Inspection on 16/08/05 for Bowley Close, 4

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bowley Close, 4 15/08/06

Bowley Close, 4 20/02/06

Bowley Close, 4 09/12/04

Bowley Close, 4 13/07/04

Bowley Close, 4 22/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Bowley Close, 4 Farquhar Road London SE19 1SS Lead Inspector Ms Alison Pritchard Announced Inspection 16th August 2005 10:00 DS0000007076.V254292.R01.S.doc Version 5.0 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 DS0000007076.V254292.R01.S.doc Version 5.0 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. DS0000007076.V254292.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bowley Close, 4 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 (if applicable) Type of registration No. of places registered (if applicable) 0208 670 2360 Choice Support Oluwatoyin Onabanjo Care Home 4 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Mental disorder, excluding of places learning disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) DS0000007076.V254292.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 (four) people with learning disability and mental disorder, 1 (one) of whom may be over 65 years of age. 9th December 2004 Date of last inspection Brief Description of the Service: 4, Bowley Close is a home for four people with learning disabilities who may also have mental health problems and present behaviour which is challenging. At the time of the inspection there were two residents, both of whom were under 65 years of age. There were well-developed plans in place for another resident to be admitted to the home. The home is located in a cul de sac close to the centre of Crystal Palace where there are shops, sports facilities, pubs and restaurants. Public transport routes are close by allowing easy access to other parts of London. The road from Bowley Close to Crystal Palace is steep and could present problems for anyone with a mobility problem. DS0000007076.V254292.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, took place in mid August 2005 and lasted for seven hours. The inspection methods included observation of care practices, conversations with residents, a tour of the building, examination of records, interviews with two members of staff, a telephone discussion with a professional contact, and discussions with the manager of the home. The manager had ensured that relatives and other professionals involved with the residents had been informed about the inspection and comment cards were distributed to them. Four comment cards were returned to the inspector from three relatives and one visiting professional. What the service does well: What has improved since the last inspection? What they could do better: There are some aspects of the recording of residents’ health care needs and their management and monitoring which need to be improved. Two areas of the building were not cleaned to a satisfactory standard and there were some repairs required. DS0000007076.V254292.R01.S.doc Version 5.0 Page 6 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. DS0000007076.V254292.R01.S.doc Version 5.0 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 DS0000007076.V254292.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 4, 5 The information provided for potential residents allows them to make a choice about the home’s suitability, but the complaints procedure needs to be added. The admission policy and practice ensures that the home gathers enough information about a potential resident to make a decision about the suitability of the placement. EVIDENCE: The Service Users’ guide is incomplete as the complaints procedure is not included in the guide. There are well developed plans for a new resident to be admitted to the home. A programme of introductory visits were arranged, including overnight stays. Staff from the home had visited the person in their current home and at day provision so that they could become familiar with each other and with the potential resident’s needs. Assessment documents had been gathered and were used as part of the decision making process. DS0000007076.V254292.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 8, 9, 10 Residents benefit from a clear care planning system. Decision making processes include residents’ views. EVIDENCE: The home is introducing a ‘person centred’ approach to care planning. Each resident has a care plan which describes their needs, and interests. Six monthly reviews of the care plans, including the residents, had taken place shortly before the inspection, and the key worker meets with the resident approximately six weekly to review the current goals. This allows regular consultation with residents so that they can be part of decision making processes. In addition an advocate is involved with the residents, as are family members who are also consulted as part of the planning process. Discussions with key workers showed knowledge of the residents and their needs. Choice Support runs a group called ‘Customer Watch’ for residents to contribute feedback to the organisation and to provide a forum for regular discussion. This allows residents’ views generally to be part of the organisational planning. DS0000007076.V254292.R01.S.doc Version 5.0 Page 10 A risk management policy is used to make sure that, when appropriate, residents can be involved in activities which may include some degree of risk. Risk assessments which support residents to maintain independence skills were seen on a file and were judged to be appropriate to the residents’ needs. Information is kept securely, with due regard for confidentiality. The managing organisation is registered under the Data Protection Act. DS0000007076.V254292.R01.S.doc Version 5.0 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 the following standard(s): 11, 12, 13, 14, 15, 16, 17 Residents have opportunities to take part in a range of valued activities at home and in the community. Relationships of value to the residents are supported by staff. Residents’ nutritional, cultural needs and preferences are reflected in the menu. EVIDENCE: The residents each have an activity programme which reflects their individual needs and interests. One of the residents attends a day centre and an art project. Both residents require individual support to participate in community activities. The community activities enjoyed by one resident include walking, swimming, shopping, cinema trips, visiting local pubs, restaurants and parks and membership of a social club. One of the residents is reluctant to join in such a wide range of activities although staff encourage this person to expand their range of interests. The support of challenging behaviour specialists