Inspection on 04/07/06 for Conifers

This inspection was carried out on 4th July 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Conifers 30/05/07

Conifers 26/10/05

Conifers 16/05/05

Conifers 11/10/04

Conifers 05/04/04

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

CARE HOME ADULTS 18-65 Conifers 44 Broad Green Avenue West Croydon Surrey CR0 2ST Lead Inspector James O`Hara Key Unannounced Inspection 4th July 2006 09:20 Conifers DS0000025773.V301328.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 Conifers DS0000025773.V301328.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. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 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.V301328.R01.S.doc Version 5.2 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. 26th October 2005 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 five 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 Mrs. Wilson is also the registered manager owns the property. The range of fees charged at the home is between £539.86 per week. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced site visit was carried out over two hours between 9.15 am and 11.15 am. Methods of inspection included a tour of the premises, observation of contact between staff and service users and discussion with the registered provider Mrs. Wilson. Records examined included service users person centred plans, needs assessments, risk assessments, complaints, adult protection, staffing training records, medication, and health and safety records. Requirements and recommendations from the previous inspection were also discussed with Mrs. Wilson. What the service does well: What has improved since the last inspection? Overall the décor of the home has improved, the hallway on the ground floor, first floor and top floor have been redecorated. Mrs. Wilson and a member of staff attended Person Centred Plan training with Croydon Council. Care plans have been drawn up and completed in the first person giving ownership of these plans to the service users. The home is working to develop these further. Regular monthly visits are carried out by an independent person to ensure that the home is running properly. Any shortfalls are fed back to the manager and copies of the visit reports are sent to the Commission For Social Care Inspection on a regular monthly basis. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 6 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. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 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.V301328.R01.S.doc Version 5.2 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): 2. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. No new service users have moved into the home since the last inspection however an appropriate admissions procedure is in place to ensure a thorough assessment of prospective service users needs and aspirations are carried out before they move in. EVIDENCE: The Statement of Purpose and Service User Guide contains all that is required in the Care Homes Regulations. It was recommended at the last inspection that the Service Users Guide be recorded on audiotape for the service user who uses this method to listen to bible stories. Sadly this service user passed away on the 2nd of May 2006. No new service users have moved into the home. The homes admissions policy states that each prospective service user must have a full assessment from the care management team, full physical and psychological assessments and involvement from family and advocates. Mrs. Wilson stated that she would also complete her own assessment prior to any new service user moving into the home. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 9 Conifers DS0000025773.V301328.R01.S.doc Version 5.2 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, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. In general service user care plans include detailed information on the service users needs and personal goals. The home needs to develop a Person Centred Plan in a format appropriate to the service users understanding. The home should do more to ensure that service users have their placement and needs assessed/reviewed by a care managers from the placing authority so they can be confident that the home can meet their identified needs. EVIDENCE: Although service user care plans included detailed information on the service users needs and personal goals it was agreed at the last inspection that the home should move toward a Person Centred Plan approach. Mrs. Wilson and a member of staff attended Person Centred Plan training with Croydon Council. Care plans have been drawn up and completed in the first person giving ownership of these plans to the service users. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 11 However these plans have been completed on a single side A4 sheet. It is recommended that Mrs. Wilson and staff support service users to complete their Person Centred Plans in a format appropriate to the service users understanding. There is evidence that the service users care managers attend care plan reviews however when sampling two service users personal files it was observed that the service users had not had an annual placement review carried by their placing authority. Mrs. Wilson must ensure that all service users have their placement reviewed by a care managers from their placing authority. Risk assessments have been reviewed at care plan reviews however the date of the risk assessment review needs to be recorded on the individual risk assessment. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 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, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using all the available evidence including a site visit to this service. Social, leisure and employment opportunities for service users to engage in both inside the home and in the wider community are well managed, age appropriate, and provide the service users with daily variety and stimulation. EVIDENCE: As recommended at the last inspection Mrs. Wilson sent a copy of the homes visitors policy to all of the service users relatives. Service users are encouraged to follow their own interests and hobbies. One service user has an interest in trains and has a large model railway in his bedroom; he also attends a local model railway club and is a keen train spotter, he also works at the Big Bus Company. Some service users have jobs others attend day services, college or the pop in club. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 13 One service user worked at the Crossfields Group as a packer however Crossfields has since closed, on the day of the inspection she was on her way out to a dance class and said that she now helps out at pop in centre three days a week. Another service user was going to the pop in centre, she said that things are going well for her and she is happy at the home. Two service users said that they were looking forward to going on holiday on Saturday to Butlin’s at Bognor Regis. Another service user is going to Spain on the 14th of July and another is going to France on the 21st July. Two service users attended Croydon Councils Learning Disability Partnerships Review day in April 2006. It was noted that both service users were forthright in their views and had a clear understanding if their rights on how they should be treated as individuals in the home and in the community. Service users are involved in menu planning. A varied menu is on offer, which is sufficiently nutritious and takes individual tastes into account; there is also an opportunity for choice with an added menu running concurrently. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 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, 19 and 20. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The arrangements for health care needs of the service users are good and service users receive personal support in the way they prefer. The homes policies and procedures for handling medicines in the home ensure the service users are so far as reasonably practicable protected from harm and/or abuse. EVIDENCE: In relation to personal care service users generally look after them selves. Mrs. Wilson said that sometimes service users just need reminding or prompting now and then. One service user does need support with personal care. A requirement was set at the last inspection that the registered provider ensure that guidelines to support service users with personal care is recorded in writing and placed in the service users file. Her care plan now indicates that she needs support with personal care but does not indicate what her support needs are or how staff should support her. It is recommended that guidelines indicating the service users support needs and how staff should support her with personal care be recorded on her care plan. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 15 All service users are registered with a local General Practitioner. Health care needs including optical, chiropody and dental health are recorded in appointment monitoring forms located in the service user files. Medication is stored in a locked cabinet in the office. None of the service users administer their own medication. Medication administration records were checked on the day of the inspection and were up to date and accurate. The home has the support of a pharmacist for advice and support. Mrs. Wilson could not locate a copy of the last visit report but the homes diary indicated that the pharmacist was due to visit the home again the day following this inspection. Mrs. Wilson was advised to keep a copy of the pharmacists report in the medication file. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using all the available evidence during the visit to this service. Unless all staff is trained on the Protection of Vulnerable Adults there is the risk that service users will not be protected in a consistent manner from abuse. EVIDENCE: The home has developed a complaints procedure for the understanding of the service users using widget, words and pictures. Mrs. Wilson stated that there have been no complaints since the last inspection. The home has a copy the Croydon Councils Adult Protection Policy and this is in use in the home. Mrs. Wilson stated that she and a member of staff attended an adult protection awareness day last year with Croydon Council but was not sure of the date it took place. There was no evidence in the staff training records to indicate that staff has attended training on adult protection. Mrs. Wilson must ensure that all Staff attends adult protection training. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. This judgement has been made using all the available evidence during the visit to this service. The hallway, stairs and landings in the home have been redecorated since the last inspection. The overall impression when visiting this home is that it is homely, comfortable clean and hygienic. EVIDENCE: It was recommended at the last inspection 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 was recommended that the hallway be redecorated. The hallway, stairs and landings in the home have been redecorated since the last inspection. Mrs. Wilson stated that she has not drawn up a rolling programme of redecoration as yet but will send this to the Commission when she does. It is recommended that the registered provider develop a rolling programme of redecoration and refurbishment and that a copy of the programme be sent to the Commission. The home was clean and free of offensive odours on the day of the inspection. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 18 Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 19 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): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Although the home has a competent staff team who clearly understand the service users more could be done to ensure that they receive the appropriate level of supervision needed to enable them to offer a consistent approach to meeting the service users needs. 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. One member of staff has completed NVQ level 2 in care and another member of staff is currently completing the qualification. Staff supervision records showed that one member of staff had received only one and another member of staff had received three formal supervisions since the beginning of 2006. Mrs. Wilson is required to ensure that all members of staff receive supervision at least once every six weeks or eight times a year. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 20 Staff records showed that one member of staff has completed an appraisal for this year however anther member of staffs appraisal is out of date. It is recommended that Mrs. Wilson review staff appraisals. Staff personnel records include completed application forms, job descriptions and two references. All staff has completed a Criminal Records Bureau Check. It was noted that some of the staff references were not completed on company paper or include a company stamp. The files did not include proof of identification or a recent photograph. Mrs. Wilson explained that the references were taken up back in 1996 when the home opened and the National Minimum Standards had not been in force. Mrs. Wilson is required to ensure that staff files are updated to include all of the details as stated in Schedule 2 of the National Minimum Standards Care Homes Regulations. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The overall impression when visiting the home is that it is well managed and service users are offered opportunities to take part in appropriate activities both in and out of the home. EVIDENCE: Mrs. Wilson has worked at the home since it opened in 1996. The home is well managed and creates an open, positive and inclusive atmosphere. Mrs. Wilson holds a City and Guilds Qualification in the Advanced Management in Care and a BTEC Award for working with people with learning disabilities. A requirement was set at the last inspection that the registered provider contact Skills for Care formerly TOPSS England for advice on how to acquire a relevant qualification in care. Since the last inspection she has contacted NESCOT and is currently completing Units RM1 and RM2 of the Registered Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 22 Managers award. Once completed by Mrs. Wilson will have the relevant qualifications. As required at the last inspection the home now carries out regular monthly regulation 26 visits and copies of the visit reports are sent to the Commission For Social Care Inspection on a regular monthly basis. At the last inspection Mrs. Wilson provided evidence that the homes gas appliances had been checked as part of an annual British Gas Home Care Agreement 02/10/05. It was recommended that Mrs. Wilson provide evidence to the Commission that British Gas are aware that this check is for a care home. Mrs. Wilson has obtained a Landlords Gas Safety Certificate 19/05/06 for the home. Fire alarms call points are tested on a regular weekly basis and an officer from London Fire & Emergency Planning Authority visited the home on the 15/06/06. All staff attended fire safety training on the 02/07/05. The home keeps a weekly record of hot water temperatures. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 23 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 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 4 13 4 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 24 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 YA6 Regulation 14 (2) Requirement Timescale for action 31/10/06 2. 3. YA23 YA36 13 (6) 18 (2) 4. YA34 19 (1) Mrs. Wilson must ensure that all service users have their placement reviewed by their care managers from the placing authority. Mrs. Wilson must ensure that all 31/10/06 Staff attends adult protection training. Mrs. Wilson is required to ensure 31/10/06 that all members of staff receive supervision at least once every six weeks or eight times a year. Mrs. Wilson is required to ensure 31/10/06 that staff files are updated to include all of the details as stated in Schedule 2 of the National Minimum Standards Care Homes Regulations. 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. Conifers Refer to Standard YA6 Good Practice Recommendations It is recommended that Mrs. Wilson and staff support DS0000025773.V301328.R01.S.doc Version 5.2 Page 25 2. 3. 4. 5. YA6 YA19 YA28 YA35 service users to complete their Person Centred Plans in a format appropriate to the service users understanding. Risk assessments have been reviewed at care plan reviews however the date of the risk assessment review needs to be recorded on the individual risk assessment. It is recommended that guidelines indicating the service users support needs and how staff should support her with personal care be recorded on her care plan. It is recommended that Mrs. Wilson develop a rolling programme of redecoration and refurbishment and that a copy of the programme be sent to the Commission. It is recommended that Mrs. Wilson review staff appraisals. Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 26 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 © 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 Conifers DS0000025773.V301328.R01.S.doc Version 5.2 Page 27 - 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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