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Inspection on 09/11/07 for Athol House, London Cheshire Home

Also see our care home review for Athol House, London Cheshire Home for more information

This inspection was carried out on 9th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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.

What the care home does well

Staff are friendly and respectful of residents. Residents commented that they feel safe and that staff understand them and are helpful. They also said that they enjoy the outings and were going up to London today to visit a museum. The manager is experienced and well qualified and communicates well with residents and staff. Staff are well inducted and trained and the atmosphere in the home is relaxed and friendly. The home makes sure that all staff have been treated fairly during recruitment and that all their work histories and police checks are properly done before coming to work at the home. There are a range of health care professionals involved in helping the staff and supporting residents. Health care and health and safety are well managed and protect residents and staff. There is good use of a well-managed group of volunteers who understand what is expected of them. This adds to the depth of experience of staff available and provides more people available to speak with residents.

What has improved since the last inspection?

All of the residents now have a full assessment of their care needs, which have been provided by social services. The home has also carried out its own assessments, and these assessments provide good information to draw up care plans for all residents. Resident`s contracts with the home fully explain their terms and conditions, including the reasons for any differences in fees charged. Information from key worker meetings is now used to update the resident`s care plans. The home now has a weekly team leader briefing to help staff become updated on any changes in resident`s needs. There is now an activities of daily living plan for each resident showing a range of activities, which they have been involved in deciding on. Resident`s personal care plans now have better information about how to support them with their mobility, and in the bathroom, so that they are able to do as much for themselves as they can. Risk assessments for all residents have now been reviewed and there is a schedule for reviewing them at least every six months. This helps to better protect residents from falls or accidents. The homes adult protection policy has now been reviewed in March 2007 and staff have received training in how best to protect residents, and to report any allegations of abuse quickly. The home has asked all residents for their views about having personal care with members of the opposite sex. What they said they want has been written down in their care plan, so that they only get support with personal care from members of the opposite sex when they wish to.

What the care home could do better:

The home should complete consultation with all residents about their wishes about end of life care and wills, and record their wishes in their care plans. Training in how to support people with learning disabilities should be provided for care staff so that they will better understand how to help residents who have this support need. Training in person centred planning should be given to some key staff such as the activities coordinators, so that residents care is more tailored to their needs, and they are fully Involved and aware of how to say what they want the home to help them to achieve.

