Inspection on 17/08/05 for Twyford Lane (9)

This inspection was carried out on 17th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Twyford Lane (9) 16/07/07

Twyford Lane (9) 24/11/06

Twyford Lane (9) 16/12/05

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 9 Twyford Lane 9 Twyford Lane Browns Wood Milton Keynes Bucks MK7 8DE Lead Inspector Moira Jones Unannounced 17 & 19 08 05 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. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 9 Twyford Lane Address 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 639087 The Disabilities Trust Care Home 3 Category(ies) of Physical Disability (3) registration, with number of places 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10 12 04 Brief Description of the Service: 9 Twyford Lane is a care home providing rehabilitative support to up to three service users with an acquired brain injury. At the time of this announced inspection three male service users were resident at the home. The home, which is part of the Brain Injuries Rehabilitation Trust, is situated on the Brownswood development in the south of the new town of Milton Keynes. The home is close to the local amenities of Bletchley and Milton Keynes. Transport to both towns is very regular and service users are orientated to access local transport into these areas as part of their rehabilitation plans. The home is one of three properties situated on the development. All properties share a communal garden, which is centrally situated and there is also a communal car park with adequate parking facilities for up to eight vehicles at the front of the development. 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. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection that took place over two visits during the course of August 2005. The House leader was not present at the home for either visit. The first visit to the home commenced at approximately 9.30am and concluded at approximately 11.30am as the service users had plans for the afternoon. On that occasion the inspection was ably assisted by Mrs Denise Girton (Residential Support Worker) and she is thanked for her participation. On the second visit, the inspection, which commenced at 12.05pm, was assisted by Ms Sandra Stevens (Registered manager designate). No staff, other than Mrs Girton and Ms Stevens were met with during the course of this inspection however, all three service users were spoken with. There are three Brain Injuries Rehabilitation Trust homes on the Brownswood development. At the time of the last inspection of this particular home, which took place in December 2004, the organisation was in the process of restructuring its management arrangement for the development and another home in Bletchley. Ms Stevens was previously the registered manager for 7 Twyford Lane and continues to retain this position. However, as the registered managers in the other homes on the development and in Bletchley leave the organisation’s employment, Ms Stevens will apply to the Commission for Social Care Inspection to be the registered manager for those homes, dependent on her successfully completing the ‘fit person’ process. To date, the manager originally registered to manage 11 Twyford Lane remains in post. As previously reported Ms Stevens is already registered to manage 7 Twyford Lane and is currently in the process of applying to become the registered manager for 9 Twyford Lane and the Bletchley home, leaving house leaders, who co-ordinate the day to day activities within the homes, to manage. The house leader in post at 9 Twyford Lane has clearly worked hard over the past nine months to ensure that standards are improved, that team working is effective and to ensure that staff are updated as far as new organisational and legislative initiatives are concerned. In relation to service users, this can only mean that the activities of their rehabilitation have improved, which was confirmed during conversations with service users and staff, who further confirmed the supporting role the house leader takes. It is a pity therefore that two of the requirements issued as a result of the last inspection of the home and which were the prerogative of the organisation to meet, continue to be outstanding, although assurances were made in relation to the requirements, which are further discussed within the section of the report marked ‘Environment’. The requirements are repeated within this report and will be further discussed with the Commission’s legal department should the organisation continue to not meet them within the timescale outlined within the report. What the service does well: 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 6 There is a statement of purpose and a service users guide in place to inform people about their rehabilitation. Service users needs are assessed prior to admission. Each service user has a support plan that outlines their individual rehabilitation needs. Service users are supported by staff to make decisions about their lives and the activities of independent living. Risk assessments that include considered control measures are in place. Service users are able to choose what activities they wish to participate in. The home is placed within a prominent position, which enables service users to access and participate in the community. Visiting times at the home are flexible. Service users are able to maintain contact with their friends and family. Staff support service users to become independent, exercise individual choice and exhibit their individuality. Service users nutrition is ensured through the provision of balanced meals. Staff provide service users with prompts and encouragement to achieve their individual goals. Staff support service users to access their NHS entitlements. Medications held within the home are well managed. The home has a complaints policy and procedure. Service users are able to make their comments known and have them acted upon appropriately. Vulnerable service users are protected via policies, procedures and staff training. The home provides service users with a comfortable and clean environment. The home rosters adequate numbers of staff to meet the assessed needs of service users. All staff are inducted to their posts. Staff are supported in their roles. There are systems in place to ensure the quality standards of the home. The health and safety of the home is well managed. What has improved since the last inspection? What they could do better: All staff need to receive training in non-violent crisis intervention. The carpet fitted in the home needs to be replaced and thereafter kept clean. The cooker needs to be replaced. