Inspection on 11/11/09 for Admiral House

This is the latest available inspection report for this service, carried out on 11th November 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Admiral House 01/04/08

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Admiral House 22 Thrale Road Wandsworth London SW16 1PA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Louise Phillips     Date: 1 1 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Admiral House 22 Thrale Road Wandsworth London SW16 1PA 02087694285 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): rajdooraree@hotmail.com Admiral Healthcare Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated: 10 The Registered Person may provide the following categories 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Admiral House is a registered care home for up to ten residents, aged 18-65 years, with mental health needs. The service has two owners, one who is the Responsible Person and the other the Registered Manager. The home is a four-storey house and each resident has a single room with en-suite, or with bathing facilities in close proximity to their room. There are a number of Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 10 1 2 0 1 2 0 0 9 Brief description of the care home communal areas for the use of residents. There is a small car parking area to the front, and a large garden to the rear of the house. The home is close to transport links that provide access to the shopping areas of Streatham, Tooting and Mitcham. At the time of the inspection the fees for the service ranged from #900 to #1500 per week. Care Homes for Adults (18-65 years) Page 5 of 26 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 inspection took place over one day and included a visit to the service by a Regulation Inspector. During the inspection we looked at the environment, and at records and relevant documentation held at the service. We also spoke to staff and observed what was going on in the service. We also received surveys from three staff who work at Admiral House, and the feedback from these are referred to in the report. Care Homes for Adults (18-65 years) Page 6 of 26 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 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 8 of 26 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. The assessment process is appropriate to ensure that the service is the right place for new people to move to. Evidence: We looked at the care files for two people who use the service. The files contain relevant information about the referral and assessment process, along with relevant information from relevant health and social care professionals involved with the person. As part of the assessment process an up-to-date needs assessment is gained from the social worker involved in their care. The home uses its own assessment form to record the assessment of new people moving to the service, which details their likes, dislikes, specific cultural needs and any safety needs in relation to all activities of daily living. Care Homes for Adults (18-65 years) Page 9 of 26 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. The needs of people who use the service are appropriately identified and relevant support plans in place. Evidence: During the inspection the care files of two people who use the service were looked at. These were seen to be reviewed every six months, or more frequently where needs have changed. People who use the service have signed these, which demonstrate that they were involved in identifying their needs. Each person has care plans that have been developed from the assessment information, and with the involvement of the person who uses the service. The care plans identify needs and support in a number of areas, such as dietary needs, cultural needs, developing domestic skills, their mental health issues and where they might be at risk of neglect. The care plan format is simple, and it is easy to establish the level of support that people who use the service have. Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: Each file contains a summary of risks, around areas such as hallucinations, anxiety, the person harming them self or others. this information has been used to inform the risk assessments and risk management plans, which are incorporated into the care plans. A requirement from the last inspection of the service was for risk assessments to be in place around the kitchen being locked to the people who use the service. The manager showed that this had been written into a general risk assessment for the service, whereas this specific limitation of people using the service needs to be recorded in each persons risk assessment. The previous inspection also recommended that one-to-one keyworker sessions, between the person who uses the service and their keyworker, should take place monthly. Evidence was seen to demonstrate that keyworker sessions do take place, and this should be continued. It is further recommended that the care plans are updated following each keywork session, to ensure they are current for the person using the service. Care Homes for Adults (18-65 years) Page 11 of 26 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. People who use the service are supported to pursue individual interests and activities both inside and outside the home. There is a relaxed atmosphere at the home. Evidence: The activities that people get involved in are varied depending on their individual commitments, such as where one person does an evening class whilst another goes to college. The care files contain a weekly record of what each person gets involved in, where some prefer to stay at the service more, whilst others like to go out and about, visiting relatives, and generally arranging their own time. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: People who use the service are involved in doing their own laundry and keeping their rooms tidy. At the service their is a pool table for use, table football and also people can access the internet, with the support of staff, which we observed happening during the inspection. When we looked at the food provided by the service, we observed a variety of foods that were fresh, frozen and dried. The manager said food purchased is in relation to the number of people using the service, their cultural needs and preferences. The records of house meetings record that people who use the service are consulted about their food and meal preferences. The opened jars and packets of food in the fridge are appropriately labeled with the date of opening and date to be disposed of. However, the service must ensure that dried goods, including cereals decanted into other containers, are also labeled accordingly, to ensure the food provided is safe and nutritious for the people who live there. The manager and staff spoke knowledgeably about the people who use the service, and have a good understanding of their needs. We observed positive interactions between the staff and people who use the service. The manager said that are holiday was not provided this year, due to the people who use the service preferring not to have this. She said that day trips had been planned, though did not take place due to bad weather. It is recommended that the service look at providing more outings and short breaks, on an individual or group basis, to enhance the lives of the people who use the service. Care Homes for Adults (18-65 years) Page 13 of 26 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 are support appropriately with meeting their health and social care needs. Evidence: People who use the service are independent in attending to their personal care needs. The care files holds records of all healthcare appointments that people attend, and care plans also detail the level of support that people have with any specific physical needs. Regular reviews of peoples care takes place with the involvement of the Community Mental Health Team (CMHT) and the person. We looked at the medication held for two people who use the service. This is appropriately stored and the information on the Medication Administration Record (MAR) corresponds with that prescribed. Following a recommendation from the last inspection, a description of each medication is recorded on the MAR chart, for easy identification if a person refuses to take this, or if it needs disposing of. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: Staff training records indicate that staff have receive training in administering medication. Care Homes for Adults (18-65 years) Page 15 of 26 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. There are systems in place to reduce risks to people who use the service. Evidence: The home has a satisfactory complaints procedure and format for the logging of complaints and concerns. The complaints book details any complaint or concern received, and of the steps taken to address these. The home has a copy of the Wandsworth safeguarding adults procedures so that staff are aware of the local authority protocol for dealing with any issues of abuse. The training records indicate that staff have received training in safeguarding vulnerable adults, and that this is planned to be updated in the near future Care Homes for Adults (18-65 years) Page 16 of 26 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 environment is homely and suitable for the people who live there. Evidence: The home is on a residential street, with good access to local community facilities and public transport. There is some off-street parking and a large garden to the rear of the home. The accommodation is sread over three floors, with separate lounges for smoking, recreation and dining. Since the last inspection improvements have been made in a number of areas, including new flooring in the kitchen and addressing the damp areas observed around the hom eon the previous inspection. Handrails have been installed on both sides of the stairway to the basement area, as these stairs are quite steep. Significant improvements have been made to the rear garden, with it being a much more user-friendly and pleasant area now for the people who use the service to access. Photographs at the service show a number of the people who use the service Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: enjoying a barbecue in the garden in the summer. A summer house has also been installed in the garden, which the manager said would be used as a games room in the future. The home was observed to be clean throughout and fresh-smelling in all areas. Care Homes for Adults (18-65 years) Page 18 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive some training relevant for their role, though the service must ensure that this is up to date. Improvements must be made to ensure that thorough recruitment processes are practiced at the home, to minimise risks to people who use the service. Evidence: Since the last inspection the staff team has increased, in response to the increased number of people using the service and with their now being a minimum of two staff on each shift throughout the day, and a waking and sleep-in staff working each night shift. During the inspection we looked at the recruitment files for three staff who currently work at the home, and who have started work since our last visit to the service. Each file contains an application form, copy of identification, and a copy of the staff members Criminal Record Bureau check. The references received in relation to two of the three staff we looked at were not good, and errors were found in each. For one staff member, the references received from a previous employer do not match the dates given on the persons CV (curriculum vitae), which in turn do also not match the dates given on the employment history that the staff recorded on their application form. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: Similarly, for another person, the references obtained did not relate to their previous employer, or to the employment history they have given on their CV. We would expect to see evidence that these discrepancies, and any gaps in employment would have been challenged by the manager during their interview of the staff member, but there was no evidence that this had happened. A requirement has been made for the service to address this, to demonstrate that they are carrying out appropriate checks on the staff they employ, so as to minimise risks to the people who use the service. We saw evidence to confirm that there is an induction process for new staff who begin working at the home. The staff training files indicate that staff are trained in areas such as food hygiene, moving and handling, health and safety, first aid and fire safety. However, in most cases, this training was provided by a previous employer of the staff, and the service needs to ensure that the training that they received is relevant to working at Admiral House, and is also in date, as in some staff files their cetificates in relation to the areas highlighted above had expired earlier this year. The training and development plan for 2009 was seen, with training planned in a number of areas, though in matching this to the training certificates of staff, there appeared to be a number of areas of training that staff still needed training in. The up-to-date recording of each staff members training undertaken needs to be recorded, along with the date when staff need to do refresher training in each area, to ensure they are competent in their role. the feedback we got from staff is that most feel they usually have enough experience and knowledge to meet the needs of the people who use the service. A requirement has been made to ensure that staff recieve up-to-date training, and that this is provided by Admiral House, so that staff receive training for the work they are expected to perform. Since the last inspection the one-to-one supervision of staff has been introduced, and records of this was seen in the staff files Care Homes for Adults (18-65 years) Page 20 of 26 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 manager is experienced and understands the responsibilities of their role. Health and safety checks are carried out to minimise risks to the people who use the service. Evidence: The manager is registered with the Commission to be the Registered Manager for Admiral House. Regular staff meetings take place and meetings with people who use the service occur approximately every three months. The area manager carries out monthly visits in accordance with Regulation 26 of the Care Homes Regulations 2001. Evidence was seen that a survey os carried out every six months with the people who use the service, where they can feedback about areas such as what they would like to improve about the service, staff helpfulness, and whether they feel able to voice their opinions. The service holds relevant certificates and records to indicate that appropriate checks Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: are carried out areas of health and safety, including the fire system and electrical systems. The gas safety certifcate demonstrates that a check of the boiler was carried out in October 2009. However, the certificate does not state that the engineer is CORGI (Council of Registered Gas Installers) registered, and this was pointed out to the manager at the time to check, to ensure that the gas systems are being checked by an appropriately qualified engineer. All accidents and incidents are recorded, and the CQC is notified appropriately. Care Homes for Adults (18-65 years) Page 22 of 26 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 23 of 26 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 34 19 The service must ensure that thorough recruitment checks are carried out on staff. To minimise risks to people who use the service 24/11/2009 2 35 18 The service must provide training to staff to ensure they are appropriately trained in the work they are expected to perform. So that the people who use the service received support from appropriately trained staff. 24/11/2009 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 6 The service should demonstrate that the care plans are updated following each keywork session, to ensure they are current for the person using the service. Care Homes for Adults (18-65 years) Page 24 of 26 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 2 14 It is recommended that the service provide more outings and short breaks, on an individual or group basis, to enhance the lives of the people who use the service. Individual training records should be used at the service to record all training undertaken by staff, and when these are due to be refreshed. The service should ensure that gas safety checks are carried out by a CORGI registered engineer. 3 35 4 42 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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