Inspection on 12/01/06 for Cleveland House

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Cleveland House 16/08/07

Cleveland House 04/08/06

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 Cleveland House 1 Cleveland Road South Woodford London E18 2AN Lead Inspector Jackie Date Unannounced Inspection 12th January 2006 10:00 Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 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 Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 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. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cleveland House Address 1 Cleveland Road South Woodford London E18 2AN 020 8530 3591 020 8252 2283 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) www.caremanagementgroup.com Care Management Group Limited *** Post Vacant *** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th April 2005 Brief Description of the Service: Cleveland House is an eight-bedded home for adults with learning disabilities and challenging behaviour. The building does not have any adaptations for people with physical disabilities and would not be accessible to wheelchair users. It is in a residential area of South Woodford close to local shops and amenities and to transport networks. At the time of the inspection there were six residents, three males and three females, living at the home. Most of the residents have limited communication. Some residents access day services, others are supported in community based activities by the staff team. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted for about five hours and took place during the morning and early afternoon. It was the second of the two inspections that each home must have during the inspection year. During the two visits all of the key standards have been checked. The manager, staff and some of the residents were spoken to. All of the communal areas and some of the bedrooms were seen and care and other records were checked. Since the last inspection there has been a change of ownership and change of manager. The main purpose of this visit was to monitor the progress of the requirements from the previous inspection and the operation of the service under the new organisation. Relatives and other professionals were contacted by telephone for their opinions of the service. In addition feedback forms were left for staff that were not on duty at the time of the inspection to give their comments on the service. What the service does well: What has improved since the last inspection? What they could do better: At the time of the last inspection improvements were better teamwork and communication between the staff team and also the residents were taking part Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 6 in more activities and going out more. However feedback this time identifies that both of these areas have deteriorated. Staff and relatives said that the residents need more activities both in the community and in the home. Feedback from staff was at the team need to work together to provide an appropriate service to the residents. Residents care plans need to be reviewed to ensure that information about their needs and wishes it is accurate and up-to-date. The organisations monitoring of the home needs to be robust and start in the very near future so that any concerns or issues can be identified and addressed before they have a more adverse effect on the service provided. 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. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 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 Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 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): These standards were not tested on this visit. However evidence from the last inspection was that information is available to enable the staff team to meet residents’ needs. If a vacancy arose the required information would be gathered on a prospective resident and they and their relatives could spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the five standards. At the time of the last inspection standards two and three were tested and assessed as met. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Residents’ plans contain detailed information so that staff can meet their needs. The residents’ plans have not been reviewed recently and therefore may not contain up to date information about their needs. EVIDENCE: Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 10 All of the residents have plans which give details of how they need/like to be supported. However the care plans have not been reviewed regularly as required by the previous inspection. The new manager said that they would be introducing the care planning process that is used by the new organisation and that all residents will have a review before this happens. In preparation for the reviews the manager has spoken to the GP and he has agreed to review each residents’ medication and health needs. It is anticipated that all of the reviews will be completed by the end of March. The timescale for meeting this requirement has therefore been extended to allow for the new systems to be introduced, reviews to be held and the new care plans to be developed. Relatives spoken to said that the organisation had stated that reviews would be taking place and new care plans introduced. The staff team has not changed and they do know the residents and are able to provide continuity of care whilst the changes are being implemented. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 Although residents take part in activities this is limited and needs to be extended to ensure that they have an enjoyable and fulfilling lifestyle. EVIDENCE: Some of the residents attend day services during the week. The staff team encourage and support them to take part in activities in the community. They visit the library and swimming pool and use the local shops. The home has a minibus that can be used for trips and outings. Some of the residents go to the Gateway club. Residents go out for lunch and one resident loves to go shopping. She said that staff take her to different places to shop and help her to buy clothes. On the day of the visit some of the residents were at day services and during the course of the visit two others went swimming. However feedback from staff and relatives indicated that residents do not have enough activities and are not “getting out enough”. This must be addressed by the organisation to ensure that residents have a fulfilling and enjoyable lifestyle. Residents must be supported and enabled to take part in appropriate activities both in the home and in the community. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 12 Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 The staff team support the service users to get the healthcare and medication that they need. Medication is appropriately administered but systems need to be in place to ensure that out of date medication is removed from the medication cabinet and appropriately disposed of. EVIDENCE: All of the residents go to the local doctor and specialist help is received from the community learning disabilities team. Staff take residents to all of their medical appointments. Residents’ files contain details of health care issues and show that residents have regular access to health care professionals. Records are kept of medical appointments and these show that residents have checks from the optician, dentist and, when needed, the chiropodist and community nurse. As previously stated the manager has arranged that the GP will be reviewing each resident’s medication and health needs. A relative said that the organisation had promised to arrange for a behaviour specialist to see one of the residents. Therefore residents’ healthcare needs are being met. Feedback from relatives spoken to was that the residents are well cared for. None of the residents are able to self medicate and medication is administered Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 14 by the senior member of staff on duty. Medication is stored in a locked cabinet adjacent to the main office. The medication administration records were appropriately completed and indicated that residents get their required medication. The manager said that the system for the administration of medication would be changed during the next couple of weeks. They are changing to the Boots Monitored Dosage System and all staff will receive training. In addition to this the manager has arranged for the Pharmacy Device Unit to visit regularly to check and advise on the administration and storage of medication. Examination of the medication storage facility found that there were some non-prescription items and some out of date items. In addition the date of opening had not been recorded on eye drops. The manager arranged for the non-prescription and out of date items to be removed during the course of the visit. Systems must be in place for medication to be checked regularly to ensure that it is still within date. Any items with a limited shelf life once open, for example eye drops, must have the date that they are opened recorded on them. This will ensure that medication is suitable and safety to use. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 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): These standards were not tested on this visit. However evidence from the last inspection was the complaints procedure is in a pictorial format to help residents understand how to complain. Also that the staff had training in methods of restraint and how to deal with “difficult “ behaviour and therefore could manage this in a way that protected the rights and safety of the residents. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the two standards. At the time of the last inspection both standards were tested and assessed as met. There have not been any recorded complaints since the last visit. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 The residents live in a clean home that is suitable for their needs. Planned improvements will make it more homely and give residents a choice of communal spaces. EVIDENCE: The house is in South Woodford and is near to the local shops, bus routes and train station. There is a combined lounge diner, a garden area, a sensory room, a kitchen and a laundry. Each resident has a single bedroom with an en suite toilet and hand basin. There are enough baths, showers and toilets to meet the residents’ needs and none of the residents needs any special adaptations. There was a service hatch from the kitchen to the dining area and wooden bars had been fitted across this as one of the residents had “dived through” the opening. The bars had been fitted to prevent re occurrence. The resulting effect was very institutional, not homely and not acceptable. The bars have now been removed and the serving hatch has been glazed. The home appeared to be clean and there were not any unpleasant odours. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 17 The manager said that the new organisation proposes to carry out a lot of work to improve the environment. Another lounge is going to be created and an activity room is being developed in an outbuilding in the garden. All areas of the home will be redecorated and the bedrooms will be more personalised and individualised. One relative confirmed that she had been asked for her input into the decoration of her sons bedroom. In addition any outstanding maintenance issues will be addressed, the fire panel will be moved and various locks will be changed to make the building more easily accessible for the residents. It is anticipated that this work will start in the near future. All of these will improve the environment and make it more homely. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 18 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): 33 and 36 Staffing levels are sufficient to meet residents’ needs. The staff team have remained fairly consistent and therefore residents benefit from being supported by staff and know them. However, poor teamwork amongst the staff team needs to be addressed before the quality of service to residents is affected. EVIDENCE: There are four staff, including a senior, on duty during the day and two waking night staff. The manager is supernumerary and the deputy has one management shift each week. Feedback from staff and relatives indicates that staffing levels meet the residents’ needs. Feedback from relatives was that they were concerned about the changes of ownership and management but as most of the staff team were the same this had alleviated some of their concerns. They also said that the staff team were very good. Feedback from staff indicated several concerns about the lack of teamwork and its effect on the service provided to the residents. A deputys post has been created and an appointment has been made recently. The deputy has one management shift per week and for the rest of the time works directly with the residents as part of the shift. However the seniors are shift leaders and not the deputy. This does cause some difficulties and Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 19 confusion about roles and responsibilities when the deputy is working as a support worker. In addition it is perceived by some staff that the deputy is not a support worker and that shifts are therefore short staffed. This was discussed with the manager and she was aware of some of the concerns and said that this will be discussed further with the organisation. Arrangements need to be made to enable the staff team to feedback to the organisation their views and concerns about the service. Issues raised must be dealt with and it is recommended that a program of team building and team development be implemented. This will hopefully result in a more effective staff team that will be able to provide a good quality service to the residents. Before the new organisation took over Cleveland House there was not a permanent manager and staff had not been receiving regular formal supervision. The new manager and deputy have only recently been in post and the staff supervision system is not fully operational. Arrangements must be made so that staff receive regular, recorded supervision at least six times per year, to give an opportunity for monitoring of work and professional guidance. Also for staff to discuss concerns individually. This requirement remains outstanding from the previous inspection and the timescale has been extended to give the new manager the opportunity to meet this requirement. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Appropriate management arrangements are now in place and a safe environment is being maintained for the residents. Although representatives of the organisation have visited the home and have been involved in plans for the future the monthly unannounced monitoring visits have not yet started and these need to be carried out EVIDENCE: A new permanent manager has been appointed as required by the previous inspection. However at the time of the visit had only been in post for about a month. It was therefore not possible to make a judgment about the quality of the management and this will be tested during future visits. Feedback from staff and residents was that it was too early to comment on the management of the home. However one relative did say that he had confidence in the new manager. The Commission has interviewed the manager as part of the registration process and is now awaiting Criminal Records Bureau checks before the process can be completed. In addition to a manager a deputy Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 21 manager has also been appointed to assist in the running of the home and to deputise for the manager in her absence. Care Management Group has recently purchased the home and will be responsible for monthly monitoring visits. At the time of the visit these monitoring visits had not commenced. The manager said that the organisation has a strong commitment to carrying out these visits and also that they do have a system for getting feedback from stakeholders and other professionals. The monthly monitoring visits must begin and copies of reports of these visits must be sent to the Commission. These visits will also be an opportunity for the organisation to receive feedback from the staff about their concerns as stated in the staffing section of this report. All of the necessary health and safety checks are carried out and additional checks have been introduced. For example a weekly fire audit checklist that includes fire alarms, extinguishers and escape routes. The new manager has carried out a fire drill and as a result of this part of the fire alarm system is going to be upgraded. A nighttime fire evacuation procedure is in place as required by the previous inspection. Therefore a safe environment is maintained. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 22 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 2 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 3 X 2 X X 3 X Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 23 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 Care plans must be reviewed with the resident and significant others at least every six months and updated to reflect changing needs. (Previous timescale of 31/07/05 not met). Residents must be supported and enabled to take part in appropriate activities both in the home and in the community. Systems must be in place for medication to be checked regularly to ensure that it is still within date. Any items with a limited shelf life once open must have the date that they are opened recorded on them. Arrangements need to be made to enable the staff team to feedback to the organisation their views and concerns about the service. Issues raised must be addressed. Arrangements must be made so that staff receive regular, recorded supervision at least six times per year. (Previous timescale of 30/09/05 not DS0000066298.V277363.R01.S.doc Timescale for action 31/03/06 2 YA14YA12 16 30/04/06 3 YA20 13 15/02/06 4 YA20 13 31/01/06 5 YA33 21 31/03/06 6 YA36 18 30/04/06 Cleveland House Version 5.1 Page 24 met). 7 YA39 26 A representative of the organisation must visit the home unannounced at least once each month to check on the standard of care provided. A written report must be made and a copy of this lodged with the home and a copy sent to the Commission 30/04/06 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 YA33 Good Practice Recommendations It is recommended that a program of team building and team development be implemented. Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Cleveland House DS0000066298.V277363.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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