CARE HOME ADULTS 18-65
Carlton Bridge 42 Woodfield Road London W9 2BE Lead Inspector
Tony Lawrence Unannounced Inspection 11th December 2006 09:45 Carlton Bridge DS0000065284.V319194.R01.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 Carlton Bridge DS0000065284.V319194.R01.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. Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Carlton Bridge Address 42 Woodfield Road London W9 2BE 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) 020 7286 4032 020 7286 4032 The Westminster Society Ms Mary Josephine Blake Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st June 2006 Brief Description of the Service: Carlton Bridge is a residential care home for eight men with a learning disability. There are currently 6 men with significant care needs living in the home. Stadium Housing Trust owns the property. Westminster Society, a voluntary organisation, provides the care and staff. The home is located near the Harrow Road, close to shops and other community facilities. Transport links are very good with both tube and buses near by. Carlton Bridge is a modern, terraced four-storey property. The service users’ rooms are arranged over the first, third and fourth floor. Lounge/dining rooms and kitchens are situated on the ground and second floors. There is a spacious lift to all floors and all parts of the home are accessible to wheelchair users. Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced key inspection took place on Monday 11th December 2006 from 09:45 – 16:00. The Inspector spoke with service users, staff and managers, checked care records and toured the building. One person living in the home completed a confidential questionnaire and their comments are included in the report. The weekly fee for the service is £1,304. 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. The summary of this inspection report can be made available in other formats on request. Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service users are given clear information about the home before they move in. Good levels of support are provided when new people come to live in the home. EVIDENCE: Following a Requirement made after the last inspection, the Society has produced a detailed Statement of Purpose that clearly outlines the service provided at Carlton Bridge. Together with the Service Users’ Guide, this provides clear information about the home for new service users and referring agencies. Both documents have been produced using Plain English, line drawings and photographs to make the information more accessible to some service users. The Inspector saw copies of the Statement and Guide on two care plan files that were reviewed during this visit. Staff must make sure that they sign and date these records to evidence that they have been discussed with and explained to each service user. Service users or their representatives should also be encouraged to sign. The home’s admission procedures include a requirement that referring agencies provide a current care plan and needs assessment for people referred to the home. One of the people who has recently moved into the home came from another home managed by the Westminster Society. The care plan file included a lot of information from the person’s previous home and a care manager from the local authority’s Social Services Department was also involved in the move. The second care plan file reviewed by the Inspector during this visit contained no care needs assessment or transition plan. This is
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 8 a concern as the person moved from a care home outside London. The last inspection report included a Requirement that a full care needs assessment is obtained for all people who move into the home. This Requirement is repeated and the home’s Manager must make sure that a needs assessment is completed for the person who moved into Carlton Bridge in June 2006. One person who returned a confidential questionnaire said that he had been given enough information about the home before he moved. This person also said that he had visited the home and stayed overnight before agreeing to move in. One care plan file included an excellent transition plan that showed how the service would be supported to move from his previous home to Carlton Bridge. The plan ensured that all essential practical tasks were completed and include a number of visits and overnight stays before the move was confirmed. The last inspection report included a requirement that each person living in the home must have a costed contract / statement of terms and conditions of residence. The home’s excellent Service Users’ Guide has been reviewed and now includes all of the information needed to meet this Standard in an accessible format. Carlton Bridge DS0000065284.V319194.R01.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 and 9. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. There is a need to make sure that each person living in the home has a current care plan and risk assessment. EVIDENCE: Staff and managers told the Inspector that the home has a system of PersonCentre Planning for assessing and recording the care needs and aspirations of people living in the home. During this visit the Inspector checked two care plan files for people living in the home. Although one file included some good information about the person’s preferences and routines, Person-Centred Planning forms had not been completed. A planning meeting was held in July 2006 and the record of this meeting included some good information about the care and support needs of the service user and how these would be met in the home. Managers were not able to explain why the Society’s care planning procedures had not been followed in preparation for the planning meeting. The second care plan file included some good information from the person’s previous home, also managed by the Society. Managers told the Inspector that they would continue to implement the care plan from the previous home until it is due to be reviewed.
