CARE HOME ADULTS 18-65
Conifers 44 Broad Green Avenue West Croydon Surrey CR0 2ST Lead Inspector
James O`Hara Unannounced Inspection 26th October 2005 09:30 Conifers DS0000025773.V260685.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 Conifers DS0000025773.V260685.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. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Conifers Address 44 Broad Green Avenue West Croydon Surrey CR0 2ST 020 8665 0237 020 8683 2329 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) Mr Milton Anthony Wilson Mrs Yvonne Wilson Mrs Yvonne Wilson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified resident over the age of 65 to be admitted. Date of last inspection Brief Description of the Service: Conifers is located in a quiet avenue off a busy thoroughfare close to the centre of Croydon. There is access to local buses and trains, facilities and amenities are all easily accessible. The home has been registered to provide support to six people with learning disabilities and includes a variation for one service user who is over the age of sixty-five, at present six people live in the home. The home comprises of four floors with the living room, kitchen and laundry in the basement, two bedrooms and a bathroom with access to the back garden on the ground floor, two bedrooms and a bathroom on the second floor and two bedrooms a shower room and a toilet on the top floor. Most of the service users who presently live at the home have done so since the home opened and all know each other very well. The proprietor who is also the registered manager owns the property. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection at Conifers this year. This inspection was unannounced and took place on a Wednesday morning. The home was inspected under the National Minimum Standards. Methods of inspection included a tour of the premises observation of contact between staff and service users, discussion with service users, a member of staff and the home registered manager/provider. Records examined included service user plans care manager needs assessments and risk assessments, complaints, staffing records, health and safety and fire records. Requirements and recommendations from the previous inspection were also discussed with the registered manager/provider. What the service does well: What has improved since the last inspection? What they could do better: Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 6 There were three requirements and six recommendations set at the previous inspection. All of the requirements have been met and the registered provider has addressed some of the recommendations. One previous recommendation has been reassessed and re-entered as a requirement. As a result of this inspection there are now four requirements and five recommendations. The overall impression when visiting the home is that it is well organised and service users are offered opportunities to take part in appropriate activities both in and out of the home however there are areas where improvement could be made. Service users have regular care plan reviews however the home should move towards the Person Centred Plan approach were ownership of the plan is given to the individual service user. The home should develop written guidance on how staff should support service users with personal care. Some areas of the home need to be redecorated. The homes quality assurance/monitoring system will improve once the home carries out regular monthly regulation 26 visits. The registered manager/provider has a City and Guilds Qualification in the Advanced Management in Care. The Commission considers that the City and Guilds Advanced Management in Care meets the management component of Standard 37 of the National Minimum Standards however for care homes there is still the requirement that managers need to have a qualification relevant to the care provided in addition to the management qualification. The registered provider should contact Skills for Care for advice on how to acquire the relevant qualification in care. The inspector would like to thank the service users, the registered provider and staff for their support on the day of the inspection. 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. Conifers DS0000025773.V260685.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 Conifers DS0000025773.V260685.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 and 2. Standards 2 and 3 were assessed as met at the last inspection. Information available to prospective service users is good, no new service user has moved to the home since the last inspection however all the procedures are in place should they be needed. EVIDENCE: The Statement of Purpose and Service User Guide has been updated as required at the last inspection however the home has yet record the Service User Guide and the homes complaints procedure on audiotape. It is recommended that the Service Users Guide be recorded on audiotape for the service user who uses this method to listen to bible stories. The last service user moved into the home in August 2003. The homes admissions policy states that each prospective service user must have a full assessment from the care management team. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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 and 9. Standards 7 and 8 were assessed as met at the last inspection. The home should move towards the Person Centred Plan approach were ownership of the plan is given to the individual service user. EVIDENCE: Service user care plans include detailed information on the service users needs and personal goals however care plans are completed by care managers and the registered provider. Risk assessments have been reviewed at these reviews however this needs to be recorded on the individual risk assessments. At the last inspection it was noted that service users have annual care manager reviews and service users reviews. These were completed on a regular six monthly basis. The care manager/service user reviews followed the same format and were completed in the third person. The wording and the overall ownership of these reviews were discussed again at this inspection and it was agreed that the home should move to the Person Centred Plan approach that should run along side care management reviews. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 10 The registered manager must ensure that each service user has a Person Centred Plan. The plan must indicate the level of involvement of the service user and must be reviewed every six months. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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, 13, 15 and 16. Standards 11, 12, 13, 14 and 17 were assessed as met at the last inspection. Appropriate arrangements are made so that all service users have regular contact with their families. EVIDENCE: The home now keeps a record of all visitors to the home as required at the last inspection. However the visitor policy was last reviewed in 1996. The registered provider said service users relatives are able to visit between 10am and 9pm and can visit service users in their bedrooms if the service user agrees. It is recommended that the registered provider reviews the home visitors policy and sends a copy to all of the service users relatives. One service users Uncle passed away, the service user was sent a letter from a solicitor informing him that he has been left some money. The registered provider said that she her accountant checks the homes financial records including the service users finances on an annual basis. The registered provider was advised that these records would be inspected at the next inspection.
Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 12 Service users are encouraged to follow their interests and hobbies. One service user has an interest in trains and attends a local model railway club and is a keen train-spotter. The inspector recently observed this service user pursuing his hobby at Victoria Station. One service user said that he is happier now that he has a voluntary job at a pop in centre, he says he likes going shopping with staff and he is very happy with the home and his room. Another was going to the pop in centre. She said that things are going well for her and she is happy at the home. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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): 18. Standards 19 and 20 were assessed as met at the last inspection. The dignity and respect of the service users will be further enhanced when the service users receive personal care in the way that they prefer. EVIDENCE: All but one of the service users look after their own personal care. The registered provider said that in general service users just need reminding now and then. One service user does need support with personal care. Her care plan indicates that staff should follow guidelines however these guidelines were agreed verbally and not written down. The registered provider must ensure that guidelines to support service users with personal care is recorded in writing and placed in the service users file. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. The home has an appropriate complaints procedure and a copy of Croydon Adult Protection Procedure that is used in conjunction with the homes own abuse policy. EVIDENCE: The registered provider has sent a copy of the homes complaints procedures to all of the service users relatives as required at the last inspection. The record of complaints book indicated that there have been two complaints made to the home by the service users. The home dealt with the complaints in an appropriate manner. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. Standard 25 was assessed as met at the last inspection. The home is suitable to meet the needs of the service users however some areas of the home require redecoration. EVIDENCE: The toilets in the basement and the top floor of the house now have new toilet seats and the bath on the second floor has been resealed as required at the last inspection. The plug socket on the top floor landing has also been refitted as required at the last inspection. Some areas of the home require redecoration. The registered provider said that she has plans to redecorate the home in the near future. The registered provider has yet to develop a rolling programme of redecoration and refurbishment as recommended at the last inspection. It is recommended that the registered provider develop a rolling programme of redecoration and refurbishment and that a copy of the programme is sent to the Commission. It is recommended that the hallway be redecorated. The home was clean and free of offensive odours on the day of the inspection.
Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 16 Conifers DS0000025773.V260685.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): 0. Standards 31, 32, 34, 35 and 36 were assessed as met at the last inspection. EVIDENCE: The home has a small well-established staff team that have worked together for a number of years. This has been of great benefit for the service users, providing stability and consistency while dealing with service users individual needs. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The registered provider has worked at the home since it opened seven years ago. The home is well managed and creates an open, positive and inclusive atmosphere however the registered provider has yet to complete all of the qualifications required in Standard 37.2 ii of the National Minimum Standards. The homes quality assurance/monitoring system would improve once the home carries out regular monthly regulation 26 visits. EVIDENCE: The registered provider and her husband are the current registered persons however the registered provider said that her husband will relinquish his role as a registered provider and her son will become the other registered provider. Applications have been sent the Commission For Social Care Inspection in regards to this issue. The registered provider must ensure that regular monthly regulation 26 visits take place at the home once her son, who does not work at the home, becomes the registered provider, copies of the regulation 26 visit reports must be sent to the Commission. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 19 The home now keeps a weekly record of hot water temperatures as required at the last inspection. The registered provider provided evidence that the homes gas appliances had been checked as part of an annual British Gas Home Care Agreement 02/10/05. It is recommended that the registered provider provides evidence to the Commission that British Gas are aware that this check is for a care home. Fire alarms call points are tested on a regular weekly basis and a fire drill/evacuation occurred on 13/19/05. All staff attended fire safety training on the 02/07/05. The registered provider has a City and Guilds Qualification in the Advanced Management in Care. The Commission considers that the City and Guilds Advanced Management in Care meet the management component of standard 37.2 of the National Minimum Standards. For care homes there is still the requirement that managers need to have a qualification relevant to the care provided in addition to the management qualification. The registered provider must contact Skills for Care formerly TOPSS England for advice on how to acquire the relevant qualification in care. The registered provider must inform the Commission in writing when she will complete the qualification. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X 3 3 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
Conifers Score 2 X X X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 3 X DS0000025773.V260685.R01.S.doc Version 5.0 Page 21 No. 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 YA66. Regulation 15 (1) and (2). Requirement The registered manager must ensure that each service user has a Person Centred Plan. The plan must indicate the level of involvement of the service user and must be reviewed every six months. The registered provider must ensure that guidelines to support service users with personal care is recorded in writing and placed in the service users file. The registered provider must ensure that regular monthly regulation 26 visits take place at the home once her son becomes the registered provider, copies of the regulation 26 visit reports must be sent to the Commission. The registered provider must contact Skills for Care formerly TOPSS England for advice on how to acquire a relevant qualification in care. The registered provider must inform the Commission in writing when she will complete the qualification. Timescale for action 31/12/05 2. YA1818. 12 (1) 31/12/05 3. YA3939. 26 (1) 31/12/05 4. YA3737. 9 (2) b (i) 31/12/05 Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 22 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. 2. 3. 4. Refer to Standard YA1YA1 YA9YA9 YA15YA15 YA28YA28 Good Practice Recommendations It is recommended that the Service Users Guide be recorded on audiotape for the service user who uses this method to listen to bible stories. Risk assessments are reviewed at reviews however they need to be recorded on the completed individual risk assessments. It is recommended that the registered provider reviews the home visitors policy and sends a copy to all of the service users relatives. It is recommended that the registered provider develop a rolling programme of redecoration and refurbishment and that a copy of the programme is sent to the Commission For Social Care Inspection. It is recommended that the hallway be redecorated. It is recommended that the registered provider provides evidence to the Commission that British Gas are aware that the annual Home Care Agreement gas check is for a care home. 5. YA42YA42. Conifers DS0000025773.V260685.R01.S.doc Version 5.0 Page 23 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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