Inspection on 12/05/08 for 10, Friday Road

This is the latest available inspection report for this service, carried out on 12th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

10, Friday Road 09/05/06

10, Friday Road 07/11/05

10, Friday Road 06/05/05

10, Friday Road 15/12/04

10, Friday Road 06/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE 10, Friday Road Mitcham Surrey CR4 3JQ Lead Inspector Emma Dove Unannounced Inspection 12th May 2008 11:30 X10015.doc Version 1.40 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 10, Friday Road DS0000027223.V363373.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 Older People. 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. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10, Friday Road Address Mitcham Surrey CR4 3JQ 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) 0208 648 7800 Mr Jose Martin Mrs Sylvia Rookmin Martin Mrs Sylvia Rookmin Martin Care Home 6 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (6) 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd July 2007 Brief Description of the Service: 10, Friday Road is a registered care home for six older people. This number may include up to three older people with additional mental health needs. Five people are currently living there. Friday Road is owned and managed by two private individuals and is situated in a residential area on the borders of Mitcham and Tooting. Local shops and public transport systems are within a fifteen minute walk. Accommodation is provided over two floors with a double bedroom on the ground floor and four single bedrooms on the first floor. The home is staffed twenty-four hours a day. Basic information about the service is provided in a written brochure, which includes details of the CSCI. The current range of fees are £410.00 to £420.00 per week. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over five hours on the 12th May 2008. One regulation inspector visited, looked at records, spoke with people who use the service, one visitor, the owner and manager and two members of staff. Questionnaires were sent to people who use the service and their relatives, placing social workers, health professionals and staff. We received three completed questionnaires, comments from these are included throughout this report. The manager completed an Annual Quality Assurance Assessment, information from this is included in this report. What the service does well: What has improved since the last inspection? Daily records now include details of what the individual has done each day and the care and assistance provided by staff. Old information has been archived, making case files less bulky and information more easily accessible. Information available to people who use the service has been produced in large print format, making it more accessible. The home has been redecorated, new carpet has been fitted in the entrance hall and dining area, new chairs have been purchased for the lounge, new paving has been laid in the front and back garden and two new benches have been bought for the back garden. This provides a better environment for people who use the service. Staff files now contain a photograph of the individual and proof of the person’s identity, showing that the recruitment process is thorough and protects people who use the service. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use this service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Basic information about the service is detailed in a brochure, which sets out the aims and objectives. The brochure is available in large print. Assessments are completed before admission. Intermediate care is not provided. EVIDENCE: A small brochure is available which provides basic information about the home, facilities, services provided, the complaints procedure and any services which incur an extra cost. This booklet has been provided in large print, making it more accessible to some people who use the service. Assessments are completed before admission and a trial period is also used to assess if the home is appropriate for an individual. The manager and staff demonstrated detailed knowledge about the lives of people who use the service. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 9 One person confirmed that they have a contract of residence and received enough information to help them decide to move in. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People have access to health care services both within the home and in the local community. Care plans are in place and kept under review. Medication is well managed. EVIDENCE: We saw improvements in care plans and case files, with more information about peoples needs. Due to the small number of staff providing care and the number of years the manager, owner and staff have known the people who use the service, care plans do not need to be as specific as larger services with more changes in care staff. The manager said that care plans are reviewed. We saw records confirming that care plans are reviewed and that annual reviews of individuals care take place. We saw the manager and staff provide support and assistance to individuals that they thought appropriate and helpful, with people confirming that they are 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 11 happy with the level of care and support they receive. On one occasion staff went over and helped a person without asking what help they needed or talking about what they were doing, this did not offer the person the choice of help, however the person was ‘delighted’ with the help and said it was ‘just right’. The manager said that people’s health needs are met by different health care professionals who visit the home when necessary. People who use the service confirmed that their health needs are met. Appropriate medication policies, procedures and practices are in place. Medication is appropriately stored and labelled. The manager and some staff administer medication to people who use the service from a monitored dosage system. Records were up to date and signed. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service are given the opportunity to take part in a few activities within the service. The menu has been developed from foods people who use the service like and to meet any dietary needs. EVIDENCE: People generally sit in the lounge and watch television, talk with staff and visitors, read the paper and sit in the garden. There is little planned activity although people who use the service did not raise this as an issue and were generally satisfied with what they do. People said they either ‘enjoy going into the garden’ or ‘I don’t want to go in the garden’. Peoples choice was respected by staff. The manager reported that the service meets peoples social cultural and religious needs by allowing them to follow their religious observations and maintain contact with friends and family through visits and daily telephone conversations. People who use the service confirmed that the nuns visit every 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 13 week and provide a service and Holy Communion. People who use the service and visitors confirmed that visitors are