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 10 During this visit, the Inspector saw care staff supporting people appropriately. Individuals were offered choices and asked what they wanted to do by staff. There is also a need to make sure that each person living in the home has a current risk assessment and risk management plan that is regularly reviewed. One care plan file did include a risk assessment and individual risk taking policy that detailed the potential risks for the person and the ways in which these would be minimised. The second care plan file included copies of the Society’s risk assessment forms but care staff had not completed these. Carlton Bridge DS0000065284.V319194.R01.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): 12, 13, 15, 16 and 17. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. There is not sufficient evidence in the home to show that service users take part in appropriate activities, especially at weekends. EVIDENCE: The Inspector saw an activities plan on one of the two care plan files checked during this visit. The second care plan file did not include an activities plan. Care staff complete a daily log book for each person living in the home. Entries in the two log books checked by the Inspector concentrated on the personal care needs of individuals – what they had to eat, when they had a bath, what time they went to bed and how well they slept. There was little mention of social activities in the logs. One log showed that the service user had not left the home at all during the four weekends before this inspection, but there was mention of the person watching the Notting Hill Carnival in August and a holiday at Butlins. Managers and staff must make sure that service users are supported to take part in activities of their choice at weekends. Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 12 Managers explained that a separate log book should also be completed by staff whenever they support people to take part in activities. The Inspector checked the activities log for the two service users who were case tracked and the records were completed poorly. According to the log, one person took part in only six activities since 24/09/06, while ten activities were recorded for the second person in the past four months. Managers told the Inspector that people are supported to take part regular activities, but staff must make sure that these are evidenced and recorded. Details of service users’ relatives, friends and other significant people were well recorded in the care plan files reviewed by the Inspector. Individual menus are prepared for each person living in the home. Sample menus provided by the manager before this inspection are evidence that a varied and nutritious diet is provided. Carlton Bridge DS0000065284.V319194.R01.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 and 20. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service users’ health care needs are well recorded and the management of medication is satisfactory. EVIDENCE: The two care plan files reviewed by the Inspector included some good information about each person’s personal and health care needs and how these would be met in the home. Information seen included assessments, reports and staff guidance from speech and language therapists and the challenging behaviour nurse. One service user whose care was tracked during this inspection is registered blind and relevant information was included on this person’s file. The file also included a record of health care appointments, including the GP, dentist and optician. The last inspection report included a requirement that the management of prescribed medication must be improved. During this visit the Inspector checked the Medication Administration Records for all six people living in the home. The records were well completed and secure storage was provided for all prescribed medication. Staff must make sure that they sign the record sheet each time they give medication to a service user.
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear and accessible complaints policy but there is a need to make sure that complaints are recorded appropriately. EVIDENCE: The home’s complaints policy and procedures are produced in an accessible format and the Inspector saw a copy on each of the two care plan files reviewed during this visit. The procedure is produced using Plain English, line drawings and photographs to make the information more accessible to some service users. Complaints are recorded in a hardback book. Entries in the complaints book are usually brief and there is a need to make sure that staff are clear about the distinction between formal and informal complaints. Staff should also make sure that they record the complainant’s response to the outcome of any complaint investigation. The Society uses the local authority’s policy and procedures for the protection of vulnerable adults. There has been one adult protection issue since the last inspection and the Society’s Head of Registered Care Services made sure that the Commission was informed appropriately. During this visit the Inspector checked the finance records for two people living in the home. While the records are well maintained, there was little evidence that service users are spending their personal money in ways they choose. One person’s record showed that no money had been spent for more than one month. The Society’s Deputy Head of Registered Care Services confirmed that staff use the home’s petty cash to cover some personal expenditure and this is being reviewed by the Society. The review should also make sure that service users are supported to spend their own money appropriately.
