Care Home: 1 Lawrence Road

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What the care home does well Staff knew about the residents` care needs. Residents seemed happy and content. Documentation was in an easy read format. Information with the care plan was current. What has improved since the last inspection? There was more choice about leisure activities because the staffing arrangements were better. The owner of the home (or their representative) visits regularly. A social worker and an advocate had visited the home to see residents. What the care home could do better: We need to know what other people think about the home. Some repair and redecoration needs to be done. The manager needs to find out about holidays for residents. The manager needs to keep better records about residents` personal allowances. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Lawrence Road 1 Lawrence Road Basildon Essex SS13 2NB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Davey     Date: 0 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 1 Lawrence Road 1 Lawrence Road Basildon Essex SS13 2NB 01268590678 01268590678 june.lai-chun@estuary.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Estuary Housing Association Ltd care home 2 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 2 1 Lawrence Road provides residential care for two adults with a learning disability. The fee for the home is 2694.55 pounds per week. Any additional fees that may occur for such items as toiletries, should be discussed directly with the registered provider. The home is a purpose built bungalow situated in a semi-rural area between Southend and Pitsea, on the outskirts of Basildon. Due to the location of the home, transport links to the area are not very good. The home consists of a lounge/dining room area, two bedrooms, a toilet/bathroom for residents, a toilet for staff and visitors, a kitchen, utility room and office. The home has a large garden/patio area to the rear of the property. There is limited parking to the front of the property. The homes Statement of Purpose and Service Users Guide are available from the home on request. At the time of the inspection we were waiting for the current Annual Quality Assessment Audit to be sent to us. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection. The visit started at 9am and we were there for 6 hours. The manager helped us to do the inspection. We sent surveys to the home asking that they be completed and returned to us. Residents, staff, an advocate and a doctor said some good things about the home. We spoke with residents and all staff on duty. We looked at records. We looked around the home. Care Homes for Adults (18-65 years) Page 6 of 27 We did not look at the homes Annual Quality Assurance Assessment as we were waiting for the home to send it. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures were in place to ensure that residents care needs would be fully assessed before admission to make sure that they could be met by the home. Evidence: The home had a Statement of Purpose and a Service Users Guide in place. Aspects of both documents were in an easy read/pictorial style. Both documents had been recently reviewed. It was noted that some information such as the Commissions details needed updating. Residents living in the home had lived there since it opened. No admissions had therefore taken place since the last inspection. The home had an admission policy and procedure in place should it be needed in the future. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plan documentation in place reflected residents current needs. Evidence: Care plans in place were detailed, current and orderly. From the activity we observed during the day and from discussion with staff, the information and detail on the care plan documentation system provided a good pen picture of residents needs. Current residents had very limited skills and abilities. The content and detail within the care planning documentation system was therefore mainly based on the homes staff understanding and perception of residents care needs. There was a good network of support from various health care agencyies in place and we could see reference to their input within the documentation. There was a resident response log in place. This had enabled staff to record individual residents responses or reactions to various activities and tasks. These responses or reactions are a tool to help staff try to understand what is pleasing or not pleasing to individual residents. Staff told us that Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: the system also helps residents to express their preferences and wishes. Many aspects of the care plan system was in pictorial form which had the potential to help residents communication skills. The risk assessment documentation we saw was detailed and current. Residents were unable to comment or provide a view on their care. The information within their completed surveys had been completed by staff. No areas of concern were noted by us within their surveys. We spent considerable time during the day in the company of residents. Their demeanor was content, comfortable and happy. Our experiences in the company of residents was in keeping with their respective documented care needs. We communicated with both residents in the best way possible and it was positive and encouraging that one resident in particular was able to verbally communicate with us in a very limited way. The environment for residents was relaxed and pleasant. During our observations, we noted that staff on duty had the ability to understand and respond to residents needs, wishes and preferences. Residents related well to staff. We spoke with all staff that were on duty to cover the morning and afternoon/evening shifts. Two members of staff on duty were either currently undertaking a night shift or had done so in the past. All staff were able to competently discuss with us the care needs of residents over a 24 hour period. Within their surveys, staff recorded that they had sufficient information about the needs of residents and described the established ways of ensuring that residents are provided with choice. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience a varied lifestyle according to ability and enjoy a good diet. Evidence: Following the last inspection there had been progress in improving the corporate and individual leisure and activity programme for residents. Residents living in the home had very different leisure and activity needs and because of staffing arrangements, residents had limited choice about what they did and where they went. Improved staffing arrangements now mean that residents can enjoy a more personal and individually tailored activity programme. The manager told us that there are still issues to resolve, for example the current mini bus needs to be changed for an automatic gearbox model so that more staff can drive it and they are exploring new community activities for one of the residents. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: During the morning of the inspection, both residents were occupied with meaningful activity. In the afternoon, one resident went out with a member of staff whilst the other resident spent time with staff in the home. From documentation we saw that residents are enabled and supported to experience, participate in and enjoy individually tailored activities and social events both within the home and within the wider community. The manager was unable to clarify the agreed arrangements about residents holidays. Funding for this had been provided within the basic fees.The manager agreed to contact their head office and the funding authority to clarify the situation. We could see that residents had enjoyed days out, but the manager was unsure about the whole issue. There was a basic four weekly menu cycle in place. Residents had been able to make individual choices about the food they wished to have by using the homes pictorial style in house menu. A record of what each resident had eaten on a daily basis was available. We noted that there were some gaps in the records. Records demonstrated that residents experience eating out and takeaways. There were additional pictorial menus to assist residents on these occasions. We spent time with one resident as they enjoyed their breakfast. The food looked appertising and the resident had been given the opportunity to make choices. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good health and personal care support Evidence: Residents personal and healthcare needs had been assessed and the details had been clearly recorded. The GP in their survey reported a good working relationship with the home. We could see that the information about residents ongoing care needs within the recording system had been reviewed on a regular basis and had been updated as appropriate. There were systems in place encouraging and enabling residents to make independent choices as far as practicable about what they wear, daily routines and choice of food. Throughout the day, we observed staff encouraging and supporting residents making personal choices. Residents had complex personal and health care needs. The manager said that the residents have been supported well by the various community healthcare agencies. There were records in place to demonstrate this activity. We sampled various aspects of the medicines storage, recording and administration Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: system. No concerns or anomalies were noted by us. The manager told us that the home is due to change the pharmacist that supplies medicines to the home in the near future. We were told that this change would be beneficial to the home and would provide a better, more flexible service. We could see that staff who undertake medicine administration duties had received training. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would experience some degree of difficulty in raising a concern independently but are protected by the homes safeguarding procedures. Evidence: The manager told us that there had been no complaints since the last inspection. There was a recording system in place should it be needed. There was a text and a pictorial complaints procedure on display. It was agreed that the current residents would not have the ability to raise a concern or complaint independently. The home had contact with a local advocacy service, but they only visit upon request from the home. This arrangement does not provide residents with regular direct access to an independent person. The advocate confirmed this within the completed survey. The manager told us that a social worker had recently visited the home to see residents and work is under way to ensure that these visits take place on a regular basis. Residents have no family connections and the current arrangements leave residents in a potentially vulnerable position. We spoke to the manager about the situation and they agreed that the arrangements are not suitable or entirely appropriate, but they stressed that everything had been done to improve matters. It is important that the manager strives to improve the situation. The manager told us that they were aware of the current risk factors given the circumstances they found themselves in and would contact the funding authorities to advise them again on the situation. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Staff on duty explained to us how the residents express their personal choices and preferences on day to day issues and also how they would be able to express a displeasure about something. Staff we spoke with were clear that issues are picked up through direct observations, any change in a behavioural pattern or through one of the homes established non communication processes. There were records in place to support what staff had told us. Records were in place to demonstrate that all staff had undertaken safeguarding vulnerable adults from harm training. We asked all staff on duty about their understanding of the term and what they would do should an incident be detected. All made reference to the reporting procedures which they said were in the office. We also talked to staff about whistle blowing procedures. All understood the term and they told us that they had confidence in the processes in place. We discussed with the manager a matter that had been referred to the Essex County Councils safeguarding team. The manager said that the home had not been contacted by Essex County Council. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is comfortable and clean and where some areas need redecoration and maintenance. Evidence: At the last inspection we recorded that a major refurbishment was underway. The building work had been finished by this inspection, but there was still a significant amount of repair and redecoration to be undertaken. For example, in the previous report we suggested that the sharp corners on the wooden lounge surrounds (work areas) be rounded off. This had not been completed. One of the residents bedrooms still requires redecoration. The door on the staff toilet did not have a lock. The bath panel and the tiling around the bath in the residents bathroom was in poor condition. The flush on the residents toilet had not worked for five days. The manager told us that this had been reported and was being actioned. Staff told us that they are having to pour water into the toilet basin every time it was used. We were told that this was a repeated problem. Residents were encouraged to be as