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 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. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2 There is a statement of purpose and a service users guide in place to inform people about their rehabilitation and any prohibitions on their freedom. Service users needs are assessed prior to admission, ensuring that their rehabilitation is tempered to their individual needs and also ensuring that staff have a good understanding of requirements. EVIDENCE: Further to the last announced inspection of the home, which was conducted on 10th December 2004, the house leader has updated the statement of purpose and service users guide to reflect the recent changes in the home’s management structure. No service users have been discharged from the home during the time under review and no new service users have been admitted. No changes have been made to the way service users are admitted to the home and the organisation’s admission policy and procedure remains unchanged. Since it was last assessed, as being compliant with the standard that pertains to needs assessments and admissions. The pro forma used to record service users needs and the process of assessment has previously been assessed as compliant. The checklist that underpins service users effective and seamless admission into the home has been updated to provide staff with a userfriendlier aide memoir. This aids to ensure that service users admission is as 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 10 stress free as possible and that individuals are prepared for their transition into the home. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Each service user has a support plan that outlines their individual rehabilitation needs. This ensures that staff have a good understanding of the levels of support required by service users in order to meet their individual goals. Service users, supported by staff, are encouraged to make decisions about their lives and activities of independent living. Risk assessments that include considered control measures have been developed that enable service users to take reasonable risks as part of their rehabilitation. EVIDENCE: Each service user has a support plan that outlines the individual activities of rehabilitation and independent living. Individual programmes of rehabilitation are generated from the information gathered during service users assessment of need, which are undertaken prior to admission into the home. Each service user has a statement of need, which focuses on their: • medical • cognitive • activities of daily living • social behaviour 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 12 • • psychological emotional needs. Service users needs are formally reviewed on an annual basis and there were notes to substantiate this. Service users progress in relation to their needs are also discussed on a more regular basis and personal goals updated as progress is positive. The personal goals set are based on what has been perceived as an area of development and rehabilitation is focused on these and the skills required in relation to independent living. Service users participate in the development of personal goals and sign acceptance of the goals via their support plans. These are acknowledged by the service users key worker and clinical neuro psychologists. Staff provide service users with the guidance, support and prompts required to achieve their goals. Support plans contain records of the activities undertaken by service users such as tasks of rehabilitation and independent living. Records were evidential of service users likes, dislikes, preferences, healthcare appointments attended and any restrictions on their rehabilitation. All entries were signed and dated and recording was found to be good. Support plans were inclusive of risk assessments that are based on the individually assessed vulnerabilities of service users. All risk assessments were found to be considered, dated and signed by the assessor and inclusive of reasoned control measures. Service plan their own weekly rehabilitation programmes with support from staff. Service users have core tasks that are routinely undertaken and are therefore an integral feature of the plans. Other, more flexible activities are fitted in for service users’ benefit. Service users sign their plans as well as the menus that they plan on a weekly basis and choose what day they want to prepare the evening meal. There is a key worker system in place and each service user has a staff member who is nominated to provide then with local advocacy services. Part of service users rehabilitation involves participating in the domestic maintenance of the home and ownership is assumed for individual bedrooms and en-suite bathrooms. The communal areas are cleaned on a rotational basis. Service users also launder their own clothing and, where able also undertake to iron their clothes. In addition to the preparation of meals service users are also able to prepare drinks and snacks as they wish. Service users meetings take place every month or so and usually take place either before the start of the staff meeting or are tagged on to the end of