Care Home: Leys Road (2 to 4)

What the care home does well Leys Road provides a range of support services to people who have a mental health need in an environment that is supportive and caring. Each person is supported within the whole life review or care programme approach system. The AQQA states "Our service offers a safe healthy environment to our service users and a home for life or until we can longer meet our service users changing needs, then suitable accommodation would be found in agreement with service users and family members. We try to promote independence to live in the community and to achieve life goals. We aim to meet all the standards set to the best of our abilities and provide a happy home for our service users". What has improved since the last inspection? Some areas of the service have been re-decorated since the last inspection was carried out for the benefit of the people that live there. Some records/policies and systems have been reviewed and updated since the last inspection. Prospective new users of the service now have the opportunity to have a one or two night trial visit. The AQQA states that there is a plan in place to encourage and support people to become more involved in the recruiting of new staff. A quality assurance system is now in place to monitor and review the services provided at Leys Road. What the care home could do better: The service should continue to explore alternative opportunities for people to take part in community based activities that meet their needs and expectations. Also the service should continue to encourage and support people to progress on to more independent living by continually assessing their needs and aspirations and setting new and achievable goals. CARE HOME ADULTS 18-65 Leys Road (2 to 4) 2/4 Leys Road Hemel Hempstead Hertfordshire HP3 9LX Lead Inspector Julia Bradshaw Unannounced Inspection 3rd September 2008 10:00 Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leys Road (2 to 4) Address 2/4 Leys Road Hemel Hempstead Hertfordshire HP3 9LX 01442 389 214 01442 389 214 tina.matthews@hpcha.org.uk 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) Hightown Praetorian & Churches Housing Association Mr Ian Searle Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (7) Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only Service Users who are independently ambulant may be accommodated. 6th September 2006 Date of last inspection Brief Description of the Service: Leys Road provides accommodation, care and support for seven service users who have a history of mental health issues. The home is arranged on three floors. There is no lift so the home would be unsuitable for anyone with restricted mobility. The service users are currently all able to manage the stairs independently. Accommodation comprises of a quiet room, kitchen, lounge, dining room and toilet on the ground floor. The first floor consists of three bedrooms, shower room, toilet and office. The second floor comprises of four bedrooms, two bathrooms and a toilet. Leys Road is situated close to the town centre of Hemel Hempstead. Current charges are £850 per week (as at 30/04/08). Additional charges are made for hairdressing, personal toiletries and newspapers. The Statement of Purpose and Service User Guide provide information about the home. These documents and a copy of the most recent inspection report can be obtained from the manager. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The information in this report is based on an unannounced visit to the service by one regulation inspector carrying out the work of the Commission. The inspection covered a variety of aspects of this service including, talking to the people who use the service and to staff members, a tour of the building, three care plans were case tracked, and health and safety records and management systems within the service were also inspected. The information provided by the manager in the Annual Quality Assurance Assessment (AQAA) has also been examined. This is a self assessment document that focuses on outcomes for service users and also provides us with some useful statistical information. The manager of the service was on a late shift and therefore this inspection was conducted with a senior support worker. Therefore some of the records were unable to be inspected on this occasion as confidential information relating to both staff training and staff supervisions were locked away. This information will therefore be taken from the AQQA, which was completed recently by the manager. Four people who live at Leys Road were in during this inspection and were able to provide the inspector with a valuable insight into the service being provided. One person stated that they found the staff “supportive and kind and were able to enjoy a lifestyle that supported them becoming more independent”. What the service does well: Leys Road provides a range of support services to people who have a mental health need in an environment that is supportive and caring. Each person is supported within the whole life review or care programme approach system. The AQQA states “Our service offers a safe healthy environment to our service users and a home for life or until we can longer meet our service users changing needs, then suitable accommodation would be found in agreement with service users and family members. We try to promote independence to live in the community and to achieve life goals. We aim to meet all the standards set to the best of our abilities and provide a happy home for our service users”. Leys Road (2 to 4) DS0000019447.V371010.R02.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. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 - 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the service is kept up to date and provided for all prospective users of this service and everyone wishing to enter the service has a full assessment of need completed. This ensures that all parties can be sure the service can meet all individual needs. EVIDENCE: A Statement of Purpose and Service User Guide is in place. These are kept up to date and are available to prospective users of this service. Prospective new users of the service are now offered a one or two night trial visit before committing fully to moving into Leys Road. A total of three care plans were reviewed and evidence gained regarding the initial assessments that are carried out to access if the service can meet the needs of the person. Information is held regarding the person’s history and current needs. An assessment of each person’s needs and aspiration are made before the person moves into the service. Leys Road has its own internal assessment forms, which have been further developed since the last inspection was carried out. Competent staff complete the assessments. The service also receives and seeks external specialist support to meet the individual’s needs. Whole life reviews and CPA’s occur to support the people in achieving and Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 9 reviewing individual needs, goals and aspirations. The assessment process includes the gathering of information from other professionals. A contract is then drawn between the service provider and the person using the service. The terms and conditions of the service are agreed in writing so that people are clear about the roles and responsibilities of all those within the service. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that the care plans reflect a detailed record of people’s needs, which ensures that people using the service are assessed, reviewed and safe from risk. EVIDENCE: Three care plans were inspected and were found to provide a detailed insight into each individual’s needs. Individual notes and guidelines for people were observed within the service. Everyone living at Leys Road is supported within the whole life review or CPA framework and reviews occur to ensure changing needs are continuously assessed and reviewed. Ranges of risk assessments are completed within the service and action points recorded. These risk assessments contain all the required information. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 11 Activities and outings are enjoyed by people living at Leys Road and staff ensure that people are supported to take risks as part of an independent life style. All risk assessments have been reviewed since the last inspection was carried out. Staff work with people to assist them to lead safe and enjoyable lives and regarding decision making and offering support where needed. There was evidence to confirm that people had been involved in their care planning with signatures from either the person using the service or their representative. However one care plan requires either the person using the service or their representative to sign to confirm they have read and agreed the content of their plan. People spoken to on the day of the inspection were all positive about the way that care is received in terms of preserving rights and dignity. People spoken to state, “The staff here are all really nice and we have just been away on holiday and it rained a lot”!!! Another person said that “the staff help me to have a bath and help me to clean my room”. The Community Learning Disabilities and Mental Health Teams provide health care support. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality outcome is good. This judgement has been made using available evidence including a visit to this service. People who use the service can feel assured that they will be offered and receive appropriate opportunities for social/leisure and community involvement. EVIDENCE: People attend a variety of schemes suitable to their individual needs and aspirations. Discussions with the support from staff determined that they have a variety of day activities to be involved with. Staff support and encourage people to maintain and develop social, emotional, communication and independent living skills. We were able to observe the preparation of the lunchtime meal and people were seen to be encouraged to take individual responsibility for laying and clearing the table. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 13 The service is centrally located, and is within a short distance from shops and the local community amenities. The service values and seeks to reflect racial and cultural diversity of people living within this service through celebration of, and awareness of different cultures, religions and festivities. During the inspection, staff and people who live in the home were observed to interact equally with one another. People are supported appropriately to take part in activities within the service. Individual needs, choices and preferences are always considered. A record of activities is maintained within the daily recording system. People access the local community services frequently and visit the local area, enjoying going out for lunch and shopping. Monthly link worker meetings occur so the views and developments of the service users are discussed and recorded. However on the day of this inspection there was no evidence to confirm that these meetings were being held regularly. The minutes of these meetings should be made available to everyone using the service and should be kept updated. Menus were available with choices available on a four-week rolling seasonal menu, which appeared well balanced. Records are maintained of food consumed and offered. People are offered choices and encouraged to support in the kitchen as appropriate. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Those who use the service have their health and personal care needs carried out effectively and respectfully, ensuring that their wishes and choices are promoted. EVIDENCE: All care provided is individual to each persons needs with each person choices and preferences being promoted. Assessments are completed ensuring that the approach adopted is person centred and holistic to each person. People are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to everyone living within the service regarding general health issues. A safe and detailed policy and procedure is in place to support the safe administration, storage and receipt of medicines. Medication training was unabled to be evidenced as the manager was not on duty on the day of this inspection. However staff spoken to on the day of this inspection confirmed Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 15 that they had been both inducted and trained in the administration and safe keeping of medication. The service use the dossette system to dispense medication and the MAR sheets were reconciled with no errors were found. Three people currently hold their own medication and this is administered within the services guidelines and policy. One person was able to explain this procedure first hand and the system appeared to be working well. Risk assessments were in place for self-medication. There is a staff signature sheet in place, with appropriate PRN guidelines for staff to follow as required. Medication appears to be well managed with no shortfalls noted. No temperature record was seen on the day of this inspection for the medication cupboard. The manager contacted the Commission the following day to inform the inspector that these temperatures are not checked or recorded. This situation must be rectified in order to ensure that medication is held within safe temperature levels to ensure that medication is stored according to the manufacturers guidance so to remain clinically effective. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living within this service can be assured that they will be protected from abuse and that they will be listened to if they raise any concerns or make a complaint about any aspect of their care. EVIDENCE: The service has a detailed complaints procedure in place. A record is maintained of any complaints made detailing actions and outcomes as necessary. People using the service have been informed about the complaints procedure. The recent AQQA stated that there have been no complaints received since the last inspection was carried out. Records to confirm this were seen on the day of the inspection. A detailed procedure is in place to ensure that people using the service are protected from abuse and harm. Staff receive suitable and adequate safeguarding training. The AQQA stated that “Staff employed within the home are all subject to enhanced Criminal Records Bureau disclosure”. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is adequately maintained and promotes a homely, comfortable safe space for people to live in, which meets their needs. EVIDENCE: Everyone living at Leys Road has their own, single room that has been decorated to reflect their own interests, hobbies and personal style. All areas of the service were maintained to a good standard without any obvious areas requiring repair or replacement. Three people spoken to were quite happy to show the inspector their own rooms and confirmed that they had been involved in selecting their own colour schemes and soft furnishings. The laundry facilities are housed at the bottom of the garden. Both the kitchen and laundry rooms are domestic in style and appear to manage their current workload effectively. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 18 The service was clean and odour free on the day of the inspection. The cleaning is carried out by the care staff and with the people who live there assisting where possible. The communal areas of the services are decorated and furnished to an acceptable standard and there is a selection of home entertainment equipment for service user to access. The water temperatures on the day of the inspection were recorded within safe limits to ensure people are kept safe from accidental scalding. Leys Road has pleasant grounds, with a vegetable patch and pond which the people who live there have been involved in creating and maintaining. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is suitably staffed with experienced individuals ensuring that at all times people’s complex and changing needs can be met. EVIDENCE: Information regarding staff recruitment, training and supervision has been taken from the recently completed AQQA and from discussions with the staff on duty on the day. The AQQA states “All staff are CRB checked and have NVQ qualifications in care and have supplied two written references. People living at Leys Road are encouraged to take part in staff interviews when possible. All new staff are given a copy of the codes of conduct and have a six month induction training in this time all mandatory training is given”. Previous inspection reports have not identified any issues within this area. Staff spoken to stated that they had received food hygiene training, moving and handling training, PCP training and the manager contacted the inspector following this inspection and confirmed that staff have also received diversity Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 20 training in April and procurement training in February 2008.The two staff spoken to confirmed that they received supervision every six weeks and also that staff meetings were held regularly. All policies and procedures relevant to this service were appropriately held on site. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 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 management within this service is effective in ensuring that changing needs of people are met and systems for effective health and safety management are in place to ensure people are kept safe. EVIDENCE: Generally people living within the service are provided with information that can be understood in relation to the complaints procedure, although the service could further improve this information by creating all documentation in a more user friendly format that can be easily understood by the people using this service. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 22 Staff spoken to on the day of the inspection stated, “The manager ensures that supervisions and staff training are held regularly “and that they feel supported and respected by the manager. The AQQA completed in June 2008 was returned as requested however; some sections contained only basic information. It would be in the mangers best interests to ensure that the AQAA is fuller to better reflect the services provided at Leys Road. All records inspected were secure and were up to date and held in accordance with the Data Protection act 1998 ensuring that people’s rights and best interests are safe guarded by the services polices and procedures. The management approach of the service endeavours to create an open and positive atmosphere, staff and users of the service spoken to comment that they feel supported. “All the staff, they are very kind to me” Individual risk assessments are in place. The general standard of fire checks/recording is good and fire records on the day of the inspection were up to date and recorded accurate. The service has embarked on introducing a quality assurance system since the last inspection was carried out in order to monitor and review the services provided. Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Score 24 25 26 27 28 29 30 3 3 x 3 x 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Leys Road (2 to 4) DS0000019447.V371010.R02.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 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 YA20 Good Practice Recommendations A record of the temperature of the medication cupboard should be maintained to ensure the health and welfare of people using the service is protected Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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 Leys Road (2 to 4) DS0000019447.V371010.R02.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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