CARE HOME ADULTS 18-65
Chamberlain Way, 17 17 Chamberlain Way Surbiton Surrey KT6 6JH Lead Inspector
Claire Taylor Unannounced Inspection 12 October 2005 1.25pm Chamberlain Way, 17 DS0000042884.V252647.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 Chamberlain Way, 17 DS0000042884.V252647.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. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chamberlain Way, 17 Address 17 Chamberlain Way Surbiton Surrey KT6 6JH 020 8399 8254 020 8399 7653 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) Royal Borough Of Kingston Upon Thames Jane Elizabeth Wells Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. Staffing must be provided to meet the assessed needs of all service users. The levels of staffing will vary according to assessed needs and occupancy levels with a minimum of one member of staff on duty at all times. Night time support should be adjusted to reflect assessed needs. Minimum staffing at night must be one waking member of staff. The Registered Manager is also registered to manage Woodbury, care home for 15 adults with a learning disability. A qualified, competent and experienced person, other than the Registered Manager, shall be employed to oversee the day-to-day operations of the home. 3 March 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: 17 Chamberlain Way is owned and managed by the Royal Borough of Kingston and provides respite care for up to three adult service users with learning disabilities. The period of stay offered can range from an overnight stay to a number of months, dependant upon the service user’s needs. The home caters for service users of both sexes aged from 18-65 years. The home is part of the Woodbury Community Housing Project, a group of houses linked through management and service provision. Two of the homes within the project are also registered with the Commission for Social Care Inspection. The home is located next door to one of these, namely Woodbury and retains strong links with the service. The Registered Manager oversees operations in all units, and is based mostly at Woodbury. As a condition of the registration of Chamberlain Way, a senior member of staff has been employed to manage the day-to-day operations of the home. There is a large garden to the front and rear of the home. Accommodation for the service users is provided in single bedrooms with a communal lounge, dining area and kitchen. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over an afternoon and lasted just over three hours. The deputy manager facilitated the inspection process, one staff was met and a walk round the premises took place. The registered manager also met briefly with the inspector during the visit. On their return from day care services, one service user spoke with the inspector about their lifestyle and experiences in the home for which they are thanked. Prior to this inspection, the Commission did not receive comment cards in respect of the home. Various records were examined including service users care plans, policies and procedures and records related to the general management and organisation. Standards relating to staffing were not fully assessed on this occasion due to the majority of records being held centrally by the owning organisation. These will be assessed at the next inspection. What the service does well:
The home offers short stay accommodation only on a respite care basis. The manager and staff work hard to ensure that service users feel at home when they stay away from their regular carers. The one service user staying in the unit at the time of inspection gave positive comments about their lifestyle and that they enjoyed coming to the home for regular stays. The service user said that they liked the staff and activities. Planning and review of care is thorough and helps the service users build upon and develop their independence as far as possible. Care plans are clearly recorded, highlight achievements and progress and are routinely shared with the service users involved. Service users have their privacy respected; are treated with respect and are consulted about the things they want such as leisure activities and meals. They are assisted to exercise choice and control over their lives as far as possible. Management of the home appeared to be very well ordered with the benefit of a consistent staff team that remains largely unchanged. Service users have access to a planned programme of activities that is based upon their individual needs and preferences. The environment appears homely and is decorated to a very good standard. Service users are encouraged to personalise their bedrooms when they come to stay and to develop their independent living skills / personal development. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 6 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. Chamberlain Way, 17 DS0000042884.V252647.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 Chamberlain Way, 17 DS0000042884.V252647.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 and 5 Some minor changes are needed to both the Service User Guide and the Statement of Purpose so that they accurately reflect the aims and objectives of the home, and provide full information about the services on offer and as required by the regulations. Service users who stay at the home have had their needs assessed and the range of needs presented is being appropriately met. The home has its own assessment plan to ensure that any new service user’s needs are fully assessed prior to their admission and that staff are aware of how to support them. EVIDENCE: The Service Users Guide had recently been revised. Formatted with photographs of the accommodation and pictures, the document is accessible to people with learning disabilities who have limited communication abilities. It now includes information about both Chamberlain Way and the neighbouring house Woodbury. Although it is acknowledged that both homes are run by the same organisation, with one registered manager, a separate Service Users Guide should be made available for each service as Chamberlain Way offers respite care only. The deputy manager produced a previous copy of the guide that outlines specific services and facilities concerning Chamberlain Way only. This should be used, as prospective service users need to have access to a Service Users Guide that is specific to the services they will be using. A brief reference to the complaints procedure is included in the guide but does not
Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 9 provide full details on how to complain to the Commission for Social Care Inspection. A summary of the home’s complaints procedure must be included with the address and telephone number of the Commission’s local office. I.e. Croydon, Sutton & Kingston. The former requirement therefore still stands. Various service users files were sampled. A specific form is used on which to record an overall assessment of each service user once they have been admitted. This covers all aspects of the person’s life, including strengths, social and cultural needs and psychological needs. Copies of these assessments were on file for each service user as well as detailed needs assessments completed by their placing authorities. I.e. undertaken by their care managers. This provides staff with comprehensive information about a person’s needs and how they should be supported. An informative needs assessment was available for a new service user who had recently started using respite care. There were also good records to show that the person had received appropriate support to familiarise themselves with the home. Each service user is provided with a contract that outlines the terms and conditions of their occupancy including periods of notice; fees charged, and arrangements for reviewing their care plans. The individual contracts need to be signed however by each service user and/ or their representative and registered manager. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 10 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 and 9 Service users’ plans of care clearly identify their needs and how they are supported to achieve their planned goals. Individual plans are frequently reviewed and reflect any changing needs. A risk management framework is in place although records must be developed to outline more clearly how service users are enabled to take risks with the necessary support. EVIDENCE: Several service users care plans were examined. They included those for service users who have regular short breaks at the home to those who stay on an occasional basis. Plans are well organised and contain good information about the service users personal, healthcare and social needs. Generated from assessments completed by the placing authority, each service user has a care plan that outlines what level of support they require. These plans tell the staff about the best ways to support each person who lives in the home. They also detail what each service user likes to do each day, the things that they like and how the staff should do best support them to achieve their personal goals. Some care plans have been developed into written and pictorial formats with photographs included. The deputy explained that the organisation intends to develop plans of care that are based on Person Centred Planning principles.
Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 11 Such planning centres on the needs of the service user and not the service. Progress on this will be assessed at the next inspection. Records showed that the plans were being reviewed on a six monthly basis and involved the service users, relatives and other professionals such as care managers. Daily records of care are completed and directly relate to the assessed needs and goal plans identified in the service user plan. Relevant risk assessments, matched to individual needs were not in place for all service users and this must be addressed. A risk assessment tells the people that support the service user if there are activities that a person undertakes, or things that might happen, that put them at risk of being harmed. The deputy manager had completed a risk checklist for the newest service user however but further information is needed. I.e. each risk assessment must specify the risk; possible consequences of the risk; and action required to minimise it. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 12 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): 12,13,15 and 16 Service users benefit from a varied choice of recreational activities both within and outside of the home and in relation to their individual preferences. The daily routines and house rules promote service users’ rights and encourage independence. Appropriate contact between service users and their families and friends is encouraged to help them maintain relationships. EVIDENCE: This home provides respite care but the service users are encouraged to maintain their usual routines as if living with their main carer. Some service users attend day centres, college classes and community activities organised by the home. Service users attend independently or with the support of staff where necessary. The home informs service users about activities through regular meetings, informal discussions and the use of a notice board. A list of planned events and activities for the forthcoming year is also sent to the service users so that they can plan their choices when they come to stay at the home. Examples include theatre and restaurant trips, sightseeing in London, cinema and house activities such as art and craft hobbies. Service users can also access social activities at the neighbouring house, Woodbury, such as barbeques and discos. The home retains good links between service users and
Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 13 their families / representatives. Parent/ carer meetings are held every two months to discuss any relevant issues about the home and the organisation. Service users are encouraged to maintain their friendships. One service has an established relationship with an individual who lives in one of the other organisation’s homes. Both service users often go out together on community activities and the service user confirmed that staff support her to maintain her relationship. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 14 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 and 19 Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Promotion of health is well observed. Service users welfare is closely monitored to ensure that their physical and emotional needs are met. EVIDENCE: Each service user’s health care needs are clearly documented in their care plan. Support with personal care needs is recorded in a way that focuses on the unique preferences and personality of each service user. The home operates a key worker system, which takes into account the wishes of the service user. Key staff are responsible for updating care plan records as necessary. The house rules and daily routines are as flexible as possible, bearing in mind the weekday commitments of the service users. The service users are given a choice of having keys to their bedrooms as part of the admission process. The home has a keypad entry system to the front door and the reasons for the entry and exit door locking system are fully documented with appropriate measures in place to secure the service users safety. The home supports service users to be flexible about when they choose to get up, go to bed, have a bath, and eat. Service users are encouraged to contribute to household management duties including cleaning, shopping and cooking. Information on individual GP contacts and other relevant healthcare professionals is recorded in the service users files.
