CARE HOME ADULTS 18-65
Bowley Close, 1 Farquhar Road London SE19 1SS Lead Inspector
Ms Alison Pritchard Unannounced Inspection 13 December 2006 3pm
th DS0000007068.V321860.R02.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 DS0000007068.V321860.R02.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. DS0000007068.V321860.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bowley Close, 1 Address Farquhar Road London SE19 1SS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager Type of registration No. of places registered (if applicable) 0208 670 0340 0208 299 8598 choicesupport@choicesupport.org.uk www.choicesupport.org.uk Choice Support Post vacant Care Home 1 Category(ies) of Learning disability (1) registration, with number of places DS0000007068.V321860.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 27th February 2006 Brief Description of the Service: The home provides care for one service user who has lived at the home since it opened in December 1995. At the time of the inspection visit there were no vacancies at the home. The accommodation consists of a ground floor flat located in a cul-de-sac close to the centre of Crystal Palace. There are several other care homes grouped together in the close, all of which are managed by Choice Support. The home is well maintained internally and externally. It is close to local facilities such as shops, cafés, pubs, a park and sports centre. Public transport routes - both buses and trains - are close by. Although the home has not had a new admission in recent years the Acting Manager stated that potential residents would be given information about the home and the services available through the service guide and statement of purpose. These documents could be made available in a range of formats including pictures, widgets, symbols or audio-tape. The Manager would also provide a copy of the annual report of Choice Support which on DVD. CSCI inspection reports would also be supplied by the home to potential service users. The current monthly fees for the home range between £4,000 and £8,000 depending on the amount of individual care that the resident requires. No additional charges are made. DS0000007068.V321860.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over an afternoon in mid December 2006. The inspection methods included observation of care practice, discussion with staff, inspection of the service user files, as well as a range of records. The Inspector spent time chatting with the resident. Involved professionals were sent survey forms so that they could contribute to the inspection process. Feedback was received from a health care professional who expressed satisfaction with the care provided to residents. The CSCI also has access to information gathered through notifications from the home. A member of staff who was helpful and courteous assisted with the inspection visit. What the service does well: What has improved since the last inspection? What they could do better:
There are a number of improvements which will make sure that the resident is safe and that her health and welfare are protected. There should be written guidelines about when to give medication which is ‘as needed’ to make sure staff know when to do so. DS0000007068.V321860.R02.S.doc Version 5.2 Page 6 Staff need to be trained in adult protection issues so that they know how best to keep the resident safe. The resident’s property list should be checked to make sure it is accurate and then dated. Information about the checks and references taken up on staff should be kept in the home so that the inspector can check that the procedures help to keep the resident safe. A bottle of bleach was in the bathroom; this could be risky to the resident so all chemical cleaning products should be safely locked away. At the moment there is an acting Manager of the home. The inspector wants to be sure that a permanent manager is appointed within a reasonable time. This will help the resident by providing leadership for the staff and direction for the way the home works. 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. DS0000007068.V321860.R02.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 DS0000007068.V321860.R02.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, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures for admitting new residents ensure that both the home and the potential resident have enough information to decide whether it would be a suitable place for the person to live. EVIDENCE: There have been no new admissions to the home for some time and none are planned, currently there are no vacancies at the home. The admission policy of Choice Support includes encouraging introductory visits. The policy of Choice Support is for social work assessments to be obtained before admission and for placements to have a twelve week trial period. DS0000007068.V321860.R02.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, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The resident is supported to make decisions about her daily life and goals for the future. The home also makes sure that people who are concerned about the resident are involved with decisions about her life. Risk management enables the resident to take part in a wider range of activities than might otherwise be possible. EVIDENCE: The home uses a person centred model for care planning. This makes sure that the resident is fully involved in planning her personal goals. Meetings to review the resident’s placement at the home, to plan care and review goals had all been held in the last six months. Each month the resident joins a part of the team meeting to talk about her own issues with staff. The resident is given a copy of the minutes of this section of each meeting. The resident is helped to make decisions about what she does each day. Each day the staff and resident make a plan using pictures for the resident and staff to refer to. This gives the resident control over her daily activities. There are
