Inspection on 12/01/09 for Admiral House

This inspection was carried out on 12th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Admiral House 01/04/08

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Admiral House 22 Thrale Road Wandsworth London SW16 1PA     The quality rating for this care home is:   one star adequate 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: Louise Phillips     Date: 1 2 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 28 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Admiral House 22 Thrale Road Wandsworth London SW16 1PA 07980211927 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) : rajdooraree@hotmail.com Admiral Healthcare Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 10 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated: 10 Date of last inspection Brief description of the care home Admiral House is a registered care home for up to ten residents, aged 18-65 years, with mental health needs. The service has two owners, one who is the Responsible Person and the other the Registered Manager. The home is a four-storey house and each resident has a single room with en-suite, or with bathing facilities in close proximity to their room. There are a number of communal areas for the use of residents. There is a small car parking area to the front, and a large garden to the rear of the house. The home is close to transport links that provide access to the shopping areas of Streatham, Tooting and Mitcham. At the time of the inspection the fees for the service ranged from #900 to #1500 per week. Care Homes for Adults (18-65 years) Page 4 of 28 Care Homes for Adults (18-65 years) Page 5 of 28 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day and included a visit to the service by a Regulation Inspector. We we visited we spoke to people who live at the service and the manager. We also looked at records, observed what was going on and looked at the environment. Care Homes for Adults (18-65 years) Page 6 of 28 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 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 who move to the service are appropriately assessed to ensure the service can meet their needs. Evidence: The manager described the assessment process at the service, which involves her gaining appropriate referral information from the social worker and any relevant professionals and using this to form the basis of her assessment. The homes own assessment form covers all relevant areas such as looking at what the person moving to the service likes/ dislikes, their future plans, religious and cultural needs, mental health needs and any areas of risk. Completed assessment documentation is held in the care files of the two people who currently live at the service, with information individualised to their needs and wants. Records are also maintained of the persons day visits and overnight stays at the service, prior to their decision to move in. Care Homes for Adults (18-65 years) Page 9 of 28 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. People living at the service are supported to pursue individual interests and develop independence in their lives. The formats used for identifying and managing risk behaviours are good. Evidence: Feedback from people who live at the service is that they are involved in the development of their care plan and that the service is flexible to their individual needs. The care files for the two people currently living at the service were looked at. They are very individualised to each persons needs and wants, with clear details about how the person will work to meet their needs, and how the service will support them with this. Examples of this include where one person might become withdrawn at times, or help that someone might want with losing weight. A record is maintained of one-toone sessions that the person has with their key-worker at the service, with a record maintained of the areas discussed. For one person the last session was recorded to Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: have occurred in October 2008. These sessions should occur more frequently, and a record maintained of these, to ensure that the care plan is current for the person using the service. The risk assessments in use at the service are in a good format, with the risk assessment being a tick-box, followed by a summary of the risk issue and then a risk management plan for each area. The management plan provides information about possible risk behaviours that staff need to observe and act upon, such as increased agitation or neglect of personal hygiene of the person. Staff interventions to manage increased risk behaviours are appropriate, including offering support, being consistent and informing relevant mental health professionals. Feedback from people who live at Admiral House is that they are treated well by staff and their privacy is respected. Observations during the inspection are that the staff have built up good relationships, and have a good understanding of the needs of the people who use the service. Care Homes for Adults (18-65 years) Page 11 of 28 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 service is flexible to the needs of the people who live there, to support them to gain maximum independence in their life. Evidence: There are currently two people living at the home. During the inspection they were seen coming and going from the home, pursuing individual activities as identified in their care plan. The care plans detail different activities that people using the service do throughout the day, and the role of staff in encouraging them to maintain these, such as attending college, cooking sessions, going to the gym, domestic work and visiting relatives. Feedback from people who live at the home is that they are able to make decisions Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: about what they want to do each day, and that these are supported by the flexible approach of the staff. One person who lives at the service showed us their room, which they are very pleased with, particularly because they can have their music system, television and own personal belongings in it to make it feel homely. There was seen to be a selection of fresh, chilled, frozen and dried foods for the consumption of the people who live at the home, and the manager said that they help decide what meals are cooked at the service. Some of the jars and packets of food in the fridge were opened but did not have a label attached detailed the date when opened, and a requirement has been made to address