Chamberlain Way, 17 DS0000042884.V252647.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 and 23 Arrangements for complaints and protection from abuse are well managed and ensure that service users feel listened to and safe. EVIDENCE: The home operates a clear and effective complaints procedure that is available to all the home’s service users in a suitable language/format. As mentioned earlier in the report, a summary of the complaints procedure needs to be included in the Service Users Guide. No formal complaints have been made about the home’s operation in the past twelve months. There are adequate systems in place regarding the protection of vulnerable adults. I.e. legislative checks, such as CRB disclosures completed on new and current staff; induction training on the prevention of abuse and numerous policies to safeguard the service users welfare e.g. management of their finances, dealing with aggression and conflict and a whistle blowing policy to state what action to take should staff suspect anything untoward. The home’s policies are used in conjunction with the Royal Borough of Kingston Protection of Vulnerable Adults Procedure. The deputy manager stated that staff are provided with training on abuse awareness and the protection of vulnerable adults. Staff records were not accessible on this occasion and will be looked at during the next inspection. Chamberlain Way, 17 DS0000042884.V252647.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, 26 and 30 The home is clean, hygienic and in a good state of repair which provides a safe environment for service users when they come to stay. Bedrooms are appropriately furnished and service users are supported to bring in their possessions that reflect their individual lifestyles and preferences. EVIDENCE: Chamberlain Way appears homely, well maintained and decorated to a good standard. It retains a family type atmosphere and provides comfortable surroundings for the service users who come to stay. The deputy manager explained that there are plans to redecorate the kitchen and bathroom. A written plan for the home’s overall maintenance and redecoration programme should be put in place to fully meet the standard. All three bedrooms were viewed and one service user spoke with the inspector in her room. Bedrooms are decorated and furnished to a good standard with comfortable furniture and fittings. Service users are able to bring in personal possessions to personalise their rooms during their stay. Television sets are provided in each room. Chamberlain Way, 17 DS0000042884.V252647.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): X- Standards not fully assessed at this inspection. EVIDENCE: These standards were not fully assessed on this occasion as staff records were not available. The owning organisation, Woodbury Community Housing Project, keep staff files centrally in a main office. The standards were however all assessed as met at the last inspection and the reader is referred to the last report (3 March 2005) for details. The home employs one full time member of staff, the deputy Manager, who had recently returned from a planned leave of absence. Staffing needs are assessed and provided according to the level of occupancy and individual service users. Minimum staffing at the home is one staff member whilst service users are at the home. Staffing is generally provided from 7am until 10am, then again from 3pm until 10pm during weekdays, and throughout the waking day at weekends. This meets the needs of service users who usually attend day services. Waking night staff are provided although the home plans to seek a variance in its registration category to use sleep in staff when the needs of the service determine so. The Commission must approve this and the deputy advised that the organisation was in the process of making an application. Staffing standards will be assessed in more detail during the course of the home’s next inspection. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 18 Chamberlain Way, 17 DS0000042884.V252647.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): 42 Overall, health and safety practices are well observed to ensure that service users live in a safe environment. Record keeping regarding some health and safety issues could be improved upon however. EVIDENCE: The home has a health and safety file in place and suitable policies and procedures to ensure that safe practices are observed. Records showed that fire drills, equipment and fire system checks are being carried out at appropriate intervals. There were valid up to date certificates for electrical safety and as required at the March 05 inspection, a gas safety check had been completed in July of this year. Two areas of concern were identified regarding health and safety. Firstly, regular hot water temperature checks must be carried out on bath and shower facilities within the premises. This should be extended to checks on all hand basins for which a recommendation is made. The manager is also required to ensure that environmental hazards around the home are risk assessed and recorded. These checks need to be carried out to further safeguard the welfare of the service users and minimise the risk of injury. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 20 Chamberlain Way, 17 DS0000042884.V252647.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 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chamberlain Way, 17 Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000042884.V252647.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES- 1 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(1) Requirement The Service Users Guide must include full details of the home’s complaints procedure, including the home’s responsibility of responding to a complaint within a maximum of 28 days and how to contact the local Commission for Social Care Inspection office. (Timescale of 30/06/05 not met) The registered manager must ensure that the service user, and/or their representative and the Home Manager sign each contract. The registered manager must ensure that there is a photograph of the service user held on their file. All service users must have a risk plan(s) that identify clearly what measures are in place to minimise incidences of risk. Timescale for action 31/01/06 2. YA5 5(1)(b,c), 17 (2) 31/12/05 3. YA6 17(1)(a) Sch.3 (2) 31/12/05 4. YA9 12(4) 13(4) 31/12/05 5. YA24 23(2)(b)(d) The registered manager must develop and maintain a written
DS0000042884.V252647.R01.S.doc 31/01/06 Chamberlain Way, 17 Version 5.0 Page 23 plan for the home’s overall maintenance and redecoration programme 6. YA42 13(4) 23(2 c& j) Water temperature checks on all 12/10/05 baths and showers must be carried out on a regular basis with records maintained. (From this inspection and henceforth) 7. YA42 13(4) 15(1) 31/01/06 Risk assessments concerning safe working practices around the home need to be completed. They must outline what measures are in place to reduce any identified risks. 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 YA42 Good Practice Recommendations That the home checks hot water temperatures on all wash hand basins on a regular basis. Chamberlain Way, 17 DS0000042884.V252647.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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