has been sought in order to assist the resident. A communication aid in the living room had previously been used with this resident. It had photographs to illustrate two activities so that the resident could be informed and give views DS0000007076.V254292.R01.S.doc Version 5.0 Page 12 on the planned activities for the day. The aid was not currently in use but nevertheless two activities were illustrated on it. The inspector was concerned that this could lead to confusion for the resident. Activities within the home are provided including cookery, television, music and radio, puzzles, board games and art activities. Both of the residents are encouraged and supported to maintain relationships of value to them. Relatives who completed the comment cards stated that they are welcomed to the home. Interaction between staff members and residents was warm, patient and respectful. Residents are given choices of activities and have freedom of movement about the home and garden. Residents assist with choosing and cooking the meals provided which reflect their dietary and cultural needs. There are plans for the menu to be presented in a pictorial form so that the residents’ opportunities for choice are increased. DS0000007076.V254292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, Residents are assisted to be well groomed and this enhances their dignity. Multi-disciplinary working has benefited residents so that staff have guidance on addressing the range of residents’ needs. However, further attention needs to be paid to the recording of health care needs and contact with health care professionals. The medication is generally well managed but improvements were needed in relation to medication given ‘as needed’. EVIDENCE: One of the relatives who commented about the care of their relative stated that the person is ‘always well dressed’, and all four comment cards expressed satisfaction with the care provided. The staff team is mixed in terms of gender, as is the resident group. This means that same gender care can be provided for a proportion of the time. Staff have understanding of the need to provide care with regard to residents’ privacy and dignity and these principles are part of the ethos of the organisation. Staff interviewed showed understanding of the support needs of residents, and how best to meet them. In some instances the verbal information given by staff was not reflected in the written information on residents’ files. For instance the particular health needs of one resident were not adequately described on the file, as there were no specific guidelines in place. DS0000007076.V254292.R01.S.doc Version 5.0 Page 14 The records showed that there is liaison with health care professionals such as the GP, psychiatric services and ophthalmology. However, the recording systems made it difficult to track contact with particular professionals. For instance it was not easy to track when one of the residents had last seen a chiropodist, even though a health condition would indicate the need for regular contact. This was passed on to the manager who agreed to follow this up. It is recommended that consideration be given to the introduction of a health care checklist so that these matters can be effectively monitored. The records showed that medication management was generally good, but there were two areas of improvement needed, both of which related to medication given on an ‘as needed’ basis. Firstly, as at the last inspection of the home, there were some instances of medication being given ‘as needed’ without adequate recording of the reasons for so doing. Secondly, one document, which described the general reasons for giving a medication ‘as needed’, had been drawn up by a Consultant Psychiatrist more than a year ago. This was pointed out to the manager who agreed to arrange for the review of the document in the week following the inspection so that any changes in the resident’s condition could be reflected. DS0000007076.V254292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The complaints and vulnerable adults procedures contribute to the protection of residents. EVIDENCE: The complaints procedure meets the legal requirements and is included in the statement of purpose. As noted above, the procedure needs to be added to the service user guide. Over the last twelve months there has been one complaint made which was upheld and the manager took action about this. The adult protection policy of the managing organisation is suitable for its purpose. There have been no investigations carried out under the adult protection procedures in the last year. Discussion with staff showed that they understand the principles behind the procedure and the action to take in the event of any concerns of this nature. There are appropriate and safe systems in place for checking financial transactions carried out on behalf of residents. Residents’ property lists were not dated; this must be corrected so that there is protection for the residents. DS0000007076.V254292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 26, 27, 28, 29, 30 The residents benefit from a building which is homely, but some areas need to be cleaned to a higher standard and some repairs are needed. EVIDENCE: The house is in a reasonable state of repair and some carpets have been replaced since the last inspection. The communal rooms are homely and comfortable. Each of the residents has a single bedroom. There are some repairs needed in one bedroom, including the replacement of a cracked handbasin and repairs to the cover of the vanity unit light fitting. Both bedrooms are fairly bare, although well decorated. There should be some discussion with the residents about whether some personal and homely touches can be added to reflect their tastes and interests, but still maintain their safety. One of the unoccupied bedrooms is to be used by the new resident and redecoration has been arranged. The décor to be used had been chosen by the new resident. A bathroom on the first floor of the home needs to be cleaned thoroughly as the basin was very dirty, as was the wall by the radiator. There was no soap available in the room. There were cobwebs at a high level in the living room indicating that the cleaning schedule needs to be reviewed. DS0000007076.V254292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 There are enough experienced and trained staff to provide the care that the residents need. Staff are well supported and supervised. EVIDENCE: A member of staff who was new to the home described the induction process, which included the opportunity to read residents’ files, introduction to the local area and working shifts as an additional staff member. There were no vacancies