Inspection on 06/09/05 for Woodcote Grove Road (100)

This inspection was carried out on 6th September 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Woodcote Grove Road (100) 10/02/09

Woodcote Grove Road (100) 18/02/08

Woodcote Grove Road (100) 08/05/06

Woodcote Grove Road (100) 12/12/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Woodcote Grove Road (100) 100 Woodcote Grove Road Coulsdon Surrey CR5 2AF Lead Inspector James Pitts Unannounced Inspection 6 September 2005 2:25pm 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 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 Stationary 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. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Woodcote Grove Road (100) Address 100 Woodcote Grove Road, Coulsdon, Surrey, CR5 2AF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8763 4256 Caretech Community Services Limited Mrs Lesley Lush Care Home 8 Category(ies) of Learning Disability (8) registration, with number of places Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 26 May 2005 Brief Description of the Service: Woodcote Grove Road (100) was registered in October 2003. The home offers eight single bedrooms; there are two bedrooms with en-suite bathrooms. There are two bathrooms with toilets upstairs and one bathroom with a toilet downstairs. The home is registered to provide support to eight people with learning disabilities. At present the home offers support to four service users, all of whom have been recognised as having Autistic Spectrum Disorder. The home is situated on a quiet main road in Coulsdon, and is within relatively easy reach of train and bus links to Purley and Croydon. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the previous inspection there has been an additional visit made to the home on 26th May of this year. The reason for that visit was to see if the home had met the six requirements that had previously been made. It was found that the home had achieved 5 of these requirements and the remaining one had been met by the time of this inspection. This inspection mainly focused on how the home keeps the service users safe from harm. The reason for concentrating on this is that there had been two recent incidents where service users have come to harm, one of whom was very seriously hurt. There are four people living at the home, one of whom was in hospital at the time of this visit. Most of the people who live here find it very difficult to speak to staff or other people to let them know how they are and what they need. The Inspector saw that these people can let staff know in small ways that they might want something and the staff have to get to know the service users very well to recognise the ways in which each person does this. One of the service users spoke with the Inspector and had filled out a comment card before this visit. The other people were not able to do this and so the way in which staff were interacting with these people (except the person who is in hospital) was observed. Three relatives sent back comment cards to the Commission before this visit. One of these said that staff do appear to be caring. One said that there does not seem to be enough staff on duty, and another said that they do not know about how to make a complaint or how to see a copy of inspection reports about the home. What the service does well: The home is good at ensuring that there are enough people working in order to care for the service users and that these people are properly trained. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 standard(s) This was not inspected on this occasion. EVIDENCE: Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 standard(s) 9 The service users can feel confident that the staff will carry out very detailed risk assessments about anything that might harm them, and that these will be kept up to date. The one problem with this is the staff must make sure that they do the things that are required in order to reduce risks to the people who live here. EVIDENCE: The home writes a risk assessment for each of the service users. A risk assessment tells the staff how to make sure that each of the service users is kept safe from anything that might harm them. The home was told at the last inspection visit that they must have a risk assessment for a service user who might be at risk from having an epileptic seizure when they are out of the house. This has now been done. The staff are now very good at doing this and they make sure that the risk assessments are looked at very regularly to make sure that these are changed if they need to be. There are also risk assessments written about anything in the house or garden that might hurt anyone if it is not taken care of. There is one thing that is of concern, which is that although the risk assessments are very detailed; the staff do not know Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 10 how to properly carry out safety checks of the hot water temperatures in the showers. Please see the comment made under the section “Environment”. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 standard(s) This was not inspected on this occasion. EVIDENCE: Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Service users cannot feel confident that all of the staff will make sure that they are always supported in the way that each of the people who live at the home really needs. EVIDENCE: As the result of the injury to a service user who was said to be properly supported to have a shower, it is of concern that the incident occurred. The Inspector has questioned whether this service user was in fact being supported properly as the home states. The reason for this is that it is difficult to understand how a service user could become so seriously scalded if there was a staff member present physically helping this person in the way that has been suggested. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 13 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 standard(s) 22 & 23 The home has clear information about how people who either live at the home or others can make a complaint. The home should, however, make sure that everyone is given this information and in particular the relatives of the people who live here. Service users can feel confident that the staff team are now better at making sure that no-one does anything to deliberately harm them. Even though a service user has been hurt recently there is nothing to suggest that this was done deliberately. EVIDENCE: The service users are given clear information about how to complain and what happens when they make a complaint. One relative said in their comment card that they do not know how to make a complaint and so the home should send a reminder to all relatives to make sure that they are told how to. One complaint has been made since the previous inspection. This was from a neighbour about a hedge dividing their property from the home. This complaint was resolved satisfactorily. There have been two recent concerns that have been raised about service users suffering harm. These concerns were under investigation at the time of this visit. The Commission will address any findings from the investigation directly with CareTech once these are concluded. The training of the staff team about making sure that all of the service users are protected from abuse (this means that the staff at the home do everything that they can to stop any of the service users from being hurt by someone else) has improved. At the time of the last inspection the home was told that staff have to be trained in the local procedures for protecting vulnerable adults. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 14 Since then three staff, including the manager and deputy, have been on the local training. Two more staff are due to attend the training in November and another in March of next year. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 standard(s) 24 & 30 The service users cannot be assured that the staff team know how to carry out water safety checks for the showers. This has placed service users at serious risk. Other safety checks do appear to be carried out properly and the home is kept clean and is comfortable. EVIDENCE: During this inspection the override to the shower control temperature settings was looked at as this had been said to be the reason that a service user had become injured when using the shower. There is no reason why such a device should be installed when the showers have a mixing valve in place specifically to guard against scalding. Considering that the home was refurbished approximately three years ago it is surprising that the installation of such a device on each of the two showers was allowed to pass. This is even more concerning, as no one knew that pressing the button on the control would result in overriding the temperature setting. The manager of the home was instructed during this visit that neither shower is to be used until such time as a properly calibrated thermostatically controlled mixing device is attached to each and that these must not be able to be overridden. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 16 During this visit the hot water in all of the baths and a selection of wash hand basins were tested. These were all within safe temperature ranges. However, both of the showers were a different matter. The override buttons had apparently been super glued by a plumber since the scalding incident to stop them working. On testing both at what is their normal setting they each showed a temperature of 50 degrees centigrade and slightly higher. The temperature should not exceed 43 degrees centigrade and therefore even in normal operation these showers were showing a dangerously high temperature reading. Examination of the record of hot water temperature checks suggested that the hot water in these showers was never being recorded at higher than 43 degrees. This record is clearly at odds with the evidence of the test of the hot water. The deputy manager was asked exactly how staff were testing the hot water in both of the en suite showers. The reply was that staff are filling a cup with water and then using the temperature probe to test how hot it is. This technique is entirely inappropriate, as it could never provide a truly accurate reading. The manager and deputy manager were then told how this should be done. This matter also resulted in an immediate requirement that staff must be properly instructed in how to carry out hot water temperature safety checks. The home is kept clean and hygienic. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 & 34 Service users can feel confident that there are enough people working each day in order to take care of them. They can also rest assured that the company that owns the home are doing what they can to make sure that the staff team are properly trained. EVIDENCE: The manager of the home is currently doing the NVQ level 4 qualification, the deputy manager is doing the NVQ level3, one care and support worker is doing NVQ level 2 and another has already achieved the NVQ level 2 qualification. The manager said that the remainder of the staff team would start their NVQ qualification course in October of this year when the next course starts. The home has enough staff working each day to make sure that they can properly support the service users. There have been three new staff come to work at the home since the previous inspection. One of the replies on a comment card from relatives said that there never seemed to be enough staff working at the home. The home has a total of 11 staff, including the manager, although three of these staff are part time employees. The staffing of the home is very tightly resourced, however, the manager has said that this will increase once there are more than four people living here. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 18 The home carries out checks to make sure that the people who work here are safe people to work with the service users. These checks include things like asking the police if a new member of staff has ever been found guilty of a crime, and asking people who used to employ them if their work was good and if they are the right sort of person to work with the service users and to support them. At the last inspection the inspector told the manager that she had to have a copy of all of the CRB checks for staff at the home. The Commission now accepts that as the home is run by a larger company that has a central personnel department that these checks can be kept there. The home does, however, receive written confirmation that the checks have been carried out. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 EVIDENCE: The following health and safety checks have been carried out within the last year: Fire Alarm System: 19/04/05 Gas Safety Check: 17/11/04 Legionellosis: Not applicable to this home. Portable appliances: 15/11/04 Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 20 Please refer to the section entitled “Environment” for comment about how the home must improve the checks of the hot water temperatures in the two en suite showers. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 3 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Woodcote Grove Road (100) Score 1 x x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 22 no 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 18 Regulation 12 (1) (a) & (b) Requirement The staff team of the home must ensure that service users are properly supported, as their care plan sets out, at all times when bathing in order to prevent the risk of injury. The home must cease all use of the two en suite showers until such time as they are fitted with thermostatically controlled mixing valves that cannot be overridden The home must ensure that hot water temperature safety checks are accurately taken and recorded Timescale for action With Immediate Effect 2. 24 13 (4) (a) and 23 (2) ( c ) With Immediate Effect 3. 24 & 42 13 (4) ( c ) With Immediate Effect 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 22 Good Practice Recommendations The home should issue a copy of the complaints procedure to the closest relatives of all of the service users. Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Woodcote Grove Road (100) G53 S65438 WoodcoteRoad100 V246200 060905 stage4.doc Version 1.40 Page 24 - 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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