Inspection on 15/02/06 for Wells Road Care Home

This inspection was carried out on 15th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wells Road Care Home 15/02/09

Wells Road Care Home 19/03/08

Wells Road Care Home 05/09/07

Wells Road Care Home 11/04/07

Wells Road Care Home 20/04/06

Wells Road Care Home 21/03/05

Wells Road Care Home 29/03/04

Wells Road Care Home 10/11/03

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Wells Road Care Home 280-282 Wells Road St Anns Nottingham NG3 3AA Lead Inspector Joanna Carrington Unannounced Inspection 15th February 2006 10:00 Wells Road Care Home DS0000002259.V283421.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 Wells Road Care Home DS0000002259.V283421.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. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wells Road Care Home Address 280-282 Wells Road St Anns Nottingham NG3 3AA 0115 955 5162 0115 950 2066 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) Nottingham Community Housing Association Mrs Karen Allison Martin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users shall be within category LD Date of last inspection 11/08/05 Brief Description of the Service: Wells Road Care Home is situated in a residential area, close to shops and amenities and is registered to provide accommodation and support for up to six adults with a learning disability. The home itself is comprised of a pair of semi-detached houses joined together and the accommodation consists of communal lounge, dining room and kitchen on the ground floor and six single bedrooms with shared bathing facilities on the upper floor. There is currently one vacancy. The home has enclosed front and rear gardens accessible to residents. The manager of the home, Carmel Hopkinson is currently unregistered and it is required that an application is completed without further delay. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over three and a half hours on 15th February 2006. This was the home’s second of two statutory unannounced inspections for this inspection / financial year. The focus of the inspection was to follow up requirements set at the last inspection and to assess the remaining key standards that must be assessed at least once over a one-year period. Therefore, it is recommended that this report be read in conjunction with the previous report. The main method of inspection was ‘case tracking’ two residents, which meant tracking their care and support through checking their records, discussion with two staff members and observation of care practices. Due to the limited communication and understanding of the residents the inspector was unable to speak with residents as part of the inspection. A partial tour of the premises also took place in order to assess cleanliness of the home. Unfortunately staff recruitment records could not be looked at, as these could not be accessed due to the absence of the manager, who was on annual leave. The deputy manager was present throughout the inspection for discussion and feedback. What the service does well: The staff team are evidently committed to providing activities to residents and ultimately promoting their quality of life. Residents have only recently returned from a holiday to Blackpool. Staff understand the issues effecting adults with a learning disability and demonstrated an understanding of the individual communication needs of residents. Staff were observed interacting with residents in a respectful and meaningful manner. A staff member was seen playing cards and eating lunch with residents. Support plans make reference to always respecting individuals’ privacy and dignity and promoting the right to make choices. From both talking with staff and reading records it is also evident that staff enable residents to maintain contact and relationships with family and friends. The healthcare needs of residents are met by ensuring that residents have access to a GP and specialist healthcare professionals such as psychologists and dieticians, when necessary. Staff are aware of their role and responsibilities in accordance with the Nottinghamshire Protection of Vulnerable Adults Policy and Procedures and there is an appropriate complaints procedure in place to enable residents and their relatives / representatives to air their views. Staffing levels are appropriate to the needs of the service users and progress is being made with getting staff qualified to at least a National Vocational Qualification Level 2 Social Care. The home is kept clean and hygienic. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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 Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The needs of residents are not fully assessed prior to admission if there is not an up to date community care assessment. EVIDENCE: At the last inspection it was noted how for a new resident their community care assessment was not up to date, with no information available for up to seven months prior to his admission. Records seen indicated that there was not enough information about his asthma management and the current arrangements for contact with his family. A requirement was made that up to date assessments must be obtained for future prospective residents. There have been no new admissions since the last inspection. For this named resident, there are still gaps in information about this resident, which need to be obtained in order to establish what support is given / how to write the necessary support plans. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 No progress has been made since the last inspection with the development of required support plans and improvements to consultation and review is also required. EVIDENCE: Since the last inspection no more support plans have been developed for the resident that was admitted to the home in March last year. Staff spoken with explained how the memory of this resident has been deteriorating, and the relevant healthcare professionals are involved. A support plan is essential in how to support the resident in this. It was also reported that challenging behaviour and issues with boundaries is also of significance for this resident. Again, a support plan for how the staff team manage this in a consistent and appropriate fashion is required. Hard copies of support plans were looked at and some were dated as far back as April 2004. If these are being reviewed on the SuRe computer system, then in accordance with Nottingham Community Housing Association (NCHA) the most up to date support plan must be printed off and kept as a hard copy. Otherwise, staff may be accessing information that is not current, which is unsafe practice. The last review meeting for one resident case tracked was October 2004, in which it states that family invited to review and consulted Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 10 about care plans. There was no further evidence of when consultation with residents and their relatives / representatives has taken place. Wells Road Care Home DS0000002259.V283421.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): 12, 14, 15 and 16 Staff are committed to providing leisure activities to residents but a lack of day services provision for one resident is limiting their participation in appropriate activities, social network and ultimately, their quality of life. Residents’ rights are respected and upheld including the right to have and maintain appropriate family and personal relationships. EVIDENCE: The deputy manager explained how it is intended that a new rota not yet implemented will aim to have three staff on an evening shift wherever possible so that more activities and access to the community can be facilitated. Residents have recently been on a holiday to Blackpool. Overall access to day services and other provision is good for residents, with activities matched to suit their needs and interests. For example, one resident goes to music therapy every week. It was explained how one resident that was home on the day of the inspection currently has only two days attendance at a near-by day centre but staff feel that the resident would prefer to and benefit from accessing appropriate day services for more than just two days per week. This needs to be followed up and in the meantime, more consideration given on how structured activities can be provided to this Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 12 resident by staff at the home. A member of staff was observed at one point interacting with this resident meaningfully, playing a game of cards. Staff reported that residents’ contact with their family and friends is promoted, which was reflected in a good support plan for one resident case tracked. One resident recently had their 40th birthday party, which was held in the local pub with all families welcome to join the occasion. Another resident invited their boyfriend over for Valentines Day, and staff cooked a meal just for the two of them. Staff spoken with recognise the importance of respecting residents’ right to privacy and to be able to make choices in their lives. Support plans also refer to maintaining dignity. As the residents that live at this home are not able to use a key to their own bedrooms this should actually be recorded on relevant support plan / risk assessment in order to acknowledge the right to privacy and security, and how this can be best achieved. As recommended at the last inspection, there are support plans identifying what domestic tasks individuals’ like to do around the home, which is important for promoting residents’ independence and daily living skills. Wells Road Care Home DS0000002259.V283421.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): 19 and 20 Residents’ healthcare needs are met and residents are protected by the home’s policies and procedures for dealing with medicines, however the suitability of where medication is stored needs to be monitored. EVIDENCE: There are excellent support plans in place for catheter care that include procedures and risk assessments for infection control and there was evidence seen that residents have access to a GP when needed and to other specialist healthcare professionals such as community nurses and psychologists, to assist in meeting both the emotional and physical health needs of residents. For one of the residents’ case tracked the support plan that lists their prescribed medication is from May 2004. It needs to specify if the medication has not changed since this date, or if there is an amended list held on the SuRe computer system, to ensure their safety, this needs to be printed off and retained as a hard copy. The medication administration records (MAR) were looked at and appeared to be in order. There were no errors and instructions for administering medicines were clear. Medicines are stored in a secure wall mounted cabinet. The only problem is that this is located above a radiator, and seemed very warm. Staff must monitor the temperature of this cabinet, and check the storage instructions of medicines, and if necessary, take appropriate action. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There is an appropriate complaints procedure in place and staff are aware of the Nottinghamshire Adult Protection Policy and Procedures and of their responsibilities in protecting residents from abuse. EVIDENCE: There is an appropriate complaints procedure, which is also in a Signs and Symbols format. The poster seen on the wall, however, is way out of date, referring to the old inspection unit. This needs to be replaced with the most recent Complaints Procedure, that provides contact details for the Commission, but to be amended to say Commission for Social Care Inspection. There have been no complaints made either by residents or their relatives / representatives in the last year. Staff spoken with demonstrated an awareness and understanding of the Nottinghamshire Adult Protection Policy and Procedures. This procedure has not yet had to be followed, as there have been no disclosures or allegations. An incident record, from last year describes a resident “hitting out” at another resident. Staff must be mindful that when an act of abuse has occurred from one resident to another then this is a Protection of Vulnerable Adults (POVA) issue, and therefore the procedures must be followed. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Residents live in a clean and hygienic environment. EVIDENCE: On a partial tour of the premises it was apparent that the environment is kept clean and hygienic. There is a cleaning rota, which staff sign to show that all necessary domestic tasks have been completed. The laundry facilities are sited away from food and are suitable to meeting the needs of residents. Residents can do their own laundry if risk assessed able to do so. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33 Ongoing progress is being made with staff obtaining the necessary qualifications. Staffing levels are adequate in meeting the needs of residents. EVIDENCE: Two new recruits are currently doing their Learning Disability Award Framework Foundation Training as part of their induction. Six out of the fourteen care staff (this includes the manager and deputy manager) are trained to at least National Vocational Qualification (NVQ) Level 2 Social Care and another member of staff is half way through their NVQ 2. Therefore, the 50 target has nearly been reached. The deputy manager reported that due to the Nottinghamshire Healthcare Trust withdrawing their employment of the staff team funding for training has been frozen. Nottingham Community Housing Association will pick up where the Healthcare Trust have left off, as investment in training and development must continue. The staff rota shows that there are always two staff members available for five residents. Some new staff have recently been recruited which has helped with covering all shifts. The deputy manager reported that there are intentions to provide three staff, wherever possible, on evening shifts so that more activities and access to the community can be offered to residents. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 17 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): 37, 39 and 42 The registration of the manager is now well over due, and must be addressed immediately so that fitness as registered manager can be assessed. Implementing quality monitoring is required, including ways that are underpinned by the views of residents. Until fire safety practice improves at the home the health, safety and welfare or residents is not adequately protected. EVIDENCE: An immediate requirement has been issued for the appointed manager to submit their Criminal Record Bureau application to the Commission, so that the application for registration as manager can be processed. Nottingham Community Housing Association (NCHA) has a number of systems for monitoring the quality of care. There are regular internal audits that use staff and residents from other services. However, there does not appear to have been any quality audits for a significant amount of time, including not seeking the feedback from residents and their relatives / representatives. The home is signed up to the ‘Quality Tree’ a Nottingham initiative that promotes quality assurance based on the involvement of residents. This is difficult for a Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 18 resident group with extremely limited communication but ways to develop this are being looked at. Fire safety records were looked at during the inspection and showed that fire drills and the testing of automatic door releases and emergency lighting are not being carried out as required in accordance with Fire Precautions in the Workplace Legislation. This has been issued as an immediate requirement. Since the last inspection there has been an incident, which adversely affected the safety and wellbeing of a resident. This event should have been notified to the Commission, so that the home can be effectively regulated. Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 19 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 2 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 x 1 X 2 X X 1 X Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement For the named resident ensure that there is a full assessment of their needs, which then informs their care plan Ensure care plans are kept under review, at least every six months. Develop support plans (following the full assessment of the named resident, see above), with particular attention to behaviour and memory loss. Consult with the named resident and Social Services over their programme of activities, having regard to their needs, activities relating to recreation, fitness and training. For safe storage of medicines monitor the temperature of storage room and then, if necessary, take appropriate action. Monthly, unannounced visits to the home are required and subsequently a report on the conduct of the home submitted to the Commission. Submit CRB application to the Commission (in person so that it DS0000002259.V283421.R01.S.doc Timescale for action 30/04/06 2. 3. YA6 YA6 15 15 31/03/06 30/04/06 4. YA12 16(2)(n) 31/03/06 5. YA20 13 28/02/06 6. YA39 26 31/03/06 7. YA37 8 15/02/06 Wells Road Care Home Version 5.1 Page 21 8. YA42 23 9. YA42 37 can be verified) without delay. This was issued as an immediate requirement. Ensure that all necessary fire 15/02/06 safety tests and practices are carried out, in accordance with Fire Precautions legislation. This was issued as an immediate requirement. Ensure that all events as 28/02/06 specified under Regulation 37 of the Care Home Regulations are notified to the Commission without delay. 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 YA16 Good Practice Recommendations Add to the relevant support plan / risk assessment individuals’ ability to use a key to their bedroom, and if support is appropriate in enabling a resident to use a key, or if other measures are in place to promote their right to privacy and security etc. Continue with NVQ training for staff. 2. YA32 Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wells Road Care Home DS0000002259.V283421.R01.S.doc Version 5.1 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!