welcome. We saw a new record of activities people have taken part in during the day, noting any visitors, if individuals have attended the communion service, had their hair done or their nails manicured etc. This record gives a quick look at what individuals have done during the day and week and identifies any times when more activity or an outing could be arranged. The manager noted that they had held more Birthday parties and could do more activities and outings for people if they had more resources. One person said that there are ‘usually’ activities that they can take part in. The manager reported that the service had recently received a three star rating from the local environmental health department. The manager said that they plan the menu on the food the people who use the service like. People who use the service made varied comments about the meals provided ranging from ‘lunch was very good’, ‘the cook is good’, ‘I eat well’ and ‘it’s passable’. One person said they ‘always’ like the meals. We saw everyone eat their midday meal and have tea or coffee and biscuits mid afternoon during our visit. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is easy to understand. The policies for safeguarding adults are available and give staff guidance on actions to be taken. The manager and staff have completed training in protection of vulnerable adults and are aware of their responsibilities. EVIDENCE: A large print copy of the complaints procedure is displayed in the entrance hall. The manager reported that records are kept of complaints with none in the last year. We have not received any complaints about Friday Road since the last inspection in July 2007. People who use the service told us that they would speak to the manager or a relative if they had any concerns or issues with the care that they receive. The manager said that she and staff have completed training in the protection of vulnerable adults and that she will continue to train staff on safeguarding issues. The manager and staff were aware of their responsibilities regarding safeguarding vulnerable adults using the service. The manager said that ‘safe checks’ are completed for new staff before they start working at the service. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26 People who use this service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is comfortable and well maintained. People who use the service can personalise their bedrooms. Screening is in place to provide some privacy in the shared room. The home is well lit, clean and smells fresh. EVIDENCE: The home has been adapted to a care home and has four single bedrooms on the first floor and one double bedroom on the ground floor. A bathroom with a raise and lower seat is available in the first floor with a walk in shower and toilet on the ground floor. No specific aids and adaptations are provided although a small plastic shower chair is used to move two people from the lounge to the dining area, toilet and bedroom. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 16 The environment is well maintained with communal areas and bedrooms being redecorated in the last year, five new chairs purchased for the lounge, new carpet fitted in the entrance hall and dining area, new paving in the front and back garden and new benches bought for the back garden. People who use the service made positive comments about the improvements to the back garden and the carpet in the dining area. The manager reported that they need to buy a new cooker and could improve the environment by purchasing new dining room chairs. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service are satisfied with the care and support they get. Sufficient staff are available to meet peoples needs. Staff complete training to help them carry out their role. Staff recruitment is in line with regulations. EVIDENCE: Friday Road is a small family run business with two staff employed to support the manager, owner, immediate and extended family members provide care and support to people who use the service. The published staff rota showed two members of staff on duty during the day and asleep but on call at the home at night. These staffing levels were seen to be sufficient to meet peoples needs. People who use the service did not raise any issues about staff levels or the support they receive. The staff rota was updated during our visit to reflect the staff on duty during the afternoon. One person said that staff are ‘always’ available when needed and that staff ‘listen and act’ on what they say. Two people said the manager is helpful and kind and that staff give the help they need. We saw that staff files have been updated to include a recent photograph of the individual and proof of their identity. Staff recruitment practices remain 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 18 good with the manager demonstrating an understanding and awareness of the checks to be completed before new staff are employed. One member of staff has completed NVQ training to Level 2. The cook has completed training in food hygiene. Some of the family members have completed nurse training. The manager said that they access training through the National Care Homes Association and can send staff to courses run by the local authority, although none completed recently due to NVQ training. The manager is aware that they could offer staff more training to help enhance peoples quality of life, however course have not yet been booked. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience to run the home. The owner and manager are key to providing the service and ensuring staff and family members continue to provide a good level of care and support to people. The AQAA contained relevant information about the service, improvements made and plans for the future. The home has clear health and safety policies and records are up to date and in good order. EVIDENCE: The manager has over twenty years experience working with older people and has been managing the home for over eight years. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 20 The manager said she has sent out surveys to relatives and other stakeholders, however only a small number of responses have been received. Information from the surveys still needs to be looked at and an action plan developed to improve the services if required. The manager said that formal residents/house meetings are not held as this would not be the most appropriate way to involve individuals in the day-to-day running of the home. The small nature of the home means that the owner and manager are available every day and spend time with individuals which they can use to discuss any proposals to improve the service. We saw health and safety records and copies of certificates to be in place and up to date. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It is recommended that the manager completes training in person centred care so she can pass this to staff and provide better care to people using the service. 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 10, Friday Road DS0000027223.V363373.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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