DS0000007068.V321860.R02.S.doc Version 5.2 Page 10 also systems to ensure that the resident is consulted about longer term goals, these are recorded and referred to as part of the care planning process. The resident has an advocate who visited the resident during the inspection and spent time chatting with her privately. The home is supportive of the resident’s relationship with the advocate, she is invited to care planning meetings and is consulted over important issues. The managing organisation has links with a service called ‘Customer Watch’ which is a forum through which people with learning disabilities can express their views on the services provided through Choice Support (Southwark). This ensures that the opinions of service users generally are included in the overall planning of the organisation. There are written risk assessments which support the resident to take part in a range of activities which may involve some degree of risk, to the resident or others. The staff member was familiar with the documents and this indicated that they are used in the daily life of the home. The assessments identify the action to be taken to minimise the risks involved and have been reviewed within the last six months. Residents’ personal information is stored with due regard for confidentiality. Choice Support is registered under the Data Protection Act and there is a confidentiality policy to ensure that staff handle residents’ personal information with care. DS0000007068.V321860.R02.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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident is supported to take part in a range of activities both at home and in the local community. The activities are age and culturally appropriate, and valued. The meals are nutritious, include fresh items and reflect the resident’s tastes and culture. EVIDENCE: The resident takes part in a range of activities in the local community including going to the cinema, shopping, and visiting local pubs and restaurants. In addition she attends a specialist art-work project three times a week. The resident uses public transport to travel in the local area. It has been identified that the resident would benefit from the opportunity to take up employment. This goal is being pursued by the home with the assistance of a specialist supported employment project. DS0000007068.V321860.R02.S.doc Version 5.2 Page 12 At home the resident is involved in cookery, art-work and photography as well as assisting with household tasks. She also uses a computer. She is going to be supported to grow vegetables in the garden with the assistance of staff. The resident has been on holiday to a sea-side cottage during the summer. She said that she had enjoyed the holiday and was accompanied by the manager of the home. Photographs of the holiday were displayed in the resident’s bedroom. The resident has been supported to develop and maintain relationships with family members and friends. Plans were in place for the resident to hold a Christmas party at the home and she had been planning who to invite to the event. She had also hosted a birthday party earlier in the year. This is a very positive development for the resident who may previously have found such events difficult. The resident has full access about the home and the way in which the home runs is aimed at increasing her independence, self determination and choice. The menu is planned by the resident with the support and advice of staff. She chooses when to be involved with the preparation of meals. The member of staff said that the resident generally helps to prepare breakfast and lunch but the main evening meal is usually made by staff. The menu records showed that a good range of culturally appropriate meals is served. On the day of the inspection the meal was beef stew with dumplings and fresh vegetables. DS0000007068.V321860.R02.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, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team work hard to provide care which is consistent with the resident’s needs and wishes. Medication is safely managed and there is careful attention to the resident’s physical and emotional health care needs. EVIDENCE: Considerable efforts are made to ensure that staff are familiar with the resident’s care needs. A new member of staff has been introduced to the staff team over the last year and her induction was gradual, to make sure that the resident became used to her and accepted her as part of the staff team. The team are very familiar with the resident’s emotional needs and communication patterns. One member of the staff team is male and as staff work alone with the resident there are guidelines in place to support this. The resident does not require assistance with intimate personal care. The resident is supported to choose her own clothes. She shops with staff for appropriate items in keeping with her tastes and with regard for her age and fashion.
DS0000007068.V321860.R02.S.doc Version 5.2 Page 14 The home has well developed contacts with a local multi-disciplinary health care team which provides specialist care for people with learning disabilities. Their assistance has been sought appropriately in the past. Positive feedback was received from a professional about the home’s ability to manage residents’ health care needs. On the day of the inspection the resident was experiencing a minor health problem. The staff member had provided some items to make her feel more comfortable and given some medication given on an ‘as needed’ basis. An appropriate record of this was made. The resident sees the GP regularly and this has led to the diagnosis of a health problem which is being addressed through medication. In addition the staff member spoken to said that the team are encouraging the resident to take gentle and regular exercise. Overall medication management is good. The medication administration form includes details of the resident’s allergies and there are systems to allow checks of the balance of medication held in stock. There were guidelines in place to ensure that staff are aware of when medication given on an ‘as needed’ basis is to be used, but one item did not have such guidelines. This must be put in place. Staff members’ competence to administer medication is assessed by the manager using a pro forma and training has been provided in medication matters. DS0000007068.V321860.R02.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, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies for complaints and dealing with adult abuse contribute to the protection of residents. To improve the protection systems the staff audit and date the resident’s property list. Confirmation should be provided that staff have received adult abuse training or will do so shortly. EVIDENCE: The complaints procedure meets the legal requirements and is included in the statement of purpose. The resident is aware of the complaints procedure and has been supported to use it in the past. Neither the home, not the CSCI has received any complaints since the last inspection in February 2006. The adult abuse policy of the organisation is suitable for its purpose. There have been no concerns of this kind at the home. There are safe arrangements in place for dealing with the residents’ financial matters. On the information supplied to the CSCI prior to the inspection there was no confirmation that staff have received training in adult abuse issues. Information on this matter is required. On a file it was noted that, although there is a list of the resident’s property, the list is undated. The list should be checked and dated as accurate to ensure that her interests are protected. DS0000007068.V321860.R02.