Care Home: Bushey Hall Road (31)

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What the care home does well Talking about one person living in the home for which they are responsible, one local authority care manager noted; "They have made significant progress this year". A parent said of another person living in the home that they had "noticed a big improvement in their general outlook.... All credit to the staff" Care outcomes are good and records of reviews held for people living in the home show a consistent pattern of improvement and development. The staff team has recovered from the disruption of early changes in the management of the home and is well supported by the current manager and the registered provider with appropriate training and supervision taking place. The standard of care planning is very good with a clear focus on each person as an individual with particular assessed needs and goals to be met and achieved. What has improved since the last inspection? The standard of medication records seen on this occasion was satisfactory, which represents an improvement since the last inspection when a requirement had to be made. This gives people living in the home greater security and confidence in the way their medication is administered. The programme of training and personal development available to staff now explicitly includes units dealing with the home`s principal service user group, provided at an appropriate level for the staff team. This means that people living in the home are receiving care from a staff team with a good understanding of their needs and how they can be met appropriately. The new manager has taken the service forward significantly since the previous inspection and has helped build a well-motivated and supported staff team. What the care home could do better: There are no requirements made following this inspection and the major task facing the home, its management and staff is to maintain the current good standard of care outcomes achieved for people living in the home. It is important that the current emphasis on providing good quality, relevant staff training, including some sourced from local training providers is maintained and developed. Wherever possible all documentation of interest to or relevant for people living in the home should be provided for them in an accessible format. CARE HOME ADULTS 18-65 Bushey Hall Road (31) Bushey Herts WD23 2EE Lead Inspector Jeffrey Orange Unannounced Inspection 15th November 2007 08:30 Bushey Hall Road (31) DS0000068401.V354606.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 Bushey Hall Road (31) DS0000068401.V354606.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. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bushey Hall Road (31) Address Bushey Herts WD23 2EE 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) 01923 219280 www.caremanagementgroup.com Care Management Group Ltd Mrs Pauline Wairimu Njoroge Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 3rd January 2007 Brief Description of the Service: 31 Bushey Hall Road is one of a pair of semi-detached houses that have been converted and adapted for use as residential care homes. Both homes are owned and operated by Care Management Group Limited, they are each registered to provide care and accommodation for up to five adults between the ages of 18 and 65 who have a learning disability. The homes are situated in a residential area of Bushey, within easy reach of Watford town centre with its facilities and services and with good local public transport links. There is limited parking available at the front of these homes, on street parking may be available in adjacent roads, subject to local parking conditions. Each house has three floors, with one bedroom on the ground floor together with an office, communal toilet, laundry, kitchen, lounge and dining room; The other bedrooms are located on the first and second floors. All bedrooms are ensuite. The home has a Statement of Purpose and Service User’s Guide that give contact details for the Commission for Social Care Inspection. Copies of the most recent inspection report are available in the home including one in an ‘easy read’ pictorial format. Current (November 2007) fee levels for the home are approximately £1936 per week for care and accommodation (subject to individual assessment of need). Additional charges apply for personal toiletries, newspapers and hairdressing, and also for chiropody, dentistry and opticians’ services where these are not available free under the NHS. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in the early morning and provided an opportunity to meet people living in the home as they were preparing to leave for a variety of activities in the community and to observe their interaction with the staff team on duty. Discussions were held with the registered manager and members of the staff team, key records were examined, including those for care planning, the administration of medication and staff recruitment. During the inspection process contact was also made with health and social care professionals involved with people living at 31 Bushey Hall Road. This is the first inspection for this service since it reached full occupancy following its commissioning and since the appointment of individual managers for the two adjacent services at 29 and 31 Bushey Hall Road. The home is currently completing its annual quality assurance assessment (AQAA), which is a self-assessment tool that focuses on how well care outcomes are being achieved for people living in 31 Bushey Hall Road. The information that the AQAA provides, and the information gathered during this inspection visit, including those surveys already received from people living in the home or responsible for them and those that may be received later, will be assessed on a continual basis with appropriate regulatory activity being taken as required. What the service does well: Talking about one person living in the home for which they are responsible, one local authority care manager noted; “They have made significant progress this year”. A parent said of another person living in the home that they had “noticed a big improvement in their general outlook…. All credit to the staff” Care outcomes are good and records of reviews held for people living in the home show a consistent pattern of improvement and development. The staff team has recovered from the disruption of early changes in the management of the home and is well supported by the current manager and the registered provider with appropriate training and supervision taking place. The standard of care planning is very good with a clear focus on each person as an individual with particular assessed needs and goals to be met and achieved. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bushey Hall Road (31) DS0000068401.V354606.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 Bushey Hall Road (31) DS0000068401.V354606.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Only those people whose needs and aspirations can be appropriately met are admitted to the home. EVIDENCE: The responsible assessment manager for the Care Management Group was met during this inspection and was able to confirm that the local manager is fully involved in the assessment process for people being considered for admission to the home, and that due attention is given to how they will mix and get on with any people already living in the home. This should ensure that as well as their own needs being met people living in the home are able to enjoy a positive and helpful life with each other. Detailed and comprehensive assessments were seen to be in place on each care plan that provided the information required by staff to ensure that they can understand the care needs of people living in the home and how they are to be met. Bushey Hall Road (31) DS0000068401.V354606.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is provided for people living in this service in a way that recognises their individuality and takes account of their personal preferences and goals. People living in this service are supported to take appropriate risks within a robust risk assessment framework, this recognises that taking reasonable risks, having identified and assessed them, is part of developing an independent lifestyle. EVIDENCE: Full risk assessment records were seen for each person living in the home, these included specific risk assessments and associated guidelines for example on accessing the community, self-harm and individual activities. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 10 Each person living in the home has a personal profile included in their care plan and there was evidence of a robust review process, including people living in the home, relatives and health and social care professionals. Significant parts of the care plan documentation are provided in an appropriate format for people living in the home. The results of the care planning and risk assessment process have been commented on very positively by relatives and social care professionals. “Significant progress”… “Big improvement”… “ They have done very well with my son” are all comments recorded about people living in the home. Bushey Hall Road (31) DS0000068401.V354606.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service enables people living there to develop their social, communication and independent living skills and to maintain and develop personal and family relationships. People living in the home are encouraged to access community activities and facilities in line with their expressed interests and goals and are also encouraged to take reasonable responsibility for their own domestic routines. EVIDENCE: As the inspection visit took place in the early part of their day, it was again possible to observe people living in the home choosing their preferred breakfast and in most cases getting it themselves or with minimal supervision and support. The menu book is discussed at residents meeting, which provides Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 12 an opportunity for people living in the home to influence the planning of the meals they have. People living in the home talked about how they were going to spend their day, and most of them then left for a range of activities. In some cases they access these on their own, although in others, in order to broaden the range of options open to them, staff accompany individuals to specific venues where this is thought necessary following risk assessment. Details seen of the range of activities accessed by people living in the home included; art and drama therapy, voluntary employment, day care, college and social activities such as bowling, snooker and swimming. The manager has been able to access activities at some distance from the home for example in North London and activities run by the National Autistic Society. This innovative and proactive approach has contributed to the positive results that have been noted with several of the people living in the home. A relative commented, “ he has come out of himself – all credit to the staff” Bushey Hall Road (31) DS0000068401.V354606.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will receive the care and support they require to maintain their social, emotional and physical wellbeing. EVIDENCE: Each person living in the home has their own health booklet, in an appropriate format, which sets out their healthcare needs and how they would like them to be met. Care plans seen included evidence of the involvement of a range of healthcare services and professionals including psychiatric services, dieticians as well as general practitioners and routine healthcare services such as dentistry and chiropody. The staff work to an efficient medication policy, supported by comprehensive procedures and practice guidance. Staff receive training in the administration of medication before being allowed to administer it to people living in the home and those records checked were Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 14 accurate and up to date. This means that people living in the home, and those responsible for them can be confident that their safety and wellbeing is being protected by the way that medication is stored, administered and recorded. Bushey Hall Road (31) DS0000068401.V354606.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are protected from abuse, neglect and self-harm by staff being appropriately trained, by a robust and accessible complaints procedure for them to use and by the staff working to policies and procedures that are comprehensive and effective. People living in the home are provided with opportunities to express their views and have access to external advocacy and support services, independent of the home. EVIDENCE: Local advocacy service are involved with at least one of the people living in the home and staff have either received or will soon be receiving training about issues around mental capacity, choice and decision making and the involvement of independent advocacy services. Training records for staff were seen to include safeguarding and the Hertfordshire County Council safeguarding policy and guidance was seen to be available to all staff. This should ensure that staff are able to recognise abuse if it is seen or suspected and that they know what action to take. Service user meeting records were seen and throughout this visit staff were seen to be actively giving people living in the home opportunities to express their wishes and preferences. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 16 There is a high level of contact between people living in the home and their families and health and social care professionals who are independent of the home and this provides considerable opportunity for any concerns to be raised with them and for their wellbeing to be monitored. Bushey Hall Road (31) DS0000068401.V354606.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and pleasant environment for those who live or work there. EVIDENCE: The overall standard of décor, furnishing and cleanliness seen was good. One area of the home where problems with odour and hygiene have been identified is to be fitted with appropriate easy clean floor covering, with the agreement of the person concerned, their family and their responsible social care worker. Problems with the heating are being resolved and suitable auxiliary heating has been provided in the meantime. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home can expect to be supported by a staff team that has been provided with the supervision and training that enables them to meet the resident’s needs appropriately and safely. EVIDENCE: “All credit to the staff team”… “All the staff are very friendly and helpful” are some of the comments made in survey returns. Training records were seen and a conversation was held with the Care Management Group training manager about courses specific to learning disability. These provide evidence of a sound basic training for staff, including NVQ at appropriate levels. The manager has accessed some additional local training which augments the basic and specialist training available through Care Management group. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 19 Staff spoken to during this inspection site visit said that they felt well supported by training. Staff recruitment files were seen, and these included the records and checks needed to provide people living in the home with confidence that care is taken to ensure that they only receive care and support from appropriate people. Staffing levels appear satisfactory at present and enable staff to accompany one person living in the home to access training outside the local community. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is well managed and is clearly focussed upon achieving good care outcomes for people living there, involving them in the decision making process, promoting their well-being and building independent living skills wherever possible. EVIDENCE: The manager is registered with the CSCI and is currently reaching the final stage of the Registered Manager’s Award qualification. Staff spoken to were very supportive and appreciative of the manager of this service and the people living in the home were seen to be at ease both with the manager and members of her staff team. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 21 The standard of record keeping found was good and contributes to the efficient and effective operation of the home, promoting the health, safety and wellbeing of people living and working there. Minutes were seen of meetings between the staff team and people living in the home and positive comments have been recorded by family and health and social care professionals about communication and involvement with the home. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 22 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA39 Good Practice Recommendations Work already started to make all documentation relating to or of interest to people living in the home available in a format that they can readily access should be reviewed and extended where necessary. Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Bushey Hall Road (31) DS0000068401.V354606.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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