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Inspection on 16/01/09 for Bowley Close, 3

Also see our care home review for Bowley Close, 3 for more information

This is the latest available inspection report for this service, carried out on 16th January 2009.

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

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bowley Close, 3 Farquhar Road London SE19 1SZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Pritchard     Date: 1 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.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: Bowley Close, 3 Farquhar Road London SE19 1SZ 02087614461 02072614148 3bowley@choicesupport.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Choice Support care home 4 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 4 4 4 people with learning disabilities and mental disorder, some of whom may be over 65 years of age Date of last inspection Brief description of the care home 3 Bowley Close is a purpose built bungalow. It is in a quiet cul-de-sac near Crystal Palace and is part of a small complex of registered care homes, managed by Choice Support and maintained by Hyde Housing Association. It is registered to support four adults who have learning disabilities. The home has four large single bedrooms, a shower room and a bath room, both with adaptations for people with physical disabilities. There is a large living room and an accessible garden on two sides of the home. There is ample on road parking and the home is close to bus and British Rail transport links. The road from Bowley Close to Crystal Palace is steep and could be difficult for anyone with a mobility problem. In January 2009 there were four residents living at the home. The current residents pay between £35.80 and £73.50 a week, additional fees are paid by the placing authorities. Care Homes for Adults (18-65 years) Page 4 of 26 Brief description of the care home The Manager has stated that he makes available information about the home as does the Service Manager. Potential residents are encouraged to visit the home to meet other service users and they given information about community facilities, leisure activities and transport arrangements. Copies of inspection reports made available to service users, relatives, advocates and discussed at annual review meetings with the Social Services staff. The reports are discussed at team meetings. 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and carried out over a day in January 2009. The inspection methods included discussion with care staff, observation of care practice, a tour of the building, inspection of files and a range of records and policy documents. Staff and involved professionals were sent survey forms so that they could contribute to the inspection process if they wished. We are grateful for the contributions received. The CSCI has access to information gathered through notifications from the home. A document called an Annual Quality Assurance Assessment was completed by the Registered Manager of the home and returned to the inspector. It provides information about how the home is addressing the National Minimum Standards along with factual Care Homes for Adults (18-65 years) Page 6 of 26 information about the operation of the home. All of this information has been taken into account in compiling this report. Staff facilitated the inspection visit. They were helpful and courteous throughout the process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 8 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 9 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 policies and procedures for admission ensure that both the home and the potential resident have enough information to decide if the placement is suitable. Evidence: There have been no new admissions to the home for some time and none are planned, currently there are no vacancies at the home. The Registered Manager stated that in the event of a referral information would be made available to a prospective resident and they would be invited to meet the other residents of the home. The policy of Choice Support is for social work assessments to be obtained before admission and for placements to have a twelve week trial period. The Registered Manager said that he would obtain the social work assessment for a potential resident to be sure that the home could meet the persons needs. Care Homes for Adults (18-65 years) Page 10 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 care plans contain useful information to provide consistent care for the residents. Some documents need review to ensure that they are still relevant. People who are important to the residents and care about them are invited to take part in care planning. A risk management system allows residents to take part in a range of activities. Information is stored safely. Evidence: Each of the residents has a key worker who coordinates the care planning process. We looked at two of the care plans in particular detail. The files included a range of guidelines which will assist staff to provide appropriate care for the residents. We were concerned that some of the care guidelines were rather old and there was no indication on some of the documents whether they had been reviewed and judged to be still appropriate. Ideally some of the older documents should be dated so that it is clear which documents are relevant. The residents need assistance to make decisions about their lives. Advocates and, Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: when appropriate, close family members are invited to care planning meetings. The managing organisation has links with a service called Surprise, previously known as Customer Watch, which is a forum through which people with learning disabilities can express their views on the services provided through Choice Support (Southwark). This ensures that the opinions of service users generally are included in the overall planning of the organisation. Risk assessments were on file, they allow residents to follow a range of activities with safe arrangements to minimise any associated risk. Personal information is stored with due regard for confidentiality. Choice