CARE HOME ADULTS 18-65
Walsworth Road (17) 17 Walsworth Road Hitchin Herts SG4 9SP Lead Inspector
Louise Bushell Unannounced Inspection 25th January 2006 4.30 Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 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 Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 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. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Walsworth Road (17) Address 17 Walsworth Road Hitchin Herts SG4 9SP 01462 420019 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) londonroad@tiscali.co.uk Milbury Care Services Limited Julie Drady Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: The home has been registered since February 2005. Walsworth Road is a large detached house with accommodation on two floors. The building has a large back garden, which provides ample communal space. There is a large kitchen, dining room, lounge, conservatory and two bedrooms on the ground floor. Upstairs comprises of office space and a further four bedrooms of which all have en suite facilities. The home is situated within walking distance of the town and all local amenities. Other local attractions are close by and service users are encouraged to integrate within the local community. There is a large car park to the front of the building with ample parking for staff and mini buses. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection focused on seeking the views of the service users and inspecting the remaining core standards. Time was spent in the main lounge / dining area of the home with a number of service users and the senior member of staff on duty. Where information has remained the same from the last report it will be carried forward. The reader is encouraged to read the report in conjunction with the previous report to gain a full insight to the home’s progress in meeting the National Minimum Standards. What the service does well:
The home is currently resourced satisfactorily. This supports the continuity of care provision for the service users ensuring their individual and specialist needs can be met. There are also a number of additional hours available to provide extra staff support in outside activities for the service users, for example day trips. The provision of training in the home is well managed with a member of the management team coordinating the process. The range of training provided includes first aid, care of medicines, mental health needs, health and safety, epilepsy, manual handling and food hygiene. Future training planed includes risk assessment and supervisory management. Following discussions with a number of service users and looking through the homes policy and procedural guidelines, it is evident that staff manage the referral and admission of service users extremely well. Positive feedback was sought from a number of service users regarding the process. The files inspected showed clear documentary evidence of review meetings having occurred and trial periods into the home. Each service user is supported and empowered within the home on an individual basis; ensuring support provided is individually tailored to the persons needs. There a key worker and a key coordinator to each service user. Comments were received from the service users regarding their key workers and how they support them. The home also supports people in gaining appropriate live skills and opportunities. One service user attends a group, which supports and promotes gardening skills. Service users attend a day care provision which provides small group skill sessions in all areas of daily living. All service users bedrooms are well decorated and personalised, encouraging a homely feel. A recent addition has been made, this being a pet rabbit. All service users appeared happy with the new addition to the home. The general atmosphere and ethos within the home promotes independence and daily living
Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 6 skills in a calm and relaxed environment. The environment presents as a clean and well-maintained space in which all service expressed that it felt like home. What has improved since the last inspection? What they could do better:
The manager must ensure that there are sound food hygiene management practices in the home. Fridge and freezer temperatures are to be taken on a regular basis. The manager discussed developing a communication board which will display in pictorial format the meal choices of the day, this will actively encourage service users self determination. Care plans are currently being constructed. There is a need for the home to ensure that clear care plans are in place for all service users, determining the level and method of needs to be provided to the individual. All care plans to be signed and reviewed. Protection of Vulnerable Adults training is required for staff and it was noted that the manager is able to provide this training. Medication systems require further developing and monitoring. Medication must be administered as prescribed and stored securely as directed. All medication must be logged and accounted for. Consent to administer medicines must be obtained and the temperature of the medication room must be recorded. Effective Quality Assurance systems must be introduced to ensure that the views and opinions of the service users are actively sought with appropriate methods occurring for feedback. It is recommended that the involvement of advocacy services is introduced and that service user meetings occur more frequently. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 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. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 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 the following standard(s): Not inspected on this occasion. Please refer to the previous report for details. EVIDENCE: Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. Please refer to the previous report for details. EVIDENCE: The requirements regarding standard 6 have been carried forward from the last report and whilst progress has been made, further work is still required. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 & 17 Service users are encouraged and supported to maintain family and personal relationships, thus providing and enabling positive relationships to develop in the best interests of the service users. Service users are offered a healthy diet, thus ensuring the supply of nutritious, varied and well-balanced meals. EVIDENCE: Meal choices are provided within the home, although there is a need for the pictorial system that was introduced following the last inspection to be further developed. Direct feedback from service users determined that they like to meals provided and are encouraged to make choices. On the evening of the inspection meat and vegetable stew and dumplings was served and looked very appetising. Service users stated that they liked it. The visual menu is progressing with a number of photo’s being taken, however the library of choices requires developing for the system to be service user specific. There is a written menu on display with choices and alternatives available. Menus were available and the home has a four-week rolling seasonal menu, which appeared well balanced. Records are maintained of food consumed and offered.
Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 12 Service users were discussing visits by friends and family. There is a visitors policy in place which is flexible and empowers and encourages visitors. Service users were talking about the different opportunities they have to meet family, friends and representatives and the support that is offered and made available. The approach and ethos of the staff, ensures that service users are encouraged to maintain these vital links inside and outside the home. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 & 21 Service users receive personal support in a way that they prefer thus encouraging rights, privacy and dignity. Medication systems require reviewing with general practice principles to be developed thus ensuring continued safety for all. EVIDENCE: All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Assessments and reviews are continuously completed ensuring that the approach adopted by the home is person centred and holistic to each service users needs. Service users needs and are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to all services users regarding general health issues. Staff have worked with individual service users and families in actively aiming to gain the wish’s of the service users should such circumstances occur, thus ensuring that their wish’s are handled with care and respect. The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receive training prior to being deemed competent to administer medication. The home uses a local
Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 14 pharmacy and has a good working relationship with them. Contracted pharmacy inspections are carried out frequently. The home uses a monitored dosage system for safe administration. A number of areas were identified regarding medications and these require further actions in order to ensure safety for the service users. A medication temperature room recording system was in place, however this was not accurately completed and at times the records showed a temperature exceeding the recommended level. A medication fridge would enable the staff to maintain a safe environment for the storage of medicines. One medicine was being stored at an inappropriate temperature and is required to be refrigerated. The senior on duty and the current manager were informed. Consent to administer medicines to service users should be obtained from the service user and or representative thus ensuring the right of the individual are being upheld and maintained. A sample signature sheet should be implemented thus ensuring that accurate auditing and tracking can be made by all staff. Staff must ensure that administration instructions are reflected on the MAR sheet and that medication is only administered as per guidelines and instructions. Surplus medications must be accounted for in a stock balance to ensure safety and for auditing purposes. All prescribed medicines must be stored appropriately. In general, record keeping of medication administered is satisfactory, with a sound training package available for staff. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. Please refer to the previous report for details. EVIDENCE: The requirements regarding standard 23 has been carried forward from the last report and whilst progress has been made, further work is still required. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. Please refer to the previous report for details. EVIDENCE: Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. Please refer to the previous report for details. EVIDENCE: The requirements regarding standard 35 has been carried forward from the last report and whilst progress has been made, further work is still required. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Service users views are actively sought however the systems in place require reviewing to ensure that the needs of the service users are sought in full with systems appropriate and user friendly. EVIDENCE: A full service review is completed annually which aims to seek the views of the service users and looks at the systems and the management to ensure needs are being met. The annual review however is not currently in a service userfriendly format and presents as a tick audit rather than a system shows the involvement of the service users. Following a detailed discussion with the manager it was determined that a service user questionnaire required developing including a questionnaire seeking the views of family, friends and representatives. Other current systems in place that ensure consultation with the service user includes Regulation 26 visits which are conducted monthly and service user meetings. It is recommended that these occur more frequently and that advocacy services are explored. Direct feedback from the service Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 19 users confirmed that they were very happy living at Walsworth Road. One service user commented that “it’s my home and I am happy here”. Following a requirement made at the last inspection, there is a need for further monitoring to occur of the fridge and freezer temperatures. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 2 3 X X 2 X X 2 x Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 21 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 YA6 Regulation 15 (1) Requirement Timescale for action 30/04/06 2 YA17 12 (2) & 16 (2) (i) 3 YA35YA23 13 (6) & 18 (1) (c) 4 YA20 18 (1) (c) Service Users must have a detailed care plan, which is current, accurate and reviewed, in order for the service users to person centred care. Requirement carried forward from last inspection. Failure to comply may result in enforcement action. The development of a choice 30/04/06 system for meals must occur to enable a flexible provision of suitable foods which is varied. Requirement carried forward from last inspection. Failure to comply may result in enforcement action. Staff must be provided with 30/04/06 suitable adult protection training. Requirement carried forward from last inspection. Failure to comply may result in enforcement action. • Medication must be 30/04/06 administered as prescribed. • Medication must be stored as directed and securely. • All medication must be logged and accounted for.
DS0000062803.V280456.R01.S.doc Version 5.1 Walsworth Road (17) Page 22 • 5 YA39 24 6 YA42 13 (4) Consent to administer medicines must be obtained. • Temperatures must be recorded of the medication room. Effective quality assurance systems must be in place seeking the views of the service users. Fridge and freezer temperatures must be accurately recorded. 30/04/06 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA39 Good Practice Recommendations It is recommended that a medication fridge be purchased to store refrigerated medicines. It is recommended that a signature sheet be introduced for auditing purposes. It is recommended that advocacy services be introduced. Walsworth Road (17) DS0000062803.V280456.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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