Inspection on 07/01/08 for Vicarage Road (1&3)

This inspection was carried out on 7th January 2008.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vicarage Road (1&3) 06/12/06

Vicarage Road (1&3) 21/09/05

Vicarage Road (1&3) 05/08/05

Vicarage Road (1&3) 22/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Vicarage Road (1&3) 1&3 Vicarage Road Dagenham RM10 9SX Lead Inspector Harbinder Ghir Unannounced Inspection 07 January 2008 08:25 th Vicarage Road (1&3) DS0000060786.V337792.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 Vicarage Road (1&3) DS0000060786.V337792.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. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vicarage Road (1&3) Address 1&3 Vicarage Road Dagenham RM10 9SX 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) 020 8592 8734 The Avenues Trust Limited Janet Frances Kedgley Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2006 Brief Description of the Service: 1 to 3 Vicarage Road is a purpose built 8 bedded unit comprising two connected bungalows set on a housing development. The home is registered to provide care for individuals with learning disabilities and physical disabilities. Current residents have very high care needs; staff use their knowledge of residents’ means of communication to effectively understand their needs, as the range of verbal communication that residents are able to use is limited. The home is operated by the Avenues Trust, which is a registered charity. All the bedrooms are en-suite, there are two large dining/sitting areas, two kitchens, two laundry rooms and two garden areas. The home also has its own custom built vehicle, which staff drive to take residents out on outings. At the time of the inspection there were two vacancies. As informed by the registered manager at the time of the inspection, the fee currently charged by the service is £1,480.44 per week. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 07th January 2007 between 8.25am and 2.00pm. The registered manager of the home was available throughout the day of the inspection and feedback was provided to the registered manager and the service manager at the end of the inspection. During the inspection the inspector was unable to talk to residents residing at the home due to their profound communication needs. Staff on duty and the advocate for residents from Mencap visiting the home during the day was spoken to. A second day was spent contacting relatives and professionals via telephone for further feedback. A community learning disabilities nurse, the speech and language therapist were spoken to; comments are included in the report. Policies and procedures had already been inspected for the Avenues Trust at a sister home prior to the inspection. The London Borough of Barking and Dagenham, who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. They did not provide any feedback to be included at this inspection. As part of the inspection the inspector toured the home and examined documents in relation to the management of the home. The Commission received a completed Pre- Inspection Questionnaire for Registered Establishments prior to the inspection. The inspector would like to thank everyone involved in the inspection What the service does well: What has improved since the last inspection? Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 6 At the last key inspection 4 requirements were made in the following areas; medication practices; contracts of terms and conditions to be signed by the resident or their representatives; recruitment practices, health and safety documentation. At this inspection 2 of these requirements have been complied with. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service Users Guide provide prospective residents with the information they need to make an informed choice about where to live. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. The registered manager must ensure all residents or their representatives sign their individual contract, to ensure they are in agreement to the services provided by the home. EVIDENCE: The Service User Guide was viewed at the home, which was presented in picture and photograph format, which was very appropriate to the communication needs of residents residing at the home. Photographs of Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 9 residents, staff, the environment and activities residents participated in included in the guide. The document was easy to understand and follow. The Statement of Purpose was also presented in the same formats and provided a good snap shot of the services provided at the home. There have been two recent admissions to the home. On examining the preadmissions assessments for these residents, it was identified that admissions are not made to the home until a full needs assessment has been undertaken. The assessments were completed comprehensively, covering the personal history, support needs, personal care and social needs of residents. Care management assessments had been obtained from health and social care professionals prior to admission. There was also an extensive pre-admission policy and procedure in place to be followed for any admissions to the home. A community support officer was spoken to as part of the inspection who assisted the transition of one of the residents to Vicarage Road. The community support officer previously supported the resident at home. On speaking to her she stated “The home has been the best place for A. The home has managed A very well. They have kept all her appointments up to date. The placement has been very positive, the family have been very happy and the home keeps us up to date on what is happening with A. We visited the home prior to A moving in and were shown around by Janet the manager of the home.” New prospective residents are able to visit the home as many times as they like and have an opportunity to stay overnight. On examining care plans and observational notes, they evidenced residents coming to visit and stay overnight at the home prior to being admitted. Evidence was also seen of family, health and social care professionals being involved throughout the admission process to ensure a smooth transition for the resident to the home. For another prospective resident who sadly passed away before being admitted, on taking a tour of the home, it was identified at how much effort the home had made in