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Inspection on 26/02/09 for Anthony Edwards House

Also see our care home review for Anthony Edwards House for more information

This inspection was carried out on 26th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Anthony Edwards House 27 Ritherdon Road London SW17 8QE     The quality rating for this care home is:   three star excellent 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: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Anthony Edwards House 27 Ritherdon Road London SW17 8QE 02086726360 02087673552 ilucas@servitehouses.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Riverhaven care home 6 Number of places (if applicable): Under 65 Over 65 2 2 mental disorder, excluding learning disability or dementia physical disability Additional conditions: Date of last inspection Brief description of the care home 6 6 Anthony Edwards House is a care home providing accommodation and support for up to six people with mental health problems and a hearing impairment. The home is situated in a pleasant residential area close to local shops, cafes, pubs, and with good access to public transport links. The accommodation is provided over four floors with single bedrooms, lounge, kitchen/ dining area and laundry facilities for use. Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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, who was accompanied for part of the inspection by a British Sign Language (BSL) interpreter to enable communication with people who use the service and some staff. We spoke to four staff and two people who use the service. We also sent surveys to people who use the service and the responses from these are referred to in the report. During the visit to the service we also looked at records, observed what was going on and looked at the environment. The current Registered Manager for the service is on maternity leave, and an interim manager was managing the service when we inspected. This person is referred to as the manager in the report. Care Homes for Adults (18-65 years) Page 5 of 26 Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are appropriately assessed to ensure the service is the right place for them. Evidence: Since the last inspection no new people have moved to the service. The service continues to keep the needs of the people who use the service under review, with relevant members of the multi-disciplinary teams,through Care Programme Approach (CPA) meetings and placement reviews. People who use the service are involved in these reviews and, where necessary, plans are discussed for people to move on to more independent accommodation. Care Homes for Adults (18-65 years) Page 9 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs met through appropriate care planning. Some improvements are needed to ensure risks are appropriately managed at the service. Evidence: We looked at the care files for two people who use the service. There is good information around their history and their reasons for using the service. Each person has a care plan that is based around their individual needs, such as support with mental health needs, physical needs, communication, developing social skills and daily living skills. People who use the service told us that they are involved in planning their care, and that they meet with their key-worker each month to review their care plan. It is unclear why the care plans are reviewed monthly, particularly where some of the needs/goals that people have are long term and do not need to be reviewed this Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: frequently. Examples of this are the care plans written around peoples BSL communication needs, mental health needs, wearing a hearing aid and attending healthcare appointments. Consideration should be given to reviewing care plans at more appropriate intervals. The care plans for each person are kept together in large folders on a shelf in the office. It is recommended that individual files are used, that these are archived, and it is required that that the files are stored in a lockable cabinet to maintain confidentiality. The service should also look at implementing a more person-centred approach, and developing the care plans into a more accessible format for the people who use the service. The manager said that she is planning to have a training day with staff in April 2009, which is focused on person-centred planning, and that this will then be introduced at the service. We looked at the incident book held at the service and followed this up in the risk assessments for some of the people who use the service. It was observed that one person had been involved in two incidents over the past two years, but that these had not been followed up into a risk assessment or management plan. And whilst these were possibly isolated incidents, it was observed that other people had been involved in similar isolated incidents, yet a risk management plan put in place. Where there are risk assessments and risk management plans, they were seen to be very well detailed, and individualised to ensure peoples safety, in such areas as self neglect, vulnerability with money, road safety and inappropriate behaviour. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make decisions about what they do each day and are supported to spend each day they way they want to. Evidence: During our time at the service we observed the people who use the service making decisions about what they were going to do for the day, and coming and going as they pleased. Each person has different activities that they get involved throughout the week. Some people work a couple of days a week at a similar service (run by the same organisation), doing a cleaning job for which they get paid, whilst another attends a gardening project a couple of times a week. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: Some people were seen going to the weekly deaf club, whilst another went to the shops to buy an item of clothing, and another spend their day in the home, chatting to staff. In the surveys that we received back from people who use the service, one person said that they like to spend their time ..visiting family... The feedback we received is that people are able to make decisions about what they do each day, and get support from staff when they need it. Records indicate that some activities have been planned, and taken place over the past year, including day trips, an art workshop, and barbecue. However, during the past six months the activity worker who organised these no longer works for the service, and their are no current plans for similar activities to take place. People we spoke to said that they like the food provided by the service, and they said that they can get involved in preparing meals and helping clear up after this. Food stored at the home was seen to be appropriately labelled with the expiry dates where packets of food had been opened. The manager showed some work that she is doing to change the menu-planning at the service. She talked about how she has spoken to each person who uses the service to find out particular meal preferences, and that these are going to be developed into pictorial menus, with recipes, to enable people to be more involved in choosing what foods to eat. Care Homes for Adults (18-65 years) Page 13 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service responds promptly and appropriately to ensure that the needs of people who use the service are met. Evidence: A majority of people who use the service are independent in attending to their personal care needs. Where people do require the assistance of staff, this is documented in their care plans. As stated earlier, all people who use the service are involved in reviews of their care and placement, and a record is maintained in each persons care file of appointments that they have with doctors, social workers, etc. People who use the service also meet monthly with their key-worker, and some people also receive the input of an outreach support worker a couple of times a month to reduce any isolation they may experience. Incidents that the CSCI have been notified about since the last inspection demonstrate Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: that the service is responsive to the different needs of people who use the service, and seek the right support for them, as necessary. The medication for three people was checked. These were all seen to be appropriately managed, and corresponding with the medication they had been prescribed. One person self-medicates, and records in the MAR (Medication Administration Record) when they have taken this. It is positive that they do this, however they are signing the chart with their initial only, which corresponds to coding printed on the MAR, which represents that the person is in hospital. To prevent any confusion, it is recommended that they use their full initials when signing the MAR. Also, the topical cream medication prescribed for one person needs to be reviewed, to be made a PRN (as required) medication, as the MAR currently states that this has been refused for a period of time, and in such circumstances a review of the medication should take place to ensure it is actually needed by the person it is prescribed for. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has appropriate procedures for addressing complaints and works proactively to protect and minimise risks to people who use the service. Evidence: The service uses the Servite Houses complaints procedure, and this was observed on display in the kitchen area at the service. There have been no complaints recorded since the last inspection of the home. People who use the service said that they would know who to talk to if they were unhappy about something and know how to raise a complaint. Staff records indicate that they have received recent training in safeguarding of vulnerable adults, and the service has the most up-to-date local authority guidance regarding this. The staff we spoke to demonstrated a very competent knowledge of what to do in the event of any safeguarding issues happening at the service, and who they should report this to. Where any safeguarding incidents have occured at the home, the Registered Manager, and current manager, have worked pro-actively, and in the service users best interests, to ensure that any risks to them are minimised and that appropriate support is in place. Care Homes for Adults (18-65 years) Page 16 of 26 Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is welcoming, clean and homely for the people who use the service Evidence: Anthony Edwards House is spacious and airy, with modern pictures on the walls and appropriate furniture which promotes a homely environment. All areas were observed to be clean and tidy. Each person has their own bedroom that that they look after themself, with the support of staff if needed. People are also able to use the communal lounge and kitchen/ dining areas on the ground floor of the service. It was noted that the carpet on the hallway stairs is starting to look quite worn and this should be replaced. Consideration should also be given to removing the white board in the kitchen area, as this is not conducive to the otherwise homely environment . The board was also observed to contain confidential information regarding one persons medication. Care Homes for Adults (18-65 years) Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive appropriate training for their role, and the home demonstrates that good recruitment practices take place to minimise risks to people who use the service. Evidence: Two staff members were spoken