Care Home: Kneller Road, 131

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What the care home does well Supports residents to take part in a range of activities according to their needs and preferences. Supports residents to maintain relationships with their families and friends. Identifies any changes in residents` needs and make sure that these changes receive an appropriate response. Seeks the advice and input of other professionals when necessary and liaises well with them about residents` care. The manager provides effective leadership to the home and good support to staff. Staff provide good quality care and communicate well as a team. What has improved since the last inspection? There has been some communication needs. progress towards meeting residents` individualSome residents have tried new activities. Some rooms have been repainted since the last inspection and new flooring has been installed in some areas. Staff feel better supported and that the manager is more accessible to them. Staff feel that they have opportunities to contribute their ideas about how the home is run. What the care home could do better: Make sure that all staff have attended training relevant to their roles. Implement the improvements to communal bathrooms necessary to meet residents` needs. Identify an effective means of demonstrating how residents are consulted about and involved in decisions that affect them. CARE HOME ADULTS 18-65 131, Kneller Road Whitton Middlesex TW2 7DY Lead Inspector Simon Smith Unannounced Inspection 24th August 2007 9:10 131, Kneller Road DS0000017375.V348472.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 131, Kneller Road DS0000017375.V348472.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. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 131, Kneller Road Address Whitton Middlesex TW2 7DY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8893 4636 020 8893 4636 kneller.road@unitedresponse.org.uk None United Response Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2007 Brief Description of the Service: The service is managed by United Response, a not-for-profit provider of residential and community services for people with learning disabilities. The property is maintained by the Metropolitan Support Trust. The home’s fees are currently £1333 each week. Opened in 1996, the home is a single-storey property situated in a pleasant residential area. Whitton high street is close by and provides a range of shops, pubs and other community facilities. The home is set back from the road and approached via a driveway. Parking is available to the front of the property. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a range of sources when making judgements about the home. These included visiting the home and talking to residents, the manager and staff. Some written information was examined, including residents’ files and health and safety checks. The home met 29 of 30 National Minimum Standards assessed at this visit. One Standard was almost met. All the residents spent some time at home during the inspection. One resident went shopping with a member of staff during the day. Another resident was supported to attend a hospital appointment and a third went to a local resource centre with the manager. The last key inspection of the home, in June 2006, raised some concerns about the support available to staff. The report noted, “Some staff said that they had not been well supported by the home’s management team, reporting that supervision sessions were not held often enough and that team meetings achieved little. Staff also said that their ideas about improvements were not taken on board or actioned by the home’s management team”. An additional visit in February 2007 found evidence of improvement and this inspection confirmed that the service provided to residents is now consistent and that residents are supported to develop their skills and communication. The new manager has had time to establish herself and to address some of the areas of concern. The staff team has been more stable and there has been a reduction in the reliance on agency staff. As a result residents are cared for by people who know their needs well. Staff now feel that they get good support from the manager and that they have opportunities to discuss how they work as a group. What the service does well: Supports residents to take part in a range of activities according to their needs and preferences. Supports residents to maintain relationships with their families and friends. Identifies any changes in residents’ needs and make sure that these changes receive an appropriate response. Seeks the advice and input of other professionals when necessary and liaises well with them about residents’ care. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 6 The manager provides effective leadership to the home and good support to staff. Staff provide good quality care and communicate well as a team. What has improved since the last inspection? There has been some communication needs. progress towards meeting residents’ individual Some residents have tried new activities. Some rooms have been repainted since the last inspection and new flooring has been installed in some areas. Staff feel better supported and that the manager is more accessible to them. Staff feel that they have opportunities to contribute their ideas about how the home is run. 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. 131, Kneller Road DS0000017375.V348472.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 131, Kneller Road DS0000017375.V348472.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): Standards 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home is available to residents. There are appropriate procedures for the assessment and admission of residents. EVIDENCE: United Response has produced a Statement of Purpose and a Service User Guide about the home. There is also an ‘Individual Charter’ for people who use United Response services, which sets out service users’ rights and responsibilities. Each resident’s file contains a copy of the Individual Charter. There are appropriate procedures for the assessment and admission of residents but there have been no changes to the resident group in the last year. 131, Kneller Road DS0000017375.V348472.