Care Home: Devon Way, 13

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What the care home does well Devon Way provides a homely setting for three people. The home is comfortable and well maintained and located in a position close to local amenities and public transport. The care plans are detailed and cover peoples daily requirements. What has improved since the last inspection? The administration and monitoring of medication has improved since the last key inspection and an audit sheet is now in place. Moving and handling risk assessments for people who use the service have been completed. Person centered care plans are at the stage of being put together to improve daily living and leisure for people. What the care home could do better: The Manager and staff team need to be established in order to make improvements for people who live in the home. The care plans need to be monitored and reviewed to ensure that all the information is up to date. Records show that people have not attended health care records regularly, this must improve. A fire risk assessment for 13 Devon Way must be completed. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Devon Way, 13 Devon Way, 13 Hillingdon Middlesex UB10 0JS     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: Susan Woolnough-Singh     Date: 1 0 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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.csci.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: Devon Way, 13 Devon Way, 13 Hillingdon Middlesex UB10 0JS 01895235432 Telephone number: Fax number: Email address: Provider web address: devon1@lifeopportunitiestrust.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mr John Denman Type of registration: Number of places registered: Life Opportunities Trust care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 13 Devon Way is home to three men with learning disabilities. The home is owned by Shepherds Bush Housing Association and managed by the Life Opportunities Trust and was originally registered in 1993. The service users accommodation is provided on the ground floor and all the bedrooms are single. There is an office/sleeping in room for staff on the first floor and a garden to the rear of the building with a seating area and lawn. The home is set in a quiet cul-de-sac near to local shops in Hillingdon and Uxbridge town centre. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 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 an unannounced key inspection of Devon Way. All of the key National Minimum Standards for Younger Adults were assessed. The inspection commenced on 10th September 2008 and took six hours and fifteen minutes approximately. The time incorporates an evening visit to the home which was completed at 21.00 hours. We met with all of the people who live in the home and were able to talk with two of them. As part of the inspection process we took a tour of the building and looked at records relating to people who use the service, staff and health and safety. Care Homes for Adults (18-65 years) Page 6 of 27 The last key inspection took place on 14th September 2006 and a random inspection took place July 2008. People spoken with indicated that they were comfortable. One person spoken with was able to talk about his daily routine life in the home. We were able to see the bedroom of one person who appeared enthusiastic about his room and music. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. Prior to moving into the home a thorough assessment of peoples care needs takes place. Evidence: We looked at the care plans of all the people who live in the home. People are placed by the London Borough of Hillingdon,who carry out a Needs Led Assessment prior to people moving in. 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. People who live in the home have their care needs assessed and a care plan drawn up to reflect these. Two care plans needed to be reviewed and updated. People are able to make different daily decisions and choices depending on their ability to do so. Risks to people are identified and risk assessments put in place. Evidence: We looked at the care plans for all of the people who live at Devon Way. A care plan is in place for each person. We saw that the care plan covers physical and mental health, self help skills, personal hygiene, mobility, sleeping patterns, communication and social and cultural needs. The care plans are written in sufficient detail for the reader to understand the care needed. The dates on the care plan did not evidence that all care plans had been recently reviewed. One care plan was dated April 2005 and one Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: October 2004. One care plan was reviewed and dated April 2008. We were able to see that risk assessments were in place for people. At the time of the inspection we had been notified by Regulation 37 report that there had been a number of incidents relating to one person. On looking on the care file/plan we were able to see that a referral had been made to the Positive Behaviour Coordinator (London Borough of Hillingdon) An assessment of triggers and a pro active strategy had been completed as guidance for staff on how to manage future incidents. We were able to see that at the time of the inspection one person required temporary mobility aides and a wheelchair assessment had been carried out. 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. In general people are able to participate in appropriate day and leisure activities. Person centred plans had just been developed but the outcomes for people could not be assessed due to the recent implementation. Additional staffng is required to improve community and leisure activities for one person. Meals are cooked by staff are served in pleasant surroundings. Evidence: We were able to see that people who live at the home attend a day service and have regular club evenings there was a timetable covering each persons weekly schedule. People generally go to the day centre four days a week with one day off to spend at home. At the time of the inspection it had been identified that to offer one person an improved activity schedule additional staffing was needed. This was discussed with the Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: Manager who was due to attend a meeting where this would be requested. One person spoken with was not attending a day centre for health reasons but was due to commence again shortly. People require different levels of support in the community. Contact with family and friends depends on individual circumstances. One person stays with his family at weekends on a regular basis. We spoke with two people who use the service and one was able to confirm that he was able to participate in every day choices and decision making. The Manager and staff had recently started to complete person centred plans for people which cover the persons likes and dislikes and aspirations. People are consulted about the menus. We observed that the kitchen was kept to a good standard of hygiene. 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. People have their personal support needs met in a manner suitable to their needs. Health care is monitored and guidance given on health care needs; improvements must be made on monitoring visits to health care professionals and ensuring that people attend appointments regularly as recommended. A system is in place for the safe administration of medication. Evidence: People are registered with a general practitioner and are able to access other health care professionals as necessary. Information seen on care plans demonstrated that health care needs were being monitored. Health Action Plans are in place and these cover all elements of physical care such as skin care, oral care and foot care. We were also able see that a record had been made visits to health care professionals. The health care records for two people indicated that dental appointments had not taken place for two years. This was verified with the Manager who responded that health care appointments needed to be reviewed. We spoke with one person who had Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: recently had a medical injury, his needs in respect of this were being addressed. Personal support is offered by staff in line with the peoples ability with regard to their self help and independent living skills. We were able to see that guidance on this is contained in the care plan. We were able to view the medication administration system. Medication is kept in a secure place and provided by a local pharmacist pre-dispensed in a dosset box. Liquid medication that had been opened dated accordingly. A weekly audit of safe administration is in place. A medication risk assessment has been completed. A L.O.T Medication Administration and infection control control policy are in place. 