Inspection on 21/07/08 for Barlby Road

This inspection was carried out on 21st July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barlby Road 14/04/09

Barlby Road 08/10/07

Barlby Road 15/08/06

Barlby Road 05/12/05

Barlby Road 09/05/05

Barlby Road 25/10/04

Barlby Road 12/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Barlby Road 37 Barlby Road North Kensington London W10 6AN Lead Inspector Sheila Lycholit Key Unannounced Inspection 21st July 2008 10.25 Barlby Road DS0000010843.V365875.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 Barlby Road DS0000010843.V365875.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. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barlby Road Address 37 Barlby Road North Kensington London W10 6AN 020 8964 8543 020 8964 8156 info@yarrowhousing.org.uk 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) Yarrow Housing Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: PC Care home only to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 8th October 2007 Date of last inspection Brief Description of the Service: 37 Barlby Road is a residential home for four people with a learning disability. The service is provided by Yarrow Housing Limited in a building owned and maintained by Kensington Housing Association. All of the service users, two men and two women, are supported by RBKC. The building is a semi-detached house in North Kensington, which has been adapted on the ground floor for wheel-chair access. The lay-out of the house provides one bedroom on the ground floor and three on the first floor. All rooms are single and of a good size. There is an office/sleep-in room in a loft extension. Service users attend day services in the Borough and are supported to pursue a range of interests in the home and in the community. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The unannounced visit took place on Monday 21st July 2008 from 10.25am until 3pm. All of the 4 ‘housemates’ (as residents are called at this service) were at home, with the Manager, Day Services Officer and Support Worker. A new member of staff who was shadowing for two weeks came on duty at 11am and another Support Worker started his shift at 12pm. The activity plan for the day was for 3 housemates to do shopping and cooking individually with staff and for one person to go swimming. Unfortunately this outing had to be postponed, as the Manager was one of the two staff planning to accompany the housemate and was unavailable because of the inspection. In addition to the Manager, the Inspector spoke with 2 staff in private. What the service does well: What has improved since the last inspection? Staff have better access to training, including NVQs. Mandatory training is now up to date. A permanent Manager has been appointed. Visits on behalf of the provider are taking place regularly, with reports available. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 6 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. Barlby Road DS0000010843.V365875.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 Barlby Road DS0000010843.V365875.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): 1, 2, 4 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Although clear information about the project has previously been available in an accessible format, copies were not on file at this visit. Comprehensive assessments are regularly undertaken with the involvement of the multi professional team. EVIDENCE: None of the 4 individual files looked at contained a copy of the services user’s guide or terms and conditions. At previous inspections these have been available in an accessible format. Records show that housemates’ needs are regularly re-assessed with the involvement of the multi-professional team. For example, a new eating and drinking plan has been developed for one housemate after an assessment by the Physiotherapist and OT. No new housemates have been admitted since the last inspection. The previous admission in 2006/7 was carefully planned and well managed. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. PCPs are of a good standard and reflect the involvement of housemates. Staff provide good support for housemates’ communication to enable each person to be involved in the life of the home and in making choices and decisions. EVIDENCE: Although PCPs were not available for all housemates on file, electronic copies were available. PCPs, which are comprised of photos and text, continue to be of a very good standard. All PCPs had recently been reviewed by the Placement Reviewing Officer. Housemates had been fully involved in their reviews using a variety of ways to communicate, including objects of reference, collage and multi media. In addition to a PCP, each housemate has a communication passport developed with the Speech and Language Therapy Team. Although the care and support of each housemate is discussed at team meetings, a more structured review should take place at least every 6 months, rather than annually as at present. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 10 Detailed risk assessments are available but staff must ensure that these are regularly reviewed. The risk assessments for one housemate whose behaviour has caused concern over recent months, had not been reviewed since January this year. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Housemates are supported to take part in a wide range of activities both at home and in the community. Relationships with families and friends are well supported. Housemates are increasingly taking part in preparing meals and are encouraged to eat a wide range of foods. EVIDENCE: PCPs, daily logs and photos show that housemates take part in a range of activities, both at Barlby Road and in the wider community. The programme is designed to develop housemates’ independence, as well as providing opportunities for work related activities and for leisure. Since the last inspection, staff have arranged for the home to have membership of a car club, which has made it easier to arrange trips further afield. Housemates also attend local day services for people with a learning disability at Scope and The Gate. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 12 Individual holidays have been arranged in line with housemates PCPs. Staff commented that a reduction in the number of hours allocated for covering absences and vacancies has meant that some activities have been curtailed, in particular going out in the evening. Menus show that housemates are encouraged to eat a wide variety of foods, including fresh fruit and vegetables. Housemates regularly eat out and this is used as an opportunity to support their cultural backgrounds. Each housemate takes part in preparing a meal at least once a week, shopping for food and cooking with a member of staff. The kitchen was clean and tidy. The fridge contained a variety of foodstuffs, which were safely stored. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 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. 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. Detailed support profiles are in place, reflecting staff’s in depth knowledge of housemates’ needs. A high priority is given to ensuring that housemates’ health care needs are met. Staff training in medication is now up to date. EVIDENCE: Support profiles are available for housemates who all require assistance with personal care. Support profiles are detailed, indicating housemates likes and dislikes and include ways of promoting their independence. Staff must ensure that the most recent update is available on the person’s file, so that all staff have access to the information. Notes of a recent team meeting indicated that staff were proposing changes to a housemate’s personal care which had not been discussed with any members of the multi professional team and could be seen as unnecessarily invasive. Although the intention of staff was to try to make the housemate more comfortable, in view of the housemate’s inability to express consent, any such action must be fully agreed with the multiprofessional team. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 14 Health action plans in an accessible format are available for each housemate and are of a high standard. Health action plans are normally discussed and agreed at review meetings. Staff give a priority to ensuring that housemates have access to relevant health care, advocating on their behalf if necessary. A ‘best interests’ meeting had been arranged for one housemate who could not be given a general anaesthetic for dental treatment, in spite of strenuous efforts by staff and health care colleagues. Since the last inspection, staff have updated their medication training. A small number of gaps in recording medication, mainly prescribed creams and lotions, were noted by the person carrying a recent visit on behalf of the provider. Medication incidents since the last inspection have been reported to CSCI and action taken. The home has a small supply of a controlled drug, which was stored in a locked box. Any controlled drugs must be kept in a secure cabinet. The Manager moved the medication to a suitable cabinet straightaway. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 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. 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. Staff take steps to understand housemates behaviour and elicit any concerns. The safety of housemates is given a high priority. EVIDENCE: Yarrow Housing has an accessible complaints procedure, which needs to be displayed in the house. The Manager reported that no complaints had been received in the past 12 months. The local advocacy service is used to represent housemates’ interests. Housemates express themselves non-verbally and staff try to interpret their behaviour. Incidents are recorded in detail, though risk assessments must be reviewed following an incident as discussed earlier. ‘Best interest’ meetings have been held to discuss concerns about a housemates’ well being and to agree an action plan. Staff have attended training in safeguarding adults and in the Mental Capacity Act. One safeguarding referral has been made since the last inspection, following concerns raised by staff. Two staff are suspended while the issue raised is investigated. Half the staff team has attended SCIP training, which will be provided for the rest of the team later in the year. Housemates’ money is checked at handovers. Receipts are obtained for all purchases. A sample of housemates’ accounts are checked during the monthly visits on behalf of the provider. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The building, which is close to local shops and services, has been well adapted on the ground floor for one housemate who uses a wheelchair. The house is decorated to support housemates’ orientation, with objects of reference and tactile signage. EVIDENCE: The house is well located, close to local shops and services and is on a bus route. The sitting/dining room leads out to a walled garden, which was looking much tidier than at previous visits. The positioning of furniture, décor and layout, as well as specialist equipment is designed to support housemates, one of whom has a severe visual impairment. There is one bedroom on the ground floor, which is used by the housemate who has a wheelchair. An accessible bathroom is also available on this floor. The Manager confirmed that the interior and exterior of the building are to be redecorated this year. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 17 All the single bedrooms are of a good size and the house is well equipped with bathrooms and lavatories. There is a sensory room on the first floor, which contains soft seating and a PC for housemates’ use. This provides a useful alternative space, as the main sitting room can become crowded when all housemates and supporting staff are present. The building was clean and tidy at this unannounced visit. A regular domestic assistant is employed and waking night staff undertake some cleaning. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 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. Steps have been taken to establish a more permanent staff team. Access to training has improved and mandatory training, including refresher training is now up to date. EVIDENCE: The staff team had been carrying a number of vacancies since the last inspection. Two new staff have recently started at the project and the Manager was interviewing for the remaining post the following week. Covering the two staff suspended pending the outcome of an investigation was creating problems for the team, together with cuts in the number of bank hours allocated to the project. Staff reported that the reduction in bank hours was curtailing some activities for housemates, particularly in the evenings. Staff administration time has also been reduced. This is discussed under standard 41. Staff are recruited with the involvement of Yarrow’s HR team, who carry out all recruitment checks. The Manager confirmed that she is informed when all checks, including CRB checks, have been satisfactorily completed. Yarrow Housing involves service users in interviewing for staff, although no one from 37 Barlby Road currently takes part. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 19 Training records show that mandatory training, including refresher training, is now up to date. Staff commented on the length of time it has taken to arrange some training specific to the needs of the project, including SKIP and managing the risk of choking. The percentage of staff achieving NVQ2 and 3 remains low, largely because of the turnover of staff. Three staff are enrolled on NVQ3 and the Deputy Manager is undertaking the Assessors Award. In discussion the most recently appointment member of staff confirmed that she was undertaking a structured induction programme and that training and supervision dates had been arranged. Records show that staff are supported by regular staff meetings, supervision and annual appraisal. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 20 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, 41, 42 and 43 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A more permanent senior staff team has been established. The health and safety of housemates is given a high priority. The Manager and staff must be allocated sufficient time to maintain records in good order. EVIDENCE: A permanent Manager was appointed in February this year following the departure of the Acting Manager who had been in post since the previous October. The Manager is experienced in working with people with a learning disability and is completing NVQ4. She is applying for registration. At the previous inspection housemates’ views had been sought about the project, with input from the local advocacy service, which had contributed to Yarrow’s evaluation of its services. The Manager was unaware of this work and in the absence of the two Deputy Managers, was unable to confirm that this initiative was continuing. Generally Yarrow Housing has a range of quality Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 21 assurance systems and user involvement initiatives, though the complex needs of people at Barlby Road limit their involvement in the current schemes. As noted earlier in the report, the previously high standard of recording, particularly in relation to housemates’ files, has not been maintained. A number of documents previously on file were no longer available and some reports had not been printed off and placed on file. The Manager explained that staff are no longer allocated a shift for administration and have to fit in recording around supporting housemates. Staff must have sufficient time to ensure that records are up to date. A regular file audit would highlight documents that were missing or out of date. The Manager said that restrictions on printing documents in colour have been imposed by Yarrow Housing and staff have to go to the head office if they want to use colour. Staff take action to ensure a safe environment. Night staff make a number of health and safety checks, including hot water temperatures and fridge and freezer temperatures. The fire risk assessment has been reviewed. The fire detection system and fire fighting equipment are regularly serviced. The fire alarm is checked weekly at different points. Only one fire drill has taken place this year. The Manager is aware that at least 4 should be carried out annually and confirmed that further dates are booked. No general risk assessment has taken place as recommended at the last inspection, although the Deputy Manager had clearly taken steps to seek advice. This was discussed further with the Manager who had herself identified a number of hazards, for example protruding metal handles on the dormer windows. The Manager said that staff would complete an assessment of the building, using a similar format to the fire risk assessment. No information is available about steps taken to reduce the risk of legionella. Visits on behalf of the provider are taking place regularly and reports were available on file. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 22 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 2 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X 2 2 3 Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 23 No 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 YA1 YA5 Regulation 5 Requirement Each housemate must have an up to date service user’s guide and statement of terms and conditions. Care plans/PCPs must be reviewed at least every 6 months. Individual risk assessments must be updated regularly. Staff must ensure that any changes to personal care routines that could be interpreted as invasive are fully discussed with relevant members of the multi professional team. Controlled drugs must be stored in a secure locked cabinet. The complaints procedure must be displayed in the home. Staff must be allocated sufficient time to ensure that records are maintained. Information must be available about steps taken to reduce the risk of legionella. Timescale for action 31/08/08 2 YA6 13 31/08/08 3 YA18 12 31/08/08 4 5 6 7 YA20 YA22 YA41 YA42 13 22 17 13 31/07/08 31/08/08 31/08/08 30/09/08 Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 24 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 YA41 Good Practice Recommendations A regular file audit of housemates’ files would ensure that all essential documents are available. Barlby Road DS0000010843.V365875.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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