CARE HOME ADULTS 18-65
71 London Road Southborough Tunbridge Wells Kent TN4 ONS Lead Inspector
Ann Block Unannounced 13 April 2005 10.45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service 71 London Road Address 71 London Road Southborough Tunbridge Wells Kent TN4 ONS 01892 515520 01892 515520 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mental Health Residential (MHR) Mr James Polack CRH Care Home 7 Category(ies) of MD Mental Disorder (7) registration, with number of places 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13 October 2004 Brief Description of the Service: 71 London Road is currently registered for 7 people. The house is a detached premises on three floors with an attached flat which is used for independent living and is currently not registered. There are gardens to front and rear which residents can use. There is car parking to the front of the house. All rooms are of good size with all single bedrooms. A single staircase accesses the upper floors of the main house. There are bathrooms and toilets on the first and second floors. Residents have use of a large kitchen and a laundry room. The home is close to local shops and pubs with bus services easily accessible. The main town of Tunbridge Wells, where there are all the facilities of a larger town, is approximately 3 miles away. There is a main line station approximately 1½ miles away. The home is owned by Moat Housing who have a specialist housing facility at the rear of the property. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3 ½ hours. Of the 7 residents, 4 were spoken with in private and one with a member of staff present. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service in the report. Many judgments about quality of life for residents was taken from observation, speaking with staff and records. The manager and two support workers were on duty, all of whom were spoken with. A partial tour of the premises was made which included two service users rooms and communal areas. Improvements to the bathrooms and work on restructuring the flat were seen. Some records were seen as part of case tracking and to assess work on requirements and recommendations made at previous inspections. What the service does well: What has improved since the last inspection?
Residents are able to take risks and are given guidance when this risk might be dangerous or likely to cause harm. Residents feel that making a decision whether to take a risk is understood even better now that staff have had training in the process. Residents medication is now stored in a suitable cupboard where they know it will be safe. Residents were pleased with the newly refitted bathrooms, especially the shower unit. Two residents have
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 6 recently had their bedroom redecorated and refurnished and were able to choose the colours and furniture. Residents feel that the atmosphere in the home is much improved since the staff team has settled and morale is better. In addition, residents can feel safer in the home as nearly all the staff team have completed the necessary core training. Record keeping has significantly improved, particularly in relation to staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 Residents are more able to settle in the home due to the very comprehensive admission process and written tenancy agreement. EVIDENCE: Residents said they were given good written and verbal information about the home before moving in. A service users guide and statement of purpose is available. Records relating to a recent admission contained very good detail of the manner in which the admission had been carried out. There was excellent detail of the needs, history and desired outcomes for the resident, which were well understood by staff on duty. Information available included assessments from professionals who had been working with the resident. The majority of staff have worked at the home for some time. There is a good understanding of the needs of the residents and how these may be met. Residents said that their keyworker assisted them to obtain work placements, go out socially, do shopping and attend appointments. Records made on a daily basis recorded that a resident recently admitted had visited the home and met others in the group. The record also showed that
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 9 there was a period of settling in which had been supported by staff and monitored. The resident appeared to be settled and familiar with the environment and staff. Resident files seen contained a written tenancy agreement which gave the resident security and rights of residency and detailed the residents and landlords rights and responsibilities. Residents were generally clear about their own responsibilities. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 and 10 The care planning system is good with individual goals well recognised. Residents are treated as individuals with their own hopes and aspirations. Responsible risk taking is encouraged with residents largely choosing their preferred lifestyle. Residents feel more relaxed about sharing information, as confidentiality is maintained. EVIDENCE: Staff have worked hard to develop records relating to residents care. The records seen would provide staff with suitable information to ensure the resident was offered consistent personalised support. Residents spoken with confirmed in general conversation elements of the care plan and spoke of how these had been met. Where there had been problems in providing agreed care, this was recorded and action taken. Staff understand that residents are individuals whose decisions should be respected. This was evident in daily records, speaking with residents and observing the general environment. One resident has said that the service was
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 11 ‘nurturing but you are still free’. Where there are differences of opinion which impact on safety or wellbeing these are discussed and outcomes recorded. Following successful staff training in person centered risk assessment, risk assessment recording has improved, potentially promoting residents safety and wellbeing. Residents were seen to take risks and to have those risks explained to them. Where necessary others, including health professionals, had been consulted and had recorded awareness of risk. Residents and staff were fully aware of confidentiality. A number of residents prefer to speak to staff and others in private and are offered the facility to do so. Written information is held securely and not shared with others without agreement from the resident unless deemed essential. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12,13,14,15,16 &17 Residents’ lives are enriched by the range of educational, recreational and social activities offered. Provision for meals is good and meets personal preferences and dietary needs. EVIDENCE: In speaking with staff and looking at daily records, daily living takes into account opportunities for developing independence and assertion skills. A good example of independent negotiation with others was mentioned. Keyworkers (coordinators) are responsible for identifying activities and work placements that might interest the resident. A resident mentioned a craft course she was undertaking and remarked how pleased she was to have passed her maths exam. Residents were seen to be out and about with good use of both the local area and Tunbridge Wells. Residents said that sometimes they went independently
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 13 and sometimes with staff. A resident was looking forward to a shopping trip to Bromley and spoke of a particular shop there. Many references were made to contact being maintained with family, including inviting family to meals. The visitors book recorded many visits from family. Keyworkers assist in negotiating appropriate family links. Residents rights to privacy are promoted with residents seen to lock their rooms, have post dealt with as agreed by the resident concerned and to join in with the group or remain in their rooms as they chose. According to individual preferences, abilities and choice at the time, residents may prepare their own meals, assist in the preparation of communal meals or manage their own catering. Suitable facilities for storage and cooking of meals are provided allowing for safe storage of foods for individuals. A resident spoke of the sauce and pasta he had recently purchased and was cooking for lunch. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 & 20 Residents’ health and personal care needs are well managed and promote physical and mental wellbeing. EVIDENCE: In talking with residents in their rooms, it was evident that individual preferences regarding personal care are taken into account whilst encouraging good standards of personal hygiene and self respect. Records and observation of a resident indicated the improvement achieved since moving in to the home. Records recorded regular appointments and consultations with health professionals and of general multi disciplinary working. A service user referred to a specialist appointment which she would be attending with her keyworker. A resident recently admitted had been registered with a local General Practitioner. Since the last inspection, all medication is stored in a suitable locked cupboard with administration records seen signed correctly. The systems for storage and recording administration promote residents health and reduce the risks of incorrect administration.
