Inspection on 19/08/09 for The Haven

This is the latest available inspection report for this service, carried out on 19th August 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

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Haven (The)

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Rugby House Project

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Haven 25A Wincott Street London London SE11 4NT     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: Mary Magee     Date: 2 1 0 8 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 35 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 35 Information about the care home Name of care home: Address: The Haven 25A Wincott Street London London SE11 4NT Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Seiriol Prys Parry Type of registration: Number of places registered: care home 25 West London Mission Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence Additional conditions: The maximum number of service users who may be accommodated is 25 The registered person may provide the following category of service only - Care HomeCode PC to service users of the following gender Either whose primary care needs on admission are within the following category Past or present dependence on alchohol Code A Date of last inspection Brief description of the care home The Haven offers long term care and accommodation to men and women who have chronic alcohol problems. The service relocated to this premises in October 2008 temporarily, while a new premises is developed on the original site in North london. A philosophy of harm reduction informs practice within the home. There are 25 single bedrooms, with a range of communal lounges and a dining area. It is not wheelchair accessible. Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 25 25 Brief description of the care home The home is located in kennington, South east london. Referral is via a community care assessment from the local authority responsible for placement. The full charge is £701.15 per week. Care Homes for Adults (18-65 years) Page 5 of 35 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: We completed this unannounced key inspection over two days, two inspectors were involved. We reviewed all the information we had about the home prior to the visit. We spoke with twelve residents over the two days, some choose to speak alone to us, others felt more at ease in a group. Residents invited us to view all communal areas and twelve bedrooms. Four residents returned surveys to us. We met with the manager and deputy manager, we spoke to five members of staff on the visits. We talked on the telephone to three care coordinators that have placed residents at the home. Since the last inspection we received reports that the home sent us about significant incidents and accidents. We examined records relating to the servicing and maintenance of equipment at the home,those recording fire evacuation and fire prevention procedures. The service has registered the service to a new premises which had to be prepared and made fit for purpose after being vacant for a number of years. Prior to the visit the manager completed an Annual Quality Assurance Self-assessment. The information we received from all the above sources was used to inform the Care Homes for Adults (18-65 years) Page 6 of 35 judgments made in this report. The judgments have been made in relation to the outcomes for the group of residents this home caters for. We recognize that homes such as the Haven have a very specific remit, which does not necessarily fit in neatly with the NMS. We have therefore tried to apply the standards and regulations in a way that is useful to the development of this service, and the people who live there. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: We recognize the dedication and commitment of staff to successfully transfer the service and a high number of vulnerable people to a new premises. Residents liked and were familiar and comfortable in their environment in North London. They had to become acquitted with a new premises, and establish contact with unfamiliar health professionals. The service did a magnificent job during this transition, hover some shortfalls have occurred in the service. Record keeping is not sufficiently robust and could be maintained more up to date . Key working sessions are important to residents, these need to be held regularly and Care Homes for Adults (18-65 years) Page 8 of 35 consistently. All residents need to have a written care plan developed that outlines all the areas where help and support is needed. The home needs to strengthen procedures when supporting individuals to manage their own finances. Staff recruitment needs to be more robust, when permanent staff are appointed all the relevant documentation must be sought before employment begins. 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 9 of 35 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 10 of 35 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. People interested in using the service receive all the information they require and are able to make up their own mind if it is a suitable facility. The service uses all the information supplied in the care management assessment in determining if the home is suitable in meeting an individuals needs. The home could be better equipped if it complete a full needs assesment for people before they make an offer of a placement. Evidence: The relocation of the service to the current site is temporary. The provider organisation West london Mission are in the process of gaining planning permission to redevelop the original site at Holly Park into a 25 bed supported housing scheme. Over the past three years management liaised with residents and staff regarding the design of the new home. The service has operated for a decade in the premises in North London. It relocated to this site in October 2008 after much planning. All the support staff and management team transferred with the service. We received a copy of the newly produced brochures, we viewed a new care home Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: guide which consists of a statement of the aims and objectives of the care home, a statement as to the facilities and the services which are to be provided. The information includes recognition that, for many, rehabilitation is