CARE HOME ADULTS 18-65
Beatrice Road 36 Beatrice Road London SE1 5BT Lead Inspector
Lisa Wilde Unannounced 9 August 2005, 10:00am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Beatrice Road Address 36 Beatrice Road, London, SE1 5BT 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 7252 0302 Choice Support Mr Keshorsingh Beegun CRH Care Home 3 Category(ies) of LD Learning Disability, 3 registration, with number of places Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th February 2005 Brief Description of the Service: The home is a bungalow design, registered to provide accommodation and high support care for 3 men with learning disabilities. It is one of a number of homes operated by Choice Support Southwark, which organisation provides staffing and daily operational support services. This particular building is owned and maintained (major repairs) by Habinteg Housing Association. The property is similar in design to others on the same side of the street, and was purpose built to provide accommodation for people with disabilities. It is located in a residential street in South East London, close to shops, banks, social, leisure facilities and public transport links. The home offers 3 single bedrooms, a lounge, dining area, kitchen, wc/laundry room, bath/shower room and a back garden. There is an additional room that is used as an office/staff sleep-in. The home currently has 5 care staff plus a manager who started working at the home in March 2004. There is vacancy for 1.5 additional staff at the time of this inspection. Service users are supported with accessing health and social care support within the local community. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in August 2005. There was one service user at home but they had limited ability to communicate verbally so the inspector met but didn’t speak with them. The inspector spoke mainly with the service manager and looked through the files and records. The inspector found a good level of support being provided to the four service users. All but one of the previous requirements made at the last inspection had been met by this inspection. What the service does well: What has improved since the last inspection?
This was the first inspection of this home by this inspector so it is more difficult to say what has improved. Previous requirements that had been made that had been met by this inspection showed that improvements have been made in the area of service users finances and how the home protects these, increased
Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 6 levels of staffing, more training for staff and renovation and redecoration of the building and garden. 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. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 & 5 All service users do not have a comprehensive individual written contract or statement of terms and conditions on file that meets the requirements of this standard and this means that service users and their families may not be fully clear about what they can expect from the home or what their rights and responsibilities are. EVIDENCE: A service user has recently moved to the home and came for trial visits with their family prior to them permanently moving in. There was a previous requirement that each service user must be provided with a costed contract/statement of terms and conditions of service. The manager stated and the files showed, that this issue has not yet been finalised as discussions are still underway with the housing authority to revise the terms and conditions for all service users. The manager stated that a meeting had been held three weeks prior to this inspection and that he was expecting the issue to be resolved soon. The previous requirement is therefore repeated. (See Requirement 1) Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 Generally care plans are in place and are comprehensive. As assessments of service users made prior to them coming to the home are not currently written and on file it is not possible for the home to fully evidence that they are basing the service user care plans on their pre-assessment needs. The area of illness, dying and death is not being fully explored with service users which means that the home can not be sure that they are meeting all the service users needs with regard to all areas of their lives. EVIDENCE: One new service user has moved to this home since the last inspection. The manager talked through the process of assessment and move in but there was no written pre-assessment on file. (See Requirement 2). The manger stated that some families of service users do not want to talk about funeral arrangements with the service users (or have staff talk with service users about the issues) and have made their own plans around this. This issue may be particularly pertinent to one service user in particular who has a serious liver condition. The manager was not sure whether this service user’s views were the same as their family’s. The home must make sure that issues around funeral arrangements or wishes in the event of becoming ill and dieing are discussed as far as possible with the service user and recorded in
Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 10 the care plan. Advocates should be used where appropriate to make sure that the service user understands what is happening to him as far as possible and their wishes are voiced and heard by their family. (See Requirement 3) Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) X All these standards were assessed as met or exceeded at the last inspection. EVIDENCE: Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 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) 19 & 20 Staff understand the physical and emotional needs of the service users and develop detailed action plans with the service users to make sure staff can meet those needs. The home is not currently protecting service users with their procedures for management of medication as current stock checks are not effective. EVIDENCE: The manager talked through the needs of service users and files showed that detailed care plans are in place to meet those needs. The home is currently working on developing picture life books for service users to record their lives and histories. The inspector checked the medication stocks and records and found that the records had been taken away by staff who had gone on holiday the previous day. They were being posted back by registered mail but they should not have been taken from the service in the first place. (See Requirement 4) Not all of the stocks of medication tallied with the stock records. (See Requirement 5) Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home has appropriate policies around protection from abuse and staff receive training in these areas. Service users finances are protected by the systems in place and solicitors or advocates are used to further protect their interest. EVIDENCE: There had been previous requirements that arrangements must be made to reopen the bank account of a service user so that money can be withdrawn to pay for his care needs. The manager talked through this issue and the inspector was satisfied that he had done all he could to address the issue as much of it was out of his control. A new building society account has been set up for the service user, he has been allocated a solicitor to advocate for him with regard to his frozen account and the organisation has lodged a complaint with the bank. Staff have now received adult protection training as required from the previous inspection. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 14 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 & 30 The home is clean, homely and comfortable throughout. Communal areas are large enough and colourful. Service users rooms are decorated to their own tastes and bathrooms are non-institutional. Equipment such as hoists and wheelchairs are checked and regularly assessed so that service users are protected from harm during the use of any specialist adaptations. EVIDENCE: There was a previous recommendation that the manager should review the outlay of one service user’s bedroom, and the use of padding for his protection, which is unsightly, to determine if more appropriate furnishing/protection could be acquired. Consideration should be given to consulting an Occupational Therapist to assist with this. An OT had been consulted but said that they could not assist with this area as it was not deemed essential. The home has enlisted the support of a physiotherapist to gain further funding to make this service users’ room safer. All equipment and adaptations necessary in the home are assessed regularly by an occupational therapist to ensure they continue to be the most appropriate. There was a previous requirement that the garden must be kept to acceptable standard, new fencing is erected and pavement stones are cleaned. This work
Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 15 had been done. The planned work to change the garden into a therapeutic/sensory garden has been put on hold as one service user has died and another cannot pay for the changes that need to take place. The housing association is not prepared to pay for the developments to the garden as they are not part of their maintenance agreement. A sensory garden has been established as an added value for these service users and as such a recommendation is made (See Recommendation 1) On the day of the inspection the home was clean and hygienic. Furniture and decoration in the home was in place to make the home comfortable and homely and each service users’ bedroom was large enough and individualised to their personal tastes. The toilets and bathrooms are suitable for purpose and non-institutional. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 16 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) 33 & 35 There are adequate numbers of permanent staff on duty to meet the needs of service users and the training programme in the organisation means that service users are being offered support by fully trained and qualified staff. EVIDENCE: There was a previous requirement that the home must be adequately staffed at all times to fully meet the needs of the service users. Recruitment has taken place and the home now has 1.5 vacancies. There is a now provision for a waking night instead of a sleep-in at the home should the increased needs of one service user require this. There was a previous requirement that all staff receive the relevant training they need to perform their duties competently. This must include training in medication from persons qualified to offer this. The inspector saw the training records and was satisfied that staff are attending training relevant to the posts they fill. All staff hold or are undertaking the NVQ Level 3 or are on an induction and foundation programme that is in line with the Skills For Care standards. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 17 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) 41 & 42 Records are maintained effectively in the home. The health, safety and welfare of the service users are protected by the health and safety policies and by staff practice at the home. EVIDENCE: There was a previous requirement that the manager must ensure that Case Files are maintained in an orderly manner, with up to date information, and in line with new Choice Support filing systems that had been met by this inspection. There was a previous recommendation that staff should be provided with all necessary equipment and tools –including a computer, photo copy/fax machine and direct dial telephone service- to help perform their duties and responsibilities efficiently. The manager stated that when the office is changed around and more space is freed up there is a plan to get a computer. The inspector felt that the current lack of a mainline phone in the office (only the payphone in the communal area of the home) was compromising the work of staff. (See Recommendation 2)
Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 18 All the required certificates with regard to health and safety were in place and fire drills and checks are taking place regularly. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 2 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Beatrice Road Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 x 2 G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 20 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 YA5 Regulation 5 (b) & (c) Requirement The registered provider and manager must ensure that each service user is provided with a costed contract/statement of terms and conditions of service. Previous requirement: Unmet timescales 9/4/03 & 1/6/05 The Registered Manager must ensure that assessments of service users are written and placed on file to form the basis of the care plan when someone moves to the home. The Registered Manager must ensure that service users wishes in the event of illness, dieing and death are sought and written in the careplan. Indepedent advocates must be used if appropriate to ensure that their wishes are expressed to their family. The Registered Manager must ensure that the medication records are maintained in the home for all service users present at the home and ensure that they cannot be taken from the home inappropriately. The Registered Manager must ensure that the medication stock Timescale for action 31/12/05 2. YA6 14 (1) & 15 (1) 30/09/05 3. YA6 15 (1) & (2) 31/12/05 4. YA20 13 (2) 14/09/05 5. YA20 13 (2) 14/09/05
Page 21 Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 checking system at the home works effectively. 6. 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 YA18 & YA 24 YA41 Good Practice Recommendations The Registered Individuals should consider seeking additional funding to make the planned changes to the garden to make it into a senory/therapeutic environment. The registered provider should ensure that staff are provided with all necessary equipment and tools –including a computer, photo copy/fax machine and direct dial telephone service- to help perform their duties and responsibilities efficiently.The registered provider should ensure that the efficient operation of the home is not compromised by the absence of these and other equipment. Previous recommendation. Beatrice Road G52-G02 S7107 Beatrice Road V243986 090805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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