Support is registered under the Data Protection Act and there is a confidentiality policy to ensure that staff handle personal information with care. Care Homes for Adults (18-65 years) Page 12 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. The residents are assisted to lead active fulfilling lives and follow a range of activities. Visitors are welcomed to the home so that residents can see people who are important to them. The menu is appropriate for the residents needs, but menu records need to be kept accurately. Evidence: All of the residents are assisted to lead active lives following activities in keeping with their interests and needs. Examples of activities followed by the residents are going to art classes; attending a Pop-In club; visiting people at another Choice Support home; having meals out and shopping in the local area. One of the residents has, until recently, been sailing at a sailing facility for people with disabilities. He also uses a sensory room in Greenwich. During the week prior to our visit one of the residents went to a musical concert in Croydon. When it is possible residents use public Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: transport, otherwise taxis are used to ensure that they are able to access community facilities. Specialist equipment to suit residents individual needs has been bought and this has allowed development of their activities in the home. This meets a recommendation made at the last inspection of the service. Arrangements were being made for a party to celebrate the 40th birthday of one of the residents. Residents are supported to keep in touch with people important to them. During our visit one of the residents had a visitor. It was noted that the residents bedroom has been arranged so that she can receive visitors in there and it is comfortable and welcoming. The menu is planned with consideration of residents nutritional needs. Details provided by speech and language therapy services are available to assist a resident who has swallowing problems. We noticed on a menu record that one of the items given contravened the advice - ie the record showed that the resident was given rice, although this was not advised by the therapist. We discussed this with a member of staff who believed that all of the staff were aware of the advice. We consider it likely therefore that the record keeping is at fault and have made a requirement about this issue. Otherwise the dietary arrangements were suitable. Care Homes for Adults (18-65 years) Page 14 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. The residents medical, personal care and health care needs are attended to well. The files should be sorted and tidied to ensure that the most relevant information is prominent. Evidence: All of the residents have specialist communication needs and it is important that staff know them well or have accurate guidelines to refer to. Some of the staff team have worked with the residents for some time so know their needs well, however there has been some recent use of temporary staff. It is acknowledged that the effects of this has been mimised by the permanent staff team working additional hours. Nevertheless it was judged that the information available to temporary staff would be improved if the files were sorted out and older guidelines archived so that it is clear which papers are currently relevant. There is good liaison with health care professionals and we could see that appropriate referrals had been made to a range of specialists - including, physiotherapy, speech and language therapy services and challenging behaviour specialists. However in some cases we could not assess whether appointments had been followed up and if further Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: action was required. An example of this is on the file of one resident a chiropodist recommended a six monthly check up. It was not clear whether this had been followed up. Although we sent surveys to a range of professionals we have not, at the time of writing, received any feedback from them. The medication arrangements were good. The storage facilities are safe and appropriate, medication administration records in good order and the use of medication used on an as needed basis was well recorded. Staff competency in this area had been assessed. Information about residents funeral arrangements was recorded on files. Care Homes for Adults (18-65 years) Page 16 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. The complaints and safeguarding procedures contribute to the protection of residents. Evidence: There have been no complaints made about the services offered at the home over the last year. The procedure is included in the service user guide and includes the required information. Issues of concern are appropriately reported to the placing authority for consideration abouth whether an investigation under their safeguarding procedure is necessary. CSCI are also informed of events of this nature. The Annual Report issued by Choice Support includes information that the organisation has conducted a thorough review of their policies, procedures and training to ensure that they are aimed at the protection of people who use their range of services. Choice Support introduced a new safeguarding adults policy and procedure in March 2007. The judgement of the CSCI is that this is a thorough document, which is clearly written, and links all the aspects of safeguarding. The policy also introduces an internal protection committee. It is judged that this demonstrates that Choice Support is actively working to improve processes and practice. There are safe arrangements for keeping service users valuables, including checking balances of cash at each shift change and management checks. When recruitment records were inspected we found that they contribute to the protection of people who use Choice Support services as they are thorough and meet Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: the legal requirements. Staff are given a handbook, which includes a summary of the safeguarding policy and the whistleblowing policy. Care Homes for Adults (18-65 years) Page 18 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 