Inspection on 14/02/07 for Ware Road (49)

This inspection was carried out on 14th February 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ware Road (49) 26/06/07

Ware Road (49) 25/08/06

Ware Road (49) 18/01/06

Ware Road (49) 20/06/05

Ware Road (49) 21/12/04

Ware Road (49) 16/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

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 Ware Road (49) 49 Ware Road Hertford Hertfordshire SG13 7ED Lead Inspector Robert Kittle Key Unannounced Inspection 14th February 2007 10:00 Ware Road (49) DS0000019608.V330497.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 Ware Road (49) DS0000019608.V330497.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. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ware Road (49) Address 49 Ware Road Hertford Hertfordshire SG13 7ED 01992 501288 01992 501288 FP h3012@mencap.org.uk H4037@mencap.org.uk Royal MENCAP Society 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) Manager post vacant Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 August 2006 Brief Description of the Service: 49 Ware Road is a large Victorian house, which has been converted to provide accommodation for six people with a learning disability. The home consists of six single bedrooms, one ground floor shower room with toilet, one bathroom, one separate toilet, lounge and kitchen/diner. It has a small front garden with limited off-road parking provided. There is a large rear garden. The home is conveniently situated on the main Hertford to Ware road, which can be busy. It is close to the shopping centre of Hertford, with all its facilities and major transport links. The home was first registered 13 November 1991 under the Registered Homes Act (1984). 49 Ware Road is part of MENCAP. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written following an unannounced visit to the service and from information that has been gained from previous inspections or is known to the Commission for Social Care Inspection (CSCI). The majority of time in the home was spent observing and talking with service users and staff. Case and other records were examined and a brief tour of the premises also took place. Had the outcome of this inspection been based only on the positive benefits and quality of life that the staff team maintain for the service users, the overall judgement of the service would undoubtedly be ‘good’. However, with service user’s needs increasing and care staff numbers diminishing, the overall outcome has been judged as being ‘adequate’ on this occasion. What the service does well: What has improved since the last inspection? What they could do better: The number of care staff available at this home has been challenged in at least the last three inspection reports. It was therefore disappointing to note that staff numbers had actually decreased since the last inspection took place. Evidence will again be sought from MENCAP on how an establishment of six full-time staff can continue to meet the needs of six service users whilst ensuring training, holidays, sickness, supervision and management are covered. An enforcement notice was not served on this occasion, but outcomes for service users continue to rely on staff goodwill and enthusiasm. To date, the staff are performing magnificently. However, it is not acceptable for the service provider to continue to rely largely on this, especially as some available care staff time continues to be ‘lost’ on cleaning tasks in the home. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 6 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. Ware Road (49) DS0000019608.V330497.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 Ware Road (49) DS0000019608.V330497.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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a proven track record of offering appropriate choice to new service users. EVIDENCE: All six service users were admitted when the home first opened. The inspecting officer has personal knowledge that they were fully involved in the setting up of the home. The level of attention paid to their aspirations and needs has continued to improve with increased experience and knowledge of the care staff. Each service user has a written statement of terms and conditions. Ware Road (49) DS0000019608.V330497.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, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person centred planning has further enhanced service users’ opportunities to influence how their needs and choices are met. EVIDENCE: Although a number of service users have limited verbal communication skills, person centred planning (PCP) is fully functional in this home and has ensured that service users are actively involved in all aspects of their daily lives. In addition to the actual plans, there were other examples such as a PCP activities board in a service user’s bedroom. Staff were extremely enthusiastic and comments such as, “It gives the guys power” and “PCP makes lives more interesting and provides choice” were made. It was also established that there is a proactive review system where any changes result in a fresh assessment. One service user may be developing a dementia and the staff are being supported by the community nurse in aspects of his care. During the inspection, service users demonstrated their ability to make choices; for example, one chose to show their bedroom, whilst another firmly declined. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 10 There were independent spontaneous activities seen as well as an arranged outing for three service users to visit High Beech. There was evidence that service users were facilitated to take risks. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lead full and active lifestyles and can rely on the care staff to facilitate this. EVIDENCE: Again, the way in which the staff group has embraced PCP helps promote and sustain service user’s lifestyles. Staff said that the process, “Helps staff to understand the service users better”, and that the “techniques help staff understand people with learning disabilities.” Staff know the service users well and have long since overcome any communication difficulties through this familiarity. Many positive interactions between staff and service users were observed during this visit. A nutritious and varied diet is available to service users. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 12 However, there remains a concern that there are insufficient staff numbers to ensure that the function of the home is always structured around the service users rather than vice versa. Activities can be spontaneous and therefore dependent of staff availability. Including assisting care staff with household tasks as an activity may not be a commonly held opinion either. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff can be relied upon to deliver care of the highest quality, the availability of care staff cannot guarantee that this level of service can be consistently delivered. For this reason, and the example given below, this outcome area has been judged as being adequate. EVIDENCE: It would not be appropriate for the current service users to administer their own medication, although there is an appropriate medication administration policy in use. One service user may be developing a dementia and the staff have been maintaining a log of observations and behaviour trends to see if patterns develop and to ensure that health and personal needs are being addressed. This site visit did reveal however, that limited care staff availability could not always enable staff to ensure delivery of personal and emotional support in a way that service users want or require. Whilst the visit was taking place, the day care activity for a number of service users was not accessible because of February half term. Staff had already agreed that three service user should Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 14 have an outing with one staff member. (It should be noted that the inspecting officer had concerns about one staff member escorting three service users on a trip to an uncontrolled area such as Epping Forest). One service user had a pre-arranged dental appointment, and was appropriately supported by a staff member. A fifth service user had returned unexpectedly from their day activity. The remaining member of staff had planned a cleaning activity with a service user that morning (as there are no housekeeping staff) and the service user who had returned unexpectedly was therefore left to their own devices in the lounge for a considerable period of time, there being no staff available. When the unannounced site visit was added to the equation, the staff response demonstrated their positive team working, but nevertheless the circumstances provided a clear warning on how easily the quality of service can slip, especially when only two staff are scheduled to be on duty. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 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. 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. Service users are listened to and protected. EVIDENCE: Interaction between service users and staff was a pleasure to watch, as they have clearly built up the type of rapport over the years where there is not sole reliance on conventional communication methods. One of the articulate service users said that, “They (the staff) look after us and talk to us. They are my friends”. Staff receive periodic training in the protection of vulnerable adults and the Commission has been notified of neither concerns nor complaints since the last site visit took place. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, safe and homely environment is being maintained. EVIDENCE: A tour of the building revealed that a good standard of cleanliness was now being maintained. Furniture was appropriate and in good order and the building has been maintained to a good decorative standard. A new wooden floor as been laid in the hall and lounge. A PCP activity board in one bedroom had become a vital guide in one service user’s daily life. Ina a chalet outside the back door, a snoozelem is being set up. Staff are currently decorating the interior prior to setting up the equipment. The chalet is heated and should prove to be a beneficial addition for the service users. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the quality of individual members of staff is not in doubt, staff numbers have continued to reduce, staff care roles are compromised by other duties and service user’s needs are increasing. EVIDENCE: This report reflects previous reports in as much as the quality of the staff is outstanding, but the additional duties put upon them and the changing needs of the service users place the depleted staff numbers in a potentially dangerous situation. Staff establishment numbers have actually decreased since the last report on the service and the manager is still taking maternity leave (effectively reducing staffing levels further as the deputy is required to ‘act up’ as manager). However, care staff are still expected to clean the home, one service user may be developing a dementia and the report also includes an example of how easily a service user’s needs could be left unmet. All required documentation was available for inspection and it was noted that a recent attempt to recruit appropriate staff was unsuccessful (although this would only have brought the full-time establishment back to the level considered worthy of review at the last inspection visit. Ware Road (49) DS0000019608.V330497.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no doubt that, subject to staff availability, service users’ views continue to underpin the running of the home. However, there is no manager and staff numbers have reduced since the last inspection took place. The judgement would have been good if the only factor had been the dedication, enthusiasm and skills of the staff group. EVIDENCE: The manager that was appointed when the last inspection took place (August 2006) will take up post in April 2007. This has place additional burdens on the deputy manager and has had a knock-on effect on other staff. The continued inclusion of cleaning duties and increasing needs of service users has also tested this effective staff group considerably. Staff confirmed that they receive support and supervision from the service manager, but only use of agency staff makes up for the shortfall in staff numbers. An example of how the current staffing arrangements can affect service users is given above. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 19 Policies and procedures are kept up to date and staff were able to demonstrate that they have embraced risk assessing into daily life and were very enthusiastic about the many benefits of person-centred planning. Ware Road (49) DS0000019608.V330497.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 3 2 3 3 X 4 X 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 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 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 3 3 3 3 3 3 3 2 Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 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 YA18 YA31 Regulation 18(1)(a) Requirement Timescale for action 27/04/07 2. YA33 13 (4)(b) Staffing levels must be adequate for the needs of service users. Evidence must be provided to CSCI to demonstrate how an establishment of six staff meet the needs of six service users whilst ensuring that cleaning, training, holidays, sickness, supervision and management are covered. Failure to meet this requirement will result in the Commission considering legal enforcement action. Staffing levels must be sufficient 27/04/07 to ensure that all activities involving service users are free from avoidable risks. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA43 Good Practice Recommendations The appointed manager should apply for registration as soon as possible after her return from maternity leave. Ware Road (49) DS0000019608.V330497.R01.S.doc Version 5.2 Page 23 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. 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