the staff meetings. Risk assessments are undertaken in line with the perceived vulnerabilities of service users when participating in the activities of independent living and rehabilitation. Risk assessments were found to be concise and the information contained within the assessments was found to be in date. The home has a Missing Persons policy that guides staff on the action required should service users either not return to the home at an agreed time, or if a service user goes missing. The contingency plans that have been put in place by the home to manage absence suggest that the home is well prepared for any eventuality. Service users are assessed as being ‘on’ or ‘off’ escort. Service users’ ability to semi or independently manage to use public transport 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 13 is assessed over several weeks or months and involves service users being fully escorted to new destinations and thereafter shadowed until it is felt that they will be able to travel unescorted, possibly using public transport to agreed destinations. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 14 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 Service users are able to choose what activities they wish to participate in, ensuring that their leisure, occupational and recreational needs are met. The home is placed in a prominent position within Brownswood, which means that service users are part of the local community and are able to easily access services and amenities. Visiting times are flexible, ensuring that service users are able to maintain links with their friends and families. Via individual rehabilitation programmes staff support service users to become independent, exercise individual choice and exhibit their individuality. Service users nutrition is ensured through the provision of balanced meals, which are prepared by service users and staff therefore also developing their skills base and promoting independence. EVIDENCE: 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 15 Two service users attend college on the Woughton campus although, at the time of this unannounced inspection were on their summer break. One service user studies maths, English community awareness and the other service user is studying numeracy. The same two service users are also employed at Thomas Edward Mitton House and at Milton Keynes Hospital and SNAP where he undertakes assembly work. The third service user has opted not to work and is concentrating on his rehabilitation, mainly on a one to one level. Service users are able to choose from a range of activities, which are noted on their rehabilitation plans. Participation is recorded on daily logs. Service users who claim benefits are supported to do so and are helped to resolve any presenting issues. 9 Twyford Lane is situated on a direct bus route that service users use as part of their rehabilitation programme to access the towns of Bletchley and Milton Keynes. Service users are assessed as being ‘on’ or ‘off’ escort and this dictates how much support they require to access the local community. Staff described the neighbours as good and reported fine neighbourly contact with service users well known in the local community. There are local shopping centres in Walnut Tree and Old Farm Park, which are within walking distance of the home. All service users are registered on the electoral roll and all were enabled to exercise their civic rights at the recent general elections. Service users are enabled to access the leisure amenities in Bletchley and avail themselves of the facilities in the gym at the leisure centre, the cinema and bowling alley in Milton Keynes and many other activities. Shopping is undertaken in either town but Milton Keynes provides service users with a wider choice. So far this year two service users have been on holiday and there are plans to visit Blackpool for a long weekend. Visiting at the home is flexible and service users are enabled to invite their friends into the home at reasonable times. Service users are supported to develop personal and platonic relationships and there is a policy in place to guide staff in the type of relationships that are deemed to be appropriate, including personal and professional relationships. Service users are able to meet with their visitors in private and are able to accept invitations out from friends and family. Service users are provided with a choice of having keys to their bedroom doors and to the front door of the home. Post is directly given to service users and staff provide support to deal with the contents, as required. Service users have unrestricted access to all parts of the home, with the exception of other service users bedrooms and staff’s sleeping in accommodation. Times of rising and retiring are in line with service users individual rehabilitation programmes. Interests, hobbies and pastimes are recorded on support plans as well as personal goals. The home provides service users with a no-smoking environment and separate arrangements have been made for those service users who do smoke. Alcohol is not encouraged within the home but service users can have a drink as long as their prescribed medications allow. Outside of prescribed medications, illicit drugs are prohibited. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 16 A planning meeting is held at the home every Thursday and service users are supported by staff to develop their individual programmes for the week ahead as well as the homes menus and shopping lists. The menus were seen and found to be a combination of traditional and contemporary meals, considerate of preferences and seasonal availability. Service users prepare their own meals with support from staff. At the time of this inspection no service users had any dietary requirements outside of mainstream needs and no supplementary foods were prescribed for any person. Healthy eating is promoted at the home and service users generally dine together in the evenings and are more flexible for all other meals. Drink and snack making facilities are accessible to service users. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 17 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 Staff provide service users with prompts and encouragement to achieve their individual goals, ensuring that their independence, individuality, privacy and dignity are promoted. Staff support service users to access their NHS entitlements. Medications held within the home are well managed, ensuring that service user’s property is protected and their health and welfare promoted. EVIDENCE: As service users receive support to rehabilitate, staff do not provide direct care. Prompting and encouragement is given to service users to enable them to achieve their individual goals. All support required and specific wishes are outlined within the individual support plans. Service users are referred to by their preferred names, although being younger people all appear to prefer staff to use their Christian names. By virtue of the fact that each service user has a single bedroom with adjacent en-suite facilities, privacy is protected and therefore dignity is ensured. The cultural ratio of staff to service users is balanced although the ratio of gender is unbalanced, as all staff currently employed at the home are female. This did not appear to have a great impact on the dynamics of the home and all parties were noted to be mutually respectful of each other and aware of gender needs. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 18 The routines of the home are reasonably flexible, within programme times. At the time of this inspection there was no college therefore two of the three service users had more free time than was usual. However, from conversations with staff and service users and as witnessed on both days of the inspection, the free time was relative as extra activities had been arranged to take place. Any restrictions placed on service users are outlined within their support plans and the activities of rehabilitation. Should service users require additional support in order to meet their rehabilitation needs, the home is able to access support from a range of therapists based at Thomas Edward Mitton House or via their doctor. Each service user has a nominated key worker who provides advocacy support. No volunteers are retained by the home and no independent advocate currently visits the home although service users have access to information that pertains to an advocacy service. As part of their rehabilitation service users undertake some domestic tasks including the cleaning of their bedrooms and the communal areas. Service users launder their own clothing. These tasks are included on individual programmes of rehabilitation and staff provide support, as required. No technical aids and equipment are fitted in the home, as service users needs do not require them. Service users are registered with a general practice that is within close proximity of the home. Consultations with doctors take place within the privacy of the practice unless service users are so unwell that a home visit is required. Should this be the case service users meet with their doctor within the privacy of their individual bedrooms. Staff support service users to attend all healthcare appointments. Support plans were evidential of the routine appointments service users attend within the community. Records indicated that service users see dentists, podiatrists and opticians on a regular basis. Access to a ‘Well man Clinic’ is available through the practice. It would appear from records assessed and discussions that service users are supported to access their NHS entitlements and that there is a robust approach towards the ensuring of healthcare needs. Medications are delivered to the home from a local pharmacy each week using the Nomad system of administration. At the time of this inspection one service user was self-administering their medication and had been provided with lockable storage to ensure that medications were effectively held. The activity of self-administration was contained within a risk assessment framework that was a requirement of the last inspection of the home. Records indicated that the assessment had been robustly approached and that there were effective risk assessments in place. All documents were signed by the service user. During the time under review both the organisational and local policies and procedures that guide staff in the administration of medications have been updated. Service users needs are reviewed regularly by the doctor. Medications stored within the home were found to be held within an appropriate facility. Stocks were found to be minimal and all medications were within their ‘use by’ dates. No controlled drugs were prescribed for service 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 19 users at the time of this visit. Medications administered to service users are recorded on a Medication Administration Record (MAR) sheet. Recording was found to be good with no gaps evident. A designated book is used to record any medications that are returned to the pharmacy. The supplying pharmacist conducted an audit of the medications held within the home in May 2005. The audit resulted in no requirements or recommendations being issued to the home. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 20 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 means that service users can make their comments known and have them acted upon appropriately. Vulnerable service users are protected via policies, procedures and staff training however, if service users’ protection is to be fully effective, all staff need to be trained to within current timescales. EVIDENCE: The complaints policy and procedure, which has previously been assessed as being compliant with regulation 26 of the Care Homes Regulations 2001, continue to be relevant. For service users reference, a copy of the complaints policy and procedure is an integral feature of the home’s service users guide, a copy of which all service users possess. There is a file in place to record any comments made known to the home however, during the time under review, no complaints have been made known to the home or to the Commission for Social care Inspection’s Aylesbury office. As no complaints had been received it was not possible to assess whether recording had been appropriately undertaken on the correct pro forma and that all issues had been concluded thoroughly and appropriately, as required further to the last inspection of the home. This aspect of the standard will therefore be further assessed at the time of the next inspection of the home and pending any complaints received. In addition to the Brain Injuries Rehabilitation Trust’s own policy for the protection of vulnerable service users, which was updated in 2003, the home also refers to the Milton Keynes inter-agency policy and procedure for the protection of vulnerable service users. At the time of this inspection, with the exception of one person who was due to attend update training, all staff 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 21 members were trained in the protection of vulnerable service users to within current timescales, complying with a requirement that was issued as a result of the last inspection of the home. Non-violent crisis intervention training (challenging behaviour) had been attended by two staff members during the week preceding this inspection. There was no evidence on the training records maintained that the other two staff members had recently attended this training and this is therefore a requirement of the report. De-escalation training is integral to the non-violent crisis intervention training, and is a feature of the BIRT Basic developmental opportunity for staff that is available to them early on in their employment. There is a finance policy and procedure to guide staff in what is the appropriate levels of support to be given to service users in managing their finances. Service users also have personal possessions and personal monies policies in place, for their reference. During the time under review there have been no adult protection issues at the home and no service user stated any discontent with the support available to them. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 22 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 The home provides service users with a comfortable environment however, to ensure that all areas of the home are safe for service users a new cooker must be purchased. Standards of cleanliness at the home are good, ensuring that service users health and welfare needs are met. EVIDENCE: 9 Twyford Lane is a purpose built home providing rehabilitative care to three adults with acquired brain injuries. The home is one of three properties built on a small complex of three homes, administrated by The Disabilities Trust, on the Brownswood development in Milton Keynes. The service users who currently reside at the home are male. Situated at the far corner of the development, 9 Twyford Lane is a detached, family type property. One bedroom, the lounge, laundry and the kitchen/diner are situated on the first floor and there are a further two bedrooms situated on the first floor. An office is situated adjacent to the lounge and staff also use this room to sleep in during the course of the night shift. No provision is made within the home for wheelchair users therefore all service users admitted into 9 Twyford Lane require some ability to be mobile. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 23 The home is brightly decorated and every attempt has been made to make the home as comfortable as possible. Soft furnishings are of a good quality and it would appear that the sofa and chair situated in the lounge are to be replaced before the end of this financial year. At the time of the last inspection of the home it was required that the carpets needed either to be professionally cleaned or replaced by 31 January 2005. While the carpet may have been cleaned further to the inspection, therefore complying with the requirement, on this occasion the carpet was again found to be very dirty and in desperate need of cleaning. It was confirmed that a capital bid has been made to have the carpet replaced. A requirement is issued within this report concurring with the need to have the carpet replaced by the end of the financial year. The home must be mindful that carpets require ongoing care and this should be considered by the home for inclusion on its maintenance programme. The kitchen/diner provides adequate space for food preparation and for service users to eat together. At the time of the last inspection of the home it was ascertained that the cooker that is fitted in the kitchen did not work appropriately and a requirement was issued either to have the cooker repaired or replaced by 31 January 2005. It was ascertained on this occasion that the cooker had neither been repaired nor replaced and, in fact, the door on the storage area at the lower part of the cooker had come adrift. It was further stated that service users were only able to prepare meals with close supervision as all food had to be cooked on a high temperature as the thermostat appeared to no longer be working. It would appear that service users rehabilitation was therefore being delayed and that there was a risk of food poisoning from cooking food at high temperatures due to the organisation’s inability to make proper provision within the home, therefore bringing their ‘fitness’ into question. Although it was reported that funds had been agreed and that the purchase of a cooker was imminent, it is required that a cooker is purchased and installed by Friday, 2nd September 2005. The home shares a communal car park and garden. A