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 There is a satisfactory complaints procedure with residents feeling they are listened to. EVIDENCE: The complaint procedure is posted on the notice board. Residents are aware they can make a complaint and that the complaint will be acted on. A recent Regulation 37 visit recorded that minor niggles were discussed in house meetings and acted on at the time or shortly afterwards. The manager said that all staff were aware of Adult Protection procedures and knew the process for making an alert, thus safeguarding residents from the risks of harm or abuse. The manager is still to arrange for the Adult Protection policy to include guidelines. The manager recorded that a staff meeting was held on 23.11.04 where a printout on POVA was given followed by a general discussion on the implications of POVA for their service. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28 & 30 The standard of décor and furnishing in the home is good providing residents with a suitable place in which to live. EVIDENCE: Residents are responsible for cleaning their own rooms with staff support. In meeting with residents in their rooms, it was clear that personal choice is recognised unless this compromises health and safety. Communal areas are cleaned by support staff but well used by residents, this results in some areas looking somewhat untidy. Since the last inspection a fire risk assessment has been carried out. Rooms identified as being a fire hazard were discussed with the resident concerned. Each resident has a large single bedroom which is furnished to individual requirements. Two residents said they had chosen the colour for their rooms and been fully involved in choosing furniture and fittings.
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 17 There is a bathroom with toilet and shower cubicle for residents on the first floor which is in the process of being upgraded. A resident said how much she liked having a proper shower in there. On the second floor there is a separate toilet and bathroom with a shower fitment which has also been recently upgraded. Staff have their own toilet and shower room. There is a large lounge with comfortable seating and TV, a separate dining room, large kitchen which is well fitted and a laundry area. Residents have access to all communal areas although by agreement some facilities in the kitchen are locked. As the majority of residents smoke, smoking is permitted in the house. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 Residents have staff available who have the training and skills to work effectively with people with mental health problems. EVIDENCE: Staff and residents considered that there are sufficient staff on duty to meet the current needs of the resident group. Staff thought there was now more time to plan, carry out scheduled duties and to work on an individual basis with residents. A resident said she felt that her keyworker was able to spend sufficient time with her. Since the last inspection the majority of staff have now completed core training and some client specific training, other training is booked for the near future. To monitor training needs a training matrix is used. 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 The home is adequately maintained providing a safe place to live. There is limited evidence that residents and others views are taken into account when planning for the future of the service. EVIDENCE: The manager felt that whilst day-to-day work with residents was good, there was a deficit, particularly in time available, to carry out the more managerial aspects of running and developing the service and to undertake further training. There remains no formal quality assurance system, nor a recorded annual development plan. This presents a risk that the service will not grow in line with good practice in working with people with mental health difficulties nor evidence how residents and others views of the service will be listened to.
71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 20 The manager said that there has similarly been no time to formalise environmental risk assessments. A regular walk round to monitor and record risk is carried out but some risks remain as seen during the inspection. Incidents which affect the wellbeing of residents are recorded with the record showing what action was taken. A recent incident was not sent to the Commission as required by regulation. SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9
71 London Road Score 3 3 x 2 Standard No 24 25 26 27 28 29 30 Score 3 3 3 3 3 x 3
Version 1.20 Page 21 H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc 10
LIFESTYLES 3
Score STAFFING Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x 71 London Road H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42.6 Regulation 13 (4) (c) Requirement A comprehensive environmental risk assessment process which is subject to ongoing review must be implemented. An extension to a previous timescale given in the report of 13 October 2004 has been given Any incident which affects the wellbeing of service users must be notified to the Commission without delay. Timescale for action 30 June 2005 2. YA42.7 37 (1) 30 April 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA23.4 YA39.2 YA39.7 Good Practice Recommendations Guidelines to staff regarding the Adult Protection procedure should be incorporated into the policy. A formal development plan which can be used in a continuous cycle of planning, action, review should be in place as recommended at the last inspection. The quality assurance system should be extended to obtain formal views from other professionals, agencies, families and funders as recommended at the last inspection.
H56 H06 S23885 71 London Rd V217865 130405 Stage 4.doc Version 1.20 Page 23 71 London Road Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane,Maidstone Kent,ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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