not a realistic goal, and residents are able to consume agreed limited amounts of alcohol. We found that residents and staff were fully consulted on the planned move. The service has accepted a number of new referrals since moving to the new premises. We examined the assessment and admission process. We heard from the manager and staff how new admissions are made. The manager said they invite prospective residents to the home to see if they like it, and they have a face to face interview and an assessment of needs. Folllowing referral by care management the manager or senior staff members requests full details of the needs of the individual. A standard referral form is used. For two recently admitted residents we found that the service used the assessment information supplied by the care management team to inform the decision on accepting the person for admission. Two care coordinators told us of the preparations made prior to the admission. Theyhad escorted prospective residents to the home for a day visit. Both shared lunch and met residents and staff. Needs and risk assessments were shared with the management team. The resident had led a chaotic life so the planned admission was organised to take place at lunch period. Staff had arranged lunch to be served and make the new resident feel welcome. Prospective residents must demonstrate that they are committed to the programe to ensure a placement. We viewed the licences /contracts in place., also costs involved. We found that the management team used the assessment information supplied by care management to see if they were able to meet the prospective residents needs before they made the decision to to offer a place. We heard from the care coordinator that all essential information is shared with the home, including the risk assessments, the health conditions. Evidence suggests that the prospective residents should also have a needs assessment completed by the staff at the home before they choose to live there, and that the assessed needs are recorded. This would ensure that the assessment would also identify and recognise more fully the care and support needed. The home relied solely on the information supplied by the care manager. The needs of other residents including compatability were not considered. The care home should not provide accommodation unless the needs of the service user has been assessed by competent staff from the home, and the home is satisfied that it can meet these needs. Residents are informed of advocacy and rehabilitation programmes, if residents are interested staff assist in identifiying appropriate services and make referrals as required. The service has a staff team that are familiar with the resident group. They have the skills and experience to work with the client group, and encourage and motivate Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: residents. Care Homes for Adults (18-65 years) Page 13 of 35 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 arrangements of the service are good. Residents are supported to live in a safe environment that offers stability and security. Staff respond to individuals in a personalised manner and develop care plans with residents. The service experiences inconsistencies in written care plan development. Individuals are given opportunities to make major decisions as well as every day choices. Risks are assessed by mental health professionals prior to admission, this information is used effectively. Consultations take place on risks, and individuals receive support to understand available options, the right to take risks and to make and learn from poor choices. Evidence: We examined care arrangements, and viewed the residents files for four people at the home. There is a personnel file for each resident. On each file except for one we found that there is a care plan and risk assessment. A new resident that moved to the home three weeks earlier did not have a written care plan developed. As there was no written care plan in place we enquired about the care arrangements. Staff described Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: how they are supporting this newly admitted resident, and in the areas where he needs assistance, and that they do this in response to his care management assessment. Staff demonstrate a good awareness of the areas of risk based on care management information shared. We found that respect for privacy and dignity is always respected. Information discussed by staff is done in a confidential manner. All written records were observed to be stored securely. Limitations on facilities choice or human rights to prevent self-harm or self-neglect are made in light of risk assessment fingings. Any incidents of aggression or violence is followed up with a review meeting with a care manager and other professionals. If deemed appropriate or if there are any concerns a resident is seen promptly by a doctor or a psychiatrist. The action plans/care plans incorporate coping mechanisms including identifying patterns, triggers or cues to prevent the problem from reoccuring. We spoke to a care manager, he described the assessment process and found it to be good, he is impressed with the consideration given by staff at the home. He said They have done everything possible to ensure the new resident adapts to his new surroundings, and especially consider the chaotic lifetsyle he previously experienced . The resident too was complimentary of the service. Another care coordinator spoke of the appropriate of the placement and the difference it makes to peoples lives, regarding a resident that moved in some months earlier he found the home has the appropriate approach in promoting and encouraging, as a result he said, the resident has overcome many obstacles and has established stability in his routines We found that staff involve residents in developing personal care plans, and the assessment incorporates the agreement to the reduction in alcohol programme. This is aligned to the harm reduction philosophy of the home, agreement is sought regarding the consumption of alcohol and is signed and kept in each persons care plan. The risk assessment as well as the plans affects the lifestyle and quality of life, people are expected to conform to limititations on alchol consumption. We spoke to staff about the support needs of residents, we found that staff understand the