handyman who is based at Thomas Edward Mitton House provides general maintenance services to the home. There is now a system in place to ensure that maintenance tasks are completed within a reasonable timescale, meeting a recommendation that was made within the report of the last inspection of the home. All bedrooms provide single room accommodation and are fitted with en-suite facilities that consist of a walk-in shower, toilet and hand washbasin. Bedrooms were noted to have been individualised by service users using their personal possessions and were decorated to individual taste. There are very few aids and adaptations fitted in the home, as the needs of the service users currently residing there do not require any supplementary adaptations. The home is fitted with a small domestic type laundry, which is situated adjacent to the front door. The laundry is fitted with a range of equipment including a washing machine and tumble dryer. The laundry has a handwashing sink and it was noted that the cupboard doors on which the sink is fitted have been replaced. The floors in the laundry are washable and the walls are partly tiled. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 24 The standard of cleanliness on both days of the inspection were good with no clutter or obstructions obvious. The home was free from offensive odours. Service users, as part of their rehabilitation, ensure that their bedrooms remain clean and tidy and they also participate in the maintenance of all communal areas on a rotational basis. Staff supports service users in achieving the domestic goals of the home. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 25 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) 33, 35 and 36 The home rosters adequate numbers of staff to ensure that service users rehabilitation needs are met. All staff are inducted to their posts and further receive training that ensures they have a good knowledge base, therefore enabling them to meet service users holistic needs. Staff are supported in their roles, which means that they are able to confidently support service users in their rehabilitation. EVIDENCE: One staff member is rostered to work throughout the course of the waking day and there is a flexible cross shift for at least three day of the week. One service user also benefits from one to one support. Support at night is provided from the person who sleeps in. A change of shift takes place during each afternoon and this is when handover takes place. Staff commented that their complement was adequate to meet the needs of service users. The house leader is not supernumerary to the roster. All staff who are new to the organisation are inducted to their individual posts in line with TOPPs. There is a local staff development plan that has been developed by the registered manager designate who is also the community 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 26 support manager. The local plan ensures that staff have good access to mandatory training courses. The wider organisation has a training and development policy that was developed in April 2004 and the registered manager designate attends meetings approximately on a quarterly basis within her role as community support manager to plan training for the forthcoming quarter. Outside of the core training required by staff to meet service users’ rehabilitation needs, separate applications to undertake other personal development opportunities are invited. Mandatory training consists of: • Moving and handling • First aid • Fire awareness • COSHH • Food hygiene • Epilepsy • Infection control. From information taken from individual training records, all staff were noted to be trained to within current timescales. The registered manager designate has attained NVQ Level 3 and has almost completed the NVQ Level 4 in management. She is now considering the A1 award, which will deem her competent to set and assess the work of candidates. The house leader, Julie Smith, has attained the NVQ Level 3 award and is part of the way through to completing the A1 award. To date, other staff have not undertaken the NVQ award, although it was stated that this is a goal the organisation are working towards. The organisation has recently set up its own assessment centre for the purposes of NVQ and has appointed a person to manage this initiative. Although the registered manager designate was not fully au fait with the details of this, it was thought that the assessment centre was based at Burgess Hill in Sussex where the organisation’s head offices are situated. Although it was not possible to assess individual records on this occasion it was confirmed that staff are supervised by their line manager every four to six weeks. A revised pro forma for recording the supervision meetings has been developed and it now identifies: • The training attended by staff • The training offered to staff • Training refused • Training required • Training requested • The date of the next supervision meeting • Performance and future goals. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 27 The pro forma is also used to record any other issues discussed. All staff receive an annual appraisal of their performance. There are individual training records in place. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 There are systems in place to ensure that quality standards of the home, which means that service users will benefit from support that is benchmarked. The health and safety of the home is well managed, ensuring that service users security is protected and welfare maintained. EVIDENCE: Monthly Regulation 26 visits to the home that are in line with the Care Homes Regulations 2001 are conducted by a senior representative of the organisation. Copies of the subsequent reports are received at The Commission for Social Care Inspection’s Aylesbury office. The home has adopted local and wider organisational methods of ensuing the quality standards of 9 Twyford Lane. They include: • Annual questionnaires that are sent out to service users, friends and family members post review. From responses received a report that has an integral action plan is produced. All goals are designed to encourage service improvement. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 29 • • • • • • • • • Formal annual reviews of service users needs. Minutes are maintained. Interim reviews, as required. Minutes are maintained. Registered managers/house leader meetings that are held on a monthly basis. Service users meetings that are held on a monthly basis. Monthly rehabilitation meetings. Medication audits on a quarterly basis by the supplying pharmacist. The complaints procedure. Supervision meetings and staff appraisals. Routine health and safety checks of the home by the organisation’s health and safety officer. All organisational and legislative initiatives, policies and relevant information are cascaded to the staff team by the registered manager/house leader. No volunteer is retained by the home and no independent advocate visits the home although information was displayed that provided service users with guidance on how to contact independent advocates of their choice. All staff are trained in the mandatory topics to within current timescales. The health and safety of the home is well managed. There are COSHH data sheets in place for all the chemicals in use within the home. The home is in the process of introducing risk assessments that are independent form the ones that are normally integral to the data sheets and progress made will be further assessed at the time of the next inspection of the home. There are generic risk assessments in place and risk assessments that are based on the individually perceived vulnerabilities of service users when undertaking the tasks of rehabilitation in independent living. The assessments were clearly laid out with indexes that correlated to the pertinent information. The assessments had been evaluated by the manager and there were six monthly reviews in place. There are plans to streamline the assessments further so that hazard ratings (low, medium and high) will be colour coordinated. It is also intended to risk assess the appliances fitted within the home and the progress made in relation to this piece of work will be further assessed at the time of the next inspection of the home. Other than the boiler and central heating systems there are no gas appliances fitted within the home. There was a gas safety certificate, which was dated January 2005 that evidenced the boiler and central heating system had been serviced and deemed fit for the purpose intended. The hardwiring for the home’s electrical systems were routinely checked in November 2004 and are therefore not due for another four years. The annual Portable electrical appliance tests were completed in May 2005 and the activity recorded. Window restraints are now fitted to all windows, be they on the ground or first floors. They are fitted on the first floor for reasons of health and safety and on the ground floor for reasons of security. Security lighting is also fitted at key external points and there is an alarm on the front door. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 30 Health and safety checks are undertaken by the organisation’s health and safety officer on an annual and interim basis. From this, a report is produced and any remedial works identified. The home’s fire fighting equipment is subject to an annual service, the last recorded service having taken place in March 2005. The emergency lighting is charged every week, discharged every quarter and serviced every six months. Fire alarms are checked each week, fire drills are conducted each month and there are ‘means of escape’ checks that are conducted every day. All initiatives are effectively recorded, meeting a requirement that was issued further to the announced inspection of the home. Risk assessments that relate to fire safety were noted to be in place and their contents deemed appropriate. Thermostatic valves are fitted to all hot water outlets. Records evidenced that safety checks on the thermostatic valves are conducted on a weekly basis. Showerheads are cleaned and de-scaled each week as part of the routine to discourage the possibility of Legionella, although, due to the size and age of the home routine bacteriological analysis are not undertaken. Routine fridge and freezer temperatures are recorded twice daily. Accidents and incidents are effectively recorded. There were few accidents and incidents recorded as having taken place and none resulted in a RIDDOR notification having to be made. 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23 ENVIRONMENT Score 3 2 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 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 9 Twyford Lane Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 32 Yes 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. 2. Standard 23 24 Regulation 18(1)(c)(i ) Requirement Timescale for action 01 October 2005 31 March 2006 19 August 2005 2 September 2005 3. 4. 24 24 It is required that all staff are trained in non-violent crisis intervention. 23(2)(c)(d The carpet in the lounge needs ) to be replaced. (PREVIOUS TIMESCALE OF 31 JANUARY 2005 NOT MET). 23(2)(d) The home must ensure that the carpets are cleaned on an ongoing basis. 23(2)(c) It is required that a cooker is purchased and installed. (PREVIOUS TIMESCALE OF 31 JANUARY 2005 NOT MET). 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 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 33 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, Bucks HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 9 Twyford Lane X00023_H53_H02_S15075_Twyford Lane 9_V245503_170805_Stage 4.doc Version 1.40 Page 34 - 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. 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