residents benefit from a home which is clean, comfortable and homely, has adequate communal space and personalised bedrooms which suit their individual needs. Evidence: The home is a purpose built bungalow that allows all of the residents to have access. It is in a good state of repair. The building is homely and comfortable. Bedrooms have been individually decorated and personalised. There is ample communal space. The bathroom and the shower room are appropriately equipped. Consideration should be given to the redecoration of the bathroom as it is showing signs of wear and tear. There are specialist items of equipment available to keep residents safe and to meet their specialist needs. Laundry facilities are suitable for the needs of the home. There were no offensive odours when we visited. Care Homes for Adults (18-65 years) Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been a period during which additional hours were worked by the staff team to cover all of the shifts. Efforts were made to make sure this did not affect the residents care. Recruitment is safe and protects residents. The training plan should be reviewed to make sure it meets the needs of the staff and helps them to do their work well. Evidence: The staff team consists of, in addition to the Registered Manager, six support staff, two of whom work only at night time. During the week that we visited one member of staff had returned from maternity leave and another had just transferred from another Choice Support service. Prior to this the rota indicated that there had been significant use of bank staff. Several members of the staff team had worked additional shifts in order to cover the gaps in the rota. Some responses on surveys referred to the need for higher staffing levels and we relate this to the period prior to our visit when there were low levels of staffing. We anticipate that as two people had recently returned to the home these problems will be reduced, but as the residents have very high care needs, it is important that staffing levels are kept under continual review. The last information that we had was that all of the staff were either studying towards, or had already achieved, NVQ 2. The feedback from staff was that there was good Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: training in relation to manadatory courses such as health and safety issues, safeguarding and moving and handling. Although some people felt that their basic training needs were met, several people indicated that they would welcome more training opportunities. Inspectors visited the head office of Choice Support to examine recruitment files. We examined twelve recruitment files. Staff members from all levels were represented in the selection and they are employed at a variety of registered care homes run by Choice Support in Southwark and Lambeth. The files were in good order and all but one item specified by Regulation was present in the files. All of the files had the required checks and references, including Enhanced CRB checks, two references, full work histories and verification that they are physically and mentally fit for their work. We found that the majority of files did not contain a recent photograph of the employee. We discussed this with a member of the Human Resources team and he has agreed to ensure that this is amended. We were pleased to see that service users have been involved in the recruitment process and see this as an area of good practice. Care Homes for Adults (18-65 years) Page 21 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. Management arrangements are good, effective monitoring systems are in place. Health and safety of service users and staff are protected. Evidence: The Registered Manager has been registered under the Care Standards Act since 2005. He is appropriately qualified and experienced for the role. Staff feedback was that he is supportive and helpful to the staff team. He will be assisted in his role when the Assistant Team Manager post is filled. There are a number of ways that Choice Support monitor the quality of the service provided at the home. Managers of other homes within Choice Support carry out monthly visits. Senior managers within the group conduct audits of the service based on standards set by an organisation called REACH. It is aimed at assessing service users experience of life in the home. The Directors, Managers and Trustees of Choice Support meet regularly with representatives of service users who sit on a service user forum. They are involved with reviews of policies and procedures and two people with learning disabilities are Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: part of the organisations Quality Assurance subcommittee. A national survey by Values into Action had been commissioned by Choice Support to assess the opinions of service users. At a more local level the Registered Manager completes a quarterly report for the residents placing authority. These monitoring systems supplement the internal scrutiny and act as a further safeguard for residents. The health and safety records were in good order, showing that appropriate checks of systems and procedures are carried out at appropriate intervals. Care Homes for Adults (18-65 years) Page 23 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 24 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 17 17 It is required that accurate records of the food provided for service users are maintained. So that the suitability of the diet for each service user can be assessed. 13/03/2009 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 2 6 19 It is recommended that documents which are no longer relevant are archived. It is recommended that the residents files are tidied to ensure that the information about their health care needs and the outcome of appointments is given prominence. Consideration should be given to redecoration of the bathroom as it is showing signs of wear and tear. The Registered manager should review the training and development plan for the home to make sure it is adequate to meet the needs of the home. 3 4 27 35 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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