independent as possible but the situation did not support this.We also noted that one of the fire doors did not fit properly. This was being addressed. The manager told us that they understood there was an element of risk should a fire break out. Comments noted within two staff surveys were interesting as they reported maintenance people do not respond quick Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: enough to the needs of the home and to be quicker on the maintenance side of the upkeep of the home. The surveys pre-dated the inspection by five months. The manager informed us that in the next year a new driveway providing a further parking space was planned and the rear patio area will be relaid with a soft surface area. The kitchen, utility and office areas were clean, tidy and functional. The lounge and dining areas were comfortable and homely. The manager was in the process of ordering some new seating, furniture and television for the lounge. Residents bedrooms were homely, practicable and reflected individual taste. The rear garden area was well kept and pleasant for residents to use. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by a team of trained staff that is reliant on agency input to maintain minimum staffing levels. Evidence: The staff rota for the day was accurate and reflected the staff on duty. A minimum of two staff were on duty during the day and one awake member of staff during the night. There are no staff no sleeping in facilities within the home. For at least two or three days a week, the manager is supernumerary to these numbers and there are three staff on duty during the day. This means that the manager has time to deal with administration duties and it also provides opportunity for one resident to go out with two members of staff, whilst the manager supports the other resident at home. The input from agency staff to maintain minimum staffing levels had improved significantly. Only the occasional shift now consist of solely agency staff. The agency staff used are regulars which provides continuity of care for the residents. The manager told us that there was a recruitment drive in place which they hoped would reduce the number of agency staff used even further. One member of staff had been recruited to the home since the last inspection. The Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: recruitment records were in good order. We spoke with this member of staff who told us that the recruitment process had been positive and they were satisfied with their comprehensive induction programme. Staff told us that they had regular supervision sessions and team meetings. We saw documentation to support this. Staff also told us that there had been good training opportunities provided. We saw documentation to support this too. We spoke with all five members of staff who were on duty at various times of the day. They impressed us as being positive and committed to their work. There was a good understanding of their respective roles and responsibilities. There was a good team spirit evident. Within their surveys staff recorded good training opportunities. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home where the day to day management is stable and effective. Evidence: The manager has been in post since May 2007 and their application to become the registered manager of the home is pending. Their completed application should be with us for processing by the end of June 2009. Since being in post, the manager had reviewed and consolidated many of the homes practices and procedures. Management monitoring tools are well established to ensure that practice, documentation and administration matters are regularly reviewed to ensure compliance with the homes policies and procedures. The four members of staff we spoke with were very positive about the homes management style. They told us the style was open, supportive, approachable and makes things happen for the benefit of residents. A random selection of safety and maintenance records were sampled and noted to be in good order. Current safe working and environmental risk assessments were in place. We saw an in house maintenance and repair book in place. Within the office Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the homes policies and procedures were accessible to staff. There were guidance and information notices in accessible places. Staff told us that information and guidance was always available to them. Essex County Fire and Rescue Service undertook an inspection in November 2008 and noted some shortfalls. The manager reported that these had all now been addressed. The homes Fire Risk Assessment had been reviewed by the manager in March 2009. We saw records to support that staff regularly check to ensure that the fire alarm system is working effectively. There were records to show that fire drill take place regularly. The manager told us that a new emergency lighting system had recently been installed and its effectiveness would be monitored periodically. The manager was arranging for an updated portable electric appliance test to be undertaken. The homes hazardous substances risk assessment register had been reviewed by the manager in February 2009. The home safeguards residents personal allowances. Within the records we noted three entries which we asked the manager to clarify as they seemed to be anomalies. The record format itself was in good order and receipts were available. The manager reported that the homes head office audits the records yearly. A representative for the registered provider visits the home on a monthly basis and prepares a report. In addition, the manager prepares a monthly Compliance Report. These regular monitoring and reviewing tasks ensures that the home is managed well. It also provides the opportunity to address any shortfalls promptly. The manager showed us the homes Quality and Development, Service Quality Monitoring report dated February 2009. We noted that the document did not make reference to any stakeholders views and opinions that had been requested and considered as part of the report. We spoke to one of the homes service managers about this. The service manager seemed unaware of what needed to be done and we requested that the matter be addressed. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 12 24 39 43 The funding and provision of suitable and appropriate holiday provision for residents should be clarified. All areas of the home should be kept in good repair The views and opinions of all stakeholders should be sought and reflected within the Annual Quality Development Plan The detail of all expenditure made on behalf of a resident should be clearly recorded Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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