Inspection on 30/04/07 for Carlton Bridge

This inspection was carried out on 30th April 2007.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Bridge 07/04/08

Carlton Bridge 11/12/06

Carlton Bridge 01/06/06

Carlton Bridge 19/12/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Carlton Bridge 42 Woodfield Road London W9 2BE Lead Inspector Tony Lawrence Key Unannounced Inspection 30th April 2007 09:15 Carlton Bridge DS0000065284.V337871.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.V337871.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.V337871.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 F/P 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.V337871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th December 2006 Brief Description of the Service: Carlton Bridge is a residential care home for eight people 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 and Paddington Churches Housing Association are responsible for the property management. 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.V337871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Monday 30th April 2007. The Inspector spent six and a half hours talking with people living in the home, staff on duty and the home’s manager. The Inspector also checked the care received by two people by talking with them and reviewing care records kept in the home. The weekly fee for the service is £ 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.V337871.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.V337871.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): 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Society has clear policies and procedures for referring and admitting new residents. People who move into the home are supported to make a positive choice to move. EVIDENCE: The Manager confirmed that no new residents have moved into the home since the last inspection in December 2006. There are currently six men living in the home and two vacancies. The Society has established referral and admission procedures and staff from Carlton Bridge are working with the local authority’s Learning Disability Services to begin the assessment of a potential new resident. The Manager has asked a member of staff to visit this person in their current home to begin a care needs assessment and develop a transition plan. The transition plan will include a series of introductory visits, including overnight stays. Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 8 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 adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan but there is a need to make sure these are regularly reviewed and updated. EVIDENCE: The last inspection report included a Requirement that a current care plan must be developed for each resident. During this visit, the Manager confirmed that work has started to update the Society’s support profiles for two people living in the home. During this visit, the Inspector checked the support profiles and risk management plans for these two people. Key workers have started some very good work to update the support profiles, using person centred planning principles. The profiles are written in the resident’s voice and concentrate on the support they need to maintain as independent a lifestyle as possible. The profiles look at a range of issues, including personal care needs, social and leisure activities, communication and healthcare. There is a need to complete the good work that has started for these two people and make sure that similarly high standards are maintained for the care plans of each person living in the home. The Requirement to develop a current care plan for each person living in the home is repeated, but the manager and staff should be Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 9 congratulated for the care planning standards that have been achieved for these two people. The Inspector also checked the risk management plans for these two people. One risk assessment had been reviewed in April 2007 and the other in July 2006. The Manager confirmed this would be updated as part of the current support profile review. The risk assessments covered areas highlighted in the support profile and included epilepsy, a Requirement made by the Pharmacy Inspector in February 2007. Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their skills, including communication and independent living skills. EVIDENCE: During this visit, the Inspector spoke with service users, the manager and staff about activities and checked the daily log books and activities record for two people living in the home. The last inspection report included Requirements that staff support people living in the home to take part in more activities and record the activities that people are involved in. The inspector checked the daily logs for two people living in the home and the separate activities log for all six people. There is evidence that people are supported to take part in a range of activities, including regular trips to local cinemas, pubs and cafes for some people. During this visit, all six men living in the home were offered the opportunity to go out with staff support. The Inspector was impressed by the way staff respected one person’s choice not to go out on three occasions. This person later agreed to go out and staff support was provided. Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 11 The home is well designed to provide people with a choice of communal areas, one of which has a large screen TV. The programme of refurbishment works provided by the Society includes the purchase of new furniture to make these areas more comfortable. The Inspector saw all eight bedrooms during this visit. Standards of furniture and decoration in the six occupied rooms were satisfactory, although some work is needed to replace furniture and decorate some rooms. People living in the home told the Inspector they are able to use their rooms when they choose and most rooms have a TV and CD player. The Manager confirmed that when new people move into the home, they are involved in choosing furniture and furnishings for their rooms, as well as colour schemes. People living in the home and staff on duty told the Inspector that meal times are flexible and people are able to choose what, when and where they eat their meals. A weekly menu is kept in the kitchen that shows people are offered a variety of nutritious meals. There are dining tables in both lounges that provide a choice of comfortable spaces for people to eat their meals. Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health needs of people living in the home are monitored and appropriate interventions are taken. Medication management has improved but standards of personal care need improvement. EVIDENCE: Support profiles checked by the Inspector had been developed by key workers and included information about each person’s health and personal care needs and how these should be met. The support profiles that are currently being reviewed are very person centred and there is some evidence that staff are involving people in writing their own support profiles. The major issue arising from this inspection is the need for managers and staff in the home to improve standards of basic personal care for each person living in the home. During this visit the Inspector saw people wearing clothes and shoes that did not fit them, people had not been supported to shave or had been badly shaved and hair had not been combed. One person told the Inspector that he had been shopping the day before and had bought new shirts and trousers. Unfortunately, this person was wearing a stained shirt that had been buttoned up wrongly and trousers that did not fit him properly. Staff must be reminded to prompt and support people living in the home with their personal care to make sure that their dignity is maintained at all times. Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 13 There is also a need to make sure that people who are incontinent are assessed and receive the support they need. Some areas of the home, including one lounge and two bedrooms, smell strongly of urine and the manager confirmed that people living in the home have not been referred to the Continence Advisor. Referrals must be made without further delay. Following the last inspection in December 2006, a CSCI Pharmacy Inspector visited the home in February 2007 to review the management of medication in the home. Four of the five Requirements made following this visit have been met. The recording of medication has improved, the Manager has obtained a book from the pharmacist to record the disposal of medication, the Society’s medication management policy has been presented to staff in a team meeting and risk assessments have been updated. One support worker in the home has attended the Society’s in-house medication training. The Requirement that all staff must attend training is repeated in this report. Carlton Bridge DS0000065284.V337871.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 good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and keeps a record of all formal complaints. Safeguarding adults procedures are in place and are known to staff. EVIDENCE: The Manager confirmed that there have been no formal complaints since the last inspection in December 2007. The Manager and staff said that informal complaints are dealt with by staff on duty at the time and would be recorded in the daily log books of people living in the home. Staff who spoke with the Inspector knew about the local Safeguarding Adults policy and procedures and said that they would report any concerns to their manager or other managers in the Society. During this visit, the Inspector checked the finance records for all six people living in the home. The records are well kept and receipts are kept for any expenditure involving people’s money. Carlton Bridge DS0000065284.V337871.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 poor. This judgement has been made using available evidence including a visit to this service. Essential refurbishment and redecoration works have not been completed. The quality of life for people living in the home is being made worse by the environment in which they live. EVIDENCE: Carlton Bridge 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. The last inspection report included Requirements that redecoration and refurbishment works identified by the Society must be completed by 31st March 2007. The Manager confirmed that, although capital funding has been agreed for the refurbishment and upgrading of both bathrooms in the home, funding for other works has not yet been agreed and no work has started. Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 16 During this visit the Inspector saw all communal parts of the home, six occupied bedrooms and the two vacant bedrooms. Although the bedrooms are individual and well personalised, some need new carpets / flooring, others need redecoration and most need some new furniture. Lounges need redecoration and some new furniture and both bathrooms need complete refurbishment. The Requirement to repeat these works is repeated. During this visit, the Inspector found that some parts of the home smelt strongly of urine. The Manager confirmed that these areas would be provided with suitable flooring as part of the planned refurbishment works. All other parts of the home were clean and tidy. Carlton Bridge DS0000065284.V337871.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. People living in the home benefit from good staffing levels and are supported appropriately to take part in activities. EVIDENCE: When the Inspector arrived at the home at 09:15, three support workers were on duty. The home’s Manager arrived to start work at 10:00. The Inspector felt that this level of staffing was sufficient and the staff on duty worked well together to make sure that people living in the home were supported. However, there is a need to make sure that people living in the home are supported to maintain basic standards of personal care. Since the last inspection in December 2006, there have been a number of staff changes in the home, including the appointment of a new Manager. The manager confirmed that all new staff are completing their Learning Disability Award Framework (LDAF) induction. After successfully completing their induction, new staff will be enrolled on a NVQ qualification training course. The Manager, Deputy Manager and 2 support workers have already completed their NVQ qualification training. Staff told the Inspector that the Society has a good programme of training opportunities and people are able to get on courses they need. The training calendar shows that staff are booked to attend a Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 18 variety of relevant courses, including Medication, First Aid, Epilepsy, Fire Safety, Manual Handling, Food Hygiene, Communication and Activities. The Manager confirmed that all new staff have a Criminal Records Bureau Enhanced Disclosure before they start work in the home. Carlton Bridge DS0000065284.V337871.R01.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, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. EVIDENCE: The home’s full-time Manager has been permanent since December 2006, after transferring from another home managed by the Society. She is qualified and experienced to run the home. The Manager must contact the Commission’s Regional Registration Team to make sure that her registration is transferred to Carlton Bridge. The views of people living in the home were sought as part of the Society’s annual service audit in 2006. Their views are included in the audit report, which has been produced in an accessible format, using Plain English and pictures. Two health and safety issues were discussed with the manager during this visit. Staff must make sure that cleaning materials and other potentially Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 Page 20 dangerous liquids are securely stored to make sure that people living in the home are safe. The last inspection report included a Requirement that weekly tests of the home’s fire alarm system must be held and recorded. The Inspector checked the fire safety records during this visit and weekly tests are still not recorded consistently. The Requirement is repeated in this report. Carlton Bridge DS0000065284.V337871.R01.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 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 1 28 2 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 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 3 X X 2 X Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 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 YA6 Regulation 15 Requirement A current care plan must be developed for each person living in the home. Repeat Requirement. Original timescale of 31/01/07 not met. Fire alarm tests must be carried out weekly. Repeat Requirement. Original timescale of 31/08/06 not met. Repeat Requirement. Original timescale of 31/01/07 not met. Training in the safe handling of medication must be prioritised and must include increasing knowledge of medication prescribed. Repeat Requirement. Original timescale of 1/04/07 not met. Managers and staff must make sure that people living in the home receive the support they need to maintain good standards of personal care. Where people living in the home are incontinent, referrals must be made to the Continence Advisor for assessments and DS0000065284.V337871.R01.S.doc Timescale for action 01/08/07 2. YA42 23 01/08/07 3. YA20 13 01/08/07 4. YA18 12 01/08/07 5. YA19 12 01/08/07 Carlton Bridge Version 5.2 Page 23 advice. 6. YA24 23 Refurbishment and redecoration works identified by the Society must be completed. Repeat Requirement. Original timescale of 31/03/07 not met. The Manager must contact the Commission’s Regional Registration Team to make sure that her registration is transferred to Carlton Bridge. Staff must make sure that cleaning materials and other potentially dangerous liquids are securely stored to make sure that people living in the home are safe. 31/08/07 7. YA37 9 30/06/07 8. YA42 13 30/06/07 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.V337871.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London 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 © 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 Carlton Bridge DS0000065284.V337871.R01.S.doc Version 5.2 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. 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