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): Standards 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home records residents’ needs and strengths and provides guidance for staff delivering care. Residents receive good support to make choices about their lives. The home supports residents in taking manageable risks. EVIDENCE: All residents have an individual care plan, two of which were checked. These contained good information about residents’ individual strengths and needs and guidelines for staff in their work with residents. Risk assessments were in place where necessary and had been regularly reviewed. The manager said that the home is reviewing the information held on file about residents and that care plans will be divided into one Lifestyle file and one Healthcare file. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 10 The home has done some good work in meeting residents’ communication needs. The home’s IT system is equipped with accessible software, which the manager said is used by one resident to assist communication. Some residents have skills in Makaton and the manager said that staff have attended training in this area. Residents are supported to make choices about their daily lives and how they spend their time. For example one resident chose to have breakfast later than his housemates during the inspection as he had been in the bath at breakfast time. The manager said that residents were involved in choosing the new furniture recently purchased for the home. 131, Kneller Road DS0000017375.V348472.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): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents participate in a range of activities according to their needs and preferences. Residents are involved in their local community. Residents are supported to maintain relationships with their families and friends. Residents’ rights and responsibilities are promoted. The home’s menu is varied and well balanced. EVIDENCE: 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 12 Residents have individualised programmes of activities and are involved in their local community. Some residents have tried new activities since the last inspection. For example an aromatherapist visits the home to work with some residents and one resident has started going swimming and using a sensory room regularly. The manager said that one resident is now involved in preparing communal meals with staff support twice each week. The manager said that Intensive Interaction had been identified as an approach that would benefit three residents and that, in future, each shift plan will identify staff time to implement Intensive Interaction with these residents. The manager reported that the local community team had run a workshop for staff to develop their knowledge of Intensive Interaction and to enable them to work successfully with residents using this approach. Staff said that residents have contact with their families and the inspection provided evidence that residents receive support to maintain relationships with their relatives where necessary. For example one resident visits his family in Lancashire with staff support. Each resident has individual charter on file that sets out tenants’ rights and responsibilities. Residents have unrestricted access to all communal areas and are able to choose how they spend their time at the home. Residents are registered to vote. The menu indicated that the home provides a varied and well-balanced diet. Responsibility for cooking and preparing food is shared amongst the staff team. All staff undertake basic food hygiene training as part of their induction process. Standards of food hygiene and storage at the time of inspection were good. 131, Kneller Road DS0000017375.V348472.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): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive good support to access community and specialist healthcare resources. Changes in need are effectively identified and receive an appropriate response. The home seeks the advice and input of other professionals where necessary. Medication is appropriately stored and recorded. EVIDENCE: The inspection provided evidence that changes in residents’ needs are identified by staff and that any changes receive an appropriate response. For example one resident has had increased incidences of challenging behaviour over a period of several months. As a result the home has sought the input of healthcare professionals including the community nurse and psychiatrist. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 14 Staff on duty demonstrated a good awareness of residents’ needs and care plans identify residents’ individual healthcare needs. One resident was supported by staff to attend a hospital appointment on the day of inspection and one resident has recently been supported to have dental treatment. The manager said that all residents have had a health check this year. There is an appropriate system for the storage and administration of medication. All medication coming into or leaving the home is recorded. Staff check medication stock daily. The manager has recently reviewed the home’s procedures for the administration of medication. Records indicated that one medication error had occurred recently but staff had taken appropriate advice following this incident and had discussed the issue as a team to prevent any reoccurrence. 131, Kneller Road DS0000017375.V348472.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): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place for the management of complaints. Training is provided for staff in the recognition, prevention and reporting of abuse. EVIDENCE: United Response has an appropriate Complaints procedure, a copy of which is on file at the home. United Response also has a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. A record of complaints is maintained, although there have been no complaints about the service. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’. The policy offers definitions of abuse and provides guidance for staff in the recognition and reporting of abuse. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, safe and well maintained. The communal rooms of the home are spacious and homely. Residents’ bedrooms reflect individual preferences. Improvements to the home’s bathrooms are needed to ensure residents’ needs are met. The home is clean and hygienic. EVIDENCE: The home is a single storey, purpose built property in Whitton. The home is set back from the road and has off-street parking for several vehicles. The shared 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 17 rooms of the home include a large lounge, separate dining room and a kitchen. There is a well maintained garden. Residents’ bedrooms are personalised and reflect their individual tastes and preferences. All areas of the home were clean and hygienic. Some areas of the home have improved since the last inspection. The lounge and dining room have been repainted and new flooring has been installed in some areas. Some new furniture has been purchased, including sofas in the lounge. The Metropolitan Support Trust (MST) has replaced the Thames Valley Housing Association as the home’s landlord since the last inspection. The manager said that representatives of MST have visited the home but have yet to make all the improvements recommended in previous reports from the CSCI and occupational therapy. For example the occupational therapy service recommended that one bathroom be converted into a ‘wet room’ to better meet residents’ needs. This has yet to be implemented and the manager reported that some residents are finding it increasingly difficult to get in and out of the bath. It is recommended that Metropolitan Support Trust implement the improvements to communal bathrooms necessary to meet residents’ needs. 131, Kneller Road DS0000017375.V348472.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): Standards 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Job roles within the service are clear and defined. Staff communicate effectively with one another. Staff receive good supervision and support. Staff are appointed following an appropriate recruitment procedure. Some staff need training in some aspects of their roles. EVIDENCE: There was a clear shift plan in place and staff on duty had a good awareness of their roles and responsibilities. Job descriptions and contracts of employment are in place for all posts within the staff team. There is a Designated Responsible Person for each shift. Records demonstrated that staff meetings 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 19 take place regularly and are used effectively to address important issues within the service. The manager said that morale amongst the team is good and that sickness and absence rates are low. There was one vacancy on the staff team at the time of inspection. Interviews were to take place in the week after inspection to recruit to this post. Examination of three staff files provided evidence of regular supervision and annual appraisal. Files also demonstrated that United Response makes appropriate pre-employment checks on news staff, including proof of identity and Criminal Records Bureau disclosure. The inspector spoke with two staff on duty, one of whom was a permanent member of staff and one of whom is employed through an agency. Both said that communication amongst the staff team is good and that they have opportunities to attend team meetings. Staff also said that they work well with their colleagues and that the manager is approachable and supportive. Although positive about her role, one member of staff said that she needed training in some areas. These areas included training to work with residents who exhibit challenging behaviour and training on specific moving and handling guidelines when working with residents. See Requirement 1. 131, Kneller Road DS0000017375.V348472.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): Standards 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides effective leadership to the home and good support to staff. Staff feel able to contribute their ideas about how the home is run. The home should identify an effective means of demonstrating how residents are consulted about and involved in decisions that affect them. Health and safety checks were comprehensive and up-to-date. EVIDENCE: 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 21 The manager has experience in the delivery of services to people with complex needs and has contributed much to improvements at the home since the last key inspection, both in the service provided to residents and in the support available to staff. Staff feel better supported and that the manager is more accessible to them. Staff also feel that they have more opportunities to contribute their ideas about how the home is run and that they communicate well as a team. Discussion with the manager confirmed that there is a commitment to running the home in the best interests of residents and to promoting residents’ choice. Whilst the manager was confident that the service residents receive reflects their individual needs and preferences, it was acknowledged that there are some challenges to demonstrating this through recording. The home should continue to seek an effective means of demonstrating how residents are consulted about and involved in decisions that affect them. The home has an appropriate fire detection system, which is checked regularly by staff. Fire drills are held each month and a night-time drill every six months. The home’s Fire Book records that the alarm system was serviced in May 2007 and the emergency lighting checked in July 2007. Staff carry out monthly health and safety checks, which were up to date at the time of inspection. The service has valid Employers Liability Insurance. 131, Kneller Road DS0000017375.V348472.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 3 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 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X 131, Kneller Road DS0000017375.V348472.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. 1 Standard YA35 Regulation 18(1) Timescale for action The Registered Person must 30/12/07 ensure that all staff have attended training relevant to their roles. Requirement 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 Refer to Standard YA27 YA39 Good Practice Recommendations Implement the improvements to communal bathrooms necessary to meet residents’ needs. Identify an effective means of demonstrating how residents are consulted about and involved in decisions that affect them. 131, Kneller Road DS0000017375.V348472.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 131, Kneller Road DS0000017375.V348472.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. 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