CARE HOME ADULTS 18-65 Athol House, London Cheshire Home Athol House 138 College Road London SE19 1XE Lead Inspector Sean Healy Unannounced Inspection 9th November 2007 10:00 Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 1 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 Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 2 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 Stationery 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, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Athol House, London Cheshire Home Address Athol House 138 College Road London SE19 1XE 020 8670 9279 020 8761 7830 allison.hardy@LCDisability.org Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Leonard Cheshire Disability Miss Allison Jayne Hardy Care Home 21 Category(ies) of Physical disability (0) registration, with number of places Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: As at last inspection, due to the size and environmental limitations of the building the organisation has decided to re-provide the service in another location. The timescale for re-provision is as yet unclear. Athol House is a care home providing personal care and accommodation for 21 people with a physical disability. The building is leased and the service has been set up and managed by Leonard Cheshire Disability, a voluntary organisation and company limited by guarantee. Since the last inspection the company name has changed from The Leonard Cheshire Foundation to Leonard Cheshire Disability. The home is located on the outskirts of Dulwich and Crystal Palace. Accessible bus routes, train services and shops are close by. It has its own vehicles and now has more drivers available. The home has a number of wheelchairadapted vehicles. It 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 spacious and well-designed garden to the rear. 20 of the 21 residents are funded by social services and one resident is privately funded, paying the same fees and charges as all other residents. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. The most recent CSCI report is currently kept at the home, with a copy open for viewing in the reception area. At 9th November 2007, the homes fees are set at between £744.80 and £1,171.30 per week for accommodation and support. The majority of these costs are met by the referring social services authorities from Lambeth, Lewisham, Bromley and Waltham Forest. The fees include food, laundry, activities and some transport costs. Residents have to pay for other personal expenses such as hairdressing and personal shopping, with a small mileage charge for using the home’s transport. The reason for differences in fees charged is due to higher dependency needs and this is stated in individual residents contracts. The provider’s email address is: allison.hardy@LCDisability.org Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection site visit took place over one day on 9th November 2007, and follow up work was completed on 15/11/07. The Registered Manager facilitated the inspection. I spoke with four residents who were in the home, and examined three resident’s planning files. Three support staff were spoken to and four staff files were examined to see recruitment and training/supervision records. The home’s health and safety co-ordinator, volunteer co-ordinator, chef and a visiting complimentary therapy practitioner also spoke with me about their experience and views. The inspection included examination of records and policies and procedures, and a tour of the building. All of the seven requirements made at previous inspections had been met, showing an improvement in the homes ability to respond to the need for making improvements. Residents said they were very happy at this home. The atmosphere was relaxed and friendly and staff involved residents and spoke with them regularly. They also said that the food was good and that they feel safe in the home. What the service does well: What has improved since the last inspection? Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 6 All of the residents now have a full assessment of their care needs, which have been provided by social services. The home has also carried out its own assessments, and these assessments provide good information to draw up care plans for all residents. Resident’s contracts with the home fully explain their terms and conditions, including the reasons for any differences in fees charged. Information from key worker meetings is now used to update the resident’s care plans. The home now has a weekly team leader briefing to help staff become updated on any changes in resident’s needs. There is now an activities of daily living plan for each resident showing a range of activities, which they have been involved in deciding on. Resident’s personal care plans now have better information about how to support them with their mobility, and in the bathroom, so that they are able to do as much for themselves as they can. Risk assessments for all residents have now been reviewed and there is a schedule for reviewing them at least every six months. This helps to better protect residents from falls or accidents. The homes adult protection policy has now been reviewed in March 2007 and staff have received training in how best to protect residents, and to report any allegations of abuse quickly. The home has asked all residents for their views about having personal care with members of the opposite sex. What they said they want has been written down in their care plan, so that they only get support with personal care from members of the opposite sex when they wish to. What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All residents’ individual needs are now being fully assessed before moving into the home. Resident’s contracts/statements of terms and conditions have been updated and includes all the necessary information including fees and what is included. EVIDENCE: There was a requirement at the last inspection for the home to ensure that all residents had a full assessment of their needs provided by the placing authority. This requirement has now been met. Examination of residents files showed that the referring agencies always provide written assessments for publicly funded residents, and the home carried out its own assessments when necessary. In these cases assessments are carried out by the Registered Manager or Care Co-ordinator, assisted by the Team Leader in the home. There is evidence of good assessments addressing a full range of service users’ support needs and these assessments include HALO assessment and a separate behavioural assessment. There was a requirement at the last inspection for the home to ensure the residents’ contracts or statements of terms and conditions are updated to include a description of the support hours to be provided and the reasons for Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 9 increased levels of fees for some residents. This has now been done and the requirement is met. All residents have a contract in place between the provider and the resident. These documents show the service that the resident can expect, with a reference to the cost for individual residents, and also states who pays the fees. All the residents’ contracts were updated in July 2007, and where a resident was previously being charged more than other residents, without any explanation as to the reasons why, changes have now been made to the contract to explain the reasons for higher fees being charged. The reason given in the contracts I examined was that the fees are higher because of additional support required, sometimes one-to-one support being provided during activities. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessed and changing needs are now fully reflected in all care plans, and risk to residents is now well managed. Residents are helped to make decisions about their own lives. EVIDENCE: The home has a good system for care planning which is linked to individual residents needs assessments. Care plans are being initially set up with each service user identifying objectives and review dates. At the last inspection the provider introduced a new system for care planning, which staff are getting to grips with. This system did not provide for showing whether objectives or goals had been met in resident’s care planning, making it difficult to review progress when carrying out reviews. Two requirements were made about care planning, one of these asking that information agreed in key worker sessions be used to regularly update the care plans for residents. This requirement is now met as any key working information is now transferred into the care plans on a regular basis. I examine three residents’ files and each was seen to have been Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 11 updated, sometimes a monthly basis, and three staff spoken to said that they felt that the new system helped them to support people better. There was a second requirement for the home to ensure that all residents’ personal care plans be reviewed to include more detailed information about how to support them in personal care activities. This has now been done and all personal care plans have been reviewed. The manager has introduced a new daily living activities plan for each resident, which clearly outlines a range of activities and simply describes when the resident is independent, or if they need support. In this case it describes the support specifically needed by the resident showing how best to support the resident. This is an excellent development and enables the staff to provide support only where it is necessary and to help residents to be more independent. The home has a person centred planning system in the development stage, and the plans I saw showed good practical information and a good system for the resident to contribute easily to their own care plans. Overall the care plans were seen to be good, clearly recorded and regularly reviewed. Residents communicate well with staff, who include them in day-to-day decision-making. A number of advocacy services are used for decision making when needed. The home provides information in the home’s service users’ guide about how to get advocacy support. The home manages finances and benefits including bank accounts for five residents who are their own appointees and signatories. Two residents have Court of Protection Orders and their finances are managed by social services or solicitors. All of the remaining 14 residents either manage their own benefits and finances or have their family do so on their behalf. Small amounts of money are held by the home at the request of these residents and good records and receipts are kept. There was a requirement made at the last inspection for the home to ensure that risk assessments are reviewed at least every six months. This requirement is now met and examination at three residents’ files showed a range of good risk assessments being done on admission to the home, and all were being reviewed at least every six months but more often in one case. Risk assessments seen included: risk of alcohol abuse, risk of depression, mobility, use of bed rails, risk in bedrooms and personal fire evacuation risk assessments. Risk assessments have been well written and reviewed at least every six months, but weekly meetings now identify when risk assessments need to be reviewed more often. Overall the management of risk in the home has much improved. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development, and are able to take part in age/peer and culturally appropriate activities. They are part of their local community, and are supported to have relationships. Service users rights are respected, and good meals are provided. EVIDENCE: Two residents are on an employment course at Southwark Cathedral run by Circles Network. Both received good support from staff and got help in some cases from a volunteer in reading, writing and computer skills. Care plans include supporting residents to continue their education and where appropriate to find jobs. Better arrangements are in place to help residents to access transport flexibly when they need it. Staff support residents to participate in their local community. There are now three wheelchair accessible vehicles to support Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 13 residents to go out, which is important given the location of the house. Other means of transport are available through the provision of taxi-cards and dial-aride. The home now employs two activities co-ordinators who plan individual and group activities for residents. Information about activities is available in care plans and on an activities’ notice board, and the home has introduced a daily living activities plan to provide a system for identifying individually appropriate activities, and for recording and reviewing whether these activities are being offered and taken up by the individual residents. Activities such as a silk printing courses and visits to Kent and North London with a community group, outings to museums, (A number of residents went to a museum in London on the day of the inspection and two said they have outings every week and said they enjoyed the trip to London on their return). Two residents have started going to an exercise group and exercise activities are also provided in the home. The home regularly uses volunteers to provide additional support for residents to access church services and social events provided by the church. There is a full time volunteer coordinator based at the home who oversees 16 volunteers and ensures thorough induction and well written agreements about their roles and responsibilities that they are aware of how to provide support. The volunteer coordinator facilitates involvement from the Dulwich College Boys School and James Alleyne Girls School who visit the home to provide social contact for residents who wish it. A core programme of service based activities is in place, which include exercise class, massage and reflexology, cooking, art & craft, bingo etc. as requested by residents as part of their care planning. Individual activites are identified by residents and with support of the activites coordinator and volunteers. Three residents have their own e-mail accounts and are developing an interest in using the Internet. Residents are supported by staff in completing benefit checks and form filling. All residents interested in voting are registered for a postal vote and support provided in reading campaign literature. One resident votes independently. Staff and residents have attended Personal Relationships training and a link person is available in the service. Two residents are currently being supported in maintaining a personal relationship. All residents have their own bedrooms and keys to their doors. Two residents who had just returned from an outing to London spoke enthusiastically about their outing and said the staff are very good in getting them in and out of difficult places when using wheelchairs. Family are encouraged to visit residents and there are no restrictions on visiting times. In emergencies overnight stays can be facilitied for close family members. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 14 Staff were observed to be respectful of residents and spoke to them in a manner that put them at ease. Residents are given their own mail to open and staff only open their mail when requested. Each resident has a nutritional assessment, which is used to devise the menu for the home. Personal food preferences are included in this information. There is a chef employed by the home who cooks all of the meals and receives information from care plans about individual residents dietary requirements. All residents are offered two choices of meals each day and three said that the food was good and they were able to eat what they wanted. The home has conducted surveys with residents about the food provided and the outcome of one survey resulted in a new chef being appointed. I spoke with the chef and his assistant both of whom were knowledgeable about individual residents food preferences and kept good records of food eaten. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Personal care support is provided in the way that people prefer and is in accordance with assessed needs. Respectful and sensitive support is provided for residents regarding health care and emotional needs, and people are supported to retain administration of their medication. EVIDENCE: There was a requirement made at the last inspection for the home to ensure that all residents’ personal care plans be reviewed and include more detailed information about how to support them in all personal care activities. This has now been done and all residents have a comprehensive personal care plan, which has been completed following a personal care assessment when they were admitted to the home. Three residents files showed that these plans now include information for staff about how to maintain independence for residents, by allowing them to do tasks for themselves when possible. A newly introduced daily activities form specifically shows staff the areas where residents are independent and when they need support. The home has also now asked all residents about their views regarding same-sex personal care, and this is Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 16 recorded in their care plan. Now only residents who are happy with having personal care support from members of the opposite sex are provided with it. The home has good links with Paxton Green Medical centre, supported by District Nurses and GPs. Good records of appointments for clinics are maintained. Physiotherapist and complementary therapists are regularly used, and a qualified reflexologist is contracted to visit the home weekly to provide massage therapy for 12 residents. He spoke with me and said the residents were benefiting and that the care provided by staff was sensitive to the need for physical stimulation for residents. Dementia Awareness Training was provided for all staff in October 2007. Staff interviewed said that this was very interesting and will help their awareness should the need arise. (Currently dementia is not an issue in the home) It is recommended that the home ensure that end of life wishes are documented and all next of kin details checked on a reguar basis. (Refer to Recommendation YA19) The following professionals also visit the home: dentist, podiatrist, SALT, counselling, district nurses, a continence advisor diabetes nurse, and eye specialists. Other professionals are accessed through the community health team at Townley Road. The home provides well for the health care support needs of residents. The homes medication policy was reviewed in October 2006. The majority of the residents have agreed for their medication to be managed and administered by the home and this is recorded in their care plans. Medication is administered by team leaders, shift leaders or staff who have been trained to do so. All residents have now been assessed about their wishes and abilities to self medicate and this has resulted in two residents managing their own medication. The home uses Boots MDS for medication provision and support and appropriate staff have received medication training. The home manager said that her experience has been that medication records are consistently correctly completed. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that they are listened to when they have any concerns. The home’s written policy on Adult Protection now does provide for the protection of service users. EVIDENCE: The home has a policy in place for the management of complaints, which was last reviewed in July 2005. The next review is scheduled for 2007 (Now due). The policy shows that complaints will be responded to within 21 days and there is a good system in place for showing complaints received, the date they were responded to and when they were resolved. There is a regional complaints coordinator that gets information from the home about complaints in order to monitor the system. Information is provided to the regional director. The regional manager sends a quarterly summary to the regional director to help the organisation to monitor levels and trends of complaints. There has been one complaint since the last inspection and this was investigated by a senior manager within the provider organisation. This was about a concern by an anonymous person about the efficiency and effectiveness of the management of the home. This was investigated promptly and found not to be upheld. There are no concerns about the management of the home resulting from today’s inspection. There was a requirement made at the last inspection for the home to review its adult protection policy especially in respect of POVA legislation requirements. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 18 This has now been done and the policy was reviewed in March 2007 and includes appropriate information regarding POVA. All care staff now have training in protection and some staff have had two yearly updates on adult protection issues in the form of a distance learning pack, which has been assessed by the organisation’s training and development officer. This is then used to identify any further training needs regarding the protection of residents. Three staff interviewed showed that they had a good understanding of how to report any suspicions or instances of abuse or neglect. There have been two adult protection issues reported since last inspection. Two residents separately complained of money going missing from their locked cabinet in their room. These were appropriately reported to social services and police were involved. However, no conclusive evidence could be found to show that the money had gone missing, as there was some confusion about whether it had been there in the first place. One of these residents has now chosen to continue to look after his own money, while the other resident has asked the home to take care of small amounts of money that he wishes to keep in the home. The home has reimbursed both residents the full amounts of the money which was alleged to have gone missing. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Residents live in a comfortable and safe home, with bedrooms which suit their needs. It is a safe, clean and hygienic place to live. EVIDENCE: There was a requirement made at the last inspection that the home must ensure that a plan of action, including consultation with residents, is drawn up to ensure that the home accommodates a maximum of 20 people, with no more than 10 people sharing a staff group, a dining area and other common facilities. The reason for this is that the dining area cannot accommodate all of the residents at any one time and there was an intention for the registered provider to find alternative accommodation for the residents. The home’s management have taken reasonable action to consult the landlord about this problem, but have found that they are not allowed to make any suitable changes to the building to better accommodate residents. The provider is actively seeking an alternative building, which might be suitable, but as yet Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 20 nothing is available. In the interim period the manager has consulted regularly with the residents about the accommodation provided, through meetings and questionnaires, and found that all of the current residents are