on the care staff team which consists of, in addition to the manager, seven full time support workers, two of whom work solely at night time. It was anticipated that when the new resident moves to the home that the staffing establishment will increase. At the time of the inspection there were two staff on duty in the morning until the mid afternoon, and two staff on duty from the mid afternoon until the late evening. Overnight there is one member of staff on waking night duty and on call support from managers is available. These staffing levels are in keeping with the current needs of the residents and allow for ‘one to one’ care to be provided throughout the day. There is a comprehensive training programme for the home which includes some mandatory courses, including health and safety, fire safety, manual DS0000007076.V254292.R01.S.doc Version 5.0 Page 18 handling, food hygiene and first aid. In addition, staff undertake a range of courses relevant to the particular needs of the residents, such as dealing with challenging behaviour, diabetes, communication, skills teaching and autism. Five of the current care staff team has achieved or are working towards NVQ level 2 or 3. Supervision of staff is conducted at appropriate intervals of approximately four to six weeks, and more frequently if the person is new in post. Team meetings take place at six weekly intervals. Both of these contribute to the support systems for staff. DS0000007076.V254292.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42, 43 The residents benefited at the time of the inspection from effective management arrangements. Residents’ views are included in management monitoring. Overall health and safety matters are managed well although checks need to be thorough to ensure the welfare of residents and staff. EVIDENCE: Prior to the inspection the manager was appointed to the post of Assistant Service Manager which involves line management responsibility for other registered houses, at that time he was continuing to cover the management of 4 Bowley Close. Since the inspection the CSCI has been informed that the manager will no longer be continuing with his role as registered manager of the home and recruitment to the post is underway. In the meantime there have been two deputy managers appointed to cover the management of the home. The registered manager is currently undertaking training to achieve the Registered Manager’s Award and NVQ 4. The indications of the inspection were that the management provided by the registered manager was appropriate for DS0000007076.V254292.R01.S.doc Version 5.0 Page 20 the needs of the home and staff felt personally supported by him. One description of the management style was ‘very helpful, very helpful indeed’. Visits are undertaken by managers from Choice Support as part of the quality assurance systems. The visits include eliciting the views of residents and staff as well as sampling records. Reports of the visits were available in the home. Records of fire safety arrangements showed that there are regular drills and weekly tests of the call points and emergency lighting carried out. The fire risk assessment was completed in February 2005. At a visit by the London Fire and Emergency Planning Authority to the home the fire safety arrangements were found to be satisfactory. The gas system was checked in June 2005 and found to be safe. A weekly health and safety check is made by staff and the results recorded. Although such a check was carried out on the day prior to the inspection the inspector found that an electrical plug socket in the hallway was damaged and potentially dangerous. The matter was reported on the day of the inspection and arrangements made for its repair. Care needs to be taken to ensure that the checks are thorough. There is a business plan in place covering the years 2005-2006. The plan identifies ten objectives for the home which arise from the overall business plan for Choice Support. DS0000007076.V254292.R01.S.doc Version 5.0 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 2 3 x 3 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 3 3 3 3 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 3 2 3 DS0000007076.V254292.R01.S.doc Version 5.0 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 YA1 Regulation 5 Requirement The Registered Person must ensure that the service users’ guide includes all of the information specified in standard 1.2 of the National Minimum Standards for Younger People. Previous timescale of 01/04/05 not met. The Registered Person must ensure that the reasons for the administration of medication given on an ‘as needed’ basis is recorded on the reverse of the medication administration record. Timescale for action 01/12/05 2 YA20 13(2) 01/11/05 3 YA19 13(1)(b) 4 YA19 13(1)(b) Previous timescale of 01/02/05 not met. The Registered Person must 01/12/05 ensure that a system is introduced to ensure effective monitoring of residents’ health care needs. The Registered Person must 01/12/05 ensure that full details of the health implications of diabetes are recorded on the health plan, including the need for regular chiropody attention. DS0000007076.V254292.R01.S.doc Version 5.0 Page 23 5 6 YA23 YA25 13(6) 23(2)(b) 7 YA30 23(2)(d) The Registered Person must 01/12/05 ensure that residents’ property lists are dated. The Registered Person must 01/12/05 ensure that the damaged wash hand basin and light cover in a bedroom are replaced. The Registered Person must 01/11/05 ensure that the first floor bathroom is thoroughly cleaned, maintained in a hygienic state and that soap is available for hand washing. The Registered Person must 01/12/05 ensure that the cleaning schedule is reviewed to ensure clean conditions throughout the home. The Registered Person must ensure that staff are given training on how to carry out thorough health and safety checks. 01/12/05 8 YA30 23(2)(d) 9 YA42 13(4)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 10 11 Refer to Standard YA11 YA25 Good Practice Recommendations The Registered Person should ensure that communication aids are used as intended or if they are no longer in use they should be removed. The Registered Person should ensure that discussion is held with the residents about whether some personal and homely touches can be added to their bedrooms to reflect their tastes and interests, but still maintain their safety. DS0000007076.V254292.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SE London Area Office 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 © 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 DS0000007076.V254292.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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