importance of residents being supported to take control of their own lives, have comfortable surroundings, and get support and encouragement from staff to limit consumption of alcohol . For the majority of residents spoken to we heard of the many postive aspects experienced from living at at the home. Residents told us of their experience of homeslessness, poor health and isolation as a result of alcohol abuse and rough sleeping. Residents find that life at the home is pleasant, residents said staff are good and are non judgemental, some can be bossy but for the right reason, my health is Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: improving, I drink less beer Individuals are encouraged to make their own decisions and choices. The written care viewed plans vary in detail. For three residents the care plans descibed all the support needed in terms of personal care, social, emotional and cultural needs. Initial care plans are generated from the single care management assessment. Once placement commences care plans are regularly reviewed and reflect the outcome of keyworking sessions, CPAs and placement reviewes. We are concerned that one resident did not have a care plan developed, for the resident the care plan was not developed, neither was the risk assessment available. This is stated as a requrement. Following consultation with the person using the service a written plan of care must be developed as to how the persons needs in respect of his health and and welfare are to be met Care Homes for Adults (18-65 years) Page 16 of 35 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. This service enables individuals to lead a life that is satisfying and fulfilling. Residents needs are met in a way that respects individuality and freedom of choice. Residents are supported to participate in activities that they are interested in and progress aand integrate into the locality by exhibiitng behaviours that are acceptable. The health of residents is promoted by the provision of healthy eating options. Evidence: Staff help individuals live more successfully within the local communities by helping them find solutions to their problems. There are regular consultation meetings for residents every month, this encourages individuals to put forward their views and feel included in shaping of the service. Residents have an awareness of the behaviours unacceptable in the community or that offends neighbours. Rules and restrictions on smoking, and the use of drugs are understood, this is also outlined in the service guide and in contracts. Work involves engaging people with goal development, as well Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: as working closely with other organisations such as advocacy and support groups. Due to their addictions accessing work is not realistic for people that are using the service. Residents are encouraged to partake in educational courses and to develop hobbies. College courses were due to open for enrollment for the new term. Residents were unable to explore these further last year due to the move. We acknowledge that the relocation of the service to unfamiliar teritory prevents people from accessing the activities and venues they were familiar with. Some of the residents spoke of the interesting sites they have visited since moving to South London, e.g The War Museum, The South bank. The staff at the home ensures that residents claim for their full benefit entitlement. These are paid directly into their bank accounts. All residents are actively encouraged to develop and maintain non-abusive friendships. Through careful planning the home has been able to re-establish indviduals contact with friends and family. Routine practices in the home are as flexible as possible and rules and sanctions are kept to a minimum. There are particular practices in place to minimise the risks to individuals who are particularly vulnerable by reason of their alcohol addiction and mental health needs. People move to the home on long term placements. We heard from the manager of the work by staff in supporting individuals to achieve small but achievable goals. The experience and skills of staff recognise that with individuals progress is slow, and that the longer term improvements in lifestyle will benefit the residents. We were informed of the progress of recenty admitted residents. A care manager that placed them at the home spoke positively of the progress made by one of the residents. He told us the person was long term street homeless, he has responded really well to the care and support given at the home. We heard of the efforts made by staff to help individuals achieve goals. Restrictions are fully explained to each prospective service user when they are assessed, this is then followed up at keyworking sessions. Residents are encouraged to attend weekly activities and participate in local events. A resident wanted to visit the place where he grew up. Staff arranged a holiday where he was able to meet his childhood friends and they were able to reminisce about the trials and tribulations that they got up to when they were younger. Another resident has made contact with his family in Poland after years of separation. It is hoped after further planning that he can move back home to Poland. For another person recently moved to the home he has had much success in reestablishing relationships with his partner and children, I am glad I am here, I have moved forward in my life thanks to the motivation by staff, I am able to visit my children now. Residents enjoy receiving regular meals in a pleasant setting. People find that meals are good and that consideration is given to promoting good health, residents said, I feel so much better as I have good meals every day, We get Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: healthy meals, fresh vegetales and fruit are available. Residents are involved in menu selection and food selection is disussed at residents meetings. We viewed the menus, they offer variety and cope for the individual choices of residents. The chef was preparing the lunch when we first arrived. Because of the physical effects of long-term use of alcohol the home placed an emphasis on providing a balanced and healthy diet. Three meals a day ae provided, with special dietary and cultural needs, and preferences, being met. There is a vegetarian option at both lunchtime and