Care Home: 225, London Road

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What the care home does well Gives residents an individual service that meets their needs. Provides a stable staff team that delivers care and support consistently. Works well with other professionals in delivering care. Promotes residents involvement in their local community. Encourages residents and staff to have their say about how the home is run. What has improved since the last inspection? The home has adopted a more person centred approach to care planning and support. Some residents have been supported to register for new activities, such as college. The home has renewed an arrangement with a pharmacist to carry out regular medication checks. The ground floor bathroom has been redecorated. What the care home could do better: Ensure that accurate records are kept of residents` medication when they are away from the home. Ensure that important information is correctly filed and up to date. Refurbish the first floor bathroom. CARE HOME ADULTS 18-65 225, London Road Twickenham Middlesex TW1 1ES Lead Inspector Simon Smith Key Unannounced Inspection 9th September 2008 10:15 225, London Road DS0000017380.V372062.R02.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 225, London Road DS0000017380.V372062.R02.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. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 225, London Road Address Twickenham Middlesex TW1 1ES 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) 020 8892 6406 020 8892 6406 londonroad@regard.co.uk The Regard Partnership Ltd Mr John Webster Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 14th June 2007 Date of last inspection Brief Description of the Service: 225 London Road is home to six young adults who have a learning disability. The service is managed by the Regard Partnership, an established provider of residential care and specialist support to people with learning disabilities. The Statement of Purpose describes the home as a specialist service for young adults with learning disabilities, some complex needs and challenging behaviours. The home’s fees currently range from £1649.25 to £1975.43 per week. The home is situated within walking distance of Twickenham town centre, which provides a wide range of community facilities and good access to public transport networks. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We used evidence from several sources to make this judgement about the home. The inspector visited the home unannounced and spoke to the manager, residents and staff. We also looked at some written records, including residents’ care plans. We checked records of everything the home had reported to us since the last inspection. The manager completed and returned an Annual Quality Assurance Assessment (AQAA). The home met 28 of 30 National Minimum Standards assessed at this inspection. Two standards were almost met. What the service does well: What has improved since the last inspection? The home has adopted a more person centred approach to care planning and support. Some residents have been supported to register for new activities, such as college. The home has renewed an arrangement with a pharmacist to carry out regular medication checks. The ground floor bathroom has been redecorated. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 225, London Road DS0000017380.V372062.R02.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 225, London Road DS0000017380.V372062.R02.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): Standards 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. Residents’ needs are assessed before they move into the home. Each resident has a written contract with the home. EVIDENCE: There was evidence that residents are given a service user guide, which contains a contract that sets out the terms and conditions of residency. These had been signed by the resident where possible. The Annual Quality Assurance Assessment (AQAA) told us that the service user guide has now been made available in a pictorial format. Prospective residents’ needs are assessed before they begin using the service. There was evidence that assessments are reviewed periodically. The residents’ files checked during the inspection contained needs assessments carried out by the manager in March 2008. One resident had moved into the home since the last inspection. The manager said this resident has a relatively full timetable but that the home is in 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 9 discussion with his placing authority to fund more structured activities such as college and music therapy. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 10 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): Standards 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive care and support in the way that they prefer. Some files should be reorganised to ensure that staff work with up to date information. The home supports residents in taking manageable risks. EVIDENCE: There was evidence that the home has a philosophy of person centred care. Residents’ ‘Personal Plans’ identify and record their preferences about how they want their care to be provided. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 11 Personal Plans also contained support plans in a number of areas. These were current and had evidence of review. However some residents’ files were disorganised, which made it difficult to find up to date information. There is a commitment to enabling residents to make decisions about their lives. Residents’ are able to choose the way in which they spend their time at the home and have individual programmes that reflect their interests and preferences. The home carries out risk assessments to enable residents to take risks as part of an independent lifestyle. Residents’ files contained risk assessments in areas that were relevant to them, such as travelling in the community or undertaking specific activities. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ have individual programmes that reflect their needs and interests. Residents have active social lives and are involved in their local community. Residents receive good support to maintain relationships with their friends and families. Residents’ rights and responsibilities are promoted in their daily lives. The home’s menu is varied and designed to meet residents’ needs. EVIDENCE: 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 13 Residents’ timetables demonstrate that they have good opportunities to participate in activities that reflect their needs and interests. One resident attends college four days a week. Two residents have had interviews with a local college and are on a waiting list for courses in computing and music. The manager said that the home will provide staff support to enable these residents to attend college should a place become available. One resident’s placing authority recently stopped funding his placement at a resource centre. The manager said that this has affected the resident negatively and the home plans to meet his care manager to discuss future funding for the day service. The manager said that the resident had also had support from an advocate to help him voice his opinion about this. A volunteer visits the home weekly to provide Intensive Interaction sessions. Staff from the home have attended Intensive Interaction training run by a speech and language therapist. One resident has aromatherapy and music therapy every week. Some residents go companion cycling and swimming weekly. Four residents went swimming on the day of inspection. Residents are involved in their local community, making use of shops, pubs, restaurants and other resources. One resident said that he enjoys eating out and helping with the house shopping. Most residents have regular contact with families and some stay with their families regularly at weekends. The manager said that some residents had plans for holidays they would like to take but that these had yet to be booked. The home should make sure that all residents who want to take a holiday this year have the opportunity to do so. Residents’ rights and responsibilities are promoted in their daily lives. Interaction between staff and residents was positive during the inspection and staff addressed residents with respect. Residents are able to choose how they spend their time at the home and to have privacy when they want it. The menu indicated that the home provides a varied and well-balanced diet. Staff said that they aim to support residents in making informed choices about their diet and to promote healthy eating. There was evidence that the home had sought the input of professionals including an speech and language therapist where residents have specific needs around eating. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 14 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): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to appropriate health care and treatment when they need it. The home works well with other professionals in delivering care. Medication is stored and administered safely but records of medication when residents stay away from the home need to be improved. EVIDENCE: There was evidence that the home liaises with community healthcare professionals about residents’ care where necessary including the community nurse, psychologist, psychiatrist and speech and language therapist. There was also evidence that residents with ongoing conditions such as epilepsy have access to specialist care and regular monitoring. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 15 Medication is stored securely in the home and there is a written medication policy. Staff attend training in this area before being authorised to administer medication. Since the last inspection the home has reinstated an agreement with the local pharmacist for two medication checks each year. The medication records checked contained no errors for administration within the home but records of medication when residents stay away from the home need to be improved to ensure a thorough audit trail is available. See Requirement 1. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 16 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): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place for the management of complaints. Staff attend training in the recognition, prevention and reporting of abuse. EVIDENCE: The Regard Partnership has an appropriate complaints policy, which is available at the home. There is also a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’ and the local authority ‘protecting vulnerable adults’ procedures are kept at the home. Training records demonstrated that staff attended Protection of Vulnerable Adults training in September 2007. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 17 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): Standards 24, 25, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, safe and well maintained. Residents’ bedrooms reflect their interests and preferences. The home is clean and hygienic. EVIDENCE: The home is situated on a busy road within walking distance of Twickenham town centre. The communal rooms include a lounge, separate dining area and kitchen on the ground floor. There is a good sized rear garden. All parts of the home were clean and tidy at the time of inspection. Residents’ bedrooms are personalised and reflect their needs and interests. There are toilet and bathroom facilities on both floors of the home. The ground 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 18 floor bathroom has been redecorated since the last inspection. The first floor bathroom should be refurbished as there is some mould on the ceiling and the flooring is marked. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 19 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): Standards 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a stable staff team. Residents are protected by the home’s recruitment procedures. Staff have access to appropriate training and good support to do their jobs. EVIDENCE: Most staff have worked at the home for some time and some have returned to work there following periods elsewhere. As a result residents benefit from a consistency of care and approach. Three new staff have joined the home in the last year. They have had the benefit of joining a settled team and have access to good support as the home employs a manager, deputy manager and three senior support workers. The manager provided evidence that the Regard Partnership makes appropriate checks on new staff before they start work. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 20 Training records demonstrated that staff have training in core areas including medication administration, first aid, food hygiene, health and safety, moving and handling and fire safety. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 21 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): Standards 37, 38, 39, 41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides good leadership and enables residents and staff to contribute their opinions. Staff are committed to running the home in residents’ best interests. The storage and organisation of records must improve. The health and safety of residents and staff is maintained. EVIDENCE: 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 22 The manager has worked at the home for some time, having transferred from another Regard Partnership service, and has applied for registration with the CSCI. The manager has established a relaxed but professional atmosphere in the home and has promoted a consistent approach by staff in their work with residents. Residents and staff are encouraged to have their say about how the home is run. The Annual Quality Assurance Assessment (AQAA) told us that the home distributes questionaires to residents and visitors. The AQAA also said that residents meetings are held weekly, supported by staff. The Regard Partnership carries out monthly quality audits of the home at which residents have the opportunity to give their views. As highlighted earlier in this report, some of the information held on file in the office is disorganised, which made it difficult to find up to date records. It is important that information is correctly filed and up to date, principally to ensure that staff work with accurate information about residents but also because records should be available for the effective management of the home and for inspection purposes. See Requirement 2. There was evidence that staff carry out weekly health and safety checks around the home. Staff also complete visual checks of fire fighting equipment every week. The fire alarm system and emergency lighting were serviced by an engineer in August 2008. The manager has drawn up a fire risk assessment for the home. The Electrical Installation Certificate was issued in June 2008 and the Landlord’s Gas Safety Record in March 2008. Portable electrical appliances were checked in March 2008. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 23 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 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 2 3 X 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Timescale for action The Registered Person must 30/09/08 ensure that accurate records are kept of residents’ medication when they are away from the home. The Registered Person must 30/09/08 ensure that important information is correctly filed and up to date. Requirement 2 YA41 17 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 2 3 Refer to Standard YA2 YA14 YA27 Good Practice Recommendations Continue negotiations with one resident’s placing authority to fund more structured activities. Make sure that all residents who want to take a holiday this year have the opportunity to do so. Refurbish the first floor bathroom. 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 225, London Road DS0000017380.V372062.R02.S.doc Version 5.2 Page 26 - 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. 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