this. The kitchen at the service is kept locked, which the manager says is for the health and safety of the people who live at the service. There are no risk assessments in place to support this restriction, and these need to be developed for all people who use the service. During the inspection the manager said that people are encouraged to prepare their own breakfast and lunch, and that cooking sessions take place to develop their independence in this. However she was observed preparing a sandwich for one person who lives at the home, and said that the staff prepare the meals. The service should look at adopting a more independent living model for developing the autonomy and living skills of the people who live at the home. Care Homes for Adults (18-65 years) Page 13 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to maintain their own health needs. Medication is managed appropriately by the service. Evidence: The people who live at the service are independent in their personal care. The care files record that people are encouraged to attend regular appointments with their dentist, chiropodist, social worker or doctor as necessary. The manager said that she has developed good links with local community mental health teams, and can access their advice and support as necessary. Medication held at the service is stored appropriately and records maintained of medication received into the home. The Medication Administration Record (MAR) charts accurately reflect the medication held at the service. The people who use the service are involved in collecting their prescriptions and picking up their medication from the pharmacy. It is recommended that a description of the appearance of each medication is provided in the medication file so that it is easily recognisable if refused Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: by the person, or is in need of disposing of. Staff have received training in administering medication. Care Homes for Adults (18-65 years) Page 15 of 28 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. There are appropriate procedures for addressing complaints. Staff need to have robust training in abuse awareness to ensure risks to people using the service are minimised. Evidence: The service has a complaints policy and procedure that is displayed in the entrance hallway to the home. Feedback from people who live at the service is that they know who to talk to if they are not happy about something, and would know how to make a complaint. A form is available in the staff office for the recording of any complaints received. No complaints have been received by the service. The service does not yet have the Wandsworth safeguarding procedures, and the manager said that she has ordered this. The staff have only received a small amount of abuse training, as part of a one-day health and safety course that covered a number of areas such as infection control, food hygiene and general health and safety. This does not ensure that risks to people using the service are minimised, and it is required that more robust training is provided to all staff in abuse issues, ideally incorporating the procedures and guidelines of the local authority. Care Homes for Adults (18-65 years) Page 16 of 28 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. Admiral House is homely for the people who live there. Some improvements are required to ensure that the home is comfortable and attractive throughout. Evidence: Admiral House is homely and modern in most areas. One person who lives at the home took pride in showing us there room, and they were especially pleased that this is ensuite, with their own toilet and shower. They said that there had previously been an issue with water coming into their room, but this had been addressed promptly by the service. It was observed that there is a water stain on the ceiling where this happened, and this needs to be repainted. The staff have the responsibility of keeping the communal areas of the home clean, whilst the people who live there look after their own rooms. It was noted that improvements have been made since the last inspection, making the environment more attractive and welcoming. Some areas were seen needing attention, and these are listed below: - rubbish needs to be removed from all external areas of the home - the hole at the top of the exterior wall to the left of the building (when looking out) Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: needs to be made good - the service should consider modernising the kitchen area to bring it up to the standard of the rest of the home - the rear garden area is in need of making good, as this work is still in progress - damp areas in the basement are seen to have been addressed, though work needs to be completed in this area - the stairs leading from the ground floor to the basement are very steep and handrails need to be installed on either side of these stairs. A risk assessment also needs to be developed for each person who lives at the homes use of these stairs. Care Homes for Adults (18-65 years) Page 18 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training that is relevant to their role. Improvements need to be made to recruitment processes and supervision of staff Evidence: One person living at the service said that they staff are very pleasant and that they support them as necessary. The home does not yet have a full complement of staff, due to there currently being only two people living there. The manager works full-time and explained that the shifts are currently covered with two other full-time staff and bank staff, who work at another service run by the same owners as Admiral House. The manager said that there is one member of staff working alone at the service during the day and two who sleep-in overnight. It is recommended that a minimum of two staff are on duty at all times to promote their safety and in case any incident occurs. Currently one person on shift and two stay in building overnight. Three staff files were looked at and seen to contain relevant recruitment information. This includes a completed application form, Criminal Records Bureau (CRB) check, two references, copy of identification, photograph and a record of their interview. Contracts Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: are in place for each staff member, although these are incomplete as they do not include the hourly rate paid to staff, some of these had also not been signed by the staff of manager. The manager said that most of the staff are working on a student visa. The information contained in