for the evening meal. Care Homes for Adults (18-65 years) Page 19 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good communication links are experienced with external health professionals. Residents have their health care needs promoted by staff that are vigilant and prompt to respond to any setbacks. The service experiences shortfalls due to the way reworking sessions are organized, also the collation of essential information. Evidence: The service makes relevant notifications of incidents and accidents. We examined the records received for the last two years and found that appropriate actions were taken as needed. The nature of the service means that the majority of residents have developed alcohol related health conditions that require frequent monitoring, and treatment. The home develops a package of care that is customized around a residents lifestyle, health concerns, personal support. Staff take time to discuss directly with each person particular needs and circumstances. Staff are proactive in encouraging residents maintain their own personal hygiene. Residents are registered with the local GP, dentist, optician and mental health services upon admission to the home. Care plans are drawn up from identified health care Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: needs in the single care management assessment. . Staff regularly provides information regarding the dangers of consuming excess alcohol and also refer them to the alcohol advisory service., these are discussed at key working sessions. Each person is allocate a named key worker. Keyworking sessions are not taking place with the required frequency for each resident. According to a resident he had no key working session for many months, records too confirmed the lack of the one to one sessions. Residents are able to see the health care specialist on their own or with a member of staff. In this area we found that the key worker makes sure that hospital and other health care appointments are attended. There are areas of inconsistencies in this too. On some files key working sessions were kept up to date and record accurately the outcomes and progress from the previous month. However information is not held consistently, for one resident we were unable to verify the outcome of appointments, results of blood test results since December 2008. The keyword did not record a number of important facts. The daily diary is used to record information on all residents such as doctor and hospital appointments but this is not transferred to the individual file. We observed hand overs on the staff team . These were observed to be thorough. This failure to transfer the information to the residents file has the potential to overlook the next appointment or follow ups. We found that the results of blood tests were not inserted on the residents file some six months after the test was completed. The health care needs of residents must be promoted with consistent practices in place for recording and communicating the information. Residents must receive where necessary treatment, advice and other services from any heath care professional. Residents are not encouraged to administer their own medication because of short/medium term memory loss as a result of long term alcohol abuse. There is a robust policy in place regarding the administration, receipt and disposal of medication. We examined the procedures All staff have received appropriate training. A senior member of staff takes responsibility for promoting safe medication procedures. Medication audits are conducted regularly every month. Medication is dispensed in Blista packs, medication not suitable for this method is supplied in original container. This is counted in and out and records confirm this. We found that occasions have arisen when residents are not swallowing medication and spit it out later, when staff member is no longer present. Staff members administring medication should make sure that staff know how to deal with problems associated with individuals taking the medication administered. Staff demonstrated a sound understanding of conditions experienced by residents, they are vigilant and know how to respond to both chronic and acute conditions. Many residents have long histories of involvement with the crimnal justice system. Through the provision of good quality accommodation the recurrence of such episodes is reduced considerably. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: The relocation of the home to South London has resulted in residents experiencing many changes to health professionals they are familiar with. Staff have worked hard to ensure that continuity is maintained. Each resident has a key worker, this has remained through the transition process. A local GP practice provides medical service to the residents, the residents find the GP service to be understanding and sympathetic. All residents have been supported to register with the practice. They have regular consultations, also consult with care coordinators, and psychiatry. For some people a visit is required to North London to consult with the relevant professional. Support workers enable residents attend the appointments. Residents are also known to the district nursing service. Care Homes for Adults (18-65 years) Page 22 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service promotes the views of residents and uses these ideas and suggestions to inform the service development. The services policy and procedure on the protection of vulnerable adults fully complies with best practice guidance and gives clear guidance on local authority safeguarding procedures. Evidence: Residents are encouraged to discuss any concerns at key working sessions with allocated staff. At review meetings care managers ensure that each resident has a copy of the funding boroughs complaint procedure. All staff at the project have received PO VA training. We found that staff spoken to are knowledgeable on local authority safeguarding procedures. The home has a copy of Lambeths Vulnerable Adults Policy & Practice Guidance. The manager understands the guidance on implementing multi-agency policies and procedures. Staff understand the client group, also that those suffering from alcohol induced dementia may be verbally abusive due to their cognitive impairment, and that careful consideration must be give on how to resolve these