Care Home: 46 London Road

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What the care home does well The home has a good approach to enabling people who use the service to live as independent a life as possible, through goal setting, consultation at regular meetings and appropriate risk assessments. In line with this people are supported to engage in a range of activities including education both inside and outside of the home and to maintain links with family and friends. The home has been pro-active in preparing information about people who use the service in a suitable format for use if they should go missing. People are protected through robust staff recruitment, training in preventing abuse and in safe working practices. What has improved since the last inspection? The dietary intake of all people who use the service is now recorded. There has been an improvement to medication storage in terms of the monitoring of storage temperatures. A security risk assessment has been completed for the premises and there are now regular recorded checks on window restrictors. What the care home could do better: There should be more accurate recording of medication administration in terms of always recording when medication has been given or omitted for any reason. More staff should be trained to NVQ level 2. Renewal of furnishings in communal areas and the consideration of a provision of some form of shelter for those who smoke would improve the environment of the home for people using the service. CARE HOME ADULTS 18-65 46 London Road 46 London Road Gloucester Glos GL1 3NZ Lead Inspector Mr Adam Parker Key Unannounced Inspection 27 & 31st March 2008 09:35 th 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 46 London Road Address 46 London Road Gloucester Glos GL1 3NZ 01452 380835 01452 380835 londonroadhome@tiscali.co.uk www.milburycare.com Milbury Care Services Ltd 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) Mrs Hayley Ruth Clutterbuck Care Home 10 Category(ies) of Physical disability (10) registration, with number of places 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th December 2006 Brief Description of the Service: 46 London Road is a purpose-built care home run by Milbury Care Services. The building is leased from The Bromford Housing Association who owns it. It provides care and accommodation for people with acquired brain injuries. The home is located close to Gloucester city centre. 10 residents are accommodated in single rooms on the ground and first floor. All of the bedrooms have en-suite facilities and a kitchenette. Stairs or lift can access the first floor. The home is designed to be fully accessible to wheelchair users. The home provides a large lounge and dining area and an adjacent communal kitchen. On the first floor there is a large craft and activities room. Outside there is a patio and lawns with extensive usable space. The home makes information about the service, including CSCI reports available to people through a service user guide and statement of purpose available in the home. Up to date information about fee levels was not obtained during this visit. 46 London Road DS0000016343.V360875.R01.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 two stars. This means that the people who use this service experience good quality outcomes. The home was visited twice, on a Thursday and a Monday in March 2008. We did not tell the home that there would be a visit. Before the visits took place the manager completed an Annual Quality Assurance Assessment (AQAA) providing information about the service. Survey forms were received from five people who use the service. During the visits various records were looked at including examples of care plans, healthcare notes, risk assessments, daily records, medication charts, training information and staff files. Discussion took place with the registered manager and the deputy as well as one person living at the home. What the service does well: What has improved since the last inspection? The dietary intake of all people who use the service is now recorded. There has been an improvement to medication storage in terms of the monitoring of storage temperatures. A security risk assessment has been completed for the premises and there are now regular recorded checks on window restrictors. 46 London Road DS0000016343.V360875.R01.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. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people who may use the service receive a full assessment of needs before they are considered for admission to the home. EVIDENCE: There had been no admissions to the home since the previous inspection. However one resident had been admitted to hospital following an accident and the registered manager described how an Assement process would be undertaken prior to the person being admitted back to the home. The service now has a senior care planner to deal with admissions. Despite the lack of admissions, the Commission believes that there are sufficient systems in place to ensure a comprehensive assessment of needs for any person who may be considered for admission to the home. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person-centred approach to care planning with comprehensive risk assessment, gives staff clear information on how people can be supported to lead as independent a life as possible. EVIDENCE: A number of files were looked at relating to the care and support of people who use the service. The files contained very detailed and specific information about people’s routines at different times of the day to inform staff. People have a number of documented goals and these are reviewed and recorded on a monthly basis on a monthly summary sheet. Summaries were written by the key worker in a person centred way as though the person themselves was speaking. Each goal was negotiated with the person and was subject to ‘goal attainment scaling’ to ensure that it was achievable. Some people had ‘communication passports’ that gave staff information about how to interpret certain forms of communication from the person and how they should respond in terms of meeting needs. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 10 Information relating to advocacy services was not on display on the first day of the inspection visit although by the second day this had been found and replaced on the notice board in the entrance. Risk assessments were completed for a number of issues such as use of the stairs, craft activities and seizures or fits. Risk assessments had been subject to review and were of a nature that supported people to have as independent a life as possible. The home had prepared a file containing people’s details and photographs this was ready for use if a person went missing, which was good practice. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in appropriate activities outside of the home, have some links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. EVIDENCE: People have been supported to pursue education at local colleges and at a day centre for people with acquired brain injury. People are encouraged to make use of facilities in the local community such as visiting Gloucester for shopping and going to a local bowling alley. Two people regularly took part in horse riding and others have mad use of a sensory room at a day centre in Cheltenham and have been swimming. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 12 The home has two vehicles to transport people including a specially adapted minibus. In addition use has been made of public transport with a recent trip to Cardiff on the train. Care plans showed that people were being supported to maintain relationships with family and friends with the use of a ‘contact log’ to record this information. A record is made of important people in the person’s life and of those that they do or do not want to be involved in their life. People’s daily routines are recorded in detailed plans specific for different times of day such as routines for getting up in the morning and their routine in the evening. Staff would knock on doors or ask permission before entering a person’s room and a number of people have their own keys. A number of housekeeping tasks are carried out by people using the service and are set out in their personal goals, these included spring cleaning their rooms, laying tables and drying up after meals. Rules on smoking, alcohol and drugs are clearly laid down. The main meal in the home is offered in the evening with the menu chosen on a weekly basis at a meeting on a Sunday evening. On a rotational basis one person receives one-to-one input from staff to prepare their meal using facilities in their flat. The home provides for two people who follow a vegetarian diet and their files contained specific information about their dietary preferences in line with daily routines. A record had been kept of the dietary intake of any person who was having alternative meals to those on the menu. One person spoken to commented positively about the meals on offer. Food likes and dislikes are recorded for each person on the document ’All about Me’ 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 21 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have their health and personal care needs met although some further improvements should be made around medication administration in the interests of people who use the service. EVIDENCE: Personal care and support needs for people are recorded in very specific plans that take into account individual preferences as well as needs. One person’s file addressed gender issues of staff giving support. There was evidence of people’s health care needs being met by liaison with health care professionals. One person’s file showed that they had been attending appointments with their General Practitioner and with a speech and language therapist. There was also input recorded in one person’s file of appointments with a Neurologist following a seizure. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 14 The arrangements for medication storage, administration and recording were checked. Medication was stored securely in two locations in the home; in the one location storage temperatures had been recorded and were being kept at correct levels. Temperature monitoring had not been carried out in the second medication storage sight in the home although this was quickly implemented when pointed out to the registered manager. There were no people in the home that were self-medicating or storing medication in their rooms. It was noted that only one out of three bottles of liquid medication had been dated on opening despite a recommendation made at the previous inspection. This should be carried out for all such medication as an indication of the expiry date. Examination of the Medication Administration Record (MAR) charts showed that although the recording of administration was generally taking place there some examples of where this had not been recorded and gaps were left on the chart. These were pointed out to the registered manager during the inspection visit. Handwritten entries in medication administration sheets had been signed by the staff member making the entry and checked and signed by a second staff member, these entries should also be dated. Staff who administer medication have completed training in conjunction with the supplying pharmacist and are shadowed by another member of staff and then assessed before giving out medication alone. The home has a list of homely remedies agreed by general practitioners displayed on the medication storage cupboard. The home has reported a number of medication errors by staff to the Commission in the past and the registered manager indicated that the monitoring of this is given a high priority in the home. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in places that enable complaints and concerns to be raised by people using the service or on their behalf. Training is given to staff to safeguard people from possible harm or abuse. EVIDENCE: The home has a record of complaints received, in 2007 comments from the relatives of a person using the service were treated as a complaint although it was reported that it had not been their intention to make a formal complaint. However the use of the complaints procedure to deal with the issues raised (which were generally about the environment of the home) demonstrated that they were taken seriously. No further complaints had been received since 2003. The service users guide contains clear information about the home’s complaints procedure this is made available to every person who uses the service by being placed in their flats. Five survey forms were received from people who use the service and all indicated that they knew who to speak to if they were unhappy. Three of these also indicated that they knew how to make a complaint. Meetings are held for people who use the service which enable them to raise any issues. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 16 Staff in the home have all received training in protecting people from abuse with an update provided by an external trainer every two years. All staff had attended non-violent crisis intervention training that gives staff the knowledge and skills to deal with any aggression. This training is updated annually. It was noted that an ‘alerter’s guide’ from the local adult protection unit which was on display in the home at the previous inspection was missing. 46 London Road DS0000016343.V360875.R01.