Inspection on 31/08/07 for Walsworth Road (17)

This inspection was carried out on 31st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walsworth Road (17) 25/01/06

Similar services:

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Bramley Avenue (73)

Paradise Lodge

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Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Walsworth Road (17) Hitchin Herts SG4 9SP Lead Inspector Patricia Rogan Unannounced Inspection 31st August 2007 10:00 Walsworth Road (17) DS0000062803.V350091.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 Walsworth Road (17) DS0000062803.V350091.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. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walsworth Road (17) Address Hitchin Herts SG4 9SP 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) 01462 420019 01462 420020 londonroad@tiscali.co.uk Milbury Care Services Ltd Dorothy Stella Medland Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 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. The current fees charged are £1,600 - £ 2,112 per week. A copy of the ‘Statement of Purpose’ and ‘Service User’s Guide’ is available from the care home. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 31st August 2007 and took part of the day. Feedback from people living at the care home and staff was sought during the inspection. Policies and procedures, a sample of people’s care plans, staff files and other documents were examined. General observation including interaction between staff and people living at the care home, the management and administration of medicines, adherence to health and safety regulations, fire safety and other linked legislation were also carried out. This was a positive inspection. All the requirements and recommendations made in the last inspection were complied with. People living in the care home said that they were being ‘well looked after’ and ‘well cared for’. The staff are ‘nice and caring’. What the service does well: 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. Each individual is supported and empowered within the home on an individual basis; ensuring support provided is individually tailored to the persons needs. There is a key worker and a key coordinator system. Positive feedback was received from a number of people living in the care home regarding their key workers and how they support them. The home also supports people in gaining appropriate life skills and opportunities. A group of residents were going on holidays to France. All bedrooms were well decorated and personalised, encouraging a homely feel. The general atmosphere and ethos within the home promotes independence and daily living 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. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The 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. Walsworth Road (17) DS0000062803.V350091.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 Walsworth Road (17) DS0000062803.V350091.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information was available to prospective clients. Residents had an assessment of their needs carried out prior to admission. EVIDENCE: People were invited to visit the home and ‘test drive’ it before any decisions for placement were made. Individual’s needs were assessed and reviews were held on a regular basis. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 9 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans demonstrate assessed and changing needs, ensuring that these needs were being met. Risk assessments and risk management support residents’ involvement in everyday living but risk assessment for people suffering from epilepsy must be carried out so that risks can be minimised and managed. EVIDENCE: Each person has a detailed care plan and an allocated key worker and coordinator to support them in the home. People living in the care home were supported within the Care Management Framework and regular reviews were undertaken to ensure changing needs were being met. However, risk assessment for people with epilepsy was not carried out nor a management plan in place should the individual suffer an epileptic attack in the bath or kitchen or while participating in other activities. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes personal development opportunities by accessing local community facilities and recognising individual rights and responsibilities. EVIDENCE: People living in the home attend a variety of schemes and colleges accessing courses suitable to their individual needs and aspirations. Staff support and encourage individuals to maintain and develop social, emotional, communication and independent living skills. The home is centrally located, and is within a short distance from shops and the local community amenities. The home values and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. Individual needs, choices and preferences are considered. A record of activities is maintained within the daily recording system. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 11 Meal choices were provided, a pictorial system has been introduced and displayed. The display is clear, eye catching and colourful for people living in the home. Menus were available and the home has a four-week rolling seasonal menu, which appeared nutritious and well balanced. Records were maintained of food consumed and offered. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals physical and health needs were being met, ensuring that their safety, wellbeing and health is promoted at all times. However, recording in the MAR sheets should be improved so that accurate information is kept and people are not put at risk. EVIDENCE: The home is able to support specialist needs and seeks appropriate support from other professionals. Staff were able to meet the identified needs of people living in the home whilst respecting their dignity and privacy. Care plans were comprehensive and detailed how individuals identified needs were being met. These also reflected their personal preferences and in turn meet their physical and emotional needs. The administration and management of medicines were kept in good order except that hand written instructions on the MAR sheets were not signed by Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 13 the person making the entries. It was also noted that when medicines were not administered, the reason for omissions were not recorded. Policies and procedures were in place in respect of ageing, dying and death. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is sufficient and adequate in order for people living in the care home to feel that their views were listened to and acted upon. Robust policies, procedures were in place to ensure that individuals were protected and safe. EVIDENCE: A complaints procedure was in place, which detailed that all complaints are responded to within 28 days. This was also on displayed within the home. Policies and procedures were in place to ensure that people living in the home were protected from abuse and harm. Staff employed were all subject to enhanced Criminal Records Bureau (CRB). Staff records were not examined on this occasion, as these were not available. However, these files were checked at the last inspection which stated (staffing records were audited as part of the inspection process and were found to be in good order with all relevant checks occurring and accurate records maintained). Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 15 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was very well maintained and promoted a homely, comfortable safe place for service users to live. EVIDENCE: Individuals’ bedrooms were personalised with their belongings and they are encouraged to bring and/or choose their own furniture and can decorate and personalise their rooms, subject to fire and safety regulations. The premises were safe, accessible, comfortable, clean and all areas of the home are clean and hygienic. Each room has sufficient light and ventilation. All rooms are for single accommodation and are well maintained and decorated. The bathroom and toilet provision is sufficient for the number of residents in the home. The home uses its own transport for service users to access local amenities and relevant support services. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 16 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, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suitably staffed with well-trained individuals ensuring that at all times service users complex and changing needs can be met. People living in the care home were supported by a competent and trained, effective, staff team. The staff recruitment policy and procedure was robust and implemented to ensure that individuals were protected and safe. The staff team are well supported by the management team and formal supervision was provided. EVIDENCE: All staff have received a series of mandatory training course in order for them to meet the complex needs of the service users. Training includes first aid, care of medicines, mental health needs, health and safety, epilepsy, manual handling and food hygiene. Future training planned includes risk assessment and supervisory management. Currently, there are only 2 staff who have completed their NVQ Level 2. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 17 Staff files were not examined on this occasion, as these were not available. However, these files were checked at the last inspection and the report stated (copies of certificates are held on file and confirm training received and staffing individual qualifications. The manager has also implemented a training matrix which visually displays training completion and renewal dates. Recruitment practices appear well structured, with relevant checks occurring prior to employment. Pre employment checks have occurred with a checklist system in place). All policies and procedures relevant to the home were appropriately held on site. Staff confirmed that they received formal supervision on a regular basis. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management within the home is secure and effective ensuring that changing needs of people are met and that the home is meeting its aims and objectives. Systems for effective health and safety management were in place. EVIDENCE: The ethos and management approach in the home creates an open, positive and inclusive atmosphere, staff and people living in the care home spoken to commented that they feel extremely supported and they feel the home is well managed. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 19 Staff are adequately and suitably trained in order to meet the complex and changing needs of the people living in the care home. Relevant training is provided to ensure staff development is maintained. All records examined were well documented. Staff spoken to confirmed that regular fire drills take place, which everyone takes part in. The home’s policies and procedures were kept in the office and were available to staff. Staff spoken to said that they adhered to these. All staff complete the statutory training to maintain safe working practices and the home complies with all relevant legislations to safeguard the health, safety and welfare of service users and staff. All staff who handled food have undertaken food and hygiene training. Accidents, injuries, incidents of illness were recorded and reported. The home has a valid insurance cover for legal liabilities to employees, service users and third party persons to a limit commensurate with the level and extent of activities undertaken or to a minimum of £5 million. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 (6) Requirement Risk assessment must be carried out for people who suffer from epilepsy so that risks can be minimised and managed. Timescale for action 26/10/07 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. YA20 Refer to Standard Good Practice Recommendations a) Hand written instructions on MAR sheets should be signed by the person making the entry. b) When medicines are not administered, the reason for omission should be recorded. Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Walsworth Road (17) DS0000062803.V350091.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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