to during the inspection. They both said that they feel there is good teamwork, and that they get good support and regular supervision from their line manager. One spoke about their current work towards achieving the National Vocational Qualification (NVQ) level 3 in care, and the recent training they have done in safeguarding vulnerable people. The training records indicate that most staff have received recent training in safeguarding, as well as food hygiene, health and safety, mental capacity act, medication administration and moving and handling. Some people have not done fire training since 2007, and this must be updated to ensure that risks to people who use the service are minimised. The staff recruitment files we looked at indicate that staff do have regular supervision and annual appraisals of their work. The information held also indicates that Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: appropriate recruitment checks are carried out on staff prior to their starting work. Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements are needed to the health and safety checks at the home. However, overall findings indicate that the service continues to be well managed and in the interests of the people who use the service. Evidence: At the time of the inspection the Registered Manager was on maternity leave and due to return back to their post in June 2009. During this period an interim manager is overseeing the day-to-day running of the service. The manager spoke about previous experience she has of managing services and of working with people who have a hearing impairment. She said that when she first started working at the service she received some induction from the Registered Manager, and now receives good support from her line manager. The manager also said that she feels the service is well-run and that there is good teamwork, where all the staff work well together. The manager said that since she started working at Anthony Edwards House at the start of December 2008, she has held one staff Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: meeting, and plans that these will take place monthly. During the inspection the manager spoke enthusiastically about areas where she would like to move the service forward, particularly around introducing a person-centred approach and plans for the environment. There is a quality assurance system in use at the service, where monthly quality monitoring is carried out to monitor such areas as staffing levels, complaints and care plans. People who use the service attend monthly house meetings and complete a questionnaire each month about whether they are happy with activities, the staff and food provided. It was observed that often 2-3 people do not complete these questionnaires, and the service should look at alternative ways of getting feedback about the service. Records indicate that the last visit, in accordance with Regulation 26 of the Care Homes Regulations 2001, took place in October 2008, whereas they must be taking place monthly, with a record held a the service. A requirement has been made to address this. The home maintains records to demonstrate that appropriate health and safety checks are carried out on the water chlorination, portable electrical appliances and fire equipment and systems. The gas safety check is within date, though further checks need to be made to ensure that water dispersed around the service is at, or around 43 degrees Centigrade, as the records for water temperature testing indicate that this is not always the case, with some temperatures as low as 20 - 26 degrees Centigrade. The electrical installation certificate is dated October 2006, and states that this needs to be inspected within one year, but there is not a more recent certificate available to evidence that this has been done. The records indicate that the last fire drill took place in October 2008, and prior to this in December 2007, November 2007 and September 2006. The frequency of these should increase, to approximately every three months, to ensure that risks to people who use the service are minimised. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Risk assessments and risk management plans must be in place for all areas of risk identified. 31/03/2009 To minimise risks to people who use the service. 2 10 17 All records relating to people 31/03/2009 who use the service must be kept securely at the service. So that people who use the service can be assured that information about them is kept confidential. 3 35 23 All staff must receive up-todate fire training. To ensure the risks to people who use the service are minimised. 4 39 26 The visits, in accordance 31/03/2009 with this regulation must take place monthly, and a report of the visit held at the service. 31/05/2009 Care Homes for Adults (18-65 years) Page 24 of 26 To assure people who use the service that it is being monitored properly. 5 42 23 An up-to-date electrical installation certificate must be held at the service to demonstrate that these checks have been carried out. To ensure the safety of facilities for people who use the service. 6 42 23 Hot water provided at the service must be properly regulated, to ensure it is dispersed at, or around 43 degrees Centigrade. So that people who use the service have appropriate facilities 30/04/2009 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 10 The care plans should be developed into a more accessible format for people who use the service. The service should implement individual care files to hold information about each person using the service, and these should be archived so that the most up-to-date information is held. Fire drills should take place at least every three months at the service. 3 42 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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