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home provides adequate standards of accommodation but there is a need to make sure that agreed refurbishment and redecoration works are completed without further delay. EVIDENCE: Carlton Bridge is located in a residential part of Westbourne Park, close to shops, cafes, pubs, bus routes and an underground station. The accommodation is arranged over four floors. There is a passenger lift and all parts of the home are accessible to people in wheelchairs and those with limited mobility. During this visit the Inspector saw all 8 bedrooms and all communal areas. Service users’ bedrooms are well decorated, furnished and equipped. Each room reflects the personality and interests of the individual. The Inspector saw evidence on one care plan file that the service user had been consulted about colour schemes for their bedroom before they moved into the home. Managers confirmed that the Society had completed a Building Development Plan and Building Risk Assessment earlier in the year. Both plans and individual assessments of service users by an Occupational Therapist identified
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 16 redecoration and refurbishment works that need to be completed. Although funding was agreed in March 2006, there has been little progress in completing the identified works. During the inspection, the Inspector discussed the delays with the home’s acting Manager and the Society’s Assistant Head of Registered Care Services. It was agreed that: o All works identified in the Building Development Plan and Building Risk Assessment for 2006-2007 will be completed by the end of March 2007. o Bathroom works recommended by the Occupational Therapist will be completed by the end of March 2007. o Vinyl flooring will be fitted in two bedrooms by the end of March 2007. o The redecoration of the ground floor lounge and kitchen will be included in the Building Development Plan for 2007-2008. Carlton Bridge DS0000065284.V319194.R01.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, 34 and 35. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed to meet service users’ needs but there is a need to make sure that staff complete their qualification training. EVIDENCE: Information provided by the Society before this inspection is evidence that there are usually 2 staff on each shift plus a duty Manager. On the day of this inspection, the acting Manager and 5 care staff were on duty, including one new member of staff. Throughout the day, the inspector saw the staff team working well together to respond to service users’ requests for support. Managers and staff confirmed that care staff have completed a number of training courses since the last inspection, including medication, health and safety, communication, assessing need and learning disability awareness. Training planned for the future includes first aid, food hygiene, manual handling and person centred support. The home had achieved the target of 50 staff qualified to NVQ Level 2 or 3 but this percentage has dropped due to staff leaving. The Society’s Deputy Head of Registered Care Services confirmed that three new staff have recently been appointed and they will start their NVQ training once they have finished their induction period.
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 18 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, 40, 41 and 42. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home has all the required policies and procedures and these are known to staff. There is a need to appoint a permanent Manager for the service and two health and safety issues need to be addressed. EVIDENCE: The Society’s Deputy Head of Registered Care Services confirmed that the home’s Manager has been suspended since 03/11/06 following concerns about her practise. An experienced and qualified Manager has been seconded from another Society project for an initial period of three months. If the registered Manager does not return to work, the Society must keep the Commission informed of arrangements for appointing a permanent Manager. The Society has clear quality assurance procedures and service users are formally consulted about their home each year. The home has all of the policies and procedures needed to meet these Standards and standards of record keeping are adequate.
Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 19 Two health and safety issues must be addressed by the home’s acting Manager: o The last inspection report included a requirement that weekly fire alarm tests are held and recorded. The Inspector checked the records and there is still a need to make sure that tests are held weekly and recorded appropriately. This Requirement is repeated. o Some service users’ bedrooms have a full-length window / patio door that can be opened. Inside the window is a step and outside is a waist height barrier. Staff said that they open the windows to air the rooms. A risk assessment must be completed to make sure that possible risks to service users in these rooms are assessed and minimised. Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 20 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 2 2 2 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 3 3 2 X Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 21 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 4 Timescale for action Staff and service users must sign 31/01/07 and date the Statement of Purpose, Service Users’ Guide and complaints procedure. A current care needs assessment 31/01/07 must be completed for each person before they move into the home. Repeat Requirement. Original timescale of 31/08/06 not met. The home’s Manager must make 31/01/07 sure that a full care needs assessment is completed for the person who moved into Carlton Bridge in June 2006. A current care plan must be 31/01/07 developed for each person living in the home. A current risk assessment must 31/01/07 be developed for each person living in the home. Service users must be supported 31/01/07 to take part in appropriate activities of their choice at weekends. When staff support service users 31/01/07 to take part in social activities, this must be recorded. Staff must make sure that they 31/01/07
DS0000065284.V319194.R01.S.doc Version 5.2 Page 22 Requirement 2. YA2 14 3. YA2 14 4. 5. 6. YA6 YA9 YA12 15 13 13 7. 8. YA12 YA20 16 13 Carlton Bridge 9. 10. 11. 12. YA22 YA24 YA24 YA37 22 23 23 8 13. YA42 23 14. YA42 23 sign the record sheet each time they give medication to a service user. Managers and staff must make sure that an accurate record of complaints is maintained. Refurbishment and redecoration works identified by the Society must be completed. Bathroom works recommended by the Occupational Therapist must be completed. If the registered manager does not return to work, the Society must keep the Commission informed of arrangements for appointing a permanent Manager. Fire alarm tests must be carried out weekly. Repeat Requirement. Original timescale of 31/08/06 not met. Risk assessments must be completed for all service users who have full-length windows in their bedrooms. 31/01/07 31/03/07 31/03/07 31/03/07 31/01/07 31/01/07 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 YA23 Good Practice Recommendations The review of financial management in the home should make sure that service users are supported to spend their own money appropriately. Carlton Bridge DS0000065284.V319194.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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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