Inspection on 15/08/05 for Buxton House

This inspection was carried out on 15th 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 but made no statutory requirements on the home.

Other inspections for this house

Buxton House 22/04/08

Buxton House 12/12/07

Buxton House 31/05/07

Buxton House 05/07/06

Buxton House 24/11/05

Buxton House 23/03/05

Buxton House 11/11/04

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

CARE HOME ADULTS 18-65 Buxton House 50 Barrow Road Streatham Londin SW16 5PG Lead Inspector Mary Magee Unannounced 15 August 2005 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. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Buxton House Address 50 Barrow Road, Streatham, London, SW16 5PG 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 8679 2846 Buxton Healthcare Ltd Mr Eugene Owusu CRH Care Home 6 Category(ies) of PC Care home only registration, with number of places Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23 March 2005 Brief Description of the Service: Buxton House is a care home located in an end of terrace house on a residential road in Streatham, South west London. It was registered in July 2004 to provide care and accommodation for up to six people with mental health related issues. There are six bedrooms laid out over three floors, a lounge, dining room/kitchen and a conservatory. It is a short distance away from public transport facilities and the local shopping area. There are currently two service user vacancies. The service users are young adults all of whom are from ethnic minority backgrounds. Nursing care is not provided. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over a whole day in august. The registered provider and a director of the company met with the inspector. Three service users and two members of staff were spoken to and contributed to the inspection findings. A number of records were viewed that included staff and service user personal files. All the communal areas were seen as well as three bedrooms. 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. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 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 Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 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 The staff team lack the skills and experiences necessary to meet fully the needs of service users. EVIDENCE: A new Statement of purpose and a Service User Guide has been produced. However there have been further changes to the management of the home with the manager discharged from employment a week prior to the inspection. The information in both documents will need to be updated to reflect the changes and include the new manager due to be appointed. The inspector examined the records for two service users. Assessments of needs were available on both service users’ files; there were also reports and minutes from a CPA meeting recently held at the psychiatric hospital for one of these individuals. Also included was a schedule of medication and the psychiatrists report. Care plans had been agreed to address the care needs identified in the assessments. Other areas of support needs such as relationships, interests and activities are not included in great detail and have an enormous impact on the lifestyle experienced at the home. Records for one service user evidenced that he had a review of his needs with the psychiatrist every two weeks. The inspector found that the home was not fully meeting individuals’ needs. Although two service users were very satisfied with the support at the home there are insufficient skills and competencies among the staff team. Several Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 8 members of staff member have had no prior experience in looking after people with mental health needs apart from the induction programme. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 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 7 9 Individuals have their care and support needs agreed and drawn up in care plans. Risk management strategies need to be developed to ensure that unnecessary risks to the health and safety of service users are identified and as far as possible removed. EVIDENCE: New care plans had been drawn up with service users. Progress had been made in care planning. Plans of activities were in place to respond to individual needs and preferences; monthly reports were available of key working sessions. Daily progress notes were maintained of how service users use their time and of how they were responding to staff support as well as to external activity participation. No curfews were in place; service users had been issued with keys to the front door. Service users spoke to the inspector of the effort made by staff at the home in providing information and support that they need to make decisions about their lives. There were no indications that consideration had been given to restrictions that may be necessary because of risks assessed. Records were viewed of random testing for the use of illegal drugs Although progress had been made with developing care plans this had not been the case for risk assessments. The risk assessments available were Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 10 completed by other professionals involved in the referral process. The home had not been developed it’s own risk management strategy to indicate the risks, boundaries needed to reduce any risk individuals themselves or to other service users. Work had commenced on this; the inspector examined the format the owner was starting to develop. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 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) 12 15 16 17 Service users enjoy the lifestyle offered at the home and are supported to engage in activities that they enjoy and that are fulfilling. EVIDENCE: One service user spoken to said that he took part in part time employment that involved gardening. He said that this had given him a great opportunity to do something he enjoyed. From discussions with the owner and service users it was evident that service users are supported to take part in numerous fulfilling activities. When service users show interest in pursuing an interest they are supported to pursue this. Another service user had not been exercising for the last few months. He said that he was looking forward to returning to the gym. He had become obese due to medication and sedentary lifestyle and wanted to become more fit and healthy. The inspector found that there was insufficient emphasis on supporting him with healthy meals. His weight had not been recorded for over nine months. Service users choose meals that they like and do this at weekly meetings. On service user spoke of taking turns in the kitchen as part of their activity Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 12 programme and preparing the evening meal. Menus recorded demonstrated that a variety of meals that met individuals cultural needs were served. However more emphasis is need on promoting healthy eating. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 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 standard(s) 18 19 21 Service users are confident in the knowledge that their conditions are closely monitored and that if there are notable changes to their physical or psychological conditions these are responded to promptly. EVIDENCE: Staff of similar culture and ethnic origin looks after service users. Individuals have been allocated their own key workers. There has been more stability in the past six months with no further changes to the staff team except for the manager. Interaction observed between service users and staff was positive. Service users were comfortable with staff and demonstrated that they trusted them. Feedback from two service users was that staff were kind but firm. Two service users spoken to said that “they were confident that the home was a good environment for them to get their lives back together and looked forward to the day when they would not need the help”. Records were viewed of key working sessions and of monthly progress. The home maintains records of progress on a daily basis; these are collated at the end of the month. These records evidenced that people’s conditions were monitored carefully, both psychological and physical. There were occasions when areas of concern were identified and that the home took prompt action to seek professional guidance to avoid relapses. For service users at risk of using illegal substances random drug testing is undertaken. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 14 Records of accidents and incidents are maintained. One accident was recorded that had occurred outside of the home. The home has experienced further difficulties with the administration of medication. Medication reviews have been undertaken for service users as part of the reviewing process. The medication administration has experienced Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 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 standard(s) 22 23 Service users find that their views are listened to carefully and responded to however the formal complaints procedure has not been provided to service users. The staff team including the registered provider require training in Adult Protection Procedures so that people living at the home are protected from abuse. EVIDENCE: No progress has been made on developing the complaints procedure further. Three service users spoken to told the inspector that they had no complaints but that they have regular house meetings every week, in this forum they raise any issues of concerns. No complaints were recorded since the last inspection. Interviews by the inspector demonstrated that there was a lack of awareness by some service users regarding the formal complaints policy process. At the previous inspection inspector asked that the provider ensure that all service users are given a copy of the home’s complaints policy and that it is adequately explained to them. This has not been actioned within the stated timescale. The home has an Adult Protection policy with procedures in place to safeguard service users from abuse or neglect. From discussions with the registered provider and staff there were indications that further training is required in order that they can understand fully the policies and the procedures to be adopted if there were suspicions of abuse or neglect. This is particularly relevant as a number of staff are new to this service. Another area where further training is required includes the guidance on POVA. The registered provider must ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are performing. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 16 This was detailed as a requirement at the previous inspection and was within permitted timescales. Training, the inspector was informed, was planned for the week following the inspection. The registered provider must forward confirmation that all staff have received training in Adult Protection Policies and procedures. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 17 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 27 30 Service users enjoy living in comfortable and homely surroundings with personal possessions around them. Communal areas are spacious and well equipped and encourage service user to integrate socially and participate in daily routines of the home. EVIDENCE: The home is registered to provide care and accommodation for up to six people with mental health related problems. There were two vacancies at the time of inspection. It is conveniently located to public transport and local leisure facilities. It is situated on a residential road. It is an end of terrace spacious house. The overall environment is bright and well furnished and provides a pleasant and homely environment. There are six bedrooms in total, a large lounge, dining room and kitchen and a conservatory. Bedrooms are located on the ground floor, first floor and second floor. Three bedrooms were viewed. These were pleasantly presented and personalised. The premises were clean and well ventilated. Care is taken to ensure that fridges and freezers are monitored and maintained at correct temperatures. A smoking area is available in a garden room at the end of the garden. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 18 There is a small pleasant garden to the rear. Service users that enjoy gardening are encouraged to take an interest and assist with maintaining the garden. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 19 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 Not all staff at the home are experienced and competent at looking after people with mental health related issues. A training and development programme is necessary for staff to ensure that they are equipped with the necessary skills and knowledge to meet the assessed needs of service users. Service users needs are not fully understood until staff are competent in their roles. Staff must be supervised and supported on a regular basis. EVIDENCE: The staff team is comprised mainly of staff that were appointed earlier in the year. The team is very mixed in terms of skills and experiences. There are a number of individuals that have worked in the mental health field previously, while there are others that have no experience in care but show a willingness to learn and develop. The inspector spoke to two staff members. They were interested and keen to have a better understanding of the specific conditions affecting service users There are significant gaps in experience and training among the team. The training and development programme has not been devised according to individual staff training needs and to meet the needs of service users. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 20 A training needs assessment must be carried out for the staff team and a suitable training and development programme implemented to address these needs. This was the subject of a requirement at the previous inspection. The registered provider advised the inspector that she was in the process of developing a programme and would comply with this within the timescale set. There have been improvements in the recruitment programme but there are still concerns about the references provided. Two personnel files were viewed. The reference request form used by the home has changed, one staff file had two references but one of these was not an employment reference. All the other necessary information was present. It is essential that professional references are sought for staff before appointment. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 21 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 39 41 42 The absence of a qualified and competent manager has affected the stability of the home. Service users and staff need the leadership and guidance of a good manager. EVIDENCE: There was no manager in post. The new manager appointed earlier in the year was dismissed within her probationary period as she was found to be unsatisfactory. The registered provider had commenced the recruitment of a new manager. Staff and service users said that the presence of the registered owner at the home every day gave them confidence. It is essential that a suitable manager is appointed and takes charge of the home as soon as possible. There have been to many changes in too short a period at the home. This has a negative impact on the quality of life experienced by service users. The home has not developed an effective quality assurance system to determine how successful it is in meeting its aims and objectives. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 22 Monthly visits to the home are undertaken by one of the directors of the organisation. Reports are made of these visits but have not been submitted to CSCI as requested in previous inspection report. The building is well maintained. Records were viewed of recent fire evacuation procedures undertaken. There were also records of regular weekly testing of fire alarm points. Servicing and maintenance was due for fire fighting equipment including smoke alarms. A copy of certificate of completion for this servicing to be forwarded to the inspector. Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 23 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 2 x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x 3 3 2 Standard No 31 32 33 34 35 36 Score x 2 2 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Buxton House Score x x x x Standard No 37 38 39 40 41 42 43 Score 1 x 2 x 2 3 x G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 24 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 3 35 Regulation 18 (1) c Requirement The registered provider must ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. (This was a requirement from the inspection, it remains unmet within timescale set 31/07/2005 The registered person must ensure that unnecessary risks to the health and safety of service users are identified and as far as possible removed.(This requirement was within permitted timescales) The registered person must ensure that healthy eating is promoted by the promoting healthy meals, service users to be supported in monitoring their weights. The registered provider must ensure that medication procedures are adhered to by staff that are trained and competent in these procedures The registered provider and manager must ensure that records of all complaints are maintained and that all service users are informed regarding Timescale for action 30/10/200 5 2. 7&9 13 (4) c 31/08/200 5 3. 17 16 (2) i 30/9/2005 4. 20 13 (2) 30/09/200 5 5. 22 22(5) and 17(2) Schedule 4 (11) 30/09/200 5 Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 25 6. 23 18 (1) c 7. 32 33 18 (1) a, b,c 8. 34 19 (1) a,b,c. 9. 36 18 (2) 10. 37 8 11. 39 24 (1) a,b their rights under the complaints policy, the system for making complaints(Previous requirement not met within timescale of 31/st July 05) The registered provider must ensure that persons employed to work at the care home receive training appropriate to the work they are performing including training on the Protection of vulnerable adults. This was a requirement from the inspection and is now restated (within permitted timescales ) The registered provider must ensure that staff that work at the home have the qualifications suitable to the work they are to perform, and the skills and experience necessary for such work. (This requirement within permitted timescale) The registered person must not employ a person to work at the home unless , He is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person,Some progress had been made towards meeting this requirement within original timescale of 31/07/05) . The registered person must ensure that staff are regularly supervised and supported(This requirement was not met within the permitted timescale of 31/07/05). The registered person must ensure that management arrangements are in place for the home, and that the home is managed by a person qualified competent and experienced to do so The registered provider must 31/08/200 5 30/11/200 5 30/9/2005 30/09/200 5 30/09/200 5 31/08/200 Page 26 Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 12. 41 26 (2) ensure that a system is established and maintained for reviewing at appropriate intervals and improving the quality of care provided at the home. (Within permitted timescales) The registered provider must ensure that copies of reports made of Regulation 26 visits are submitted to CSCI every month(This is an outstanding requirement that remains unmet). 5 30/09/200 5 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 42 Good Practice Recommendations The registered person should ensure that records confirming servicing of fire fighting equipment is forwarded to the inspector Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection SE London Area Office Ground Floor, 46 Loman Street Southwark London 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 Buxton House G52-G02 S41799 BuxtonHse V244542 150805 Stage 4.doc Version 1.40 Page 28 - 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. 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