Inspection on 26/04/05 for Athol House, London Cheshire Home

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Athol House, London Cheshire Home 09/11/07

Athol House, London Cheshire Home 09/01/07

Athol House, London Cheshire Home 03/11/05

Athol House, London Cheshire Home 18/01/05

Athol House, London Cheshire Home 02/08/04

Athol House, London Cheshire Home 17/03/04

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Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

The Royal Star and Garter Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Athol House 138 College Road London SE19 1XE Lead Inspector Mark Stroud Unannounced 26 April 2005, 10:00 th 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. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Athol House Address 138 College Road London SE19 1XE 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) 020 8670 9279 020 8761 7830 Athol House, London Cheshire Home Sandra Seymour CRH care home PC care home only 21 Category(ies) of PD physical disability registration, with number PD(E) physical disability - over 65 of places Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 18th January 2005 Brief Description of the Service: Due to the size and environmental limitations of the building the organisation has decided to reprovide the service. The timescale for reprovision is unclear, the organisation currently prioritising the reprovision of other London based services. Athol House is a care home providing personal care and accommodation for 21 people with a physical disability. The building is leased; the service set up and managed by The Leonard Cheshire Foundation, a voluntary organisation.The home is located on the outskirts of Dulwich and Crystal Palace. Accessible bus routes, train services, and shops are close by. The home has its own vehicles, but is currently mostly reliant on volunteers for drivers. The home consists of a two-storey building, bedrooms provided over both floors. All the bedrooms are single. There is a passenger lift between floors. The home has a garden to the rear. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a single day in April 2005, and was unannounced. The inspector spoke to seven service users, two social services professionals, staff, and the manager, as well as looking at records and making observations. What the service does well: What has improved since the last inspection? What they could do better: The home needs to work more closely with individual service users, and other professionals working with them, and needs to understand that no one has all Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 6 the answers, but that together a lot more can be achieved, and planned for. Staff need to be more confident about spending time with service users individually, so that their wishes and feelings can be understood and acted on, and service users skills can be developed in an organised way, particularly since service users will be going though big changes when the current building is no longer used. Staff must be supported as a team to understand the risks to the vulnerable adults at the home, in the home, as well as in the community. The privacy of service users must be taken seriously, locks fitted to bathrooms, and good window covering provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 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 Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 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) 2 Service users know that their needs have been assessed before moving into the home. EVIDENCE: The home holds assessments completed by the purchasing authority, normally the Social Service Department (SSD) as well as annual reviews including updated assessments by the SSD. The home includes the views of families in assessments, and makes signed agreements with service users about the gender of care. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 9 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 Service users know what their needs are, but plans and assessments of risk are not good at helping them to develop their skills and make informed decisions with staff, or to involve other people who support them like friends and family, and health or social care professionals. EVIDENCE: The home has written plans for each service user. They include health needs, and the home ensure these needs are met, and that they are reviewed and reassessed by health professionals where this is needed. Service users agree the gender of carers they are happy to support them with personal care. They also agree to restrictions such as bedsides, where they are at risk of falling. Plans do not demonstrate the involvement of service users at an early stage, and lack detail where service users might agree how staff will support them to maintain and develop the independence skills they have, or strategies they are using to keep themselves safe. Language is problem focused, and lacks detail, which might prevent service users, and staff, reflecting on what they might do differently, or who else might be able to help. An example would be one service user who has a hearing impairment, whose care plan says that they should be spoken to in a quiet area, yet communal areas are noisy, and the Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 10 television often on. Advocates support service users to make decisions for themselves. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 11 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) 13, 14 & 17 Some service users are active, but those who are less sure what to do, do not receive enough planned help that could offer them more choices and stimulation. EVIDENCE: Service users go to local day services that provide transport from the home, one service user attending a support group for a specific disability. Since the last inspection the homes ‘activities organiser’ has supported several service users to regularly do their own washing, and some service users cooked during the morning of the inspection visit. New computer equipment will enable service users to have access to IT, delivery expected in four weeks time and a room at the home is already available. There continues to be a number of service users who remain in the home through the week, without regular day services away from the home. Because the needs of service users can arise from the sudden onset of disability, the home has to support service users with depression and social withdrawal. While the staff team appear committed, recorded planning to engage with service users is not detailed, and is patchy. One service user has fortnightly support from a volunteer, while no other support is clearly recorded from the Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 12 home. Another service user previously an independent traveller, has challenged the service, and again plans are unclear as to how the home will support them to take up activity. A static group of service users spend their day around the entrance, or in the dining area, engaged in repetitive activity, or are inactive. Again, their recorded individual plans are not developed, and not detailed. This will make it difficult for the service user or other stakeholders to understand how the service user is being supported, and how they can help. The home still has few drivers amongst the staff group willing to drive the home’s vans. As a result, the home is reliant on volunteers. The manager needs to review arrangements with the staff team to identify a plan of action as a team. The activity organiser has supported service users to apply for bus and dial-a-ride passes since the last inspection. The home is about to change arrangements for the planning and provision of meals, using an outside contractor. The decision was made after the previous chef left. Service users agreed they had been consulted, and seen suggested menus, which they liked. All but one of the service users spoken to enjoy the food provided. The arrangement needs to be reviewed, and will be looked at again at the next inspection. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 13 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 & 20 Service users are looked after well but do not have enough opportunities through the day to share their wishes and feelings and build better working relationships with staff. The home is beginning to plan for more support to help service users manage their own medication, and make sure the building is more accessible to them. EVIDENCE: Service users are supported in private where appropriate, and have choice over the staff they work most closely with. Staff interact with service users demonstrating respect for them, for instance smiling, waiting for them to speak, checking their understanding, and responding quickly to their needs. One staff member was seen checking all service users nails in turn. Staff are not currently spending time sitting with service users, where they might support service users to move to a new activity, or give a chance for them to routinely share their wishes and feelings. Staff do not, for instance, sit with service users at mealtime. One service user was sitting on their own again at mealtime, with no table. The manager said that a table had been offered but declined. The service user was seen at the home, before a meeting following the main inspection day, happy to talk, and staff should build on this to put further plans in place. An occupational therapist has not visited the home since Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 14 the last inspection, and this is needed to look at service users access to the dining table, and other access around the home. The organisation’s medication policy, which the home wishes to use, is in discussion with the Commission for Social Care Inspection; several amendments are required. The home needs to plan for service users to take more responsibility for their own medication, providing support and training to them as necessary. The manager said that lockable storage for medication is available in service users’ rooms, and that self-medication will be planned for with service users after the medication policy is approved. All other medication procedures were found to be in order at the last inspection, and will be checked at the next inspection. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 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) 23 Staff have not been working well as a team to recognise and respond to the potential for abuse within the home. EVIDENCE: The home has a Protection of Vulnerable Adults Procedure. After a recent incidence, it is clear that staff and the manager need to work harder as a team to understand how to identify and respond to abuse, and potential abuse. This is recognised by the manager. There has been delay in reporting an incident. At a recent meeting, it was agreed the home would provide more detail when reporting to purchasing authorities. The home needs to work in partnership with service users to understand what they are doing to keep themselves safe, what impact potential or actual abuse has on them, and how they would like to be supported to be kept safer. This includes the need to work harder and more closely with other services where the home might find expertise to support service users better, and also friends and family who can provide ideas and support to service users as well. All this needs to be recorded in a plan, as described under ‘Individual Needs and Choices’, earlier in this report. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 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, 27, 30 The building is large making it difficult to reflect the individual needs and wishes of service users. EVIDENCE: While the current accommodation is seen to be adequate currently, uncertainty over its future is preventing some of the needs of service users being met, for example a reluctance from the home to spend money to provide independent and secure access for service users to their rooms, where they are not able to operate the existing manual doors on their own. The home has redecorated showers, and service users enjoy this. Locks to bathrooms are still not provided for the use of service users, and an upstairs bathroom has yet to be decorated. Some window covering in the bathroom, which is used throughout the building, does not provide sufficient privacy, and this must be replaced urgently. Other small items need replacement including a bin lid in the ground floor bathroom and grubby light cords that would benefit from larger easy grip pendants. The home smelt fresh, and was clean. The laundry room was tidy, making it easier for service users to use. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 17 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) EVIDENCE: These Standards were not assessed. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 18 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 Service users are unsure of their future, and where they will live. EVIDENCE: The home is to be reprovided but the timescale, and nature of the reprovision is not clear. The organisation is holding a meeting with service users and their families the week after this inspection. One service user said the ‘organisation can’t expect people to come from this home to something different just like that’. It is likely that given a clear choice and timescale, service users will make a variety of decisions, which need to be reflected in the organisation’s final plans. This will involve a lot of individual work to build the skills of service users to make meaningful choices, and make these understood to their supporters, and other agencies that can help them. Some cleaning liquids were left out in a bathroom and the laundry. The home must make sure that any cleaning liquids that might be dangerous are kept safely, assessing individual service users for any risks if necessary. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 19 Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 20 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. 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 2 x x 3 Standard No 11 12 13 14 15 16 17 x x 2 2 x x 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Athol House Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 21 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 6, 7 & 9 Regulation 13, 15 Requirement The Registered Provider must ensure that Service User Plans reflect needs and wishes of service users in sufficient detail, and are kept under review to reflect changing needs and wishes, inlcluding areas of risk. The Registered Provider must ensure that service users are supported and consulted individually about their social interests, and make arrangements as a staff team including transport, to enable them to engage in local, social and community activities, extending their choice. The Registered Person must ensure that potential and reported abuse is taken seriously, and the homes policies and procuedures followed by staff, reporting and acting on infomation. The Registered Provider should ensure that these arrangements are assessed by an occupational therapist or other suitably qualified professional, to consider better access and support to service Timescale for action 31.07.05 2. 13, 14 12(2), 16 31.07.05 3. 23 13 31.05.05 4. 18 23(2)(n) 31.07.05 Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 22 5. 24, 39 12(1)(a), 23 6. 24 23(2)(n) 7. 27 23 8. 9. 30 42 13, 16 13 users(timescale of 30.04.05 not met). The Registered Provider must ensure that a clear plan of action including service user consultation is drawn up, so that the home accommodates a maximum of twenty people with no more than ten people sharing a staff group, a dining area and other common facilities by 1st April 2007. The Registered Provider must ensure that service users are supported to enter and exit their bedrooms securely, avoiding unecessary dependence on staff, in consultation with health professionals. The Registered Provider must ensure that service bathrooms are all decorated, have lockable doors and window covering to ensure service users privacy and dignity, and independence. The Registered Provider must ensure that bin lids are replaced, and light cords cleaned. The Registered Provider must ensure that dangerous liquids are kept safely, while upholding the independence of service users, completing risk assessments as necessary. 31.05.05 30.06.05 30.06.05 30.06.05 30.06.05 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. Refer to Standard 18 Good Practice Recommendations The Registered Manager should ensure that staff are encouraged to routinely sit and spend time with service users through the day, to listen to their wishes and feelings, and make plans with them. G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 23 Athol House 2. 27 The Registered Provider should ensure that service users are consulted and the views of an occupational therapist sought about the accessiblity of light cord pendants. Athol House G52-G02 S7004 AtholHouse V227496 260405 FINAL.doc Version 1.30 Page 24 Commission for Social Care Inspection 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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