the staff files regarding this is vague, with some only having a copy of the visa, which states limited leave to remain, but no further information from the Home Office about what this is. There is an induction programme in place that covers covers new staff orientation to the homes policies, procedures, use of equipment and health and safety checks. Staff have undertaken training in medication administration, first aid, fire safety, health and safety and basic food hygiene. Some staff have also completed training in challenging behaviour and dealing with people who self harm. The manager said that she is currently planning for staff to do moving and handling training. One-to-one supervision between the manager and staff does not currently take place, and the manager said that she hopes to start this in the near future. There is a supervision contract and recording form in place at the service to minute the sessions. Care Homes for Adults (18-65 years) Page 20 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is experienced in her role, and people who live at the home say they feel it is well run. Improvements need to be made to the systems for measuring and auditing quality at the home. Evidence: The manager has a number of years experience in managing and providing a care service to people with mental health needs. She has worked in different care settings and says she is currently undertaking the NVQ Level 4 in Management, and has completed training in health and safety and first aid, however evidence of this was not available at the service. The service has a quality assurance questionnaire in place for people who use the service, their relatives and professionals involved in their care. The manager said that these had not been used yet. A notice was on display in the entrance hallway of a residents meeting that is to occur the following day, and the manager said that this will be the first such meeting to take place. The manager said that a visit by the Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: Registered Person, in accordance with Regulation 26 of the Care Homes Regulations 2001, is carried monthly, and that a list is left of things that she needs to do. However, more robust recording of this process is required, and a copy held at the home. Appropriate health and safety checks are carried out around the home, with records to demonstrate that up-to-date checks have been done on gas safety, water testing and fire system. Portable Appliance Testing (PAT) has been carried out recently, but before any people had moved into the service. This testing must also be carried out on all electrical equipment brought into the home, prior to its use. Care Homes for Adults (18-65 years) Page 22 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 28 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 7 16 Risk assessments must be in 27/01/2009 place for any limitations on freedom, specifically where people are unable to access the kitchen. To ensure that limitations are in the interests of people who use the service. 2 17 16 The Registered Persons 29/01/2009 must ensure that restrictions of people using the kitchen are clearly assessed and documented. So that people using the service are not restricted from using facilities unless appropriate. 3 17 16 The Registered Persons must ensure that opened jars and packets of food are labelled with the date opened. 23/02/2009 Care Homes for Adults (18-65 years) Page 24 of 28 To ensure that people using the service are provided with suitable and nutritious food 4 23 13 All staff must receive robust 23/04/2009 training in abuse awareness. A copy of the local authority safeguarding procedures must be held at the service. This is to ensure that risks to people who use the service are minimised. 5 24 23 The Registered Persons 30/04/2009 must address all environmental issues as detailed below: - room 1 - the water stain on the ceiling must be repainted - rubbish needs to be removed from all external areas of the home - the hole at the top of the exterior wall to the left of the building (when looking out) needs to be made good - the rear garden area is in need of making good - work must be completed on the damp areas in the basement - handrails must be installed on either side of the stairs leading from the ground floor to basement. A risk assessment must be developed for peoples use of these. Care Homes for Adults (18-65 years) Page 25 of 28 To make the service more safe and attractive for the people who live there. 6 33 18 The Registered Persons 31/01/2009 must ensure that at all times there are sufficient numbers of staff on duty. To ensure the safety of staff and people who live at the service. 7 35 13 he Registered Persons must ensure that all staff working at the home receive training in moving and handling. To ensure that staff are properly trained for their work. 8 36 18 The Registered Persons must ensure that all staff receive a minimum of six supervision sessions a year. To ensure that staff are appropriately supported in their work. 9 39 24 The Registered Persons 27/02/2009 must ensure that the quality assurance systems are in use at the service. To ensure that the service is run in the best interests of the people who live there. 10 39 26 A report of the visits in accordance with this regulation must be made at held at the service. 29/01/2009 31/01/2009 27/03/2009 Care Homes for Adults (18-65 years) Page 26 of 28 To ensure that the service is run in the best interests of the people who live there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 One-to-one key-work sessions should occur monthly, and a record maintained of these, to ensure that the care plan is current for the person using the service. The service should consider adopting a more independent living model for developing the autonomy and living skills of the people who live at the home. A description of the appearance of each medication should be provided in the medication file so that it is easily recognisable if refused by the person, or is in need of disposing of. The service should consider modernising the kitchen area to bring it up to the standard of the rest of the home It is recommended that a minimum of two staff are on duty at all times to promote their safety and in case any incident occurs. PAT testing should be carried out on all electrical equipment brought into the service, prior to its use. 2 11 3 20 4 5 24 33 6 42 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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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