happy with the accommodation. There has been consultation about the dining room area and an agreement has been reached to stagger the dining times so that residents are comfortably accommodated in the dining area at mealtimes. It has been agreed that the lounge area can also be used for dining on special occasions such as during Christmas. There are regularly monthly meetings between residents and the management at which discussions are held about the reprovision of accommodation. As there has been no suitable alternative accommodation identified, the issue of possibly moving has become a dormant one. The home’s management have agreed to continue to keep residents informed of any plans and consult them before any decisions are made. The home is taking reasonable steps to try to comply with ensuring the home is suitable for residents, and residents said they are happy with current arrangements. Therefore this requirement is now met with the proviso that management continue to keep this issue on the agenda and continued to consult with residents. Residents personalise their own rooms and three residents said that they are happy with their rooms and accomodation. Safes are provided in all bedrooms for residents to store their valuables. All areas of the home are wheelchair accessible, and new room plates have been provided written in braille to help unsighted residents to identify their room. Staff are trained in infection control and self assessment completed. Adequate laundry facilities are provided. Specialist equipment is provided including a range of hoists and lifts and there is an activities room for using specialist exercising equipment and an adjustable height kitchen suitable for wheelchair users. This activity is a regular part of in house activities for residents who enjoy cooking. A new decoration schedule has been implemented there is a rolling schedule for redecoration. A new domestic staff post has been created and a new worker has started in this post. Corporate volunteer projects have developed a sensory garden, decorated fences and created some garden art. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 21 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff, who are properly trained to carry out their duties. They are protected by the home’s recruitment policy and practices and staff are well supervised and supported by the homes management. EVIDENCE: All staff undergo comprehensive induction and there are excellent records maintained of the induction, which are signed by the supervisees and usually completed within one month of employment. Four staff files examined showed that these staff had undergone a detailed induction provided by the manager and other experienced staff, and that very good records of this induction are on file. Three care staff said that they found the induction very good, and that it involved shadowing experienced staff in a range of areas of care provision, and undergoing an induction in the care needs and personal care plans for a range of residents for whom they would initially provide support. The home employs a total of 27 care staff to provide support for up to 21 residents. There are also separate housekeeping staff such as two cleaners, Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 22 two laundry staff and one maintenance worker, to provide maintenance services for the home. Cooking is contracted to an outside chef who provides the service on site in the home with an assistant. There are currently no staff vacancies. The registered provider and the home is registered with the Skills for Care organisation and more than half of the care staff are qualified to NVQ level 2/3. (18 of the 27 care staff are qualified) Examination of four staff files showed that excellent recruitment processes are in place and are being consistently applied. Good records are being kept about staff recruitment. These are well organised, enabling the management of the home to make sure that everything is in place properly before staff begin employment. There is a good standard of training offered to staff, and training is coordinated by the Leonard Cheshire training coordinator. More specialised training such as medication, health and safety, fire safety, first aid, and moving in handling are contracted in from trained professionals. Training needs of staff are identified to annual appraisal and through supervision. It is recommended that the home provide specific training in learning disability issues for all care staff, and in person centred planning for at least specific staff such as the activity coordinators. (Refer to Recommendation YA35) Examination of four staff files showed that supervision is now consistently happening at least every two months, and in some cases monthly formal of supervision is being recorded. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 23 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed by a manager who receives good support from the registered provider. Resident’s views are included in the home’s system for quality assurance and planning. The health and safety of residents and staff are promoted by the home and registered provider. EVIDENCE: The registered manager is qualified to NVQ level 4 in care management and also has a postgraduate diploma in management. She also previously worked as a manager of a resource service for a ten-year period. She is registered with CSCI and the registration certificate displayed is accurate. The manager is fully involved with staff recruitment, supervision and training. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 24 The registered provider has developed an organisational self-assessment quality assurance system. The registered manager completes this annually and an external quality assurance team carries out a full audit every three years. The regional director carries out comprehensive monthly management visits and these show that action is being taken to address any shortcomings. This system gives good support and direction for the manager who confirmed that she received good support from management. Residents have a monthly residents’ forum, which the home’s manager attends, for sharing information and minutes of these meetings are kept and displayed. Separate residents satisfaction surveys are being conducted. There is a development plan in place for the organisation and a specific one for this home. This plan covers the period 2006 to 2008 and the recent service user survey report, which is about to be published, shows clearly a range of areas for development as a result of service users identifying areas for improvement. Health and safety within the home is well managed and all documentation was found to be in order and up-to-date. The home has an adequate health and safety policy, which includes risk assessment, fire safety, food hygiene, moving and handling, and all of these are included in the staff induction and training programme. Fire equipment checks are being done on a weekly basis and the home has certificates for electrical and gas appliances which are up to date. Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA19 YA35 Good Practice Recommendations The registered manager should complete the documentation of residents end of life care wishes and record when residents don’t want to discuss this The registered provider and manager should include more training regarding in the homes training schedule for the activity coordinators and other key staff regarding person centred planning The registered provider and manager should include more training regarding learning disability support issues in the homes training schedule for all care staff 3 YA35 Athol House, London Cheshire Home DS0000007004.V348678.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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