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, 25, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident benefits from a home which is clean and comfortable. There are many examples of the resident’s art work displayed throughout the home and this makes it very personalised and homely. Recent redecoration has also made the bathroom and WC more attractive rooms. EVIDENCE: The home is a ground floor two bed-roomed flat. The resident has the largest bedroom and the second is used as an office and sleeping in room. The resident’s bedroom is attractively decorated according to her tastes. There is a large living room which has a door to the garden. Since the last inspection the bathroom and WC have been redecorated and this has increased the homeliness of the building. The home is furnished in a domestic style and there are pictures and photographs by the resident on display. The home is satisfactorily clean and laundry facilities are suitable for the home. DS0000007068.V321860.R02.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident benefits from a staff team with whom she is familiar and which is knowledgeable about her needs. Information about the recruitment checks should be kept in the home for inspection. The staff team has received training in a range of topics appropriate to their duties. Confirmation that they have received training in adult abuse issues is required. EVIDENCE: Staff working at the home need to have skills appropriate to the resident’s needs. Staff observed, both during this inspection, and at other visits to the home have shown that they are approachable, calm and patient. One of the support workers has achieved NVQ 2, as has the Acting Manager. Staff training over the last year has included input on health and safety matters, medication and grief and loss issues. As noted above (in relation to standard 23) confirmation is required that staff have received training in adult abuse issues. DS0000007068.V321860.R02.S.doc Version 5.2 Page 18 In accordance with the resident’s needs there is one member of staff working with her at all times, other than at shift handovers when there will be two members of staff in the building. This means that generally staff work alone for lengthy periods. Staff are made aware at induction of the particular demands this creates. Additional management support is available through the on-call system out of office hours. Staff meetings take place at approximately monthly intervals. The home is working towards providing an all female team to work with the resident. Staff are aware of this aim. Good progress has been made towards this. When the staff recruitment records were last checked at the managing organisation’s head office they were in good order. As the records are kept centrally the home should ensure that a checklist confirming that appropriate checks and references have been taken up is kept in the home and available for inspection. DS0000007068.V321860.R02.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although the previously Registered Manager has left his post there are appropriate arrangements in place to provide management cover and support. There are a number of systems to monitor the work of the home and these include reference to the resident’s views. Overall health and safety is well managed although care needs to be taken to ensure that chemical cleaning products are always locked away after use. EVIDENCE: The previously registered manager has now left his post at the home. Management of the home is now being covered on an acting basis by the Assistant Team Manager while the post is recruited to. The previously registered Manager still works within Choice Support and provides support to the Acting Team Manager as does the Service Manager. The Acting Manager has been provided with management training. The CSCI was appropriately DS0000007068.V321860.R02.S.doc Version 5.2 Page 20 informed of the changes. The schedule for the recruitment to the vacant post should be sent to the CSCI. A Manager of another Choice Support residential service makes visits to the home and reports of the visits are made. Although some reports of recent visits could not be located the staff member provided assurance that the visits are made regularly. The reports of the visits were particularly thorough and included discussions with the resident and staff. The resident’s views are integrated into the way that the home’s work is monitored. As noted above the resident takes part in staff meetings and this gives the opportunity for her to discuss issues with staff. Checking records of challenging behaviour is another management tool to monitor the work of the home. There has been a significant reduction in the incidents of the challenging behaviour over the time that the resident has lived at the home. The resident has contact with members of Customer Watch, the forum through which people with learning disabilities can express their views on the services provided through Choice Support (Southwark). The details of the group are available in the home. Regular checks of health and safety matters in the home are carried out, including checks of the operation of the fire safety systems and fire drills. A bottle of bleach was found in the bathroom, staff need to be sure that they lock away chemical cleaning products after use. This is the subject of a requirement of this report. DS0000007068.V321860.R02.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 3 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 3 3 2 X 2 X 3 X X 2 X DS0000007068.V321860.R02.S.doc Version 5.2 Page 22 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. 1. Standard YA20 Regulation 13(2) Timescale for action The Registered Provider must 01/02/07 ensure that there are guidelines in place to ensure that staff are aware of when medication given on an ‘as needed’ basis is to be used. The Registered Provider must 01/02/07 ensure that the resident’s property list is checked to ensure its current accuracy and dated. The Registered Provider must 01/02/07 provide confirmation that training for staff in adult abuse issues has been provided or is planned to ensure that the resident is protected adequately. The Registered Provider must 01/04/07 ensure that a checklist confirming the take up of required recruitment checks and references is kept in the home. The Registered Provider must 01/04/07 inform the CSCI of the anticipated schedule for recruitment to the vacant manager’s post.
DS0000007068.V321860.R02.S.doc Version 5.2 Page 23 Requirement 2. YA23 13(6) 17(2)sch4 para10 13(6) 3. YA23 4. YA34 17(2)sch4 para6 5. YA37 8(1)(a) 6. YA42 13(4)(a) The Registered Provider must 15/01/07 ensure that chemical cleaning products are locked away after use. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000007068.V321860.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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
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