provided for the inspection. The organisation is accredited by ‘Investors in People’. Most training events are held at ‘T.E.M House. The programme included training on a range of subjects including; First Aid, Epilepsy, Manual Handling, POVA, ‘Fire & COSHH’, and Health & Safety with a footnote stating that training on Food Hygiene and Medication’….will also be included when trainers appointed’. The registered manager said that the organisation’s induction programme now covers the current Skills for Care Common Induction Standards. Formal (‘one to one’) supervision is established in the home. Supervision is held monthly. Notes are taken by the supervisor and a copy is held both by the Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 24 supervisor and supervisee. All staff have an annual appraisal (‘Performance and Development Review) which takes place around November each year. The training programme was under review at the time of this inspection following the recent death of a key member of the training staff. A revised programme was to be issued in the near future. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home with a positive approach to the involvement of residents and the application of a systematic approach to quality assurance. This aims to ensure that the service meets the needs of residents. Arrangements for health and safety are generally thorough and aim to ensure the safety of residents, staff and visitors. EVIDENCE: The registered manager has over eight years experience with the Brain Injuries Rehabilitation Trust. She has acquired the NVQ 3 and NVQ 4, Registered Managers Award (RMA), and is an NVQ Assessor. The registered manager is also responsible for the other two registered services on the Twyford Lane site. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 26 The organisation has recently acquired CARF accreditation which will require it to conform to CARF standards – to quote from the organisation’s newsletter ‘Systems and procedures will continue to be monitored in line with the CARF standards to ensure conformance and to maintain the continuing improvement in the quality of our services’. It was too early to assess the impact of this development on the home but it should entail the implementation of systems to monitor conformance to the necessary standards. Monthly meetings were being held with residents in connection with CARF. The organisation is accredited by Investors in People which requires it to invest in staff training and development activities aimed at supporting a quality service to residents. The service had a business plan for 2006/07 – this was not examined on this inspection. Regulation 26 visits are regularly carried out by the Community Services Manager and reports filed. The service conducts an annual stakeholder survey involving residents, relatives, local authority funders, and social workers. Arrangements for health and safety appear satisfactory. The organisation has a national policy which is implemented through local procedures. Risk assessments cover a wide range of activities. All documents are available to residents in the office, although there is not a specific ‘user friendly’ version drawn up for residents. Staff are required to attend basic and update training in first aid, moving & handling, fire safety, health & safety, food hygiene, POVA, ‘De-escalation’ (of aggression), COSHH, safe handling of medicines, and epilepsy. Given the nature of the home infection control is not considered a mandatory subject by the organisation. Arrangements are in place for the maintenance of fire safety equipment, portable appliance testing and checking gas appliances (by a CORGI registered engineer). Fire safety training is carried out six monthly. A fire risk assessment is conducted by the registered manager. A fire procedure is on display in the entrance hall and fire evacuation procedures have been drawn up for each resident. Fire alarms are checked weekly. A fire drill is carried out monthly. There did not appear to be a record of the last visit to the home by the fire service and the registered manager undertook to contact the fire authority with regard to this. Temperatures of fridges and freezers are recorded twice a day. The temperature of hot food is tested with an electronic probe. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 27 Showers are cleaned weekly and descaled monthly. Arrangements for testing for Legionella were unclear and the registered manager undertook to contact the local environmental health service with regard to this. Systems are in place for recording accidents and seizures. Reports are submitted to senior managers. Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 3 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 2 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations It is recommended that the registered manager seek technical advice aimed at resolving the problems with the front door so that residents in the lounge are not disrupted by visitors entering and leaving the building It is recommended that the registered manager seek the advice of the local environmental health department with regard to the precautions required to prevent Legionella developing in the home’s hot water storage system 2 YA42 Twyford Lane (9) DS0000015075.V338863.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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