decorating the resident’s room and furnishing it for them, to ensure a warm welcome. A thank you card viewed sent by a relative of the prospective resident thanked the home for their work and stated in the card that they “were a ray of sunshine among the clouds.” Due to the profound communication needs of residents the inspector was unable to verbally communicate with residents. However, staff were observed to interact positively with residents, showing warmth and understanding of their needs. On the interaction from staff, residents were observed to respond through smiles and hand gestures. Staff were very aware of how each individual resident liked to have their daily needs met. For example, one resident liked to sit in the manager’s office, which he was supported to do by staff and the manager. Staff were also seen asking residents whether they would like to go out for an outing during the day or stay at home, promoting their rights to choice and ensuring they delivered a service, which ensured individuality. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 10 A requirement was made at the last inspection that all contracts are shared with residents and their representatives and are signed by residents’ representatives or their family where they are unable to sign. On examining contracts, they still had not been signed by all residents or their representatives. It will be a repeated Requirement, which will be stated as Requirement 1 that residents or their representatives sign contracts of terms and conditions to ensure they are in agreement to the services provided by the home. Vicarage Road (1&3) DS0000060786.V337792.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, 9 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a good care planning system in place, which accurately reflected residents’ changing needs and personal goals. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, and are always updated according to residents’ changing needs. EVIDENCE: Three care plans were closely examined. Care plans were written in plain language, and were easy to understand and looked at all areas of the individual’s life, concentrating on person centred care. Each care plan included a very detailed life history of the resident giving a lot of detail on the identity and past history of the individual. Care plans were devised in both text and Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 12 picture format and also included photographs of residents. Information was found specific to the religious, cultural and social care needs of residents and how the service was to meet these needs. All residents with the support of staff had completed a document called “My cultural assessment.” Some residents who had identified their religious preferences as following the Christian faith were supported to attend church every week by staff. The information provided in care plans was very detailed and individualised, and clearly recorded and described how residents wanted their needs met. For example one resident’s care plan informed how they would communicate that they wanted to taste foods. The resident’s care plan stated “ I am very happy to eat as much sweet stuff, I will stick my tongue out to taste.” Detailed information was also found in regards to how each resident communicated. A care plan stated “ Y shows displeasure by his facial gestures, he is able to laugh, chuckle and smile.” Care plans were written from the residents point of view and who had also developed a pen picture of themselves with the support of staff, which was displayed in their bedrooms, including information on the things they liked and disliked and how they liked to be cared for. Care plans were reviewed on a six monthly basis. However, residents also have a regular meetings with their key worker to discuss any concerns they may have and as a result key workers completed reports covering any new risks posed to residents and any concerns with regards to health issues, communication needs, relationships, personal care and finances. Risk assessments were completed for residents and identified risk areas in care plans including, the event of a fire, risks that may be presented by the building, mobility, falling and wandering. Risk assessments included clear guidelines for staff to follow in managing risks posed to people who use the service. Risk assessments were reviewed regularly and amended. The service at the present time does not hold residents’ meetings but is in the process of organising these working in partnership with advocacy services from Mencap. Residents’ meetings would be an opportunity to encourage residents to express their views and feelings about the running of the home and any issues that they may have and changes they would like made. Vicarage Road (1&3) DS0000060786.V337792.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): 11, 12, 13, 14, 15,16, 17 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Daily routines respect the rights of residents ensuring their needs are met in the way they prefer. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 14 EVIDENCE: People who use the service are involved in meaningful activities of their own choice and according to their individual interests and capability; they have been fully involved in the planning of their lifestyle and quality of life. Residents are encouraged to go out for walks, to the local park, shopping, and bowling and eat out. On the day of the inspection two residents were supported to go out for lunch and visit the Blue Water shopping centre, in Kent. Each resident had a weekly activity planner, which was devised in picture format, describing his or her activities planned for the week. On viewing one resident’s care plan, it was identified that they loved indoor bowling, which they were supported to do. Photographs were seen of the resident at the bowling alley in Romford. Further photographs of residents were seen of them sight seeing and visiting various destinations which included canal boating; visiting the Hainault kite and picnic park; Chigwell riding trust and visiting Walton on the-Naze. An annual holiday has not yet been arranged for residents as staff are in dispute with the company over pay arrangements when they support residents on holiday away from the home. The service must ensure this situation is resolved as soon as possible to avoid any adverse impact on the quality of