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): 24,26 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although generally well maintained and clean, people using the service would benefit from some improvements to certain aspects of communal areas of the home. EVIDENCE: The home has been purpose built and service users can access all areas, with doors wide enough to allow access by wheelchair users. A tour of the premises showed that the home had been well maintained although furnishings in the communal lounge particularly seating and dining tables were showing some wear and tear and were reported by the registered manager as being over eight years old. The home is close to local amenities in the City of Gloucester (including the railway station) and surrounding areas. The home has a large communal area 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 18 on the ground floor and gardens to the side and rear of the home that are accessible to all people who use the service. At the previous inspection it was reported that consideration was being given to providing a covered area in the garden for people who smoke. This issue had also been raised by a relative of a person who uses the service during the annual service review. There had apparently been no progress on this issue and it is recommended that it should be given further consideration. Service users rooms (known as flatlets) are all single occupancy and have ensuite toilet and shower facilities as well as a small kitchen area fitted with a microwave, electric hob and sink unit where meals can be prepared. One person spoken to was happy with their room that contained many personal items and had been decorated according to their taste. Rooms were also personalised with their own furniture. All flatlets on the ground floor have patio doors giving access to the garden, in addition they have lockable doors and a number of people who use the service have their own keys. The premises were clean and free from offensive odours. The laundry which is used by people who use the service and by night staff was in good order with hand-washing facilities provided and readily cleanable wall and floor surfaces. 46 London Road DS0000016343.V360875.R01.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): 32,34 & 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures are generally robust ensuring that people using the service are safeguarded. However an increase in the number of staff with an NVQ would ensure that people are supported by a qualified staff team. EVIDENCE: Staff in the home have undertaken training relevant to the needs of service users such as training in dealing with behavioural problems and ‘brain tree’ training relating to head injuries. Staff have also received training in ‘goal attainment scaling’. However the level of care staff trained to an NVQ level 2 is still under 50 , despite a recommendation at the previous inspection. The AQAA document completed by the registered manager showed that only a third of care staff has an NVQ at level 2 although six staff were currently undertaking an NVQ. A number of staff recruitment files were examined these showed robust recruitment checks had been made with all the required information and 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 20 documentation obtained to protect people who use the service. Staff applying for jobs in the home had criminal records checks and had provided two references. At the previous inspection it was noted that people who use the service were involved in the staff selection process through being part of interviews. Staff are given a general induction when they start work in the home as well as a specific induction relating to acquired brain injury. In a recent development staff induction training is now provided via a lap top training package available within the home. There was evidence that the induction training of staff links with the nationally recognised Common Induction Standards. Staff have individual staff training plans and records. 46 London Road DS0000016343.V360875.R01.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): 37,39 & 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed with a variety of quality assurance audits in operation and safety checks to ensure that the home is run in the best interests of people who use the service. EVIDENCE: The registered manager has had previous experience working in other care homes and experience in working in 46 London Road starting as a support worker, then a senior support worker and as manager since April 2005. She has completed the registered managers award at NVQ level 4. In addition she has recently undertaken training in health and safety and NVQ 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 22 assessment. The registered manager also has management responsibility for a new local service development that is not a registered care home. Quality assurance checks were in operation including a monthly audit carried out during a visit to the home by the operations manager and reported to the Commission and an annual service review. Copies of reports of these visits showed that people using the service and staff had been interviewed. Part of the annual review involves questionnaires sent to the relatives of people who use the service. A development plan is produced as a result of the review. In addition a monthly audit specific to each person in the service is carried out. The Annual Quality Assurance document submitted by the home for the inspection was brief in content although completed in full. Staff in the home have received training in relevant safe working practices including the areas of health and safety, manual handling, first aid and food hygiene. Heating and electrical systems and appliances had been serviced and maintained. Work had recently been carried out in the home by a specialist consultant regarding reducing any risks associated with Legionella. Regular checks had been made and recorded on the temperatures from hot water outlets in the interests of people’s safety and comfort as well as on bath water temperatures. Attention had been given to the hot water system when it was found that some temperatures were too low. The home has carried out weekly fire alarm tests and the system has been serviced by an outside contractor. A risk assessment has now been completed relating to the security of the premises. Restrictors were fitted to the windows of the home, and regular recorded checks were now being made. Cleaning materials had been stored in secure cupboards with no decanting into smaller containers. 46 London Road DS0000016343.V360875.R01.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 X 2 3 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 2 25 X 26 4 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X 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 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action No requirements. 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 4 5 6 Refer to Standard YA20 YA20 YA20 YA24 YA24 YA32 Good Practice Recommendations All handwritten entries in medication administration records should be dated by the staff member making the entry. Liquid medication should be dated on opening as an indication of the expiry date. Medication administration charts should accurately record medication given or omitted. Furnishings in the communal lounge and dining area should be considered for replacement. Consideration should be given to providing a shelter in the garden for people who smoke. There should be a minimum level of 50 of the care staff trained to an NVQ level 2. 46 London Road DS0000016343.V360875.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 46 London Road DS0000016343.V360875.R01.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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