issues. The majority of staff have received aggression management training. All financial transactions are recorded to ensure an audit trail. These records are kept in the main office where only designated staff are able to access. All monies held are kept in a safe. We checked the money held for two residents, we found it to be accurate according to records held. Two staff at the beginning of each shift check the cash held. It is very time consuming job as there are twenty residents, plus Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: checking the homes petty cash money. We noted that for a number of purchases some made by the residents relative there no receipts. We were told this sometimes happens when relatives take residents out, and the resident spends but they dont always get a receipt. Staff too find it difficult they say to get families to bring back receipts. Some residents manage their own money. Residents use either a post office or bank account. Large sums of money had been withdrawn but there was no receipt to say how it had all been spent or by whom. We discussed the methods used currently,which leaves the system open to abuse and staff vulnerable to possible accusations of financial abuse. There needs to be a more robust system in place to protect residents from potential abuse, and staff from possible accusations of financial abuse. A Requirement is stated. West London Mission has a gifts and donations policy which stipulates that charitable income is recorded. The numbers of formal complaints are low. Residents interviewed feel confident that the service welcomes the views of residents, they feel able to voice their concerns. The relocation of the service to thisvenue was a very stressful time for residents and staff. Management and staff are to be commended on the efforts made by staff to ensure as smooth a move as possible. They liaised with everyone concerned to make sure communication was good, and to allay individuals fears. Care Homes for Adults (18-65 years) Page 24 of 35 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 premises offer a safe comfortable envirornment where people can find security. Evidence: Prior to relocation to Wincott Street a full Disability Discrimination Assessment of the building was carried out. From this report the service completed a number of installations to make the building more accessible, however as the building is old there are restrictions for those with severe mobility issues i.e. there are two sets of stairs leading to and from the dining area and a further set of stairs when exiting the building also no lift access to the 15 first floor bedrooms. We found the premises communal areas to be pleasant. The communal areas were clean at the beginnig of the day, but as the day progressed some areas were more stained from the spillage of drinks. We toured the communal areas, and viewed twelve bedrooms. The bedrooms varied according to individual wishes. Some residents choose to display possessions that they have treasured over the years, others have few possessions as they were rough sleepers for long periods in the past. Keyworkers should endeavour to help individual residents personalise their bedrooms. Each room was comfortably furnished with clean bed linen and suitable furniture. Residents choose to express themselves as they like, and rooms reflect choices of Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: lifestyle. Bedrooms are the only personal space residentsy have. For many it may be the first time for many months/years that they have had such a space. Staff promote individuality, and take responsibility to ensure that the home is clean and hygienic, the individual choice of each resident also has to be respected. We found evidence on this visit to demonstrate that staff at the home work hard to achieve a good balance. The building is much bigger than the premises Holly Park, therefore they have been able to allocate a games room which has a pool table, table tennis and a computer for residence use. There are some problems with water presure for hot water supply, this is an ongoing issue. The service needs to make sure that the hot water supply is attended to and that residents comforts are considered. Care Homes for Adults (18-65 years) Page 26 of 35 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. The service benefits from the presence of a stable staff team. The organisation provides training and development to equip staff with the relevant skills. As a result of increased worload in relation to relocation staff are not receiving the supervision as frequently as they requre. Evidence: The staff team have not experienced much changes despite relocation of the service. We were able to sit in on the handover. Staff were very though and went through the welfare of each person using the service, stating how they had been and any issues that had arisen on their shift. They demonstrated a good awareness of confidentiality during the handover. We spoke to four staffafter the hand over session. Staff are reasonably happy working in the home , it has meant longer journeys for staff to travel from home to work place. All are long standing members of staff. They said they had regular supervision and team meetings which they found helpful and they felt supported by the management of the home. They said there was regular training by the organisation and mandatory training was kept up to date. They said they had done the food hygiene course, health and safety, medication and POVA but not moving and handling because they didnt do this with residents. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: We recommend this may be something that needs to be done because there could be a time when it is required. There is low turnover of staff, this gives stability and consistency. We examined staff files for two new members of staff recruited shortly after the last inspection in 2006. Both members of staff were supplied as temporary agency staff prior to appointment as permanent staff to current posts. The accompanying documentaion was supplied by the agency when supplied on temporary assignment. References were suppliedand other relevant supporting documentation was present. Since taking up permanent posts a new CRB was not requested. A requirement is stated. The staff team is consists of a group with a wide range of individual skills and experiences. These range from persons with BSc,BTEC management, Dipsw. Of the remaining staff the majority have achieved NVQ level 3 in Care and independence. Due to the the relocation this has placed additional pressures on management and staff. We observed that some of the training is overdue. The service should ensure that all the planned training is delivered and that staff training is kept up to date. Staff have regular meetings, and staff say they feel that they are supported and get supervision. Records seen did not support this fully, as supervisions records were inconsistent. We also found evidence of areas of practice where there were shortfalls. Much of this is a result of the additional pressure due to the relocation of the home. The manager must ensure that staff receive regular supervision and that areas od practice are monitored for performance. Care Homes for Adults (18-65 years) Page 28 of 35 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. There is an effective quality assurance process. The service benefits from the presence of an experienced and competent manager. Additional pressures associated with the relocation has resulted in some shortfalls in record keeping and health and safety audits. Evidence: The registered manager is qualified and has many years of experience with the client group. He has shown good leadership skills through the difficult stages of planning and moving the service to South london. The premises had to be prepaid for the operation of a new service, registered and suitably equipped after a long period of closure. Staff and residents commented favorably on the calm effective manner of the registered manager throughout the upheaval. The service has an effective quality assurance process and the voices of residents are included. Residents are consulted on an ongoing basis, The manager in conjunction with the Deputy, chairs residents meetings where individuals are able to discus matters of concern. This enables management to Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: understand the residents needs in an open and transparent forum. Each resident is encouraged to complete and annual questionnaire requesting feedback on the positive and negative attributes of the home. In addition, every month a member of the organizations management committee visits and feedbacks issues raised by individuals. The manager demonstrates a commitment to the promotion of equal opportunities in the service. We found that there are areas of record keeping that need to improve. Records in relation to care planning missing for a resident, records of key working sessions absent for months, records of appointment and hospital checks not completed in relevant formats. We found further shortfalls in health and safety check documentation. Members of staff are assigned responsibilities such as medication audits and health and safety audits. We found that no health and safety audits were completed for some months recently yet this was the practice prior to the move. A requirement is stated that record keeping must improve. Fire prevention measures are in place. A range of fire fighting equipment and emergency lighting is supplied. This is serviced and maintained in good order. There are restricted areas for smoking including some bedrooms. Fire drills are conducted with the frequency specified in the fire risk assessment. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 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 6 15 Following consultation with the person using the service a written plan of care must be developed as to how the persons needs in respect of his health and and welfare are to be met. So that staff working at the home are kept informed of the support and care needed. 30/09/2009 2 18 13 Staff must make sure that 30/09/2009 residents have regular and consistent key working sessions, and that these are used to monitor and support individuals health care needs. . 3 19 13 Residents must receive where necessary treatment, advice and other services from any health care professional. 30/09/2009 Care Homes for Adults (18-65 years) Page 32 of 35 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 The health care needs of residents must be promoted and protected with consistent practices in place. 4 23 13 The registered person must ensure there is a more robust financial accounting system in place to protect both residents and staff . To prevent allegations of financial abuse. 5 27 23 The service needs to make sure that the hot water supply is attended to and that there are adequate supplies of hot water available for residents. For the comfort and convenience of residents. 6 34 19 The registered person must 30/10/2009 not employ a person to work at the home unless he has obtained in respect of that person all the necessary documentaion as specified in Schedule 2 To safeguard vulnerable people 7 36 18 The manager must ensure that staff receive regular supervision and that areas od practice are monitored for performance. 30/09/2009 30/10/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 33 of 35 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 To promote good practice 8 41 17 Record keeping must improve, records referred to in Schedule 3 must be maintained up to date. Information in respect of each resident must be made available 9 42 13 All parts of the home to which residents have access must be kept free from hazards. Records must be held of the regular health and safety audits conducted To promote a safe hazard free environment 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 30/09/2009 30/09/2009 1 2 The care home should not provide accommodation unless the needs of the service user has been assessed by competent staff from the home, and the home is satisfied that it can meet these needs. Staff members administering medication should ensure that staff know how to deal with problems associated with individuals concealing the medication administered. Keyworkers should endeavour to help individual residents acquire a sense of ownership and personalise their bedrooms. The manager should ensure that all the planned training is delivered and that staff training is kept up to date.. Page 34 of 35 2 20 3 24 4 35 Care Homes for Adults (18-65 years) 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. 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