life for residents or restricting their opportunity of going on holiday this year. Daily routines promoted the rights and choices of residents. On arrival at the premises at 8.25 am only one resident had just got up and the rest of the residents were seen getting up leisurely at their preferred time throughout the morning. There was a very calm and relaxed atmosphere while residents were being supported with their personal care and breakfast. The home provides meals, which are varied and nutritious and meet the dietary needs of residents. There is a four weekly menu, and residents are able to choose their meals from a folder of pictures of foods, meals and ingredients. Separate menus were also devised for individuals on a soft diet to ensure they were not placed at any risk of aspirating from foods, which may not be suitable for them. Staff were observed offering residents a choice of meals at lunch time and were seen giving a resident a choice of soups to choose from for her lunch. Residents also could refuse their choice of meal on the menu on the day and staff prepared alternative meals specified by the resident. Residents also go out shopping with the support of staff. Evidence was also seen of residents going out to local restaurants and being provided with take away meals of their choice. The daily nutritional intake for each resident was re corded, to ensure their nutritional intake is monitored. Individuals living at the home have the opportunity to develop and maintain important personal and family relationships. Some service users visited their family household on a weekly basis while others had family visit them at their Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 15 home. Relatives spoken to as part of the inspection spoke very highly of the home. One relative described the home as “wonderful” when asked what she thought about the services provided at the home. She further stated, “I have lots of dealings with the home and I phone everyday, the communication from the home is very good. I live a distance away and recently I stayed at a hotel and staff even picked me up and took me to the home, so I could see my son The staff are brilliant, they are courteous, polite and always talk to me and explain things to me. I even go the hospital with my son. I can’t fault the service; it’s a grade 1 home, its fantastic. All the staff are great.” Another relative spoken to commended the home for their services and stated “The accommodation is superb, the care is genuine and it is a real home. We are very happy with the services. The care staff are very welcoming, they always offer us a cup of tea.” Vicarage Road (1&3) DS0000060786.V337792.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, 20, 21 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive personal support and care in the way they prefer and require. Medication practices do not always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. EVIDENCE: Each resident has a devised health profile and plan in place. The plan identified their daily routine including the type of support they need in relation to personal hygiene and according to their level of care needs; it gives a comprehensive overview of their health needs and acts as an indicator of change in health requirements. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 17 All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to personal preferences in relation to the provision of personal care, for example whether one prefers a shower or a bath. Personal support takes account of individual preferences and residents’ choice of dress and appearance is respected. All residents were seen to be well dressed and groomed. Residents are supported by staff to attend appointments with healthcare professionals and their health is closely monitored and prompt referrals are made to multli-disciplinary healthcare professionals where required. Regular appointments are seen as important and systems are in place to ensure they are not missed. Evidence was seen of well women checks being arranged for female residents. Professionals spoken to, spoke positively about the staff team, in regards to meeting the needs of residents. The speech and language therapist who visits the home was spoken to as part of the inspection who spoke positively about the care provided at the home. She stated, “I recommended that staff attend training in dysphasia which was taken on board by the manager and was arranged which I provided. I have found staff helpful and I am happy with the care provided at the home. I don’t have any concerns.” The community learning disabilities nurse was also spoken to who commented very positively about the care provided at the home. She stated, “The home always contacts me promptly. Whatever I tell staff to do, they do carry out, they communicate well with me, they are polite and respectful. The treat residents with respect and they always use their own initiative. I am very happy with the services provided.” The service is highly efficient when identifying the needs and wishes of residents in the event of death. The arrangements residents want are openly and sensitively discussed during the development of the care plan. These are clearly recorded, respected and known to the staff delivering care. Residents’ care plan identified whether they wanted to be buried or cremated, the type of flowers they wanted, the type of head stone they liked, whether they would like the local vicar present and their preferred selection of music to be played at their funeral, which was all presented in picture format and was completed with the support of Mencap advocacy. There are also policies and procedures for staff to follow in the event of a death; to ensure the death of service user is handled with respect and as the individual would wish. The service is commended for the high level of detail the information provides and the way it is presented in pictorial format. A resident recently passed away and a collage of pictures and photographs were displayed in the lounge area, in memory of him. A thank you letter written by his relative was also viewed which thanked the home for their services. The letter stated “Thank you to you and your team, for all the loving care you gave to M. I know it meant a lot to him as it did to me and my family. Thank you for the help and support you have given to him, during this sad time.” On speaking to the relative as part of the inspection, she further stated Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 18 “The care at Vicarage Road is the best care, the staff are really devoted with the way they care for people, it is excellent. Janet (manager) was very supportive throughout the time of the funeral, we couldn’t have wished for better care for M.” There are policies and procedures for the handling and recording of medicines. Each resident has a medication care plan file, including information on residents’ current medication. A list of all staff authorised to administer medication and signatures trained to administer medication was kept on the medication file. An audit of two residents’ medication was checked with the quantity administered on the Medication Administration Record, which was found to be in good order. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts was also examined. The following issues were identified; Medication Administration Records were not recorded in full for the months of December and January, as staff had not signed for some entries. Since the last inspection the service has worked hard to meet the requirements made in relation to medication practices at the last inspection. However, due to the above finding it is Requirement 2 that medication practices are reviewed to ensure the safety of residents. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 19 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, 23 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be assured their views are listened to and acted on. However, the service needs to record all concerns to ensure any dissatisfaction with the service is recorded regardless of source. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. EVIDENCE: People who use the service are supplied with a complaints procedure that is easy to understand and follow. The procedure is devised in picture format and was displayed around the home. The procedure is also available on CD and cassette. A complaints logbook is kept by the home, which was viewed. No recent complaints had been received by the service. The Commission for Social Care Inspection has also not been informed of any complaints. The home has comprehensive policies and procedures in place to follow when investigating a complaint. However, evidence was not seen of verbal concerns recorded by the service or how they are actioned. It is Recommendation 1 that all concerns Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 20 about the care of service users, regardless of source or how they are made, are recorded and responded to. All staff had attended Safeguarding Adults training which is also covered in the induction programme. The service has comprehensive Safeguarding Adults procedures and protocols in place. The service has obtained Safeguarding Adult procedures devised by The London Borough of Barking and Dagenham. There was also comprehensive guidance for staff on how to record incidents of abuse and preserving evidence. On speaking to staff they were all able to demonstrate their knowledge on identifying abusive practices and the protocols they would follow in reporting the incidents. On viewing the complaints book, which also has a section for recording compliments, a number of compliments had been received by the service. One comment made the previous community learning disability nurse had stated “Vicarage Road has very friendly and helpful staff. All staff make me feel very welcome, they offer a drink and have time to speak to me about service users I am visiting. The home is always clean with a homely atmosphere.” Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 21 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, 27, 28, 29, 30 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment and décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. But further environmental safety checks would improve the environment of the home. EVIDENCE: Vicarage Road consists of two bungalows linked via a corridor. Up to four residents live in each bungalow, which has its own kitchen area, dining room, lounge, laundry and rear garden. At the present time three residents live in each bungalow. Residents from both bungalows can freely move around both bungalows as they wish and socialise with residents. One resident from bungalow one like to spend his time at bungalow two, and was seen through out the inspection having his lunch at bungalow two and interacting with Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 22 residents and staff. The interior of the property is very well maintained, is pleasant and furnished to a very good standard. All bedrooms and communal rooms meet the National Minimum Standards or are larger; all residents’ bedrooms are also en-suite. During a tour of the home, some residents’ bedrooms were viewed. Bedrooms were bright and personalised to the taste of each resident. Residents had furnished their rooms with TV’s, DVD players and music equipment. Sensory equipment was also provided to some residents. The well-maintained environment provided specialist aids and equipment throughout the home to meet the needs of people who use the service. It was disappointing to find during a tour of the building that the COSHH cupboard in bungalow one in the laundry room was left unlocked. On viewing residents’ risk assessments two residents were identified at risk of poisoning themselves through consuming shower gels or bathing products. They could also place themselves at risk of consuming cleaning products. On touring the kitchen areas, foods were not labelled with date of opening in the fridge and foods were also not stored in airtight containers. Entries for fridge and freezer temperatures were also not recorded consistently. All parts of the home to which residents have access must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. This will be stated as Requirement 3. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff, but needs to review its staffing levels at peak times, to ensure adequate numbers of staff are on duty to meet the needs of residents. EVIDENCE: The service does not store staff recruitment files at the home, these are kept at the service’s head office. A data sheet was provided for each member of staff confirming their CRB number, number of reference checks, employment history, confirmation of identity checks and a list of previous training, which Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 24 was examined for three members of staff at the inspection, which were all in good working order. On viewing staff training files it was identified that there is a comprehensive training programme in place and all staff receive on-going training. Training provided to staff this year included training in person centred active support, care of the dying, safeguarding adults, food hygiene, first aid, health and safety, training in epilepsy, manual handling, de-escalation and diffusion, breakaway techniques, valuing diversity and shift leading. The organisation must be commended for the quantity of training it provides to its members of staff and placing a high level of importance on training. The service has a ratio of 50 of NVQ qualified staff. On viewing the staffing rotas, five members of staff are on duty throughout the day, with two members of staff on duty in bungalow one and three members of staff on duty in bungalow two. Two waking members of staff are on duty at night. The service regularly uses agency staff to cover sickness, from a pool of staff all Avenues Trust homes use. Some relatives spoken to did inform that there is a high turn over of staff but this did not concern them as staff were described as very “helpful”. However, residents in bungalow one have a high level of care needs and one resident is prone to having epileptic seizures. Two members of staff on duty would not be sufficient to meet the needs of other residents if the resident had a seizure and staff from bungalow two would have to assist, resulting in their staffing levels to be minimised. Staff members were spoken to as part of the inspection who highlighted that staffing levels do not always provide the home with adequate cover. The service has recently cut its staffing levels down to five members of staff during the day due to the two vacancies they have at the home. One member of staff spoken to stated “This has left us short at peak times as some of the residents have a high level of needs, and we could be really left short if one resident who has epilepsy has a seizure.” Due to the high level of complex needs of residents residing at bungalow one it is Recommendation 2 that staffing levels are reviewed, to ensure residents needs are met by adequate levels of staff during the day. Staff meetings take place on a monthly basis to ensure staff have an opportunity express their views or any concerns they may have. During the inspection the advocate from Mencap was visiting the home was spoken to as part of the inspection and commented very positively about the staff team at the home. He stated, “I have no issues with the home, Janet (manager) has a very good dialogue of communication and staff also communicate well to residents, they are approachable, friendly and welcoming.” Vicarage Road (1&3) DS0000060786.V337792.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, 42 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a well run home. The systems for service user consultation are in place, to ensure the home is run in the best interests of residents. The welfare of staff and residents is promoted by the home’s policies and procedures. EVIDENCE: The and The and registered manager has completed her Registered Managers Award has extensive experience of working with people with learning disabilities. registered manager communicates a clear sense of direction, leadership openness. One member of staff informed, “The management are very nice DS0000060786.V337792.R01.S.doc Version 5.2 Page 26 Vicarage Road (1&3) and very supportive. I am happy working at the home, it is a good home to work at. Service user’s look healthy, they are happy here.” Another member of staff stated “Janet (manager) is supportive, we can always go to her. Management does listen to us, I can’t think of any improvements that could be made to the home.” A relative spoken to as part of the inspection described the manager as “delightful”. Quality assurance systems are in place and surveys are given to relatives, family, representatives and stakeholders to complete. Evidence was seen of the results being compiled centrally, received by all respondents throughout the organisation and transferred into charts and a report, which was published and available to anyone on request. The manager informed that they have just sent out surveys to family, representatives and stakeholder and one survey had been returned by a stakeholder. On viewing the survey they commended the service and the comments stated “This is one of the best homes I visit in my work. The staff are friendly and helpful. The home is always clean and tidy.” Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. Monthly regulation 26 visit reports were available to view at the home, and the Commission for Social Care Inspection has also been sent copies of these reports. Visits have been completed on a monthly basis and provide sufficient information on the day-to-day operations of the home. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No 1 2 3 4 5 Score CONCERNS AND COMPLAINTS Standard No 22 23 Score 3 3 3 3 2 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000060786.V337792.R01.S.doc LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Vicarage Road (1&3) Score 3 3 2 4 3 x 3 x x 3 x Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement The registered persons must ensure that residents or their representatives sign contracts of terms and conditions to ensure they are in agreement to the services provided by the home. Repeated Requirement The registered persons must ensure medication practices are reviewed to ensure the safety of residents. Repeated Requirement. The registered persons must ensure that all parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. Timescale for action 31/03/08 2 YA20 13 21/03/08 3 YA30 YA24 13 (4) (a) 31/03/08 Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA22 YA33 Good Practice Recommendations It is recommended that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to. It is recommended that staffing levels are reviewed, to ensure residents’ needs are met by adequate levels of staff during the day. Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Vicarage Road (1&3) DS0000060786.V337792.R01.S.doc Version 5.2 Page 31 - 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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