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. The required procedures for complaints and protection are in place for people who use the service. A system is in place for the management of peoples finances. Evidence: A pictorial complaints policy is available for people who use the service. The last complaint received by the home was in 2001. Staff receive training in the protection of vulnerable adults on an annual basis. Prior to the inspection we had received a Regulation 37 incident form reporting incidents in the home affecting the welfare of people who use the service. We discussed with the Manager in detail strategies that had been put in place to manage this situation. We were able to see a detailed behaviour management plan. The incidents had been referred by the home to the London Borough of Hillingdon under the Safeguarding Vulnerable Adults Procedure. Meetings had been taking place and a future meeting planned to review and address this situation. We looked at the system in place for managing peoples finances. Staff assist people to manage their money: only permanent members of staff staff are permitted to do this. People sign for money kept on their behalf and a record of purchases is kept. Care Homes for Adults (18-65 years) Page 17 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable safe and well maintained and the communal areas of the home are warm and homely. Bedrooms and nicely furnished and reflect individual preferences. The home is kept to a high level of cleanliness. Evidence: The home is situated in a quiet residential area with access to public transport, open spaces and local shops. We toured the building and looked with two people at their bedrooms. The home is furnished and decorated to a high standard. There is a lounge/dining room and three bedrooms on the ground floor. The staff office and sleeping in room is on the first floor. There is a well kept and ample rear garden. Care Homes for Adults (18-65 years) Page 19 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. At the time of the inspection the Manager of the home had only been in post for approximately two weeks and other staff were new, people who use the service had experienced instability due to a complete turnover of the staff team. Policies and Procedures are in place for the safe recruitment of staff. Staff receive training appropriate to their roles. Evidence: Three staff are employed at the home including the Manager, currently there is one vacancy. All of the staff have who have recently been employed at Devon Way have worked with Life Opportunities Trust for a number of years. Staff work alone, but on occasion two people will be duty. On the evening of the inspection two staff were on duty. People who use the service would benefit from additional staff on duty to offer more evening and weekend activities. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: Staff receive mandatory training in food hygiene, moving and handling , fire safety and first aid. Two staff have an NVQ in care. We looked at the recruitment files of two members of staff. One person worked with the Life Opportunities Trust on the bank(locum) team and one was employed at Devon Way. Criminal Records Burueo verification and training certificates were available. We were informed that the employees personnel records were to be transfered from the previous LOT residential home. For the second person who worked a a locum (employed by LOT) an application form, two references and Criminal Records Bureau information were on file. We were informed that a new Induction Course had just been developed although this had not yet been put into operation, would would be used for new employees. A copy of the new induction package was to be forwarded by the Manager to be used as part of the inspection evidence. During the inspection process we ascertained that the complete change of staff team which involved all previous staff members leaving had had a detrimental effect on people who use the service. The reason for being that people who use the service must be supported in a skilled manner; the new team being at the early stages of working with people and identifying their needs. Care Homes for Adults (18-65 years) Page 21 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. The new Manager of the home has the experience to manage the home in the best interests of people who use the service. She is in the process of applying to be registered with CSCI. The Manager needs to establish herself and the new staff team to provide consistent care for people. There is a commitment to quality assurance and running the home for the benefit of people who use the service. Systems are in place to administer the home safely. A premises fire risk assessment must be put in place. Evidence: At the time of the inspection the Manager had only been at the home for a short period. She was in the process of applying for Registration with the Commission for Social Care Inspection, this is to include a new Criminal Records Bureau check. She has obtained an NVQ Level 4 in care and was due to commence with the Registered Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: Managers Award. An Annual Quality Assurance Assessment had been recently completed for the service, whereby all of the National Minimum Standards had been reviewed by the home, improvements for the future had been identified. We were able to see that surveys had been sent out to people who use the service and their families, these are in pictorial form and cover questions on choices likes and dislikes. Information on the Annual Quality Assurance Assessment confirmed that policies are in place for fire safety, food hygiene, COSHH and infection control. The fire system was serviced in January 2008 and a Gas Safety check is dated October 2007. We looked at fire safety records, monthly fire drills take place whereby people are evacuated, the last fire drill was dated in August 2008. Risk assessments seen cover Lone Working, Stress in the Work Place, and Office Working. Risk assessments had also been completed for household tasks such as food preparation and ironing. A fire risk assessment was not available for the premises. Care Homes for Adults (18-65 years) Page 23 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 24 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 1 6 15 The Registered Provider and Registered Manager must keep the the information on the care plan under review. The care plan must give up to date information on how people are to be cared for. 01/12/2008 2 19 10 The Registered Provider and Registered Manager must ensure that people attend regular health care checks and appointments. The healthcare of people who use the service must be monitored and they must be supported to attend appointments as necessary. 01/12/2008 3 42 18 The Registered Provider and the Registered Manager must complete a fire risk assessment for the premises. 01/12/2008 Care Homes for Adults (18-65 years) Page 25 of 27 All areas of the premises must be risk assessed for the protection of people who use the service and staff. 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 33 The Registered Provider and the Registered Manager should ensure that there are enough staff on duty in the evening and at weekends to enable and support people in their leisure activities. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 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 © (2008) 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. 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