Inspection on 09/05/05 for Barlby Road

This inspection was carried out on 9th May 2005.

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

Other inspections for this house

Barlby Road 14/04/09

Barlby Road 21/07/08

Barlby Road 08/10/07

Barlby Road 15/08/06

Barlby Road 05/12/05

Barlby Road 25/10/04

Barlby Road 12/07/04

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 BARLBY ROAD 37 Barlby Road North Kensington LONDON W10 6AN Lead Inspector Sheila Lycholit Announced 9 May 2005 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. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Barlby Road Address 37 Barlby Road, North Kensinton, London W10 6AN 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 8964 8543 020 8964 8156 Yarrow Housing Limited Acting Manager Kim Poller Care Home 4 Category(ies) of Learning Disability (4) registration, with number of places BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 October 2004 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, three men and one woman, 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 leisure interests. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Acting Manager was available throughout the inspection, which took place from 10.30am until 3.15pm. All of the 4 service users were present for part of the visit. The inspection included a tour of the building. What the service does well: What has improved since the last inspection? 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. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 6 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 BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 7 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) 1,2,3,4 and 5 Clear information about the home, using signs and symbols as well as text, is provided for each service user. In addition to the Guide, the contract is also produced in an accessible format. Service users at 37 Barlby Road have complex needs, which are regularly reviewed and reassessed. EVIDENCE: Each of the service users has lived at 37 Barlby Road since it opened. While it is regarded as their permanent home, discussion with the Manager and records show that their needs are regularly reassessed and a move to more independent accommodation may be offered where appropriate. All of the service users’ individual files were seen. Each contained an up to date copy of the Service User’s Guide and a signed contract. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 8 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) 6,7,8 and 9 Over the past 12 months, staff have given priority to developing person centred plans that reflect the aspirations, wishes and needs of service users. In view of the individual and largely non-verbal means of communication used by service users, staff have needed to develop strategies for capturing their views and concerns about all aspects of their lives. Service users are supported to lead as independent a life as possible and to pursue the lifestyle, interests and activities identified in person centred plans. EVIDENCE: An up to date individual plan is available for each person, in an accessible format. Detailed support guidelines are also available in the working files. The support guidelines are detailed and demonstrate the authors understanding of the needs of the service users. Plans are reviewed 3 monthly by staff in the home and 6 monthly with the Reviewing Manager from RBKC. Not all reviews had been filed, though most were found on the PC by the Manager. Records show that issues raised at reviews and actions agreed are followed up. The Manager reported that equipment has been purchased by Yarrow Housing to enable staff to implement multi-media profiling. The equipment is to be shared between projects. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 9 Staff had ensured that the suitability of the wheel chair used by one service user was fully assessed, using external resources. Where service users had expressed an interest in certain activities, records showed that action had been taken to facilitate that activity. A detailed risk assessment is available on each individual file. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 10 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) 11,12,13,14,15,16 and 17 Service users are supported to take part in a range of leisure and social activities, in addition to attendance at local day services. Routines are flexible and service users assist with daily tasks such as laundry, food preparation and shopping. Friendships are supported and contact with families maintained. Menus reflect service users likes and dislikes and are regularly reviewed. EVIDENCE: Staff are aware of service users’ rights and take steps to ascertain their wishes and to offer choices. The care guidelines show that routines are flexible, with service users getting up and going to bed at their chosen times. Some restrictions are in place, such as the front door being locked, as some of the service users would be at risk from the busy road nearby. Guidance is available for staff on managing the behaviour of one of the service users. Use is made of the local advocacy service and one service user currently has an advocate. In addition to attendance at local day services for people with a learning disability and adult education college, service users are supported to pursue a range of interests. Communication with day services has improved with the BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 11 use of books for each service user that travel between the services, though there is still room for improvement, with staff at 37 Barlby Road not being informed of some issues. One service user has joined a volunteer project and another has a part-time job as part of his work experience. Individual holidays that reflect his/her interests have been arranged for each person. The staff rotas are designed to support service users in activities outside the home, including in the evening. The activities officer works one late shift each week to support an evening activity. Meal times vary depending on the routine of the service user. Menus are not very adventurous but staff find it difficult to persuade service users to try new foods. Records show that service users are being supported to widen their tastes by going to some of the many restaurants in the area serving food from different regions and cultures. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 12 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) 18,19 and 20 Staff are aware of service users’ individual needs and offer assistance sensitively. Staff support service users to access health care services and have established contacts with a range of health professionals. Service users health care needs are regularly reviewed. Policies, procedures and training are in place regarding the administration of medication. EVIDENCE: As noted elsewhere in this report, well-written support guidelines are available for each service user. Records and discussion with the Manager show that staff have followed up health issues identified at reviews and by staff. For example 3 service users have had dental checks at a local practice that is able to treat people with special needs. Regular health checks take place and staff are supported by the specialist nurse from the Learning disability Team. Accidents are carefully recorded, though it was not clear that the risk assessment had always been reviewed following an accident. MAR sheets seen were up to date with no gaps. All medication is administered by 2 staff. The medicine cupboard has been moved to a locked walk-in cupboard to provide more space in the kitchen. The Boots Pharmacist normally visits every 3 months though she had not made a visit for some time. Guidance for some medication prescribed ‘as required’ is available. It is BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 13 recommended that this is extended to all regularly prescribed ‘as required’ medication. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 14 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) 22 and 23 Staff take steps to elicit service users concerns, which are followed up. The particular vulnerability of service users is recognised by staff, who are alert to any signs of abuse or mistreatment. EVIDENCE: Staff are developing ways of finding out service users views using non-verbal methods such as objects of reference. The home has a complaints procedure in an accessible format and any complaints are recorded. There have been no complaints since the last inspection. A copy of the multi-agency adult protection policy is available. Training records show that 70 of staff have attended adult protection training. All support staff are expected to attend within 18 months of starting to work for Yarrow housing. There has been 1 adult protection investigation in the previous 12 months, following an accident to a service user. Steps to prevent a reoccurrence and to improve recording have been put in place. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 15 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) 24,25,26,27,28,29 and 30 Staff take steps to make the house as safe as possible for service users, who have a variety of needs. The ground floor has been well adapted for wheel chair use, although the garden needs additional hand or guide rails/ropes to assist the service user with a sensory disability. The building is spacious, with good-sized single bedrooms and sufficient communal space for the 4 service users. The décor is attractive and welcoming. EVIDENCE: A tour of the building showed that staff have helped service users choose more personal items, including framed photos, for their rooms, which together with the new colours in which much of the building has been redecorated, has created a more home-like appearance. Some further changes have been made to assist one service user to be more independent, including lowering her clothes rail and removing a cupboard in the kitchen to provide easier access to the low level work surface. It is disappointing that plans to make the garden more accessible for the service user with a sensory disability have not materialised. The area at the front of the house, which has weeds growing through the paving and a dead potted plant, is in need of attention. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 16 The building was clean and tidy on the day of the inspection. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.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) 32,33,34,35 and 36 Staffing levels and rotas allow staff to support service users in a range of daily and leisure activities. Continuity of staffing is maintained by using staff from Yarrow Housing’s bank who are known to service users, rather than agency staff. Yarrow Housing has a comprehensive training programme based on accredited training as well as the identified training needs of staff. Staff are supported through regular supervision and team meetings. EVIDENCE: The Acting Manager and Deputy Manager are NVQ Assessors. One Support Worker has completed NVQ2, a Deputy Manager has completed NVQ3 and six staff are undertaking NVQ2. All new staff, including bank staff, undertake LDAF induction training. In addition to NVQ training, the training programme available in the home and training records show that staff have access to comprehensive training. Rotas show that staff are available to support service users, including accompanying them on evening and weekend outings and activities. The Manager was unable to complete the required information regarding staff checks, as she had not been provided with the data from Yarrow Housing’s HR Department. Supervision records for 2 staff were seen. A pro-forma is used and staff receive a copy. Supervision is planned ahead and noted in the house diary. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 18 BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 19 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) 37,38,39,41,42 and 43 The Acting Manager was previously the Deputy Manager and knows the service well. She has applied for registration. The Acting Manager has introduced new ways of trying to obtain feedback from service users and to increase participation in decision making. Systems are in place to protect service users and staff and to create a safe environment. Support from the registered provider regarding regular visits to the home, needs to be improved. EVIDENCE: The Acting Manager is developing ways of further increasing the participation of service users in the running of the home and development of the service. Objects of reference had been used with one service user to help her give feedback on the service. Issues she raised had been followed up. Team meetings take place regularly and are minuted. Senior staff meetings are also regularly held but are not recorded. It is recommended that notes are kept of these meetings. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 20 The Acting Manager will need to consider completing NVQ4/Registered Manager’s Award following registration/appointment as Manager. Yarrow Housing is piloting a quality assurance system across all services. Barlby Road also takes part in the RBKC Quality Network. Records show that health and safety checks are regularly carried out. A number of checks form part of the daily shift plan. Monitoring information is provided to head office monthly but visits by the Service Manager on behalf of the registered provider are still not taking place at the required frequency, nor has the Acting Manager received regular supervision. It is expected that a new manager, who in addition to taking over 37 Barlby Road has also been over-seeing another project, would receive more support, with regular supervision sessions planned ahead. BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 21 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 2 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 BARLBY ROAD Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 3 x 3 3 2 G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 22 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 34 Regulation 19 Requirement Timescale for action May 31st 05 2. 43 26 The Manager must receive confirmation from Yarrows HR Department of satisfactory employment checks including CRB checks for all staff, including bank and agency staff. Reports of visits, which must May 31st take place at least monthly, on 05 behalf of the registered provider must be available. A supervision schedule for the Acting Manager must be available. 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. 3. 4. Refer to Standard YA19 YA20 YA24 YA38 Good Practice Recommendations Confirmation that risk assessments have been reviewed following any accident/incident should be noted. Guidance on all prescribed as required medication should be available. The front garden would benefit from some attention and the rear garden should be made more accessible to service users. Notes of senior staff meetings should be kept for reference. G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 23 BARLBY ROAD BARLBY ROAD G60-G09 S10843 BARLBY ROAD AIV215689 090505 STAGE 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26/28 Hammersmith Grove London W6 7SE 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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